Hepatitis B virus infection in Honolulu students.

OBJECTIVES: To determine hepatitis B virus (HBV) carrier and infection rates and HBV epidemiology in Honolulu students. DESIGN: Cross-sectional survey. SETTING: Honolulu public elementary, intermediate, and high schools. PATIENTS: A volunteer sample of 4936 students from 43 Honolulu schools. MAIN OUTCOME MEASURES: HBV carrier rate (presence of hepatitis B surface antigen) and infection rate (presence of either hepatitis B surface antigen, antibody to hepatitis B surface antigen, antibody to hepatitis B core antigen, or any combinations of these) by school grade, ethnicity, and place of birth. RESULTS: Eighty-three (1.68%) students were identified as HBV carriers, and a total of 353 (7.15%) students had serologic evidence of infection. Infection rates increased from elementary school age to high school age, more so in Asian/Pacific Island-born students. The prevalence of infection was higher in Asian/Pacific Island-born students than in those born in the United States. The majority of infected Hawaiian-born students were first-generation Asian/Pacific Island Americans. CONCLUSIONS: Horizontal transmission of HBV occurs in Honolulu school-age children. HBV immunization of all infants in Hawaii, not just those born to carrier mothers, is necessary to reduce HBV transmission in Hawaii.

Ciguatera: a review.

Hawaii State Department of Health epidemiological records were reviewed for cases of ciguatera poisoning for the entire state, from January 1984 through December 1988. During the 5 year interval, the numbers of ciguatera poisoning incidents, number of cases, and date of onset were recorded, as well as age and sex of individuals involved. The place of catch of each fish was noted as well as whether or not the fish was obtained commercially. The parts of the fish consumed were also recorded. A total of 150 ciguatera incidents occurred during this period, involving 462 individuals for an average annual incidence rate of 8.7/100,000 population. The 3 most frequently implicated species of fish were the Carangoides species (jack or papio or ulua), Ctenochaetus strigosus (surgeon fish or kole), and Aphareus furcatus (fork-tailed snapper or waha nui); however, more than 50 species of fish had caused one or more outbreaks. The most frequently implicated areas of the toxic fish were the Kona coast as well as the South Point of the island of Hawaii, and the Napali coast of the island of Kauai. Of the 150 outbreaks, 32 (21%) were related to commercial fish. The rest were related to sportfishing.

Characterization of a variant strain of Norwalk virus from a food-borne outbreak of gastroenteritis on a cruise ship in Hawaii.

A gastroenteritis outbreak affecting at least 217 (41%) of 527 passengers on a cruise ship was caused by a variant strain of Norwalk virus (NV) that is related to but distinct from the prototype NV strain. Consumption of fresh-cut fruit served at two buffets was significantly associated with illness (P < or = 0.01), and a significant dose-response relationship was evident between illness and the number of various fresh-cut fruit items eaten. Seven (58%) of 12 paired serum specimens from ill persons demonstrated at least fourfold rises in antibody response to recombinant NV capsid antigen. A 32-nm small round-structured virus was visualized by electron microscopy in 4 (29%) of 14 fecal specimens, but none of the 8 specimens that were examined by an enzyme immunoassay for NV antigen demonstrated antigen. Four (40%) of 10 fecal specimens were positive by reverse transcriptase-PCR by using primer pairs selected from the polymerase region of NV. In a 145-bp region, the PCR product shared only 72% nucleotide sequence identity with the reference NV strain and 77% nucleotide sequence identity with Southampton virus but shared 95% nucleotide sequence identity with UK2 virus, a United Kingdom reference virus strain. In addition, the outbreak virus was serotyped as UK2 virus by solid-phase immune electron microscopy. The genetic and antigenic divergence of the outbreak strain from the reference NV strain highlights the need for more broadly reactive diagnostic assays and for improved understanding of the relatedness of the NV group of agents.