An Epidemic of Hepatitis in a Chronic-Hemodialysis Unit

In a chronic-hemodialysis unit all nine patients and six of 15 staff members, within one year, had evidence of viral hepatitis. Australia antigen (Au1), a virus-like particle associated with acute and chronic viral hepatitis but not other liver diseases was found in the blood of eight of the nine patients and in the two staff members with hepatitis tested. Clinical and laboratory features of hepatitis in the staff and the patients in dialysis were different. In the former an acute disease characterized by serum bilirubin over 3 mg per 100 ml, SGPT over 1000 units and duration of SGPT elevations of less than 10 weeks developed. The patients on dialysis manifested a chronic anicteric disease, with SGPT's under 1000 units but SGPT elevations lasting for 20 weeks or more; the cases were detected only because of frequent testing for Au(1) and SGPT. Susceptibility of patients with chronic renal disease to chronic Au(1) hepatitis is probably related to impaired immunologic responsiveness.