Bloodborne pathogen exposures in a developmental center: 1993-2000.

In a developmental center, 257 potential bloodborne pathogen exposures (119 bites, 91 scratches, 30 sharps injuries, 17 mucosal breaks) occurred during 8 years (13,187 employee-years and 6,980 resident-years). Of the residents, 9% were hepatitis B virus (HBV) surface antigen carriers. Serological follow-up of exposed, susceptible employees and residents identified no transmission of HBV, hepatitis C virus (HCV), or human immunodeficiency (HIV) virus. This outcome has been due primarily to hepatitis B immunization and low prevalences of HCV or HIV infections among the subjects. Proper follow-up of all potential exposures is crucial to identify transmission promptly, allay anxiety, and prevent unwarranted workmen's compensation claims. Measures are suggested to reduce exposure further.

Epidemiology and control of enterobiasis in a developmental center.

OBJECTIVE: To determine if enterobiasis could be controlled in a developmental center. DESIGN: Population-based study. Annual screening of all residents by perianal swabs for enterobiasis and on admission or discharge. Treatment of infected residents and their contacts with mebendazole, 100 mg orally, with two doses given 14 days apart. MAIN OUTCOME MEASURES: The number of residents with enterobiasis and the cost of the program. RESULTS: The prevalence of enterobiasis fell rapidly and progressively, from 21% before mass medication to 1% after 3 years. CONCLUSION: Mass medication of residents with enterobiasis and their contacts was beneficial, harmless, and cost effective.

Fracture epidemiology and control in a developmental center.

During 3.5 years, 182 fractures occurred among 994 residents of a developmental center. The fracture rate was 5.2 per 100 person-years (1.7 times greater than the rate in the US population). Fracture rate was significantly greater in residents with: epilepsy, older age, male gender, white race, independent ambulation, osteoporosis, and residence in intermediate care (versus skilled nursing) units; it was not affected by severity of mental retardation. Hand and foot bones were fractured in 58% of cases. Femur fracture occurred in 13 cases (7%). Fracture was caused by a fall in 41 cases (23%); its cause was indeterminable in 105 cases (58%). Fractures, occurring without significant injury, may be an important cause of preventable disability in this population. Control measures are suggested.

Eighteen fractures in a man with profound mental retardation.

A 39-year-old man with generalized tonic clonic epilepsy and profound mental retardation sustained 18 fractures (15 in appendicular and 3 in axial bones) during 19 years. Both femoral necks were fractured, requiring surgical repair. Although he had been on antiepileptic drugs for 35 years, he had no radiographic or biochemical sign of osteomalacia. He had a very low bone mineral density, suggesting osteoporosis. This case illustrates an important medical problem affecting people with developmental disability and a management challenge for their caretakers.

School eye health appraisal.

School children form an important large target group which must be screened adequately for early detection of eye diseases and prevention of blindness. A total approach in a school eye health programme must include teacher orientation and health education of children in addition to screening for eye diseases. The ocular morbidity pattern in 5135 school children of Jodhpur is discussed in this paper and it is hoped that it will be an indicator to all eye care agencies to help plan their priorities in the delivery of school based eye care.

Xerophthalmia in school children.

The prevalence of xerophthalmia was studied in 5135 school children of Jodhpur ranging between 6 and 16 years of age. The total prevalence of xerophthalmia was found to be 9.89%. Night blindness (XN) and milder conjunctival form (XIA, XIB) of the disease were predominantly prevalent in the studied population. Corneal disease (X2, X3A, X3B) was found in 8 cases and xerophthalmia scar (XS) in only one case. Recognition of early xerophthalmia and urgent vitamin A therapy is of paramount importance to preclude the onset of the corneal stage and irreversible blindness. It is suggested that xerophthalmia screening be made an essential component of routine medical check-up in schools with XN (night blindness with or without conjunctival xerosis) and XIB (Bitot's spots) used as criterion for screening to effectuate early detection and treatment of xerophthalmia.

Serum alpha fetoprotein in 714 mentally retarded carriers of hepatitis B surface antigen.

