Higher anti-hepatitis B response with combined DTPw-HBV vaccine compared with separate administration in healthy infants at 3, 4 and 5 months of age in Slovakia

To help achieve universal infant immunisation against hepatitis B, the World Health Organisation has recommended the development of a combined diphtheria, tetanus and pertussis (DTP) and hepatitis B vaccine (HBV). The advantages come from the fact that DTP coverage is estimated to be over 80% worldwide and a combined DTP-HB vaccine would increase the coverage of HBV. This study was conducted to compare the immunogenicity and reactogenicity of a combined DTP-HB vaccine with separate, concomitant administration of DTP and HBV vaccines. One hundred and twenty infants were randomised in a 1:1 ratio to one of the two vaccination regimens, given as three injections at approximately 3, 4 and 5 months of age. The only difference in immunogenicity between the two regimens was a higher antibody response to hepatitis B in the group given the combined vaccine, possibly as a result of the adjuvant effect of the whole cell pertussis component of the DTP vaccine. Both vaccine regimens were well tolerated.

Overview of hepatitis B and transplantation in the hepatitis B patient

Hepatitis B is a disease that infects 300,000 people in the United States each year, resulting in 15,000-30,000 cases of chronic hepatitis. Outcomes include death; development of chronic carrier state, chronic hepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma. Hepatitis B surface antigen (HBsAg) carriers, especially those with cirrhosis, are at high risk for development of hepatocellular carcinoma. Histologically, chronic carriers of HBsAg may have a range of degree of tissue changes, ranging from normal, to varying degrees of portal or lobular inflammation, to significant cell injury with widespread necrosis, fibrosis and cirrhosis. Current histological grading systems reflect both graded inflammation and stage of fibrosis.

[Hepatitis B, C, and E in New Caledonia. Seroepidemiologic study in military recruits]

A seroepidemiological study in army conscripts was carried out to collect data on hepatitis B, C, and E in New Caledonia. All young men recruited between October 1998 and June 1999 (n = 351) were retrospectively included in study. Anamnestic data was obtained during the induction physical examination. Blood tests to detect viral markers and assessment of liver function were performed in all cases. The incidence of hepatitis B was 6.6 p. 100 of chronic carriers of HB antigens. The overall number of vaccinated subjects was low, i.e., 17.9 p. 100. The incidence of carriers presenting at least anti-HBc antibodies was higher in persons of Melanesian and Wallisian extraction, i.e. 59.5 p. 100 and 49.2 p. 100 respectively. This is logical since vaccination rates in these ethnic groups were lower. The incidence was also higher in the northern province and islands, i.e., 48.7 p. 100 and 75 p. 100. Mention of a family history of hepatitis B was a significant predictor of infection. No case of hepatitis C was found. Six carriers of anti-HVE were identified including three who had never left New Caledonia. Detection tests for viral RNA were negative in all cases. This study confirms the high incidence of hepatitis B in New Caledonia and the need for mass vaccination. Findings also suggest that the area may still be free of hepatitis C but the presence of hepatitis E cannot be ruled out.

[Evaluation of the analytic performance of blood collection tubes (BD Vacutainer SST) for the screening of anti-HIV, anti-HTLV, anti-HCV, anti-HBc, anti-CMV antibodies, and of HBs, P24 HIV antigens, and of alanine aminotransferase]

The Laboratory of Viral Diseases Immunology (Laboratoire d'Immunologie des Maladies Virales) of the Northern Region Blood Bank (Etablissement Français du Sang Nord de France) performs between 180.000 and 200.000 viral blood qualifications per year. The use of a serum gel separator evacuated tube should contribute to improve the quality of the pre-analytical phase. However, it must not impact negatively the analytical performances. We evaluated such tube within our specific environment and with the various reagents used in routine. The open study compared the BD Vacutainer plain tube (7 mL, non siliconised) with the BD Vacutainer SST tube (6 mL siliconised with serum gel separator) against the anti-HIV, anti-HTLV, anti-HCV, anti-HBc, anti-HBs, anti-CMV antibodies, the HBs, HIV P24 antigen and the alanine aminotransferase. The study objectives were to find potential gel interference; to verify the diagnostic sensitivity, reagents specificity, and reproducibility. The results analysis show: equivalent performances with the anti-HIV Ab (Anti HIV 1/2 recombinant--Biotest et Genscreen HIV 1/2--Sanofi), anti HIV WB Ab (New Lav Blot 1--Sanofi), anti-HBs Ab (Enzygnost anti-HBs micro--Behring), anti-HBc Ab (HBc Elisa Test System--Ortho), anti-CMV Ab (Enzygnost anti-CMV IgG + M--Behring) kits; lower performances with: The Vironostika HIV Uni Form II plus 0--Organon kit with a -3.5% signal decrease around the ratio R = 2.7 for positive anti-HIV Ab. The Elisa test System 3 Ag HBs-Ortho kit with an increase of the mean ratio of the negative Ag HBs samples; better performances with: the Vironostika HIV 1 Antigen--Organon kit with a +10% signal increase around the threshold ratio R = 1 for positive Ag HIV samples. This deserves further study to verify that the specificity is maintained. The HTLV Type 1 et 2 EIA--Ortho kit with +8% signal increase around the ratio R = 2 for positive anti-HTLV Ab samples without change of the specificity. The Ortho HCV 3.0 Elisa Test System and HTLV Type 1 et 2 EIA kits with a clear and significant improvement of the reproducibility of the anti-HCV and anti-HTLV Ab screenings. The results of this evaluation, together with the intrinsic BD SST tube characteristics, lead to the conclusion that its use would contribute to improve the quality. Because of the specificities of each laboratory, a change of tube type, as with any other material or reagent, request a close monitoring of the first results to confirm the absence of negative effects.

