Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-09T13:56:52.921Z Has data issue: false hasContentIssue false

Nosocomial Transmission of Hepatitis A in an Adult Population

Published online by Cambridge University Press:  02 January 2015

Ramona Baptiste
Affiliation:
Hospital Epidemiology Service, The Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland
Deloris Koziol
Affiliation:
Hospital Epidemiology Service, The Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland
David K. Henderson*
Affiliation:
Hospital Epidemiology Service, The Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland
*
Hospital Epidemiologist, The Clinical Center, Building 10, Room 11N223, 9000 Rockville Pike, Bethesda, MD 20892

Abstract

Nosocomial transmission of hepatitis A from patients to staff members is an unusual event. Recently, several cases of occupational transmission of hepatitis A to health care workers have been reported in the literature. Most of these have occurred as a result of transmission from an infected child to a staff member involved in his or her care. We report an additional case of transmission of hepatitis A from an infected adult to a staff member and review the literature regarding nosocomial hepatitis A transmission. The review emphasizes several points that nearly all instances of nosocomial transmission of hepatitis A have in common, including the role of asymptomatic infection, the timing of hospitalization, and the fact that index patients often have an underlying illness that obscures the early diagnosis of hepatitis A. In addition, several other areas of controversy with respect to hepatitis A are discussed.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1987

