James E. Maynard

An outbreak of gastroenteritis due to E. coli 0142 in a neonatal nursery

A nursery outbreak of gastroenteritis casued by Escherichia coli 0142/K86/H6 is described. Over a period of nine months, 59 epidemiologically linked cases of diarrhea occurred, including 21 intractable cases with four deaths. The epidemic strain, which was not agglutinated by commerical diagnostic antisera, was isolated from the hands of personnel in five instances directly incriminated hand carriage as the mode of spread. Acquisition of illness, which was especially high among low-birth-weight infants less than 17 days old, did not correlate with any treatment modality investigated and appeared to be related to a host factor. Noninvasive small intestinal colonization, production of enterotoxin, and multiple antibiotic resistance of the epidemic strain were demonstrated and helped to explain the intractability of clinical illness in many infants, despite intensive parenteral antibiotic therapy. Surveys of fecal coliforms on the hands of nursery personnel revealed no change in prevalence after introduction of a policy of triple handwashing with 3 percent hexachlorophene soap, but a significant decrease occurred during the use of disposable gloves. The frequent occurrence of E. coli 0142 in throat swabs of affected infants suggested that pharyngeal colonization may serve as an important diagnostic clue in E. coli diarrhea.

Inadvertent exposure of endoscopy patients to viral hepatitis B

During 6 months of surveillance for hepatitis B surface antigen (HBsAg) in patients undergoing endoscopy in a hospital, 4(2%) of 199 patients were found to be positive. Only 1 of the 4 was previously known to be an HBsAg carrier. The first 5 patients endoscoped after each of 2 HBsAg-positive index patients were followed prospectively for evidence of hepatitis B infection. The endoscope used was routinely cleaned and disinfected (not sterilized) after each use. Transmission of viral hepatitis B was not demonstrated even though the index patients were e antigen positive. Our results show that inadvertent contamination of endoscopes with blood and saliva from HBsAg-positive patients occurs frequently (1.5% of 199 endoscopies) and suggest that meticulous cleaning and disinfection of endoscopes after all procedures may diminish the risk of hepatitis B transmission by this route.

Stability of a reference panel of lyophilized hepatitis B antigens and antibodies

A lyophilized hepatitis B working/reference panel has been prepared for use in standardization tests. This panel includes HBsAg, anti-HBs, HBeAg/anti-HBe and subtype reagents. Quantitative analysis of the HBsAg reagents indicates that at a storage temperature of -20 degrees C, only 1 log at maximum of RIA counts per minute would be lost in 95 years. After storage at -20 degrees C for 1 year, there has been no loss of reactivity in any of the tests used to detect HBsAg, anti-HBs, HBeAg/anti-HBe or subtypes.