Oren I, Hershow R C, Ben-Porath E, Krivoy N, Goldstein N, Rishpon S, Shouval D, Hadler S C, Alter M J, Maynard J E
Rambam Medical Center, Haifa, Israel.
Ann Intern Med. 1989 May 1;110(9):691-8. doi: 10.7326/0003-4819-110-9-691.
A nosocomial outbreak of fulminant hepatitis B infection at a medical center in Haifa, Israel, between 7 and 26 June 1986, involved five patients who had been hospitalized previously in the medical ward in late April and early May (first generation). This outbreak had an unusual clinical course, with fulminant hepatic failure associated with acute renal failure from acute glomerulonephritis, leading to death within a few days. The onset dates of hepatitis were tightly clustered temporally and incubation periods were short. Extensive laboratory and epidemiologic evaluation showed that the probable common-source vehicle of transmission was a multiple-dose vial of heparin and normal saline flush solution that may have been contaminated by blood of a known HBsAg carrier, who was positive for anti-HBe, hospitalized at the same time. A sixth patient died in August 1986 (second generation), after his initial admission in June that coincided with the terminal hospitalizations of three first-generation patients. Those patients had marked coagulopathies, and transmission to the sixth patient most probably occurred through environmental contamination by patients or through cross-contamination between patients through staff. The unusually high mortality rate (5 of 6) in this outbreak has not been definitely explained.
1986年6月7日至26日期间，以色列海法一家医疗中心发生了一起暴发性乙型肝炎感染的医院内疫情，涉及5名患者，他们于4月下旬和5月初曾在该医疗病房住院（第一代）。此次疫情的临床病程不同寻常，暴发性肝衰竭与急性肾小球肾炎所致的急性肾衰竭相关，导致患者在数天内死亡。肝炎的发病日期在时间上紧密聚集，潜伏期较短。广泛的实验室和流行病学评估表明，可能的共同传播源是一瓶多剂量的肝素和生理盐水冲洗液，可能被一名已知的乙肝表面抗原携带者的血液污染，该携带者抗HBe阳性，同时也在该医院住院。1986年8月，第六名患者死亡（第二代），他于6月首次入院，当时正值三名第一代患者的末期住院。这些患者有明显的凝血功能障碍，第六名患者很可能是通过患者的环境污染或工作人员造成的患者之间的交叉污染而被感染。此次疫情中异常高的死亡率（6例中有5例）尚未得到明确解释。