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Capps, RB, Bennett, AM, Stokes, JS Jr: Endemic infections hepatitis in an infants' orphanage. AMA Arch Inlern Med 1952;89:623.Google Scholar
2.Snow, DJR, Infective hepatitis among student nurses: An epidemiologic study. Med J Aust 1:406409.CrossRefGoogle Scholar
3.Luparello, FJ, Wolf, J, Hospital epidemic of hepatitis. Am J Digest Dis 1958;3:436443.Google Scholar
4.Robinson, CG, Gladstone, JL, Goodman, S, et al: Outbreak of viral hepatitis in a municipal hospital. Arch Intern Med 1968;122:318321.Google Scholar
5.Eisenstein, AB, Aach, RD, Jacobsen, W. et al: An epidemie of infectious hepatitis in a general hospital: Probable transmission by contaminated orange juice. JAMA 1963;185:171174.Google Scholar
6.Meyers, JD, Romiti, KJ, Tihen, WS. et al: Food-borne hepatitis A in a general hospital. JAMA 1975;231:10491053.Google Scholar
7.Byrne, EB, Viral hepatitis: An occupational hazard of medical personnel. JAMA 1966;195:118120.Google Scholar
8.Centers for Disease Contral: Outbreak of viral hepatitis in the staff of a pediatric ward—California. MMWR 1979;26:7778.Google Scholar
9.Osterholm, M, Andrews, JS, Viral hepatitis in hospital personnel in Minnesota: Report of a statewide survey. Minn Med 1979;62:683689.Google Scholar
10.Oretistein, WA, Wu, E, Wilkins, J, et al: Hospital-acquired hepatitis: A report of an outbreak. Pediatrics 1981;67:494497.Google Scholar
11.Rhame, FS, van Drunen, N, Cameron, S, et al: An outbreak of nosocomial hepatitis A. Program and Abstracts: Eighth Annual Conference of the Association of Practitioners in Infection Control, Atlanta, 1981.Google Scholar
12.Goodman, RA, Carder, CC, Allen, JR, et al: Nosocomial hepatitis A transmission by an adult patient with diarrhea. Am J Med 1982;73:220226.Google Scholar
13.Ebisawa, I, Kurosu, Y, Hatashita, T, Nursery-associated hepatitis A traced to a male nurse. J Hyg Camb 1984;92:251254.CrossRefGoogle ScholarPubMed
14.Klein, BS, Michaels, JA, Rytel, MW, et al: Nosocomial hepatitis A, A multinursery outbreak in Wisconsin. JAMA 1984;252:27162721.Google Scholar
15.Krober, MS, Bass, JW, Brown, JD, et al: Hospital outbreak of hepatitis A, Risk factors for spread. Ped Infect Dis 1984;3:296299.Google Scholar
16.Reed, CM, Gustafson, TL, Siegel, J, et al: Nosocomial transmission of hepatitis A from a hospital-acquired case. Ped Infect Dis 1984;3:300303.Google Scholar
17.Edgar, WM, Campbell, AD, Nosocomial infection with hepatitis A. J Infect 1985;10:4347.Google Scholar
18.Skidmore, SJ, Gully, PR, Middleton, JD. et al: An outbreak of hepatitis A on a hospital ward. J Med Virol 1985;17:175177.Google Scholar
19.Capps, R, Sborov, V, Scheiffley, CS, A syringe-transmitted epidemic of infectious hepatitis. JAMA 1948;136:819824.Google Scholar
20.Seeberg, S, Brandberg, A, Hermodsson, S, et al: Hospital outbreak of hepatitis A secondary to blood exchange in a baby. Lancet 1981;1:11551156.Google Scholar
21.Barbara, JAJ, Howell, DR, Briggs, M, et al: Posttransfusion hepatitis A. Lancet 1982;1:738.Google Scholar
22.Skidmore, SJ, Boxall, EH, Ala, F, Short communication: A case report of posttransfusion hepatitis A. J Med Virol 1982;10:223.Google Scholar
23.Azimi, PH, Roberto, RR, Guralnik, J, et al: Transfusion-acquired hepatitis A in a premature infant with secondary nosocomial spread in an intensive care nursery. Program and Abstracts: 23rd Interscience Conference on Antimicrobial Agents and Chemotherapy, Las Vegas, 1983.Google Scholar
24.Khanchit, L, Dayton L, Planks, et al: Transfusion-transmitted hepatitis A with subsequent nosocomial and community spread. Program and Abstracts: 32nd Annual Epidemic Intelligence Service Conference, Atlanta. 1983.Google Scholar
25.Hollinger, FB, Khan, NC, Oelinger, PE, et al: Posttransfusion hepatitis type A. JAMA 1983;250:23132317.Google Scholar
26.Noble, RC, Kane, MA, Reeves, SA, et al: Posttransfusion hepatitis A in a neonatal intensive care unit. JAMA 1984;252:27112715.Google Scholar
27.Sheretz, RJ, Russell, BA, Reuman, PD, Transmission of hepatitis A by transfusion of blood products. Arch Intern Med 1984;144:15791580.Google Scholar
28.Goodman, RA, Nosocomial hepatitis A. Ann Intern Med 1985;103:452454.Google Scholar
29.Aach, KD, Szmuness, W, Mosley, JW, et al: Serum alanine aminotransferase of donors in relation to the risk of non-A, non-B hepatitis in recipients. N Engl J Med 1981;304:989994.CrossRefGoogle Scholar
30.Maynard, JE, Nosocomial viral hepatitis. Am J Med 1981;70:439444.CrossRefGoogle ScholarPubMed
31.Adler, SP, Transfusion-associated cytomegalovirus infections. Rev infect Dis 1983;5:977993.Google Scholar
32.Corey, L, Stamm, WE, Feorino, IM, et al: HBsAg-negative hepatitis in a hemodialysis unit: Relation to Epstein-Barr virus. N Engl J Med 1975;293:12731278.Google Scholar
33.Maynard, JE, Viral hepatitis as an occupational hazard in the health care profession, in Vyas, GN, Cohen, SN, Schmid, R (eds): Viral Hepatitis: A Contemporary Assessment of Etiology, Epidemiology, Pathogenesis and Prevention. Philadelphia, Franklin Institute Press, 1978, pp 321331.Google Scholar
34.Szmuness, W, Dienstag, JL, Purcell, RM. et al: Hepatitis type A and hemodialysis—A seroepidemiologic study in 15 US centers. Ann Intern Med 1977;87:812.Google Scholar
35.Francis, DP. Hadler, SC, Prendergast, TJ, et al: Occurrence of hepatitis A, B, and non-A/non-B in the United States. Am J Med 1984;76:6974.Google Scholar
36.flail, WT, Madden, DL, Mundon FK.etal: Protective effect of immune serum globulin (ISG) against hepatitis A infection in a natural epidemic. Am J Epidemiol 1977;106:7275.Google Scholar
37.Mosely, JW, Epidemiology of hepatitis A infection, in Vyas, GN, Cohen, SN, Schmid, R(eds): Viral Hepatitis: A Contemporary Assessment of Etiology. Epidetniology. Pathogenesis and Prevention. Philadelphia, Franklin Institute Press, 1978, pp 85104.Google Scholar
