4
Journal of Public Health Dentistry
PREVALENCE OF HEPATITIS B SURFACE ANTIGEN IN A DENTAL SCHOOL PATIENT POPULATION Michael J. Tullman, A.B., D.D.S., M.P.H.* Ronald A. Barrett, D.D.S., M.S.# Charles H. Boozer, D.D.S., M.A.+ J. T. Hamrick, M.D., M.P.H.”” Jack H. Rayson, D.D.S., M.A.## Introduction
,
This article reports on a study designed to gain basic information about the presence of dental patients in a dental-school-patient population who are potentially infectious)+ for viral hepatitis. Concern exists for protecting individuals who provide dental care from exposure to hepatitis B, and as such, an attempt was made to identify high-risk, potentially infectious, and actively infectious persons in the treatment population. Additionally, it was felt that an attempt to document the magnitude of the presence of potentially infectious patients was warranted so that the need for implementation of policies designed to improve sterilization procedures could be evaluated and any changes in policy could be justified. Several studies appear in the literature dealing with the prevalence of potentially infectious asymptomatic carriers of the hepatitis B surface antigen in samples of dentists.H,i,”l’The current study was designed initially to gather information on the treatment population so that further prospective investigation about changes in the presence of hepatitis B surface antigen (HBsAg) in providers of treatment could be monitored - that is, once the threat of hepatitis infection from the patient was recognized and addressed through improved sterilization procedures. A final purpose of the study was to gather information on which a decision could be made whether to monitor all incoming dental patients for potential infectivity for hepatitis B by testing for HB,Ag. It is commonly accepted that many patients with hepatitis B are not diagnosed because they do not have clinical manifestations. These “subclinical” patients pose the same problem of persistent potentially infectious individuals as do the diagnosed cases; however, there is no past history of hepatitis to warn of the possible existence of the carrier state and serological testing is necessary to identify these people. Review of the Literature
The medical and dental literature contains many reports of the increased incidence of type B hepatitis in dentists, as well as other health p r o f e s s i ~ n a l s . ~ ~ ~ J ~ Individuals with serum positive for hepatitis B surface antigen (HB,Ag) are consid‘Assistant Professor, Department of Oral Diagnosis/Medicine/Radiology #Associate Professor, Department of Oral Diagnosis/Medicine/Radiology fAssociate Professor and Head, Department of Oral Diagnosis/Medicine/ Radiology, LouisianaState University School of Dentistry *“Professor and Chairman, Department of Health Services Administration, Tulane University School of Public Health and Tropical Medicine ##Dean, Lonisiana State University School of Dentistry (Submitted 5/2/i7; Returned for revision 6/10/77; Resubmitted 7/22/77; Accepted 11/30/77) ++Theterms ‘potentially infectious” and “carrier” refer to those individuals who demonstrate hepatitis B surface antigen in their blood serum.
Vol. 38, No. l-Winter,
5
1978
ered potentially infectious for type B hepatiti~.'~ Analysis of blood samples for hepatitis B surface antigen has furnished information on its incidence in samples of general populations and in samples of health professionals.2s6Various methods of serum analysis have been used to record, within the limitations of the various experimental frameworks, the increased incidence of HB,Ag in dentists as compared to general or control p o p ~ l a t i o n s . ~ JCases J ~ of hepatitis B in dental patients linked to exposure to dentists positive for HB,Ag have been documented in several r e p o r t ~ . Fifty-five ~J~ patients with hepatitis B occurring over a four- year period were investigated epidemiologically and found to have been associated with dental treatment provided by an asymptomatic oral surgeon who was positive for HBSAg.l2The risk of transmission of hepatitis B from patient to dentist and dentist to patient requires further investigation.8 The knowledge that there is an increasing incidence of hepatitis B in the general population," and that HBsAg is found in the saliva of individuals with serum positive for HB,Ag16J8 further emphasizes the need for evaluating the risks of transmission of hepatitis B through dental treatment. The persistence of HB,Ag in patients' sera has been documented after clinical recovery from hepatitis B and return of biochemical indicators to normal 1 e ~ e l s . l ~ Such persistence may be transient lasting less than three months after recovery, whereas in approximately five to 10 percent of patients diagnosed as having type B hepatitis, the antigenemia persists indefinitely after apparent r e ~ o v e r yIn . ~ addition, people are known to develop hepatitis B infections who do not show clinical manifestations, and therefore are not diagnosed. Individuals who suffer subclinical cases of hepatitis B can become persistent for HB,Ag just as those who fully manifest the disease clinically.17 There is a need for properly controlled epidemiological studies to gather information on the prevalence of the HB,Ag carrier state and on the risks of transmission of infections associated with contact with such individuals.' Currently there is no specific information on which to base an evaluation of the magnitude of the risks of transmission of hepatitis B from dental school patients to those providing dental treatment, or from those providing treatment, to dental patients. Additionally, it has been demonstrated that HB,Ag must be subjected to stringent steriliza tion procedures in order to be ina~tivated.~ Dental schools have used a variety of methods to sterilize instrument^.'^ As more information on the relation between risks of transmission of hepatitis B and dental care is gained, new standards for sterilization and disinfection procedures can be established.5 Procedure
