AN OUTBREAK OF HEPATITIS-A - SCHOOL TOILETS AS A SOURCE OF TRANSMISSION

An outbreak of hepatitis A associated with a Middle school involved 23 cases; 17 were pupils attending the Middle school, one was a teacher, one was a relative of a case, and four were from the associated First school, of whom three had siblings in the Middle school. The probable source case was a male pupil infected by a sibling who had contracted hepatitis A while abroad on holiday. A questionnaire survey and saliv ary IgG and IgM anti-HAV testing of the pupils demonstrated a statisti cally significant association between infection and the use of a chang ing room toilet for defecation. An inspection of the school showed tha t toilets lacked toilet paper, soap and hand towels. Advice was given to pupils, parents and staff on hygiene. Human normal immunoglobulin w as administered to susceptible family contacts, pupils and staff at th e school. The school outbreak might have been prevented if the source case for the school had been given immunoglobulin when his sibling dev eloped hepatitis A.