Shaw F E, Sudman J H, Smith S M, Williams D L, Kapell L A, Hadler S C, Halpin T J, Maynard J E
Am J Epidemiol. 1986 Jun;123(6):1057-65. doi: 10.1093/oxfordjournals.aje.a114334.
Between June 1, 1983 and August 30, 1984, an epidemic involving 313 cases of hepatitis A occurred in Muskingum County, Ohio. One hundred ninety-seven cases occurred in the city of Zanesville, with 34.7% of cases concentrated in two neighborhoods in the eastern part of the city. Case characteristics were similar to those reported in previous community-wide outbreaks, including a maximum attack rate among 5-9-year-olds and a very low attack rate in adults over 30 years. Case households were larger, and their members were less educated than the mean for households in the city. Forty-eight per cent of the cases reported exposures to other cases which temporally could have been the source of infection. A case-control study failed to show differences in several behavioral factors between case and control households, but did confirm that lower socioeconomic status was a risk factor for the disease. Broad use of immunoglobulin was effective in preventing clinical disease among family contacts, but did not stop the outbreak. This outbreak typifies a genre of hepatitis A epidemic transmitted from person to person in which exact routes of spread are poorly understood and control is difficult. Lower socioeconomic status may be a marker for some unidentified behaviors that promote hepatitis A transmission.
1983年6月1日至1984年8月30日期间，俄亥俄州马斯金格姆县发生了一起甲型肝炎疫情，涉及313例病例。赞斯维尔市出现了197例病例，其中34.7%的病例集中在该市东部的两个社区。病例特征与以往社区范围内爆发的疫情报告相似，包括5至9岁儿童的最高发病率以及30岁以上成年人的极低发病率。病例家庭规模更大，其成员的受教育程度低于该市家庭的平均水平。48%的病例报告曾接触过其他病例，这些病例在时间上可能是感染源。一项病例对照研究未能显示病例家庭和对照家庭在几个行为因素上存在差异，但确实证实社会经济地位较低是该疾病的一个风险因素。广泛使用免疫球蛋白在预防家庭接触者的临床疾病方面有效，但并未阻止疫情爆发。此次疫情是人际传播的甲型肝炎疫情的典型代表，其确切传播途径尚不清楚，控制难度较大。社会经济地位较低可能是一些未明确的促进甲型肝炎传播行为的标志。
