Material for the Review section, including books, monographs, reprints of articles, and audiovisuals, should be sent to Sego Matsumiya, R.N., Infection Control Nurse, Veterans Administration Medical Center, 500 Foothill Blvd., Salt Lake City, UT 84148.

An outbreak of hepatitis B in a dental practice S. C. Hadler, D. L. Sorley, K. H. Acree, et al: Ann Intern Med 95:133-138, 1981. Reprint requests: Stephen C. Hadler, M.D., Hepatitis Laboratories Division, Centers for Disease Con- trol, 4402 North 7th St., Phoenix, AZ 85014.

This paper discusses the fourth documented instance of hepatitis B virus transmission from an infected dentist to his patients. In this out- break, the dentist had had acute hepatitis B in June 1978 and had remained positive for HBsAg and HBeAg over the ensuing 6 months. In the 3 months prior to his diagnosis, the dentist took no special precautions to decrease the likeli- hood of transmission of hepatitis B virus (HBV) infection to his patients. Six of 395 patients (1.5%) who were treated during this time de- veloped evidence of HBV infection. In the 3 months after the diagnosis, the dentist wore gloves during all patient contacts. During this time, none of 369 patients became infected. These data suggested that the use of gloves might have reduced the risk of virus transmis- sion by the dentist. In addition, the investiga- tors noted an association between the amount of trauma associated with the dental procedure and the risks for hepatitis acquisition. The at- tack rate of hepatitis was 6.9% among patients who had highly traumatic dental work such as tooth extractions or oral surgery. The frequency of hepatitis among patients exposed to less traumatic work was 0.5% and among those who were not traumatized was 0.

This epidemic investigation not only reminds us of the possibilities that dentists or other health care professionals may transmit hepa- titis but also documents the effectiveness of a specific intervention to prevent the spread of infection. The authors recommend the wearing

of gloves by all dental practitioners as a routine infection control practice.

Pneumococcal vaccine in the United States. A critical analysis J. V. Hirschmann and B. A. Lipsky: JAMA 249:1428-1432, 1981. Reprint requests: Dr. B. A. Lipsky, Veterans Administra- tion Medical Center, 4435 Beacon Ave S, Seattle, WA 98108.

This paper critically reviews the efficacy of polysaccharide pneumococcal vaccine and chal- lenges the recommendations for its use. The au- thor suggests that the vaccine is not helpful for most groups of patients for whom immuniza- tion is recommended.

In January 1978, the Public Health Advisory Committee on Immunization Practices recom- mended pneumococcal immunization for (1) certain institutionalized populations, (2) peo- ple at increased risk during a localized out- break, (3) patients at high risk of influenza complications, (4) patients with functional or anatomic asplenia, and (5) patients with cer- tain chronic diseases such as diabetes mellitus or impairments of the cardiorespiratory, he- patic, or renal systems. The authors’ review of the literature showed no documentation of an increased incidence of, or mortality from, pneumococcal disease for many of these sug- gested categories. They note that patients with some immunocompromising underlying dis- eases that render them susceptible to pneu- mococcal disease respond with poor antibody responses after immunization. They state that except for children with sickle cell disease, there is no convincing evidence that the vaccine is effective for the chronically ill. Moreover, they cite unpublished controlled studies that have failed to demonstrate a benefit for im-

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