Krober M S, Bass J W, Brown J D, Lemon S M, Rupert K J
Pediatr Infect Dis. 1984 Jul-Aug;3(4):296-9. doi: 10.1097/00006454-198407000-00003.
A 34-month-old girl with Down's syndrome from the Marshall Islands was hospitalized in September, 1981, at Tripler Army Medical Center for evaluation of a heart murmur and definitive repair of an imperforate anus for which she had had a colostomy since birth. She became jaundiced and had serologic evidence of hepatitis A infection. Over the next month eight hospital personnel (four nurses, three nursing assistants and one physician) who had had direct contact with the patient became ill with hepatitis A. Our patient, like the index cases in five previous reports of nosocomial hepatitis A outbreaks, was incontinent of feces. In addition she was hospitalized during the incubation period before clinical illness when virus fecal excretion is likely to be maximal. Patients in the prodromal stage of hepatitis A infection who are hospitalized pose a significant risk to exposed hospital staff. This risk is enhanced if there are additional factors present which promote spread of disease by the fecal-oral route such as infancy, mental retardation, diarrhea and fecal incontinence.
一名来自马绍尔群岛的34个月大患有唐氏综合征的女孩于1981年9月入住特里普勒陆军医疗中心，接受心脏杂音评估以及自出生以来就进行了结肠造口术的先天性肛门闭锁的最终修复手术。她出现黄疸，并有甲型肝炎感染的血清学证据。在接下来的一个月里，与该患者有直接接触的八名医院工作人员（四名护士、三名护理助理和一名医生）感染了甲型肝炎。我们的患者，就像之前五份关于医院内甲型肝炎暴发报告中的首例病例一样，大便失禁。此外，她在临床疾病出现前的潜伏期住院，此时病毒粪便排泄量可能最大。甲型肝炎感染前驱期住院的患者对接触的医院工作人员构成重大风险。如果存在如婴儿期、智力迟钝、腹泻和大便失禁等促进粪-口途径疾病传播的其他因素，这种风险会增加。
