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December 24, 1997, Vol 278, No. 24 >
ARTICLE | December 24, 1997

Hepatitis B Virus Transmission in an Elementary School Setting FREE

Ian Williams, PhD, MS; M. Geoffry Smith, MD; Dolly Sinha; Donald Kernan, MD; Gail Minor-Babin, RN; Enid Garcia, MD; Betty H. Robertson, PhD; Richard Di Pentima, RN; Craig N. Shapiro, MD
[+] Author Affiliations

Reprints: lan Williams, PhD, MS, Hepatitis Branch, MS G-37, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333.


JAMA. 1997;278(24):2167-2169. doi:10.1001/jama.1997.03550240057034
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References

Context.  —The risk of transmission of hepatitis B virus (HBV) in day care centers and schools is low.

Objective.  —To investigate the source of HBV transmission for an elementary schoolteacher with acute hepatitis B.

Design.  —Serologic survey for HBV infection among elementary school students, school staff, and household members of an HBV-infected teacher and student.

Setting.  —General community and elementary school.

Patients.  —Elementary school students and staff members and household members of an HBV-infected teacher.

Main Outcome Measures.  —Elementary school students, school staff, and household members of an HBV-infected teacher were tested for markers of HBV infection. Samples positive for hepatitis B surface antigen (HBsAg) were tested for HBsAg subtype using monoclonal antibodies and examined for HBV DNA homology by polymerase chain reaction techniques.

Results.  —An HBV-infected student and the teacher were found to have the same HBV subtype (ayw1-2) and to have identical HBV DNA sequences. The teacher reported none of the usual risk factors for acquiring HBVinfection, and none of her family members had been infected prior to her illness. The specific means of HBV transmission from student to teacher was not identified. Of 108 total children in the same grade as the HBV-infected student, 102 (94%) were tested for serologic markers of HBV infection, and none was positive.

Conclusions.  —This investigation documented transmission from an HBVinfected student to a teacher in an elementary school setting without a reported overt percutaneous or permucosal exposure to blood or infectious body fluids. Transmission of HBV to other students or staff members in the school was not observed.