Beginning on January 5, 1977, 300 consecutive patients (Table I) who were accepted through the Louisiana State University School of Dentistry's screening section of the Oral Diagnosis Clinic for dental treatment had a blood sample drawn for radioimmunoassay for hepatitis B surface antigen. These patients were accepted through an open enrollment procedure with no limitations placed by their dental treatment needs. Having signed a consent form, the participant then completed an additional' health questionnaire (Table 11) consisting of six ques'Each patient normally completes a standard medical questionnaire form.
Journal of Public Health Dentistry
6
TABLE I Composition of Sample Population of Dental School Patients at Louisiana State University School of Dentistry, New Orleans, Louisiana by Age, Sex, Race, January, 1977. Age:
25 years and under ........ 92 26 thru 35 years ........... 80 36 thru 45 years .......... 46 45 years and over ........297
"TOTAL Sex:
Race:
White Black Other
..... .217 ...... 76 .....
*TOTAL
297
Male .............. .114 Female. ...........J 8 J TOTAL
300
"Three questionnaires were blank with respect to age and race.
TABLE I1 Positive Responses on Participant's Health Questionnaires"
1. 2. 3. 4. 5. 6.
History History History History History History
of of of of of of
YES jaundice.. ..................................... .13 hepatitis.. ..................................... .ll contact with someone with hepatitis.. ............ . 3 9 receiving blood transfusion.. .................... .46 working in hospital laboratory .................... 9 6 injecting drugs into own body ....................
~~
"Of the 300 participants, 200 gave all-negative responses on the questionnaire. The figures in this table represent the cumulative responses of those 100 participants who gave at least one positive response on the questionnaire.
tions designed to identify a past history of hepatitis B or potential exposure to hepatitis B in the patient's past medical history. The participants then proceeded to the Clinical Diagnosis Laboratory where the blood samples were drawn. A commercial clinical pathology laboratory was employed to analyze the blood samples. The results of the analysis were reported to the Oral Diagnosis Department for recording and tabulation. Patients who gave a history of jaundice or hepatitis were recontacted in an attempt to confirm a history of hepatitis, to classify the hepatitis as having been type A (infectious) or type B (serum), and to document any demonstration of HBsAg during the course of their hepatitis. Results Eleven participants gave a history of hepatitis but only seven of these were medically confirmed by the physicians of record. Three patients were classified as
Vol. 38, No. 1-Winter,
1978
7
having had type B (serum) hepatitis, though HBsAg had not been tested for previously in any of the three, and four were classified as having had type A (infectious) hepatitis. Of the 13 episodes of jaundice reported, seven were associated with verified hepatitis, and six were associated with causes unrelated to viral hepatitis. Analysis of the blood samples showed two patients to be positive for HBsAg (both of these patients had a past history of hepatitis B) (Table 111).The prevalence of HB,Ag was therefore 0.67 percent. From the 95 percent confidence limit around this figure (0.0,1.6 percent) it seems likely that the true proportion of patients positive for HB,Ag is between HB,Ag is betweenO.O and 1.6 percent. It may, therefore, be anticipated that up to 1.6 percent of the population from which the sample was drawn may be potentially infectious for hepatitis B. TABLE I11 Comparison of Histories of Hepatitis and RIA' for HB,Ag Results in Sample Population of Dental School Patients, LSUSD, January, 1977. Positive History of Hepatitis
Verification by Physician
11
7 Verified Positive
Classification by Physician Type A Type B
..... ... 4 .... . . .. 3
RIA Results
0 Positive 2 Positive
~
,'Radioimrnunossay (AUSRIA I1 by ABBOTT)
Discussion The current study used a convenience sample of 300 participants, the size of which was limited by budgetary constraint. N o patient solicited refused to participate. The findings of the two patients positive for HBsAg, both of whom indicated a past history of hepatitis B on the questionnaires provided, were felt to be clinically significant in that these findings documented the potentially infectious state of persistence of HB,Ag in dental school patients who have had hepatitis B. Because HBsAg has been shown to be present in the saliva as well as serum of patients positive for HBsAg, clinical precautions of gloving and wearing a face mask and glasses are indicated for all personnel involved in treating such patients's* Such patients should not be treated unless there are sterilization facilities available which meet established guidelines for inactivation of HBsAg which may contaminate the dental instruments used in treatment. Suggestions The following suggestions are made based on this preliminary study: 1. Dental patients who give a history of hepatitis B should be screened by radioimmunoassay for presence of HBsAg before any treatment is performed. 2. Dental patients who give a history of hepatitis which cannot be confirmed by a physician, or cannot be documented as having been hepatitis A, should be screened by radioimmunoassay for presence of HB,Ag. "One reviewer felt these precautions should be routine.
