The discovery of Australia antigen—the hallmark of hepatitis B—in patients who gave no history of vaccinations, inoculations, injections, or transfusions, effected a break in the traditional link between the transmission of the pathogenic virus and the needle. Although the latter still is a major conduit for the pathogen, there are clearly cases that must be accounted for in some other fashion.
Occasionally, sound detective work could track down the transmission route to a needle—albeit not one in the service of medicine—as in the epidemic of hepatitis that followed ear-piercing with inadequately sterilized needles.1
Sometimes the sexual route appeared to be implicated, particularly in homosexuals.2 This transmission, however, is largely discounted by Fass (p 861), whose study produced no evidence to support it.
More frequently, the entry of the virus could be traced to skin abrasions that were exposed to blood. Ringertz and Zetterberg3 reported the occurrence of