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Am J Public Health. 1993 Dec;83(12):1679-84.

An outbreak of hepatitis A among health care workers: risk factors for transmission.

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Department of Internal Medicine, University of Iowa College of Medicine, Iowa City 52242-1081.



The purpose of this study was to investigate a nosocomial outbreak of hepatitis A that occurred in the burn treatment center of a referral hospital.


Retrospective cohort and case-control studies were performed to determine acquisition rates and risk factors for transmission. Adjusted infection rates were calculated by week of exposure. A case-control study was conducted to determine potential mechanisms for nosocomial acquisition. Recently infected health care workers were defined as case patients; exposed, serosusceptible health care workers without infection served as controls.


The outbreak of hepatitis A affected 11 health care workers and 1 other burn patient (1 secondary patient case). All 11 health care workers became ill after the admission of a man and his 8-month-old son who developed hepatitis A while in the hospital. The cumulative incidence risk ratio was elevated for health care workers caring for either the infant or the father during the same week of exposure. The case-control study implicated the behavior of eating on the hospital ward as the single most important risk factor for infection.


Inadequate hand-washing and subsequent oral contamination appear responsible for the outbreak. Hospitals may witness other institutional outbreaks if health care workers regularly eat on the wards.

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