Journal of Public Health Dentistry
8
3. If radioimmunoassay cannot be performed on patients with a history of hepatitis B, or on those patients with questionable histories of hepatitis, then these patients should be treated in the same manner as those positive for HBsAg. 4. Sterilization procedures in dental schools should meet criteria established for inactivation of hepatitis B surface antigen. 5. Decision on screening of all dental patients for HBsAg must be made after sampling of larger populations is completed. Summary A sample of 300 adult patients* accepted for initial treatment between January 5th and Nth, 1977 at the Louisiana State University School of Dentistry had blood samples drawn and analyzed by radioimmunoassayt for the presence of hepatitis B surface antigen (HBsAg). Two patients were positive for HBsAg (a prevalence of .67 percent. Medical questionnaire information obtained from each participant indicated that 11 patients had had hepatitis; seven were confirmed by the patients' private physicians. Both patients positive for HB,Ag gave confirmed histories of having had hepatitis. The information gathered tends to indicate that dental patients who give a history of hepatitis should have a blood sample drawn and analyzed by radioimmunoassay for HBsAg to determine whether they are carriers of HBsAg. This analysis should precede any dental treatment. Further studies are planned to obtain information from another sample population. Biography 1. Alter, €1. J., and Chalmers, T. C. Management of the asymptomatic carrier of the hepatitis associated (Australia) antigen. N. Eng. J . Med., 285:615-6, Sept. 9, 1974. 2. Alter, H. J., et. al. Health care workers positive for hepatitis B surface antigen. N. Eng. J. Med., 292:454-7, Feb. 27, 1975. 3. Bond, W. W., Petersen, N. J., and Favero, M. S. Viral hepatitis B: aspects of environmentalcontrol. Health Lab. Sci., 1977. In press. 4. Bryan, J. A., and Pattison, C . P. Viral hepatitis - a primer. Postgrad. Med., 59:66-84,Jan., 1976. 5. Crawford, James. New light on the transmissibility of viral hepatitis in dental practice and its control. Am. Den. A. J., 91:829-35, Oct. 1975. 6. Feldman, R. E., and Schiff, E. R . Hepatitis in dental professionals. Am. Med. A. J., 232-1228-30, June 23, 1975. 7. Glenwright, H. E., et. al. Serum hepatitis in dental surgeons. Brit. Dent., J., 136409-13, May 21, 1974. 8. Hepatitis B - traffic in the dental office. Edit. Am. Med. A. J., 232:1270, June 23, 1975. 9. Levin, M. L., et. al. Hepatitis B transmission by dentists. Am. Med. A. J., 228:1139-40, May27,1974. 10. Mosley, J. W., and White, E. Viral hepatitis as an occupational hazard of dentists. Am. Dent. A. J., 90392-7, May 1975. 11. Mosley, J. W., et. al., Hepatitis B virus infection in dentists. N. Eng. J. Med., 293:729-34, Oct. 9, 1975. 12. Rimland, D:, et. al. Hepatitis B outbreak traced to an oral surgeon. N. Eng. J. Med., 296:953-8, Apr. 28, 1977. 13. Sims, W. Serum hepatitis and the dental surgeon. J. Dent., 4:154, July 1976. 14. Trachtenberg, Donald. On methods of instrument sterilization - an opinion. Pa. Dent. J.,49:15-17, 1973. ~
"Adult patient is here defined as a patient 12 years of age or older, in that pediatric patients are accepted through a different procedure. +Ausria I1 by Abbott Laboratories, the most sensitive system commercially available for determining presence of HB,Ag in the blood.