38.Centers for Disease Control: Recommendations for protection against viral hepatitis. MMWR 1985;34:313335.Google Scholar
39.Centers for Disease Control, Department of Health and Human Services: Immune globulins for protection against viral hepatitis. Ann Intent Med 1982;96:193197.Google Scholar
40.Dienstag, JL, Routenbert, JA, Purcell, RH, et al: Foodhandler-associated outbreak of hepatitis type A. Ann Intern Med 1975;83:647650.Google Scholar
41.Stokes, J Jr. Neefe, JR, The prevention and attenuation of infectious hepatitis by gamma globulin. JAMA 1945;127:144145.Google Scholar
42.Gellis, S, Stokes, J Jr. Brother, GM, et al: The use of human immune serum globulin (gamma globulin) in infectious (epidemic) hepatitis in the Mediterranean thealer of operations. JAMA 1945;128:10621063.Google Scholar
43.Havens, WP Jr, Paul, JR, Prevention of infectious hepatitis with gamma globulin. JAMA 1945;129:270272.Google Scholar
44.Brooks, BF, Hsia, DY-Y, Gellis, SS, Family outbreaks of infectious hepatitis: Prophylactic use of gamma globulin. N Engl J Med 1953;249:5860.Google Scholar
45.Ashley, A, Gamma globulin effect on secondary attack rates in infectious hepatitis. N Engl J Med 1954;250:412417.Google Scholar
46.Hsia, DY-Y, Lonsway, M, Gellis, SS, Gamma globulin in the prevention of infectious hepatitis studies on the use of small doses in family outbreaks. N Engl J Med 1954:250:417419.Google Scholar
47.Ashley, A, Use of gamma globulin for control of infectious hepatitis in an institution for the mentally retarded. N Engl J Med 1955;252:8891.CrossRefGoogle Scholar
48.Ward, R, Krugman, S, Giles, JP, et al: Infectious hepatitis: Studies of its natural history and prevention. N Engl J Med 1958;258:407416.Google Scholar
49.Clark, WH, Beck, MD, Edwards, GB, et al: A special study of infectious hepatitis in the general population of three counties in California. Am J Trop Med 1960;9:639651.Google Scholar
50.Noble, IIB, Peterson, DR, Evaluation of immune serum globulin for control of infectious hepatitis. Public Health Rep 1965;80:173177.Google Scholar
51.Drake, ME, Ming, C, Gamma globulin in epidemic hepatitis: Comparative value of two dosage levels, apparently near the minimal effective level. JAMA 1954;155:10321035.Google Scholar
52.Fowinkle, EW, Guthrie, N, Comparison of two doses of gamma globulin in prevention of infectious hepatitis. Public Health Rep 1964;79:634639.Google Scholar
53.Aach, RD, Elsea, WR, Lyerly, J, et al: Efficacy of varied doses of gamma globulin during an epidemic of infectious hepatitis, Hoonah, Alaska, 1961. Aj PH 1963;53:16231629.Google Scholar
54.Gardner, P, Oxman, MN. Breton, S, Hospital management of patients and personnel exposed to communicable diseases. Pediatrics 1975;56:700708.Google Scholar
55.Stiehm, ER, Standard and special human immune serum globulins as therapeutic agents. Pediatrics 1979;63:301319.Google Scholar
56.Seelf, LB, Hoofnagle, JH, lmmunoprophylaxis of viral hepatitis. Gastroenterology 1979;77:161182.Google Scholar
57.Krugman, S, Ward, R, Giles, JP, et al: Infectious hepatitis: Studies on the effect of gamma globulin and on the incidence of inapparenl infection. JAMA 1960;174:823830.Google Scholar
58.Walter Reed Army Institute of Research, Division of Medicine, Washington, DC, Prophylactic gamma globulin for prevention of endemic hepatitis: Effects of US gamma globulin upon the incidence of viral hepatitis and other infectious diseases in US soldiers abroad. A cooperative study. Arch Intern Med 1971;128:723738.Google Scholar
59.Robinson, WS, Hepatitis A virus, in Maudell, GL. Douglas, RG, Bennett, IE (eds): Principles and Practice of Infectious Diseases. New York, John Wiley and Sons, 1984, pp 829840.Google Scholar
60.Frostier, GG, Haas, H, Hotz, G, Hepatitis A antibody in commercial lots of immune serum globulin. Lancet 1977;1:432433.Google Scholar
61.Smallwood, LA, Tabor, E, Hnlayson, JS, et al: Antibodies to hepatitis A virus in immune serum globulin. Lancet 1980;2:482483.Google Scholar
62.Smallwood, LA, Tabor, E, Finlayson, JS. et al: Antibodies to hepatitis A virus in immune serum globulin. J Med Virol 1981:7:2127.Google Scholar
63.Steere, AC, Mallison, GF, Handwashing practices for the prevention of nosocomial infections. Aim Intern Med 1975;83:683690.Google Scholar
64.Albert, RK, Conche, F, Hand-washing patterns in medical intensive-care units. N Engl J Med 1981;304:14651466.Google Scholar
65.Preston, GA, Larson, EL, Stamm, WE, The effect of private isolation rooms on patient care practices, colonization and infection in an intensive care unit. Am J Med 1981;70:641645.Google Scholar
66.Stokes, J Jr, Farquhar, JA, Drake, ME, et al: Infectious hepatitis: Length of protection by immune serum globulin (gamma globulin) during epidemics. JAMA 1951;147:714719.Google Scholar
67.Friedman, LS, O'Brien, TFMorse, LJ, et al: Revisiting the Holy Cross football team hepatitis outbreak (1969) by serological analysis. JAMA 1985;254:774776.Google Scholar
68.Lednar, WM. Lemon, SM, Kirkpatrick, JW, et al: Frequency of illness associated with epidemic hepatitis A virus infections in adults. Am J Epidemiol 1985;122:226233.Google Scholar
69.Faveto, MS, Maynard, JE, Leger, RT, et al: Guidelines for the care of patients hospitalized with viral hepatitis. Ann Intern Med 1979;91:872876.Google Scholar
70.Hoofnagle, JH, Acute hepatitis, in Mandeli, GL, Douglas, RG, Bennett, JE (eds): Principles and Practice of Infectious Diseases. New York. John Wiley and Sons, 1984, pp 772785.Google Scholar
71.Garner, JS, Simmons, BP, CDC guidelines for isolation precautions in hospitals. Infect Control 1983;4:245325.Google Scholar