REFERENCES

1 +
Follett EAC, McMicheal S.  Hepatitis B in the school environment . BMJ . 1978;;1:1279-1280.
2 +
Shapiro ED.  Lack of transmission of hepatitis B in a daycare center . J Pediatr Infect Dis . 1987;;110:90-92.
3 +
Repp R, Seuchter C, Breitbach B, Lampert F, Gerlich W.  Risk of hepatitis B virus transmission in school . Lancet . 1994;;344:961-962.
4 +
Shapiro CN, McCaig LF, Gensheimer KF, et al.  Hepatitis B virus transmission between children in day care . Pediatr Infect Dis J . 1989;;8:870-875.
5 +
Foy HM, Swenson PD, Freitag-Koontz MJ, Boase J, Tianji-Yu, Alexander ER.  Surveillance for transmission of hepatitis B in child day care . Pediatrics . 1994;;94( (6) , pt 2):1002-1004.
6 +
Hurwitz ES, Deseda CC, Shapiro CN, Nalin DR, Freitag-Koontz MJ, Hayashi J.  Hepatitis infections in the day-care setting . Pediatrics . 1994;;94( (6) , pt 2):1023-1024.
7 +
Jackson LA, Stewart LK, Solomon SL, et al.  Risk of infection with hepatitis A, B, or C, cytomegalovirus, varicella or measles among child care providers . Pediatr Infect Dis J . 1996;;15:584-589.
8 +
American Academy of Pediatrics.  Recommendations for care of children in special circumstances . In: Peter G, ed.1994 Red Book: Report of the Committee on Infectious Diseases . 23rd ed. Elk Grove Village, Ill: American Academy of Pediatrics; 1994;:87-89.
9 +
Centers for Disease Control.  Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination: recommendations of the Immunization Practices Advisory Committee (ACIP) . MMWR Morb Mortal Wkly Rep . 1991;;40:1-26.
10 +
Deseda CC, Shapiro CN, Carrol K, Hinds W.  Hepatitis B virus transmission between a child and staff member at a day-care center . Pediatr Infect Dis J . 1994;;13:828-829.
11 +
David E, McIntosh ED, Bek MD, Burgess MA, Isaacs D, Cossart YE.  Molecular evidence of transmission of hepatitis B in a day-care centre . Lancet . 1996;;347:118-119.
12 +
Oleske J, Minnefor A, Cooper R, Ross J, Gocke D.  Transmission of hepatitis B in a classroom setting . J Pediatr . 1980;;97:770-772.
13 +
Hayashi J, Kashiwagi S, Nomura H, Kajiyama W, Ikematsu H.  Hepatitis B virus transmission in nursery school . Am J Epidemiol . 1987;;125:492-498.
14 +
Nigro G, Taliani G.  Nursery-acquired asymptomatic B hepatitis . Lancet . 1989;;1:1451-1452.
15 +
Pon EW, Ren H, Margolis H.  Hepatitis B virus infection in Honolulu students . Pediatrics . 1993;;92:574-578.
16 +
Swenson PD, Riess JT, Krueger LE.  Determination of HBsAg subtypes in different high risk populations using monoclonal antibodies . J Virol Meth . 1991;;33:27-38.
17 +
Alter MJ, Mast EE.  The epidemiology of viral hepatitis in the United States . Gastroenterol Clin North Am . 1994;;23:437-455.
18 +
Hepatitis Surveillance Report No. 56. Atlanta, Ga: Centers for Disease Control and Prevention; 1995.
19 +
Szmuness W, Harley EJ, Prince AM.  Intrafamilial spread of asymptomatic hepatitis B . Am J Med Sci . 1975;;270:293-304.
20 +
Bernier RH, Sampliner R, Gerety R, Tabor E, Hamilton F, Nathanson N.  Hepatitis B infection in households of chronic carriers of hepatitis B surface antigen: factors associated with prevalence of infection . Am J Epidemiol . 1982;;116:199-211.
21 +
Pattison CP, Boyer KM, Maynard JE, Kelly PC.  Epidemic hepatitis in a clinical laboratory: possible association with computer card handling . JAMA . 1974;;230:854-857.
22 +
Bancroft WH, Snitbhan R, Scott RM, et al.  Transmission of hepatitis B virus to gibbons by exposure to human saliva containing hepatitis B surface antigen . J Infect Dis . 1977;;135:79-85.
23 +
Alter HJ, Purcell RH, Gerin JL, et al.  Transmission of hepatitis B to chimpanzees by hepatitis B surface antigen-positive saliva and semen . Infect Immunol . 1977;;16:928-933.
24 +
Francis DP, Favero MS, Maynard JE.  Transmission of hepatitis B virus . Semin Liver Dis . 1981;; 1:27-32.
25 +
Centers for Disease Control and Prevention.  Update: recommendations to prevent hepatitis B transmission—United States . MMWR Morb Mortal Wkly Rep . 1995;;44:574-575.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Follett EAC, McMicheal S.  Hepatitis B in the school environment . BMJ . 1978;;1:1279-1280.
