Stokes et al [1954] reported the transmission of hepatitis A by stool samples obtained from children with apparent chronic hepatitis. Two children were involved, aged 11 and 28 months, and the stool samples were collected 22.7 and 67.1 weeks, respectively, after the onset of illness. Both of these children were considered to have hepatitis A, which was endemic in the orphanage to which they were confined. When these stools (20% suspension) were inoculated separately into two groups of four prisoner volunteers, one member of each group developed hepatitis with jaundice 22 and 26 days, respectively, after inoculation. On the basis of this experience, the presence of both chronic hepatitis A and chronic fecal excretion of hepatitis A virus were postulated.
While at least three recent textbooks on liver disease [Schiff and Schiff, 1982;Sherlock, 1981; Wright et al, 19791 state that chronicity and a carrier state do not occur in hepatitis A, and though no other evidence to the contrary has been presented since 1954, there remains the nagging question of whether these children were, in spite of all the evidence in later studies, truly chronically infected with hepatitis A virus. Indeed, reference was made to the 1954 experiments as recently as March, 1984 (International Symposium on Viral Hepatitis, San Francisco, CA).
The purpose of this communication is to report an unsubstantiated experiment, which may, however, shed some light on the subject. Dr Richard B. Capps was one of the co-authors of the 1954 paper, and much of the blood work on the children studied had been done in his laboratory (The Liver Research Laboratory, Presbyterian-St Luke's Hospital, Chicago). In the late 1960s, when complement fixation testing for hepatitis B surface antigen (HBsAg) was first available, the author was in charge of the laboratory. A search of the laboratory freezer was made, and among those items found were single serum samples from each of the two children whose clinical and biochemial data had been reported and whose stools had apparently transmitted hepatitis A. Only enough serum was available for a single test, but both of the specimens were positive for HBsAg by complement fixation, in titers of 1:16 and 1 :32, respectively.
Though much more recent experiments have shown no evidence for fecal excretion of hepatitis B virus, there is also no evidence that contamination of either of the stool samples by blood was sought and/or excluded.