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Possible Transmission Via Oropharyngeal Secretions

Barry S. Levy, MD; Robert E. Fontaine, MD; Clarence A. Smith, MD; James Brinda; Gladys Hirman, PHN; David B. Nelson, MD; Peter M. Johnson; Oren Larson

JAMA. 1975;234(3):289-294.

Abstract
In Minneapolis, 107 cases of hepatitis A were identified and traced primarily to consumption of cold sandwiches served for lunch in a department store's popular basement restaurant. A sandwich-maker in the restaurant was the index patient. The date of onset of her illness and the dates of food consumption and onset of illness of infrequent restaurant patrons were consistent with accepted periods of infectivity and incubation for hepatitis A. Because the sandwich-maker frequently touched her hands to her mouth when she worked, and because we could not find evidence for fecal, airborne, or other modes of transmission, we believe that she may have contaminated food with infectious oropharyngeal secretions. The secondary attack rate was much lower among household contacts who received immune serum globulin than among those who had not.

(JAMA 234:289-294, 1975)

Author Affiliations
From the Minnesota Department of Health (Dr Levy) and the Minneapolis Health Department (Dr Smith, Mr Brinda, Ms Hirman, Mr Johnson, and Mr Larson), Minneapolis, and the Field Services Division (Dr Levy) and Viral Diseases Division (Dr Fontaine), Bureau of Epidemiology, Center for Disease Control, Atlanta. Dr. Nelson was a fourth-year medical student taking the epidemiology elective at CDC.

Footnotes
Reprint requests to Minnesota Department of Health, 717 Delaware St SE, Minneapolis, MN 55440 (Dr Levy).

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