[The survey of HIV prevalence among children between 0 to 7 years old in one county in China]

OBJECTIVE

To estimate the HIV prevalence among children between 0 to 7 years old in one county with HIV epidemic.

METHODS

In September 2000, finger tip blood samples were collected from 619 children between 0 to 7 years old in three districts of one county with high HIV prevalence and tested for HIV antibody and HBV antigen.

RESULTS

Among those 619 children, 11 were found HIV positive, with the prevalence of 1.8% (11/169). The HIV prevalence of three districts were 5.9% (10/169), 0.5% (1/206), and 0% (0/244), respectively. The possible channel associated with the HIV infection was mother-to-child transmission since none of the infected children had the history of blood transfusion. Twenty-four tested children were found HBV positive and the prevalence was 4.3 (24/619).

CONCLUSION

There was higher HIV prevalence in children between 0 to 7 years old in certain areas. More intervenes are needed in the future to prevent the HIV spreading through mother-to-child transmission.

Recent advances in the treatment of viral hepatitis

The viral hepatitis viruses and the diseases they cause are presented in terms of their importance to the practice of dentistry. Each virus will be discussed in terms of its epidemiology, risk of transmission in dentistry, and steps that can be taken to avoid transmission. The scope of this review emphasizes publications from 1996-1999.

Levels of viraemia in subjects with serological markers of past or chronic hepatitis B virus infection

Subjects with serological markers for a past HBV infection may still have HBV DNA in their serum, but the levels of viraemia in such cases are not known. In the present study, of 63 consecutive HBsAg-negative, anti-HBc-positive serum samples with or without anti-HBs, 20 were HBV DNA-positive as analysed by a highly sensitive quantitative PCR, the Cobas Amplicor HBV Monitor test. However, all of these 20 samples had viraemia levels below 1000 copies/ml, compared with median viraemia levels of 10(8.6) and 10(4.3) copies/ml, respectively, in 98 HBeAg-positive and 124 HBeAg-negative HBsAg carriers. There was no difference in viraemia between subjects with anti-HBc alone compared with both anti-HBs and anti-HBc, nor between those with or without hepatitis C virus antibodies. The findings indicate that HBsAg-negative subjects may retain a low infectivity. Their risk for progressive liver damage is probably low, but this deserves further study.

Ten-year serological follow up of hepatitis B vaccine recipients

AIM

To determine long-term persistence of antibodies to hepatitis B surface antigen (anti-HBs) after vaccination against hepatitis B.

METHODS

Thirty-four laboratory workers received hepatitis B vaccine in 1989 in a 0-1-6 month vaccination schedule. Group A (n = 16) received a booster at 3 years after vaccination whereas Group B (n = 18) did not. Anti-HBs was quantitated at 1 month and 1, 2, 3, 5, 6 and 8 years post-vaccination.

RESULTS

At eight-year follow up, 10 of 15 subjects in Group A and 3 of 16 in Group B had protective levels of anti-HBs; in addition, two and four subjects, respectively, had detectable anti-HBs though below protective levels. At ten years, 9/15 and 3/16 were anti-HBs positive in Groups A and B, respectively. One subject in each group had rise in anti-HBs titer at 6-year follow up but both of them tested negative for IgG antibodies to hepatitis B core antigen (anti-HBc). A booster dose at 10 years to anti-HBs negative subjects led to an anamestic response in 3/4 and 8/10 persons in Groups A and B, respectively.

CONCLUSION

Immunological memory after vaccination against hepatitis B is maintained for at least 10 years.

[Carcinoma hepatocellular. Description of verified clinical characteristics in a region of Southern Chile]

BACKGROUND

Hepatocellular carcinoma is the most frequent primary tumor of the liver. It is associated to chronic liver diseases and has a high prevalence in some regions of Africa and Asia.

AIM

To describe the clinical characteristics of patients with hepatocellular carcinoma, admitted to two hospitals of the IX region of southern Chile.

