Hepatitis B in a hospital for the mentally subnormal in southern England.

Kingham, J. G. C.; McGuire, Michael J.; Paine, David; Wright, Richard

doi:10.1136/bmj.2.6137.594

Cited by 41 publications

(17 citation statements)

References 12 publications

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“…These data agree with those of other studies which have shown that the prevalence of HBV infection in institutions is significantly greater than in the general population,6'7 [13][14][15][16] and highlight problems discussed in the accompanying commentary.' It is reasonable to infer that the behavioral and serological condi-**This was not measured by the survey.…”

Section: Discussionsupporting

confidence: 90%

Deinstitutionalized mentally retarded hepatitis-B surface antigen carriers in public school classes: a descriptive study.

Bakal¹,

Marr²,

Novick³

et al. 1980

Am J Public Health

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Twenty-seven of 33 formerly institutionalized retarded HBsAg carriers exhibited behaviors which might facilitate viral transmission in classrooms where they had been placed with retarded susceptibles. Classroom conditions included lack of handwashing facilities and frequent failure to inform staff of the presence of such carriers in their classes. A seroIn 1977, placement of mentally retarded children, many of whom are hepatitis-B surface antigen (HBsAg) carriers, into public schools from institutions caused concern among parents, teachers, and New York City Health Department (NYCHD) officials about the hazards of transmission of the virus to susceptible students. The controversy that ensued is described in an accompanying commentary.'HBsAg is found on the surface or outer shell of the double-shelled hepatitis-B virus (HBV) and on accompanying unattached particles which have not been incorporated into complete virions.2 It is considered a marker for the presence of HBV; HBsAg carriers are equivalent to HBV carriers in almost all cases. The "e" antigen (HBeAg) is associated only with complete virions and is a marker for increased infectivity in persons with HBsAg-positive sera.3A4 At the time of this study, the significance of HBeAg was not yet completely understood and a routine assay for this antigen was not available. Thus, we were able to test only for the presence of HBsAg and the antibody to HBsAg, anti-HBs.Acutely or chronically viremic individuals are sources of HBV for others, but mere exposure to an HBsAg-positive individual does not guarantee subsequent transmission of the virus.4 Transmission probably depends on the amount of infectious virus transferred to the susceptible individuals.

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Section: Discussionsupporting

confidence: 90%

Deinstitutionalized mentally retarded hepatitis-B surface antigen carriers in public school classes: a descriptive study.

Bakal¹,

Marr²,

Novick³

et al. 1980

Am J Public Health

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“…Another category of patients already known as prime candidates for hepatitis B vaccination are those with Down's syndrome (11). Their first risk for a hepatitis B infection is the institutionalization, since non-Down's syndrome patients and staff members of institutions for the mentally retarded also have elevated levels of hepatitis B virus markers (12)(13)(14). Furthermore, Down's syndrome patients are supposed to have an impaired immune response (15)(16)(17), which may enhance their susceptibility to infection and their chance to become a chronic carrier.…”

mentioning

confidence: 99%

Hepatitis B Vaccination in Down's Syndrome and Other Mentally Retarded Patients

et al. 1984

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The immune response after vaccination with H-B-VAX (20 micrograms, Months 0, 1 and 6) was investigated in 23 Down's syndrome patients and compared to that in 30 other mentally retarded patients and 32 staff members. About 90% of Down's syndrome and other mentally retarded patients and 100% of staff members had anti-HBs at Month 9, but anti-HBs less than 10 IU per liter were found in 6/23 (26.1%) of Down's syndrome, 7/30 (23.3%) of other mentally retarded patients, in contrast to 2/32 (6.2%) of staff members. No differences in anti-HBs response with regard to sex and age were observed in staff members, but geometric mean titers of anti-HBs were lower in older Down's syndrome and other mentally retarded patients, and in male Down's syndrome patients. Supplementary vaccination is necessary in these individuals to obtain "protective levels" of anti-HBs.

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“…A study from the United States demonstrated high transmission rates to staff at day schools (2 6 % staff infected per year), showing that community care workers are also at significant risk [3]. The Serological evidence of exposure to hepatitis B was found in 0-5 %, 35-7 % and 541 % of patients in north-east England, south Wales, and southern England respectively [2,4,5]. The current emphasis on care in the community [6] has important implications for infection control in mentally-handicapped patients.…”

Section: Introductionmentioning

confidence: 99%

Seroprevalence of hepatitis B and C in a Merseyside hospital for the mentally handicapped

Cunningham

Izmeth

et al. 1994

Epidemiol. Infect.

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SUMMARYThis study reports the prevalence of antibodies to hepatitis B virus (HBV) and C virus (HCV), and the frequency of potential exposure to these viruses among patients and staff in six long-stay wards of a hospital caring for mentally handicapped adults from the Mersey region. A retrospective survey of risk behaviour among 134 patients and questionnaire survey of 75 nursing staff was performed. Serum samples from both groups were tested for HBV markers and patient sera for antibodies to HCV by enzyme-linked immunosorbent assay (ELISA). None of the 102 patients tested had antibodies against HCV, although 17 had detectable antibody to HBV core (anti-HBc). Seven out of the 17 were positive for HBV surface antigen. None was positive for IgM antibody to HBV core. Only 1 out of 61 staff had anti-HBc and none was positive for surface antigen. Twenty-nine of 75 (39 %) staff reported bites sufficient to break the skin and 52 (69 %) significant other injuries from patients; 25 (31 %) of staff had not received HBV vaccination. None of the patients had received HBV vaccine.We conclude that HCV does not appear to be a major hazard in this closed community but the prevalence of HBV markers indicating past exposure among patients is high, vaccine uptake is incomplete and incidents which may allow viral transmission are frequent.

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Hepatitis B in a hospital for the mentally subnormal in southern England.

Cited by 41 publications

References 12 publications

Deinstitutionalized mentally retarded hepatitis-B surface antigen carriers in public school classes: a descriptive study.

Deinstitutionalized mentally retarded hepatitis-B surface antigen carriers in public school classes: a descriptive study.

Hepatitis B Vaccination in Down's Syndrome and Other Mentally Retarded Patients

Seroprevalence of hepatitis B and C in a Merseyside hospital for the mentally handicapped

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