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ARTICLE |

Transmission of Hepatitis

Michael J. Boulter, MD; Gerald E. Harmon, MD; Joyce M. Fester, RN
JAMA. 1981;245(11):1121. doi:10.1001/jama.1981.03310360013012.
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To the Editor.—  Viral hepatitis, type B, may be transmitted by direct inoculation of blood or blood products or by inoculation with any of a variety of body secretions, including saliva,1 and possibly tears2 and synovial fluids.3 Inoculation with infected blood or blood products can occur in many ways, some of them bizarre. For example, it has been reported that Scandinavian cross-country runners were infected by blood deposited on thorns by previous runners who were hepatitis B surface antigen (HBsAg) carriers.4We were involved with a hepatitis B outbreak transmitted by an unusual and, to our knowledge, previously undocumented mode. Within two weeks we saw seven young men, aged 23 to 39 years, with complaints of nausea, anorexia, malaise, and jaundice. When first seen, all had substantially elevated serum hepatic enzyme and bilirubin levels. All but one were HBsAg positive. Five of the seven were hospitalized

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