Sera from 714 mentally retarded carriers of hepatitis B surface antigen were screened for alpha fetoprotein (AFP) by monoclonal radioimmunoassay. Serum AFP levels were less than 20 mcg/L in 708 (99.2%) carriers. One 29-year-old carrier with normal liver function had serum AFP level of 1500 mcg/L, which increased to 12,500 mcg/L after 72 days. She died of multifocal hepatocellular carcinoma (HCC) with cirrhosis. Five other carriers with serum AFP levels between 20 and 165 mcg/L are alive without clinical HCC. No correlation was found between serum AFP level and race, age, sex, Down's syndrome, serum alanine aminotransferase level, and hepatitis B e antigen positivity. Single cross-sectional serum AFP screening by itself is not sufficient for early diagnosis of HCC.

Hepatocellular carcinoma in hepatitis B surface antigen carriers in eight institutions.

We reviewed records of all persons dying between 1979 and 1986 in eight California institutions for the mentally retarded. Autopsies had been done in 71% of the 1,181 deaths. Nine deaths were due to hepatocellular carcinoma, which invariably developed in carriers of hepatitis B surface antigen (HBsAg) and was fatal within four months of diagnosis. The mean age at death was 32.7 years. The incidence of hepatocellular carcinoma in HBsAg carriers was 140 times greater than in the US population. Persistent hepatitis B infection was probably etiologically related to hepatocellular carcinoma in this population, which is relatively free of exposure to other hepatocarcinogens.

Aflatoxin content of foods served to a population with a high incidence of hepatocellular carcinoma.

During three seasons, 36 samples of foods served to mentally retarded clients with a high incidence of hepatocellular carcinoma were analyzed for aflatoxin. Aflatoxin was not detected (less than 5 ppb) by thin-layer liquid chromatography in 35 food samples containing peanuts, corn, wheat or milk. One peanut butter sample contained 20 ppb aflatoxin. Aflatoxin content of these foods was at or below the level permitted by the Food and Drug Administration. Aflatoxin is probably not responsible for liver disease in this population.

Occupational risk of hepatitis B from institutionalized mentally retarded HBsAg carriers: a prospective study.

In an institution for the mentally retarded, a total of 13 (2.4%) susceptible employees seroconverted for hepatitis B during 539 person-years. Two of them developed acute hepatitis B; the cost of their medical care and temporary disability was $7,772. Eleven seroconverters had no elevation of serum alanine aminotransferase, and all seroconverters recovered without chronic sequelae. Nine converters acquired antibody to HBsAg alone; three of these had no client contact. Difficulty in identifying nonoccupational causes of hepatitis B infection in the institutional setting often leads to labeling of all seroconversions as occupationally acquired. Hepatitis B vaccine is recommended for client-care personnel.

Epidemiology of hepatitis B infection in institutionalized mentally retarded clients.

In 1,149 clients of an institution for the mentally retarded, the prevalences of hepatitis B surface antigen (HBsAg) and hepatitis B virus markers were 12 per cent and 66 per cent, respectively. HBsAg prevalence was higher in males, Down syndrome, ambulatory, and older clients, and those with longer institutionalization. Serum alanine aminotransferase levels were abnormal in 31 per cent of HBsAg positive and 10 per cent of HBsAg-negative clients.

Epidemiology of hepatitis B e antigen and antibody in mentally retarded HBsAg carriers.

Screening for HBeAg and anti-HBe was performed on 133 carriers of HBsAg in an institution for the mentally retarded. By radioimmunoassay, the prevalences of HBeAg and anti-HBe were determined to be 16 and 78%, respectively. HBeAg prevalence was significantly different in the following pairs of carriers: 70% in blacks, 10% in whites, and 35% in carriers with Down's syndrome, 8% in carriers without Down's syndrome. Mean age of HBeAg-positive carriers (25.7 years) was lower than HBeAg-negative carriers (29.6 years, p less than 0.05). SGPT levels were abnormal in 66% of HBeAg-positive and 25% of HBeAg-negative carriers (p less than 0.01). This suggests an association between HBeAg positivity and functional liver impairment.

Hepatocellular carcinoma in young, mentally retarded HBsAg carriers without cirrhosis.

In a Californian institution for the mentally retarded, surveillance by autopsy of all deaths (n = 138) identified three cases of hepatocellular carcinoma. Hepatocellular carcinoma cases occurred in young (mean age = 26 years) male carriers of HBsAg and were not associated with cirrhosis. They were of the nonfibrolamellar oncocytic type and were rapidly fatal. Hepatocellular carcinoma incidence in HBsAg carriers was estimated to be 246 times greater than United States males.