The relationship between infectious hepatitis and Down's syndrome.

IN a series of papers published during the past four years, Collmann and Stollerl'5 have developed and, in their opinion, epidemiologically substantiated the hypothesis that mongolism, or Down's syndrome, is caused by infection of the mother with infectious hepatitis virus, clinical or subclinical, at or near the time of conception. This suggested relationship is being increasingly cited in the literature6-8 as an example of a viral cause of a chromosomal aberration. Data apparently inconsistent with this hypothesis have recently been published by Stark, et al.,9 and by Leck.10 We have analyzed relevant data from the Seattle area and carefully reexamined the literature to date in an attempt to assess the degree of substantiation of this proposed etiological association. The Seattle-King County Health Department serves a region whose population according to the 1960 Census was 935,014. In that year, 21,273 live births were recorded. The reported annual incidence of hepatitis and prevalence at birth of mongolism since 1952 have been plotted in Figure 1. Although there was some variation in the number of mongoloid births annually, no recurrent pattern with a fiveto seven-year period is evident. Furthermore, if hepatitis caused mongolism, an increase in the hepatitis should be followed by an increase in mongoloid births. Actually, the increased hepatitis incidence during 1960-1963 is preceded by an increased number of mongoloid births. To exclude the possibility that the epidemic curve for hepatitis in women in the child-bearing age period was not synchronous with the curve for the population as a whole, age-sex specific hepatitis incidence rates were calculated for this time interval. The hepatitis rate for women aged 15-40 closely paralleled those for the entire population. These data appear to be inconsistent with the above-mentioned hypothesis.