OBJECTIVE: This is a case report describing the occurrence of hepatitis A in three workers at a waste water treatment plant during a small community outbreak involving 16 cases. CASE REPORT: The first case was a 26 year old operator who had worked in the plant for two years, the second was a 23 year old employee hired to add new biolite in the secondary treatment area. These two cases never worked together and only met two or three times before the onset of disease in the second case. The third case occurred three months later in a 34 year old ventilation mechanic. All three cases were confirmed by IgM serology and virus was recovered by polymerase chain reaction in the stools of the last two cases. Despite an extensive search for other risk factors for hepatitis A in these workers none was found. CONCLUSION: This report confirms that hepatitis A is an occupational hazard for sewage workers. The numerous potential sources of contamination associated with that occupation support the use of vaccine to provide effective prevention.
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