Vol. 38, No. l-Winter,
1978
9
15. 11,S. Public Health Service, Center for Disease Control: Hepatitissurveillance report no. 38. HEW publ. No. (CDC) 76-8261, Washington, Government Printing Office, Sept., 1976. 24 p. 16. Villarejos, V. M., et. al. Role of Saliva, urine, and feces in the transmission of type B hepatitis. N . Eng. J. Med., 291:1375-8, Dec. 26, 1974. 17. Wands, J. R., Koff, R. S., and Isselbacher, J. Acute hepatitis. p. 1590-1600. (In Thorn, G. W., et al. ed. Harrison’s Principles of Internal Medicine. 8th ed. New York, McGraw-Hill, 1977.) 18. Ward, R., et al. Hepatitis B antigen in saliva and mouth washings. Lancet, 2:726-7, Oct. 7, 1972. 19. Weil, Ralph. The Council on Dental Health preliminary report of hepatitis B serological survey. N . Y. S. Dent. J., 42531-2, Nov. 1976. 20. Williams, S. V., et al. Dental infection with hepatitis B. Am. Med. A. J.,232:1231-3,June23, 1975.
CALL FOR ABSTRACTS The Dental Health Section of the American Public Health Association is interested in abstracts of papers for presentation at its annual meeting to be held in Los Angeles, California on October 15-19, 1978. Papers dealing with school dental programs, expanded function auxiliaries, and dental care programs are particularly appropriate. Abstract forms will appear in the February issue of The Nation’s Health or may be obtained from: Dr. Anthony Jong Section Program Chairperson Department of Public Health and Community Dentistry School of Graduate Dentistry 100 East Newton Street Boston, MA 02118
Journal of Public Health Dentistry
PREVALENCE OF HEPATITIS B SURFACE ANTIGEN IN A DENTAL SCHOOL PATIENT POPULATION Michael J. Tullman, A.B., D.D.S., M.P.H.* Ronald A. Barrett, D.D.S., M.S.# Charles H. Boozer, D.D.S., M.A.+ J. T. Hamrick, M.D., M.P.H.”” Jack H. Rayson, D.D.S., M.A.## Introduction
,
This article reports on a study designed to gain basic information about the presence of dental patients in a dental-school-patient population who are potentially infectious)+ for viral hepatitis. Concern exists for protecting individuals who provide dental care from exposure to hepatitis B, and as such, an attempt was made to identify high-risk, potentially infectious, and actively infectious persons in the treatment population. Additionally, it was felt that an attempt to document the magnitude of the presence of potentially infectious patients was warranted so that the need for implementation of policies designed to improve sterilization procedures could be evaluated and any changes in policy could be justified. Several studies appear in the literature dealing with the prevalence of potentially infectious asymptomatic carriers of the hepatitis B surface antigen in samples of dentists.H,i,”l’The current study was designed initially to gather information on the treatment population so that further prospective investigation about changes in the presence of hepatitis B surface antigen (HBsAg) in providers of treatment could be monitored - that is, once the threat of hepatitis infection from the patient was recognized and addressed through improved sterilization procedures. A final purpose of the study was to gather information on which a decision could be made whether to monitor all incoming dental patients for potential infectivity for hepatitis B by testing for HB,Ag. It is commonly accepted that many patients with hepatitis B are not diagnosed because they do not have clinical manifestations. These “subclinical” patients pose the same problem of persistent potentially infectious individuals as do the diagnosed cases; however, there is no past history of hepatitis to warn of the possible existence of the carrier state and serological testing is necessary to identify these people. Review of the Literature
The medical and dental literature contains many reports of the increased incidence of type B hepatitis in dentists, as well as other health p r o f e s s i ~ n a l s . ~ ~ ~ J ~ Individuals with serum positive for hepatitis B surface antigen (HB,Ag) are consid‘Assistant Professor, Department of Oral Diagnosis/Medicine/Radiology #Associate Professor, Department of Oral Diagnosis/Medicine/Radiology fAssociate Professor and Head, Department of Oral Diagnosis/Medicine/ Radiology, LouisianaState University School of Dentistry *“Professor and Chairman, Department of Health Services Administration, Tulane University School of Public Health and Tropical Medicine ##Dean, Lonisiana State University School of Dentistry (Submitted 5/2/i7; Returned for revision 6/10/77; Resubmitted 7/22/77; Accepted 11/30/77) ++Theterms ‘potentially infectious” and “carrier” refer to those individuals who demonstrate hepatitis B surface antigen in their blood serum.
