With the adoption of policies requiring mainstreaming of institutionalized mentally disabled children into regular schools, the transmission of hepatitis B virus (HBV) from carriers to susceptible students and staff poses a potential problem.1,2
The recent rise in hepatitis B infection in the United States, especially in adolescents, has led the American Academy of Pediatrics and the Centers for Disease Control Advisory Committee on Immunization Practices to recommend universal HBV immunization of infants and to encourage immunization of all adolescents.3,4 Adolescents at increased risk of acquiring HBV infection should receive priority for immunization, but if resources permit, the immunization of all adolescents is recommended. These new recommendations, therefore, encourage the use of HBV vaccine in children with the eventual aim that all children be immunized against HBV infection. Cost and feasibility are the major limiting factors. Thus, the use of HBV vaccine in school settings should also be liberalized and encouraged. There is a growing body of evidence that demonstrates the spread of HBV infection under certain conditions to classroom contacts in schools and nursery school programs.5-9
When universal immunization is achieved, the need for special school concerns will be eliminated. Until universal immunization is well established, school systems need guidance as they undertake HBV infection control programs. A prevention strategy should be adopted that is based on studies of HBV transmission.
It has been known for several decades that HBV is endemic in institutions for the mentally disabled. Surveys conducted in large institutions have shown that between 5% and 20% of residents may be carriers of the hepatitis B surface antigen (HBsAg) and an additional 60% may have antibody to HBsAg (anti-HBs).6