title: A large outbreak of acupuncture-associated hepatitis B.
abstract: An epidemiologic investigation of an acupuncturist's practice in Rhode Island identified 35 patients who were infected with hepatitis B virus during 1984. Of 366 patients seen by the acupuncturist during 1984, 316 (86%) completed questionnaires and submitted serum for hepatitis B serology. Use of tests for immunoglobulin M antibody to hepatitis B core antigen (IgM anti-HBc) identified 17 case-patients who otherwise may have gone undetected. Thirty-four of the 35 case-patients were treated in only one of the two clinics run by the acupuncturist. Patients who received a greater number of acupuncture needles during their treatment course were more likely to have been infected; the attack rate for patients who received less than 150 needles was 9%, compared with 33% for patients who received greater than or equal to 450 needles (p less than 0.001). Attack rates were higher during a one-month period when the index case-patient was more likely to have been viremic than during any other period in 1984 (relative risk = 4.1, 95% confidence interval = 2.3-7.3). While observing the acupuncturist's technique, the investigators noted several potential mechanisms for needle contamination. This study highlights the potential for transmission of hepatitis B in situations of repeated needle use.
authors.affiliation: Division of Field Services, Centers for Disease Control, Atlanta, GA 30333.
authors.forename: G P
authors.initials: GP
authors.lastname: Kent
authors.forename: J
authors.initials: J
authors.lastname: Brondum
authors.forename: R A
authors.initials: RA
authors.lastname: Keenlyside
authors.forename: L M
authors.initials: LM
authors.lastname: LaFazia
authors.forename: H D
authors.initials: HD
authors.lastname: Scott
mesh_terms: D015670:Acupuncture Therapy / Q000009:adverse effects*; D004196:Disease Outbreaks; D004812:Epidemiologic Methods; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology* / Q000209:etiology; D006510:Hepatitis B Antibodies / Q000032:analysis; D006512:Hepatitis B Core Antigens / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006801:Humans; D007565:Jaundice / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009339:Needles; D012237:Rhode Island; D011795:Surveys and Questionnaires
chemical_list: D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens