Serologic investigation of an outbreak of hepatitis A in a rural day-care center

We studied an outbreak of hepatitis A in a day-care center in a rural community where less than 7% of the population possessed anti-HAV. Serotesting for IgM specific antibody to hepatitis A virus identified 78 cases in center attendees, staff, and families. Thirty-five per cent of the center children were seropositive. In children under age three anicteric infection was at least 17 times more frequent than icteric infection, but in older children and adults icterus was a predominant manifestation of the disease. Clinical suspicion should be high in any day-care child with nausea, emesis, diarrhea, or arthralgia. The low incidence of icterus in infected children suggested that outbreak reports reaching public health departments are likely to be incomplete and poorly indicative of outbreak magnitude. The high frequency of intrafamilial transmission and anicteric infection appeared to justify administration of immune serum globulin to household contacts of center children under age three when a day-care outbreak is detected.