Vol. 38, No. l-Winter,
5
1978
ered potentially infectious for type B hepatiti~.'~ Analysis of blood samples for hepatitis B surface antigen has furnished information on its incidence in samples of general populations and in samples of health professionals.2s6Various methods of serum analysis have been used to record, within the limitations of the various experimental frameworks, the increased incidence of HB,Ag in dentists as compared to general or control p o p ~ l a t i o n s . ~ JCases J ~ of hepatitis B in dental patients linked to exposure to dentists positive for HB,Ag have been documented in several r e p o r t ~ . Fifty-five ~J~ patients with hepatitis B occurring over a four- year period were investigated epidemiologically and found to have been associated with dental treatment provided by an asymptomatic oral surgeon who was positive for HBSAg.l2The risk of transmission of hepatitis B from patient to dentist and dentist to patient requires further investigation.8 The knowledge that there is an increasing incidence of hepatitis B in the general population," and that HBsAg is found in the saliva of individuals with serum positive for HB,Ag16J8 further emphasizes the need for evaluating the risks of transmission of hepatitis B through dental treatment. The persistence of HB,Ag in patients' sera has been documented after clinical recovery from hepatitis B and return of biochemical indicators to normal 1 e ~ e l s . l ~ Such persistence may be transient lasting less than three months after recovery, whereas in approximately five to 10 percent of patients diagnosed as having type B hepatitis, the antigenemia persists indefinitely after apparent r e ~ o v e r yIn . ~ addition, people are known to develop hepatitis B infections who do not show clinical manifestations, and therefore are not diagnosed. Individuals who suffer subclinical cases of hepatitis B can become persistent for HB,Ag just as those who fully manifest the disease clinically.17 There is a need for properly controlled epidemiological studies to gather information on the prevalence of the HB,Ag carrier state and on the risks of transmission of infections associated with contact with such individuals.' Currently there is no specific information on which to base an evaluation of the magnitude of the risks of transmission of hepatitis B from dental school patients to those providing dental treatment, or from those providing treatment, to dental patients. Additionally, it has been demonstrated that HB,Ag must be subjected to stringent steriliza tion procedures in order to be ina~tivated.~ Dental schools have used a variety of methods to sterilize instrument^.'^ As more information on the relation between risks of transmission of hepatitis B and dental care is gained, new standards for sterilization and disinfection procedures can be established.5 Procedure
Beginning on January 5, 1977, 300 consecutive patients (Table I) who were accepted through the Louisiana State University School of Dentistry's screening section of the Oral Diagnosis Clinic for dental treatment had a blood sample drawn for radioimmunoassay for hepatitis B surface antigen. These patients were accepted through an open enrollment procedure with no limitations placed by their dental treatment needs. Having signed a consent form, the participant then completed an additional' health questionnaire (Table 11) consisting of six ques'Each patient normally completes a standard medical questionnaire form.
Journal of Public Health Dentistry
6
TABLE I Composition of Sample Population of Dental School Patients at Louisiana State University School of Dentistry, New Orleans, Louisiana by Age, Sex, Race, January, 1977. Age:
25 years and under ........ 92 26 thru 35 years ........... 80 36 thru 45 years .......... 46 45 years and over ........297
"TOTAL Sex:
Race:
White Black Other
..... .217 ...... 76 .....
*TOTAL
297
Male .............. .114 Female. ...........J 8 J TOTAL
300
"Three questionnaires were blank with respect to age and race.
TABLE I1 Positive Responses on Participant's Health Questionnaires"
1. 2. 3. 4. 5. 6.
