The New York Times - December 13, 1985
Erik Eckholm

Experts said the danger could be eliminated through wider use of a vaccine. But they said many school workers had resisted immunization because of unwarranted fears that the vaccine could give them AIDS.

The study, based on blood tests from 1978 to 1982 of 1,209 mentally retarded students and 689 staff members at 68 city schools, found an annual hepatitis B infection rate of 1.3 percent among teachers and others working with children known to carry the virus.

This is similar to the infection rate among unprotected medical personnel working with hepatitis patients, said Dr. Stephen M. Friedman of the New York City Health Department, one of six authors of the study. He described the finding as "not reassuring."

Lesser Risk for Students

The risk for fellow students was found to be only half as great as that for teachers and othrs who supervise children in the classroom.

The study was published yesterday in The Journal of the American Medical Association. In an editorial in the same issue, Dr. Saul Krugman of the New York University School of Medicine, an authority on hepatitis B, said that use of the vaccine, together with close adherence to sanitary guidelines, could reduce the risks of viral transmission in schools to "negligible levels."

Hepatitis B, one of the most serious forms of hepatitis, which attacks the liver, is spread through blood, sexual intercourse and sometimes saliva. About 250 Americans die directly from hepatitis B infections each year, but scientists say that nearly one million are chronically infected with the virus and were at heightened risk of death from cirrhosis or liver cancer.

The disease often afflicts drug addicts and male homosexuals, but also poses a special threat at institutions housing retarded children, apparently because of the high number of incidents involving bleeding, biting and scratching. Nationwide studies have shown that in large institutions for the retarded more than half the children contract hepatitis B and that 5 percent to 20 percent become chronic carriers, potentially infectious to others. #54 Known to Be Carriers Over the last decade, in accordance with a 1975 Federal law requiring that children with mental disabilities be offered public school educations, thousands of formerly institutionalized children, some of them carrying hepatitis B, have entered public schools throughout the country. There they have joined other retarded children who had never lived in institutions or been exposed to the hepatitis B virus.

As of 1982, 54 of the 253 formerly institutionalized children and young adults placed in New York special education classes were known to be hepatitis B carriers. Besides providing guidelines for sanitary practices, the health department recommends that principals, teachers and paraprofessionals be informed of who the carriers are so that they can be monitored.

In addition, Dr. Friedman said, the city two years ago began offering the hepatitis B vaccine free to school staff members who work with the retarded.

Fears About Policy on AIDS

Scientists said the new findings should not provoke fears about the city's policy of allowing some children with AIDS, or acquired immune deficiency syndrome, into classrooms.

In contrast to hepatitis, no spread of the AIDS virus through nonsexual contact has ever been documented among children within families or living in institutions.

The new study found that that a principal, four teachers and two paraprofessionals out of 234 staff members who had worked closely with virus carriers had been infected with hepatitis B from 1978 to 1982, but none had become ill as a result. Four of 313 students sharing classrooms with carriers became infected in the same period, again without ill effects, the study found.

For every 100 people who are infected with hepatitis B, according to Dr. Krugman, about half develop no symptoms and then are immune for life. The other half develop hepatitis, but most of these recover completely. Of these, from five to 10 become chronic carriers and may later develop cirrhosis or liver cancer as a result.

Low Use of Hepatitis Vaccine

Hepatitis experts have been disheartened by the low use of the hepatitis vaccine nationally, even among health workers. A second study in the same issue of the journal reported that only 6 percent of patients and 32 percent of vulnerable staff members at hemodialysis centers, a commonly risky arena for hepatitis B transmission, had been immunized.

Reluctance to use the vaccine appeared to arise from two concerns, "neither of which is justified," said the authors of the second study, all scientists at the Centers for Disease Control in Atlanta.

First, they said, fears that the hepatitis B vaccine might spread AIDS have proved totally unfounded. The vaccine is made from plasma of people infected with hepatitis B, including many homosexual men, but it is repeatedly treated with virus-killing agents. Dr. Krugman said studies of those receiving the vaccine showed "conclusively" that the vaccine had not spread AIDS.

Second, the high cost of the vaccine, $100 for an adult and $50 for a child, will generally be reimbursed if needed under Federal, state or local programs.

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