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Hepatitis D Virus Infection in Illinois State Facilities for the Developmental Disabled: Epidemiology and Clinical Manifestations

Ronald C. Hershow, MD; Bruno B. Chomel, DVM; Donald R. Graham, MD; Paul M. Schyve, MD; Eric J. Mandel, MS; Mark A. Kane, MD; Howard A. Fields, PhD; and Stephen C. Hadler, MD
[+] Article, Author, and Disclosure Information

Requests for Reprints: Ronald C. Hershow, MD, University of Illinois at Chicago, School of Public Health, Room 504, 2121 West Taylor Street, Chicago, IL 60612.

Current Author Addresses: Dr. Hershow: University of Illinois at Chicago, School of Public Health, Room 504, 2121 West Taylor Street, Chicago, IL 60612.

Dr. Chomel: Ecole Nationale Veterinaire de Lyon, B.P. 31-Marcy L'Etoile, 69752 Charbonnieres Cedex, Lyon, France.

Dr. Graham: Springfield Clinic, 1025 South Seventh Street, Springfield, IL 62708-3746.

Dr. Schyve: Joint Commission on Accreditation of Healthcare Organizations, 875 North Michigan Avenue, Chicago, IL 60611.

Mr. Mandel and Drs. Kane, Fields, and Hadler: Hepatitis Branch, Centers for Disease Control, Building 6, Room 154, 1600 Clifton Road, Atlanta, GA 30333.

©1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;110(10):779-785. doi:10.7326/0003-4819-110-10-779
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Objective: To define the epidemiology and clinical manifestations of hepatitis D virus infection in an institutionalized population.

Design: A case-control study of hepatitis B carriers with and without serologic evidence of hepatitis D virus infection. Demographic, institutional, and medical data were obtained through questionnaires and chart review. Clinical status was assessed by liver function assays.

Setting: Thirteen Illinois state facilities for the developmentally disabled.

Participants: Clients (238) who were hepatitis B carriers.

Results: Antibody to hepatitis D virus (anti-HDV) was detected in 71 of 238 (30%) hepatitis B carriers. Nine of thirteen facilities housed positive clients. Previous residence at one facility, designated B, was the strongest correlate of anti-HDV positivity; 85% of positive persons had lived there compared with 16% of negative controls (odds ratio 28.3 [95% CI, 13.2 to 60.7], P < 0.001). Past hepatitis episodes were more common among anti-HDV-positive clients (37% compared with 7%) (odds ratio, 7.5 [95% CI, 3.0 to 19.1], P < 0.001) and occurred mainly at facility B from 1950 to 1975. Liver function tests were infrequently abnormal among anti-HDV-positive clients.

Conclusions: Results show widespread hepatitis D virus infection in our institutionalized population and suggest that transmission occurred mainly in the past at the overcrowded facility B. The low prevalence of laboratory evidence of chronic liver disease in the anti-HDV-positive clients may be explained by increased mortality among those originally infected from 1950 to 1975.





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