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Acute clinical outcomes of hepatitis B infection.

To the Editor.— Dr Hamilton 1 has assumed the following frequencies for acute outcomes of hepatitis B infection in medical center employees: subclinical, 20%; anicteric, 30%; icteric, 40%; and fulminant, 1% (total, 91%). The author has not indicated the outcome for the remaining 9% of cases. Moreover, his reference source for this assumption, the Hepatitis Knowledge Base, contains no mention of these frequencies. Apparently, these frequency estimates are based on outcomes observed following high-dose hepatitis B virus (HBV) exposure by parenteral injection or microtransfusion route in hemodialysis staff, homosexual men, and volunteers inoculated with plasma containing hepatitis B surface antigen (HBsAg). 2 These estimates of acute clinical anicteric, icteric, and fulminant hepatitis B (ACHB) are too high for most instances of HBV infection. Indeed, in both retrospective and prospective population studies, ACHB has occurred in only 25% to 50% of adults and 10% of children infected by HBV; jaundice developed