PEDIATRICS Vol. 106 No. 4 October 2000, p. e54
ELECTRONIC ARTICLE:
Sources of Infection Among Persons With Acute Hepatitis A and No
Identified Risk Factors During a Sustained Community-Wide Outbreak
Received Feb 4, 2000; accepted May 9, 2000.
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From the * Salt Lake City-County Health Department, Salt
Lake City, Utah; Division of Infectious Diseases, University of Utah
Health Sciences Center, Salt Lake City, Utah; § Hepatitis Branch,
Centers for Disease Control and Prevention, Atlanta, Georgia; and the
Department of Preventive Medicine, Medical College of Wisconsin,
Milwaukee, Wisconsin.
Context. Hepatitis A is a common vaccine-preventable disease in the United States. Most cases occur during community-wide outbreaks, which can be difficult to control. Many case-patients have no identified source.
Objective. To identify foodborne and household sources of hepatitis A during 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 with hepatitis A during May 1996 to December 1996, who had no identified source of infection; and 730 food handlers working in establishments where case-patients had eaten.
Main Outcome Measure. Prevalence of immunoglobulin M antibodies to hepatitis A virus (IgM anti-HAV) among household and food service contacts.
Results. Overall, 70 household contacts (20%) were IgM
anti-HAV-positive, including 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 
14 days between illness onset and
reporting (OR: 7.9; 95% CL: 1.7,38) were associated with household
transmission. Of 18 clusters of infections linked by transmission
between households, 13 (72%) involved unrecognized 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 source of transmission within and between households. Transmission from commercial food establishments was uncommon. Ongoing vaccination of children may prevent future outbreaks. Key words: hepatitis A, epidemiology, outbreak, prevention and control, immunization.
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