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A Hospital ‘Whodunit’: The Hepatitis Outbreak of 1962 at The Jewish Hospital of St. Louis

St. Louis Globe-Democrat article on the Jewish Hospital hepatitis outbreak, 1962
A St. Louis Globe-Democrat article from 1962 on the hepatitis outbreak at The Jewish Hospital of St. Louis
Graph tracking the hepatitis outbreak at Jewish Hospital, 1962
A graph tracking the outbreak of hepatitis at The Jewish Hospital of St. Louis in the summer of 1962
Questionnaire used to track the eating habits of infected persons
A questionnaire used to track the breakfast consumption habits of infected persons
Results of the questionnaire tracking the eating habits of infected persons
The results of the study tracking the breakfast consumption habits of infected persons
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In 1962, a hepatitis outbreak strikes staff members at Jewish Hospital of St. Louis. Somewhere within the city is the source of the infection, likely contaminated food or water – but where? Learn how investigators tracked the source of the outbreak in what writers of the time called a hospital ‘whodunit.’

In July of 1962, two senior student nurses at The Jewish Hospital of St. Louis were diagnosed with infectious hepatitis. Within three days, two more cases of infectious hepatitis appeared among Jewish Staff members, and by summer’s end, 23 total cases of the disease were discovered, mainly among hospital staff members. The administration of The Jewish Hospital of St. Louis at the time faced an outbreak of a contagious disease which required them to not only contain its spread, but also to discover its source.

In attempting to contain the disease, the hospital administered doses of gamma globulin to staff members and patients deemed at risk. Those patients and staff members not deemed at high risk for infection were also informed of the outbreak and were offered the option of gamma globulin immunization. Hospital administrators were also aware that containing the disease and preventing further cases from developing would be expedited by learning quickly where and when the staff members had first contracted hepatitis.  However, determining a common source of infection for 23 people was not an easy task. Indeed, the authors of “How a Hospital Solved a Hepatitis Riddle” noted that the investigation into the outbreak source, “took on some aspects of a ‘whodunit’” (87).

First, the true cases of hepatitis infection needed to be determined. Multiple Jewish Hospital staff members, upon learning of the outbreak, developed symptoms similar to those of a hepatitis-infected person without actually being infected by the disease. These sympathetic symptom false cases had to be weeded out in order to allow concentration on the true cases of infection. Six of the true infected persons were out of town or admitted to other city hospitals at the time of the inquiry, thus delaying investigators in learning about these further cases. Finally, however, 23 total cases of hepatitis among 22 hospital staff members and 1 hospital visitor were determined to have occurred.

Next, the investigators fixed the likely time of exposure based on the time of the onset of symptoms as late June/early July of 1962. As infectious hepatitis can be passed through infected food or water, investigators had the hospital’s water supply tested, and found it to be safe. They then surveyed the disease victims in order to learn about their movements in late June/early July, asking them to recall their experiences of a time which was then almost a month and half in the past. The infected staff members were scattered across wards and living quarters, so places of employment and housing were eliminated as shared sites among the patients. A social event and neighborhood restaurants were also considered and cleared before investigators focused on the hospital cafeteria. All infected persons recalled eating breakfast at the employee cafeteria on July 1st and/or July 2nd, which then prompted investigators to focus on the breakfast food items as infection sources. However, which of the items had caused the outbreak?

 Hepatitis patients, as well as staff members serving as a control group, were asked to recall, using questionnaires, whether they always, occasionally, or absolutely never ate the various items on the hospital’s breakfast menu. These questionnaires were tabulated, and it was found that the one item which 100% of the infected respondents had marked as always or occasionally eating was orange juice. The staff then looked at the reconstitution process used for orange juice in the hospital kitchen, and found that while the same batch of orange juice was served to staff in the employee cafeteria as well as to patients, the patient orange juice was prepared by different hospital staff than the employee orange juice. This was a key finding, as it explained why no patients, only employees, had become sick.

Investigators now felt they were closing in on the source – orange juice in the employee cafeteria. The cafeteria employee who had prepared this orange juice which was served on July 1st and 2nd in the employee cafeteria did not test positive for hepatitis. However, as a month had passed since the infection, this negative test was considered normal, and investigators believed she could have still been carrying the disease at the time of the infection. The cafeteria employee also recounted that her husband had recently become sick with hepatitis-like symptoms, leading investigators to guess that she had infected him as well.

The source of the infection thus discovered, the hospital now focused on healing its staff. Thankfully, most of the cases of hepatitis were mild, and the infected student nurses felt well enough to attend their graduation ceremony on August 16th that year. The hospital also made changes to the food preparation techniques used in the hospital cafeteria to better prevent another outbreak. As the summer ended, life returned to normal at The Jewish Hospital of St. Louis. Some 53 years later, the hepatitis outbreak of 1962 at The Jewish Hospital of St. Louis remains an excellent example of medical detective work.

This account is adapted from:

Gee, David A., David Littauer, M.D., and Richard D. Aach, M.D.. “How A Hospital Solved a Hepatitis Riddle.” The Modern Hospital June 1963: 85-88. Print.

Full documentation of the Jewish Hospital of St. Louis hepatitis outbreak of 1962 can be found in collections of the Bernard Becker Medical Library Archives.

 

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