Cj. Staes et al., Sources of infection among persons with acute hepatitis a and no identified risk factors during a sustained community-wide outbreak, PEDIATRICS, 106(4), 2000, pp. NIL_63-NIL_69
Context. Hepatitis A is a common vaccine-preventable disease in the United
States. Most cases occur during community-wide outbreaks, which can be diff
icult to control. Many case-patients have no identified source.
Objective. To identify foodborne and household sources of hepatitis A durin
g a community-wide outbreak.
Design. Serologic and descriptive survey.
Setting. Salt Lake County, Utah.
Participants. A total of 355 household contacts of 170 persons reported wit
h hepatitis A during May 1996 to December 1996, who had no identified sourc
e of infection; and 730 food handlers working in establishments where case-
patients had eaten.
Main Outcome Measure. Prevalence of immunoglobulin M antibodies to hepatiti
s A virus (IgM anti-HAV) among household and food service contacts.
Results. Overall, 70 household contacts (20%) were IgM anti-HAV-positive, i
ncluding 52% of children 3 to 5 years old and 30% of children <3 years old.
In multivariate analysis, the presence of a child <3 years old (odds ratio
[OR]: 8.8; 95% confidence limit [CL]: 2.1,36) and a delay of greater than
or equal to 14 days between illness onset and reporting (OR: 7.9; 95% CL: 1
.7,38) were associated with household transmission. Of 18 clusters of infec
tions linked by transmission between households, 13 (72%) involved unrecogn
ized infection among children <6 years old. No food handlers were IgM anti-
HAV-positive.
Conclusion. During a community-wide outbreak, HAV infection among children
was common, was frequently unrecognized, and may have been an important sou
rce of transmission within and between households. Transmission from commer
cial food establishments was uncommon. Ongoing vaccination of children may
prevent future outbreaks.