• I Williams, M G Smith, D Sinha, D Kernan, G Minor-Babin, E Garcia, B H Robertson, R Di Pentima, and C N Shapiro.
• Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Diseases Control and Prevention, Atlanta, Ga 30333, USA.
• JAMA. 1997 Dec 24; 278 (24): 2167-9.

ContextThe risk of transmission of hepatitis B virus (HBV) in day care centers and schools is low.ObjectiveTo investigate the source of HBV transmission for an elementary school teacher with acute hepatitis B.DesignSerologic survey for HBV infection among elementary school students, school staff, and household members of an HBV-infected teacher and student.SettingGeneral community and elementary school.PatientsElementary school students and staff members and household members of an HBV-infected teacher.Main Outcome MeasuresElementary school students, school staff, and household members of an HBV-infected teacher were tested for markers of HBV infection. Samples positive for hepatitis B surface antigen (HBsAg) were tested for HBsAg subtype using monoclonal antibodies and examined for HBV DNA homology by polymerase chain reaction techniques.ResultsAn HBV-infected student and the teacher were found to have the same HBV subtype (ayw1-2) and to have identical HBV DNA sequences. The teacher reported none of the usual risk factors for acquiring HBV infection, and none of her family members had been infected prior to her illness. The specific means of HBV transmission from student to teacher was not identified. Of 108 total children in the same grade as the HBV-infected student, 102 (94%) were tested for serologic markers of HBV infection, and none was positive.ConclusionsThis investigation documented transmission from an HBV-infected student to a teacher in an elementary school setting without a reported overt percutaneous or permucosal exposure to blood or infectious body fluids. Transmission of HBV to other students or staff members in the school was not observed.

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