2 +
Shapiro ED.  Lack of transmission of hepatitis B in a daycare center . J Pediatr Infect Dis . 1987;;110:90-92.
3 +
Repp R, Seuchter C, Breitbach B, Lampert F, Gerlich W.  Risk of hepatitis B virus transmission in school . Lancet . 1994;;344:961-962.
4 +
Shapiro CN, McCaig LF, Gensheimer KF, et al.  Hepatitis B virus transmission between children in day care . Pediatr Infect Dis J . 1989;;8:870-875.
5 +
Foy HM, Swenson PD, Freitag-Koontz MJ, Boase J, Tianji-Yu, Alexander ER.  Surveillance for transmission of hepatitis B in child day care . Pediatrics . 1994;;94( (6) , pt 2):1002-1004.
6 +
Hurwitz ES, Deseda CC, Shapiro CN, Nalin DR, Freitag-Koontz MJ, Hayashi J.  Hepatitis infections in the day-care setting . Pediatrics . 1994;;94( (6) , pt 2):1023-1024.
7 +
Jackson LA, Stewart LK, Solomon SL, et al.  Risk of infection with hepatitis A, B, or C, cytomegalovirus, varicella or measles among child care providers . Pediatr Infect Dis J . 1996;;15:584-589.
8 +
American Academy of Pediatrics.  Recommendations for care of children in special circumstances . In: Peter G, ed.1994 Red Book: Report of the Committee on Infectious Diseases . 23rd ed. Elk Grove Village, Ill: American Academy of Pediatrics; 1994;:87-89.
9 +
Centers for Disease Control.  Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination: recommendations of the Immunization Practices Advisory Committee (ACIP) . MMWR Morb Mortal Wkly Rep . 1991;;40:1-26.
10 +
Deseda CC, Shapiro CN, Carrol K, Hinds W.  Hepatitis B virus transmission between a child and staff member at a day-care center . Pediatr Infect Dis J . 1994;;13:828-829.
11 +
David E, McIntosh ED, Bek MD, Burgess MA, Isaacs D, Cossart YE.  Molecular evidence of transmission of hepatitis B in a day-care centre . Lancet . 1996;;347:118-119.
12 +
Oleske J, Minnefor A, Cooper R, Ross J, Gocke D.  Transmission of hepatitis B in a classroom setting . J Pediatr . 1980;;97:770-772.
13 +
Hayashi J, Kashiwagi S, Nomura H, Kajiyama W, Ikematsu H.  Hepatitis B virus transmission in nursery school . Am J Epidemiol . 1987;;125:492-498.
14 +
Nigro G, Taliani G.  Nursery-acquired asymptomatic B hepatitis . Lancet . 1989;;1:1451-1452.
15 +
Pon EW, Ren H, Margolis H.  Hepatitis B virus infection in Honolulu students . Pediatrics . 1993;;92:574-578.
16 +
Swenson PD, Riess JT, Krueger LE.  Determination of HBsAg subtypes in different high risk populations using monoclonal antibodies . J Virol Meth . 1991;;33:27-38.
17 +
Alter MJ, Mast EE.  The epidemiology of viral hepatitis in the United States . Gastroenterol Clin North Am . 1994;;23:437-455.
18 +
Hepatitis Surveillance Report No. 56. Atlanta, Ga: Centers for Disease Control and Prevention; 1995.
19 +
Szmuness W, Harley EJ, Prince AM.  Intrafamilial spread of asymptomatic hepatitis B . Am J Med Sci . 1975;;270:293-304.
20 +
Bernier RH, Sampliner R, Gerety R, Tabor E, Hamilton F, Nathanson N.  Hepatitis B infection in households of chronic carriers of hepatitis B surface antigen: factors associated with prevalence of infection . Am J Epidemiol . 1982;;116:199-211.
21 +
Pattison CP, Boyer KM, Maynard JE, Kelly PC.  Epidemic hepatitis in a clinical laboratory: possible association with computer card handling . JAMA . 1974;;230:854-857.
22 +
Bancroft WH, Snitbhan R, Scott RM, et al.  Transmission of hepatitis B virus to gibbons by exposure to human saliva containing hepatitis B surface antigen . J Infect Dis . 1977;;135:79-85.
23 +
Alter HJ, Purcell RH, Gerin JL, et al.  Transmission of hepatitis B to chimpanzees by hepatitis B surface antigen-positive saliva and semen . Infect Immunol . 1977;;16:928-933.
24 +
Francis DP, Favero MS, Maynard JE.  Transmission of hepatitis B virus . Semin Liver Dis . 1981;; 1:27-32.
25 +
Centers for Disease Control and Prevention.  Update: recommendations to prevent hepatitis B transmission—United States . MMWR Morb Mortal Wkly Rep . 1995;;44:574-575.

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