History History History History History History
of of of of of of
YES jaundice.. ..................................... .13 hepatitis.. ..................................... .ll contact with someone with hepatitis.. ............ . 3 9 receiving blood transfusion.. .................... .46 working in hospital laboratory .................... 9 6 injecting drugs into own body ....................
~~
"Of the 300 participants, 200 gave all-negative responses on the questionnaire. The figures in this table represent the cumulative responses of those 100 participants who gave at least one positive response on the questionnaire.
tions designed to identify a past history of hepatitis B or potential exposure to hepatitis B in the patient's past medical history. The participants then proceeded to the Clinical Diagnosis Laboratory where the blood samples were drawn. A commercial clinical pathology laboratory was employed to analyze the blood samples. The results of the analysis were reported to the Oral Diagnosis Department for recording and tabulation. Patients who gave a history of jaundice or hepatitis were recontacted in an attempt to confirm a history of hepatitis, to classify the hepatitis as having been type A (infectious) or type B (serum), and to document any demonstration of HBsAg during the course of their hepatitis. Results Eleven participants gave a history of hepatitis but only seven of these were medically confirmed by the physicians of record. Three patients were classified as
Vol. 38, No. 1-Winter,
1978
7
having had type B (serum) hepatitis, though HBsAg had not been tested for previously in any of the three, and four were classified as having had type A (infectious) hepatitis. Of the 13 episodes of jaundice reported, seven were associated with verified hepatitis, and six were associated with causes unrelated to viral hepatitis. Analysis of the blood samples showed two patients to be positive for HBsAg (both of these patients had a past history of hepatitis B) (Table 111).The prevalence of HB,Ag was therefore 0.67 percent. From the 95 percent confidence limit around this figure (0.0,1.6 percent) it seems likely that the true proportion of patients positive for HB,Ag is between HB,Ag is betweenO.O and 1.6 percent. It may, therefore, be anticipated that up to 1.6 percent of the population from which the sample was drawn may be potentially infectious for hepatitis B. TABLE I11 Comparison of Histories of Hepatitis and RIA' for HB,Ag Results in Sample Population of Dental School Patients, LSUSD, January, 1977. Positive History of Hepatitis
Verification by Physician
11
7 Verified Positive
Classification by Physician Type A Type B
..... ... 4 .... . . .. 3
RIA Results
0 Positive 2 Positive
~
,'Radioimrnunossay (AUSRIA I1 by ABBOTT)
Discussion The current study used a convenience sample of 300 participants, the size of which was limited by budgetary constraint. N o patient solicited refused to participate. The findings of the two patients positive for HBsAg, both of whom indicated a past history of hepatitis B on the questionnaires provided, were felt to be clinically significant in that these findings documented the potentially infectious state of persistence of HB,Ag in dental school patients who have had hepatitis B. Because HBsAg has been shown to be present in the saliva as well as serum of patients positive for HBsAg, clinical precautions of gloving and wearing a face mask and glasses are indicated for all personnel involved in treating such patients's* Such patients should not be treated unless there are sterilization facilities available which meet established guidelines for inactivation of HBsAg which may contaminate the dental instruments used in treatment. Suggestions The following suggestions are made based on this preliminary study: 1. Dental patients who give a history of hepatitis B should be screened by radioimmunoassay for presence of HBsAg before any treatment is performed. 2. Dental patients who give a history of hepatitis which cannot be confirmed by a physician, or cannot be documented as having been hepatitis A, should be screened by radioimmunoassay for presence of HB,Ag. "One reviewer felt these precautions should be routine.
