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Public Health Dilemmas Concerning a Two-Year-Old Hepatitis B Carrier (Response)

Marcel Verweij and Jim van Steenbergen

The public health physician is concerned about the possibility that, at a nursery, this boy would have close contact with other children and might infect them with hepatitis B virus (HBV).
HBV infection in children is often asymptomatic, and acute disease with severe complications is rare. However, children often become chronic carriers after infection, which may lead to cirrhosis and liver cancer. HBV carriers also remain life long sources of infection to others and hence contribute to the spread of disease.

HBV is mainly spread via blood and semen. Transmission through saliva, though unlikely, is certainly possible, especially where the boy shows a high HBV viremia [1]. The risk of transmission in day care is low, but has been reported and confirmed by genotyping [2–6]. The theoretical routes of transmission are direct through small wounds and, more important, by child bites. Indirect transmission is also possible through the sharing of utensils including toothbrushes, and, to a lesser …