Role of Saliva, Urine and Feces in the Transmission of Type B Hepatitis

Abstract

To identify vehicles of transmission of Type B hepatitis virus, feces, urine and saliva of chronic carriers of the hepatitis antigens and patients with acute Type B hepatitis were examined by radioimmunoassay and counterelectrophoresis. Antibody to the antigen was detected by passive hemagglutination. The antigen was found in none of 120 fecal extracts and in only three of 130 urine specimens from antigenemic carriers, but was present in the saliva of 76 per cent of patients with acute hepatitis during the first three weeks after clinical onset, and in 86 per cent of chronic carriers intermittently. thirty-five per cent of sneeze samples from antigenemic patients were antigen positive. Antibody was found in saliva early during clinical disease — probably a mechanism limiting infectiveness, as well as during convalescence. Saliva is probably the main vehicle of infection in non-parenterally acquired Type B hepatitis. Transmission may be either airborne, through large droplets expelled by sneezing and coughing, or directly from mouth-to-mouth by kissing or by exchange of chewed toys and candies among children. (N Engl J Med 291: 1375–1378, 1974)