Snydman D R, Bryan J A, Macon E J, Gregg M B
Am J Epidemiol. 1976 Nov;104(5):563-70. doi: 10.1093/oxfordjournals.aje.a112331.
In the period January-September 1974, 50 cases of hepatitis B infection occurred among a nephrology center's hemodialysis patients and staff. The in-center patient population had an attack rate of 96%. Epidemiologic analysis of risk factors for patients revealed an association between the receipt of intravenous medication and the subsequent development of hepatitis, suggesting that parenteral inoculation was a mode of spread among patients (p equals .008). Nineteen per cent of the staff contracted hepatitis, and all of these personnel had had close contact with patients (p equals .005). The prevalence of hepatitis B infection in staff was related to the failure to use gloves (p less than .01), and accidental needle puncture was associated with the development of clinical hepatitis. These data suggested that disease was transmitted to staff by contact with contaminated blood or close personal contact with patients. Additional data showed that the presence of endogenous antibody protected both patients and staff from antigenemia (p equals .002). These data support the hypothesis that contact with blood is the primary mechanism of spread of hepatitis B in dialysis units, and suggest that, as preventive measures, gloves should be used and antibody-positive staff should dialyze antigen-positive patients.
1974年1月至9月期间，一家肾病中心的血液透析患者及工作人员中发生了50例乙型肝炎感染病例。中心内患者群体的发病率为96%。对患者危险因素的流行病学分析显示，接受静脉用药与随后发生肝炎之间存在关联，这表明胃肠外接种是患者之间的一种传播方式（p值等于0.008）。19%的工作人员感染了肝炎，所有这些人员都与患者有过密切接触（p值等于0.005）。工作人员中乙型肝炎感染的患病率与未使用手套有关（p值小于0.01），意外针刺与临床肝炎的发生有关。这些数据表明，疾病是通过接触受污染的血液或与患者密切的个人接触传播给工作人员的。其他数据显示，内源性抗体的存在可保护患者和工作人员免受抗原血症的影响（p值等于0.002）。这些数据支持了以下假设：接触血液是透析单位乙型肝炎传播的主要机制，并表明作为预防措施，应使用手套，抗体阳性的工作人员应为抗原阳性的患者进行透析。
