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September 1990

An Outbreak of Hepatitis B Associated With Jet Injections in a Weight Reduction Clinic

Author Affiliations

From the Division of Field Services, Epidemiology Program Office (Drs Canter and Horan and Ms Good), the Nosocomial Infections Laboratory Branch, Hospital Infections Program (Mr Bond) and Hepatitis Branch, Division of Viral Diseases (Dr Alter), Center for Infectious Diseases, Centers for Disease Control, Atlanta, Ga; the Long Beach (Calif) Department of Public Health (Ms Mackey); and the Infectious Disease Branch, California Department of Health Services, Berkeley, Calif (Drs Roberto and Chin).

Arch Intern Med. 1990;150(9):1923-1927. doi:10.1001/archinte.1990.00390200105020

• From January 1984 through November 1985, 31 clinical cases of hepatitis B occurred among attendees of a weight reduction clinic (clinic 1). Before the onset of illness, each case-patient had received a series of injections of human chorionic gonadotropin administered by jet injectors at clinic 1. Clinical history, risk factor assessment, serologic evaluation, and review of clinic injection records were obtained on 287 (84%) of 341 persons who had attended clinic 1 in the first 6 months of 1985. Of this cohort, 21% (60/287) had evidence of acute infection with hepatitis B virus (either documented clinical cases or antibody to hepatitis B core antigen, IgM positive). Of persons who had been given human chorionic gonadotropin at the clinic during the period studied, 24% (57/239) of those receiving human chorionic gonadotropin only by jet injector experienced acute hepatitis B virus infection. None of the 22 persons who had received injections only by syringe experienced hepatitis B virus infection. Stopping the use of the jet injectors on July 2, 1985, at clinic 1, was associated with the termination of this outbreak. This investigation demonstrated that jet injectors can become contaminated with hepatitis B virus and then may be vehicles for its transmission.

(Arch Intern Med. 1990;150:1923-1927)

Snydman DR, Hindman SH, Wineland MD, Bryan JH, Maynard JE.  Nosocomial viral hepatitis B—a cluster among staff with subsequent transmission to patients . Ann Intern Med . 1976;85:573-577.Article
Garibaldi RA, Rasmussen CM, Holmes AW, Gregg MB.  Hospital-acquired serum hepatitis: report of an outbreak . JAMA . 1972;219:1577-1580.Article
Shanson DC.  Hepatitis B outbreak in operating-theater and intensive care staff . Lancet . 1980;2:596.Article
Wands JR, Walker JA, Davis TT, Waterbury LA, Owens AH, Carpenter CC.  Hepatitis B in an oncology unit . N Engl J Med . 1974;291:1371-1375.Article
Fox RA, Knight AH, Niazi SP, Sherlock S, Baillod RA, Moorehead JF.  An epidemic of hepatitis in a renal dialysis unit . Proc R Soc Med . 1971;64: 277-278.
Morgan JR, Stewart J, Jones JH.  An outbreak of serum hepatitis in a haemodialysis unit . J Med Microbiol . 1972;5:Pxv-xvi.
Snydman DR, Bryan JA, Macon EJ, Gregg MB.  Hemodialysis-associated hepatitis: report of an epidemic furthers evidence on mechanisms of transmission . Am J Epidemiol . 1976;104:563-570.
Alter MJ, Ahtone J, Maynard JE.  Hepatitis B virus transmission associated with a multiple-dose vial in a hemodialysis unit . Ann Intern Med . 1983;99:330-333.Article
Centers for Disease Control.  Hepatitis B among dental patients—Indiana . MMWR . 1985;34:73-75.
Hadler SC, Sorley DL, Acree KH, et al.  An outbreak of hepatitis B in a dental practice . Ann Intern Med . 1981;95:133-138.Article
Reingold AL, Kane MA, Murphy BL, Checko P, Francis DP, Maynard JE.  Transmission of hepatitis B by an oral surgeon . J Infect Dis . 1982;145: 262-268.Article
Stryker WS, Gunn RA, Francis DP.  Outbreak of hepatitis B associated with acupuncture . JFam Pract . 1986;22:155-158.
Centers for Disease Control.  Hepatitis B associated with jet gun injection—California . MMWR . 1986;35:373-376.
Shikata T, Karasawa T, Abe K, et al.  Hepatitis B 'e' antigen and infectivity of hepatitis B virus . J Infect Dis . 1977;136:571-576.Article
Brink PRG, van Loon AM, Trommelen JCM, Gribnau FWJ, SmaleNovakova IR.  Virus transmission by subcutaneous jet injection . J Med Microbiol . 1985;20:393-397.Article
Abb J, Deinhardt F, Eisenburg J.  The risk of transmission of hepatitis B virus using jet injection in inoculation . J Infect Dis . 1981;144:179.Article
Black J, Nagle CJ, Stracham CJL.  Prophylactic low-dose heparin by jet injection . Br Med J Clin Res . 1978;2:95.Article
Darlow HM.  Jet vaccination . Br Med J Clin Res . 1970;4:554.Article