Base Clinic Takes Aim at Hepatitis

The little girl in black braids and a black Bart Simpson sweat shirt glumly studied her shoes.

“Come on, boogie,” said her father, Marine Corps Sgt. Darrell Martin, trying to sound encouraging. “See, Daddy’s got to get a shot, too.”

Four-year-old Ceaira Martin was not impressed. She watched in silence as her dad bent over a clinic examining table to receive his gamma globulin shot first, in his backside. And when Ceaira’s turn finally came and a nurse gave the painful injection in her thigh, the little girl bit her lip and cried.

So it went Monday--with tears, complaints, and sometimes howls of protest--as 250 children, their parents and staff from the El Toro Marine Corps Air Station’s day-care center reported to the base clinic for inoculations aimed at stemming a mild outbreak of hepatitis.

By Friday, Marine Corps officials expect about 2,000 people to have received gamma globulin--all 125 day-care center staffers, all of the center’s 400 children, who range in age from 6 weeks to 6 years, and many of their parents, brothers and sisters.

Since Dec. 11, three children from the center and another three parents have tested positive for hepatitis A, a virus that causes a usually mild, but sometimes lingering, liver infection. Blood tests on four more people who may have contracted the disease are pending, said Lt. Calvin Latham, the base medical officer in charge of occupational health.

Symptoms of hepatitis A include fever, nausea, dehydration, loss of appetite, abdominal pains and sometimes jaundice, which can last from a few weeks to several months. Children under age 5 often carry the virus but show no symptoms.

The disease is spread by what epidemiologists describe as the “fecal-oral route,” in which a virus shed from human feces somehow contaminates food. The illness is a frequent occurrence at Orange County day-care centers, where young children need frequent diapering, said Health Care Agency epidemiologist Hildy Meyers, who is monitoring the outbreak.

Latham said a hospital corpsman discovered the illness Dec. 11 when, concerned about his 3-year-old daughter’s persistent stomach flu, he tested her blood and found the hepatitis A virus.

Reacting to that discovery, Latham said, Marine Corps officials that week inoculated all 24 children and four caretakers from the little girl’s class--Room 2--and also inoculated another 24 children and another five caretakers from a neighboring classroom--Room 4.

But about two weeks later, three parents reported they had contracted hepatitis A, Latham said. On Dec. 24, a woman whose husband had been deployed out of the area reported that she was ill with jaundice and unable to work. Again, on Dec. 30, a husband and wife whose child was in Room 2 reported they had become mildly ill with hepatitis A.

Concerned about halting the illness, Latham on Jan. 2 consulted with Navy epidemiologists in San Diego and Norfolk, Va., and recommended that all center children, their parents and siblings and the center staff--from 1,500 to 2,000 people--receive gamma globulin injections. The shots can reduce the severity of the illness, although they do not always prevent it, Latham and other experts said.

The base clinic gave 300 injections on Friday, the first day of its preventive campaign, and expects to remain busy through the end of the week.

Despite this unusually strong effort to stem a disease, Latham and county epidemiologist Meyers said that the outbreak so far is not a major threat to public health.

“It’s not an epidemic,” Latham said. He conceded that the Marine Corps’ inoculation campaign is “precautionary medicine” that may well be overdone. “You’ve got it,” he said in an interview Monday at the base. “This is overkill.”

The extra effort was not prompted by the threat of war in the Persian Gulf, he added. Rather, “the military has to be ready 24 hours a day,” and if Marines got sick, they would obviously not be able to be deployed.

In addition to the immunization program, Master Sgt. Jake Rodrigues said, other preventive measures are in place--”proper disposal of diapers and good personal hygiene, especially among the children.” Also, he said, “no children are being allowed back to the center--current or new--until they have been vaccinated.”

For all that, base officials remain puzzled about the source of the disease. They note that the 3-year-olds in Room 2, where the disease was first discovered, are toilet-trained, and are instructed to wash their hands at nearby child-sized sinks after using the bathroom.

Latham vowed to keep monitoring the situation at the day-care center for the next 60 days. He noted that public health officials were initially concerned, and some nurses from the Irvine Unified School District have called, worried about hepatitis spreading to their schools.