Journal of Public Health Dentistry
8
3. If radioimmunoassay cannot be performed on patients with a history of hepatitis B, or on those patients with questionable histories of hepatitis, then these patients should be treated in the same manner as those positive for HBsAg. 4. Sterilization procedures in dental schools should meet criteria established for inactivation of hepatitis B surface antigen. 5. Decision on screening of all dental patients for HBsAg must be made after sampling of larger populations is completed. Summary A sample of 300 adult patients* accepted for initial treatment between January 5th and Nth, 1977 at the Louisiana State University School of Dentistry had blood samples drawn and analyzed by radioimmunoassayt for the presence of hepatitis B surface antigen (HBsAg). Two patients were positive for HBsAg (a prevalence of .67 percent. Medical questionnaire information obtained from each participant indicated that 11 patients had had hepatitis; seven were confirmed by the patients' private physicians. Both patients positive for HB,Ag gave confirmed histories of having had hepatitis. The information gathered tends to indicate that dental patients who give a history of hepatitis should have a blood sample drawn and analyzed by radioimmunoassay for HBsAg to determine whether they are carriers of HBsAg. This analysis should precede any dental treatment. Further studies are planned to obtain information from another sample population. Biography 1. Alter, €1. J., and Chalmers, T. C. Management of the asymptomatic carrier of the hepatitis associated (Australia) antigen. N. Eng. J . Med., 285:615-6, Sept. 9, 1974. 2. Alter, H. J., et. al. Health care workers positive for hepatitis B surface antigen. N. Eng. J. Med., 292:454-7, Feb. 27, 1975. 3. Bond, W. W., Petersen, N. J., and Favero, M. S. Viral hepatitis B: aspects of environmentalcontrol. Health Lab. Sci., 1977. In press. 4. Bryan, J. A., and Pattison, C . P. Viral hepatitis - a primer. Postgrad. Med., 59:66-84,Jan., 1976. 5. Crawford, James. New light on the transmissibility of viral hepatitis in dental practice and its control. Am. Den. A. J., 91:829-35, Oct. 1975. 6. Feldman, R. E., and Schiff, E. R . Hepatitis in dental professionals. Am. Med. A. J., 232-1228-30, June 23, 1975. 7. Glenwright, H. E., et. al. Serum hepatitis in dental surgeons. Brit. Dent., J., 136409-13, May 21, 1974. 8. Hepatitis B - traffic in the dental office. Edit. Am. Med. A. J., 232:1270, June 23, 1975. 9. Levin, M. L., et. al. Hepatitis B transmission by dentists. Am. Med. A. J., 228:1139-40, May27,1974. 10. Mosley, J. W., and White, E. Viral hepatitis as an occupational hazard of dentists. Am. Dent. A. J., 90392-7, May 1975. 11. Mosley, J. W., et. al., Hepatitis B virus infection in dentists. N. Eng. J. Med., 293:729-34, Oct. 9, 1975. 12. Rimland, D:, et. al. Hepatitis B outbreak traced to an oral surgeon. N. Eng. J. Med., 296:953-8, Apr. 28, 1977. 13. Sims, W. Serum hepatitis and the dental surgeon. J. Dent., 4:154, July 1976. 14. Trachtenberg, Donald. On methods of instrument sterilization - an opinion. Pa. Dent. J.,49:15-17, 1973. ~
"Adult patient is here defined as a patient 12 years of age or older, in that pediatric patients are accepted through a different procedure. +Ausria I1 by Abbott Laboratories, the most sensitive system commercially available for determining presence of HB,Ag in the blood.
Vol. 38, No. l-Winter,
1978
9
15. 11,S. Public Health Service, Center for Disease Control: Hepatitissurveillance report no. 38. HEW publ. No. (CDC) 76-8261, Washington, Government Printing Office, Sept., 1976. 24 p. 16. Villarejos, V. M., et. al. Role of Saliva, urine, and feces in the transmission of type B hepatitis. N . Eng. J. Med., 291:1375-8, Dec. 26, 1974. 17. Wands, J. R., Koff, R. S., and Isselbacher, J. Acute hepatitis. p. 1590-1600. (In Thorn, G. W., et al. ed. Harrison’s Principles of Internal Medicine. 8th ed. New York, McGraw-Hill, 1977.) 18. Ward, R., et al. Hepatitis B antigen in saliva and mouth washings. Lancet, 2:726-7, Oct. 7, 1972. 19. Weil, Ralph. The Council on Dental Health preliminary report of hepatitis B serological survey. N . Y. S. Dent. J., 42531-2, Nov. 1976. 20. Williams, S. V., et al. Dental infection with hepatitis B. Am. Med. A. J.,232:1231-3,June23, 1975.
CALL FOR ABSTRACTS The Dental Health Section of the American Public Health Association is interested in abstracts of papers for presentation at its annual meeting to be held in Los Angeles, California on October 15-19, 1978. Papers dealing with school dental programs, expanded function auxiliaries, and dental care programs are particularly appropriate. Abstract forms will appear in the February issue of The Nation’s Health or may be obtained from: Dr. Anthony Jong Section Program Chairperson Department of Public Health and Community Dentistry School of Graduate Dentistry 100 East Newton Street Boston, MA 02118
