HEPATITIS-B VIRUS TRANSMISSION IN AN ELEMENTARY-SCHOOL SETTING

Context.-The risk of transmission of hepatitis B virus (HBV) in day ca re centers and schools is low. Objective.-To investigate the source of HBV transmission for an elementary schoolteacher with acute hepatitis B. Design.-Serologic survey for HBV infection among elementary school students, school staff, and household members of an HBV-infected teac her and student. Setting.-General community and elementary school. Pat ients.-Elementary school students and staff members and household memb ers of an HBV-infected teacher. Main Outcome Measures.-Elementary scho ol students, school staff, and household members of an HBV-infected te acher were tested for markers of HBV infection. Samples positive far h epatitis 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 t eacher were found to have the same HBV subtype (ayw1-2) and to have id entical HBV DNA sequences. The teacher reported no ne of the usual ris k factors for acquiring HBV infection, and no ne of her family members had been infected prior to her illness. The specific means of HBV tra nsmission from student to teacher was not identified. Of 108 total chi ldren in the same grade as the HBV-infected student, 102 (94%) were te sted for serologic markers of HBV infection, and none was positive. Co nclusions.-This investigation documented transmission from an HBV-infe cted student to a teacher in an elementary school setting without a re ported overt percutaneous or permucosal exposure to blood or infectiou s body fluids. Transmission of HBV to other students or staff members in the school was not observed.