To the Editor.—
The article by Hadler et al (1983;249:48) demonstrates clearly that a substantial reduction in the incidence of hepatitis A in day-care center—related outbreaks can be achieved by the use of prophylactic immunoglobulin.Those of us who work with patients with hepatitis have come to recognize the importance of the day-care center as a reservoir of infection in many communities. Lest we feel that this is a new epidemiologic phenomenon, we should recall the report of Capps and co-workers,1 who described, more than 30 years ago, transmission of hepatitis from diapered children to student nurses, a situation that I believe directly parallels that existing in the day-care center environment.Capps and co-workers also showed a substantial reduction in the incidence of hepatitis in those nurses after the institution of immunoglobulin prophylaxis. More importantly, they showed cessation of the occurrence of hepatitis in this population after the institution
Holmes AW. Prevention of Hepatitis in Day-Care Centers. JAMA. 1983;250(14):1841–1842. doi:10.1001/jama.1983.03340140017013
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