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December 24, 1997

Hepatitis B Virus Transmission in an Elementary School Setting

Author Affiliations

From the Hepatitis Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga (Drs Williams, Garcia, Robertson, and Shapiro and Ms Sinha); the New Hampshire Division of Public Health Services, Concord (Dr Smith, Ms Minor-Babin, and Mr Di Pentima); and Mountain Health Services, Gorham, NH (Dr Kernan). Dr Smith is now with IPRO, Lake Success, NY.

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

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.