Hepatitis B virus transmission in an elementary school setting
I. Williams, M. G. Smith, D. Sinha, D. Kernan, G. Minor-Babin, E. Garcia, B. H. Robertson, R. Di Pentima and C. N. Shapiro
Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Diseases Control and Prevention, Atlanta, Ga 30333, USA.
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 school teacher 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 HBV
infection, 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 HBV-infected 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.