MATERIAL AND METHODS

Prospective study of 29 consecutive patients admitted to two hospitals in Temuco, Chile. Clinical features, laboratory values and viral markers were analyzed.

RESULTS

Eighteen patients were male and ages ranged from 29 to 75 years old. The most frequent presenting symptom was abdominal pain in 21 patients. Seven subjects had a history of alcoholism. Serum bilirubin values ranged from 0.1 to 15.8 mg/dl, alkaline phosphatases ranged from 171 to 3476 U/l, ASAT from 24 to 5400 U/l and alpha feto protein from 1.4 to 350 ng/ml. Two patients had a positive hepatitis B surface antigen and all had negative hepatitis C virus antibodies. Mean tumoral diameter was 9.6 cm and the most common presentation was nodular. Mean survival after the diagnosis was 6.3 months.

CONCLUSIONS

These patients with hepatocellular carcinoma have a low frequency of positive viral markers and tumors of large sizes on presentation.

[Serological markers of hepatitis B in people submitted to blood testing in health care clinics]

OBJECTIVE

To study some of the epidemiological aspects of hepatitis B in a non-representative sample of patients seen in health care clinics.

METHODS

The study population comprised 632 patients who were seen at health care clinics in the city of Ribeirão Preto, Brazil, for the purpose of blood testing, regardless the reason. After signing a written consent, an additional amount of blood was drawn from the same venous puncture site used to collect the original sample for the testing assigned to the patient at the health care clinic. A questionnaire was applied to each participant, looking for the presence of risk factors for hepatitis B. The blood samples were tested for HBV markers, using immunoenzimatic techniques.

RESULTS

The prevalences of HBsAg and anti-HBcAg were 0.3% and 13.9%, respectively. By a logistic regression model, the following variables were significantly associated with the infection: age, time of residency in the city (higher risk among those living for a period less than one year), past history of hepatitis, incarceration and sexual behavior (higher risk among homosexual and bisexual males).

CONCLUSIONS

The growing difficulties in obtaining blood samples from a representative group of patients, as done in classic surveys, make it necessary to look for alternative methodologies which can provide information concerning the presence of infectious agents in a community. Though the results cannot be generalized to the population as a whole, the methodology used conveyed some knowledge regarding the circulation of hepatitis B virus. In addition, it makes much easier to obtain agreement from the participants, since it does not add any invasive procedure. Despite the limitations, this methodology may be helpful in epidemiological surveillance of infectious agents known as producing asymptomatic infections in much of the population.

Endogenous serum interferon-alpha in patients with chronic hepatitis B virus infection

Serum endogenous interferon-alpha was determined in 42 patients with chronic hepatitis B virus infection by radioimmunoassay using an Abbott kit (USA). The study sample included 26 males and 16 females, aged 3 to 59 years (mean, 30.1). Ten of these patients had a history of acute viral hepatitis B carrying HBsAg for more than 6 months. Thirty two patients were accidentally found to be virus carriers for 8 months to 15 years. Six of these were treated with interferon-alpha and one with Ursofalk. Forty one patients (97.62% +/- 2.38) were anti-HBcIgG positive which confirmed former hepatitis B virus infection. Only one patient who was anti-HBcIgG positive was found to be also anti-HBcIgG positive, anti-HBcIgM positive, HBeAg negative, and anti-HBe positive later biophysically verified as exacerbated chronic active hepatitis. Serum HBeAg was detected in 13 of the whole sample (30.95% +/- 7.13); 8 patients (32% +/- 9.33) were HBV-DNA positive, i.e., a third of the cases presented with active replication of the hepatitis B virus. In all 42 patients with chronic hepatitis B virus infection (convalescence and health HBsAg carriers) serum interferon-alpha levels were nil or close to nil. Only in the patient with chronic active hepatitis the serum interferon level was 3.83 IU/ml. These data support the observations that interferon-alpha production is reduced in chronic hepatitis B virus infection and are consistent with the view that treatment with exogenous interferon-alpha stimulates the clearance of the virus.

Clinical course and consequences of hepatitis B infection

Hepatitis B virus (HBV) is a small enveloped virus containing partially double-stranded DNA. The DNA and HBV-specific DNA polymerase are surrounded by the HBV core antigen (HBcAg), which in turn is surrounded by a lipoprotein envelope containing the HBV surface antigen (HBsAg). Serum of HBV-infected patients contains complete virus particles, as well as non-infectious spherical or filamentous HBsAg particles. Acute hepatitis is characterized by the appearance of serum HBV markers, including HBsAg and IgM anti-HBc, which then disappear during convalescence. Persistence of HBsAg for more than 6 months indicates a carrier state. Chronic hepatitis develops in 90% of newborns who become infected, compared with 29-40% of children infected and 5-10% of adults infected. The immune status of the infected person also influences the development of chronic hepatitis. Chronic HBV infection can be diagnosed by serology (identification of HBsAg and HBV DNA), biochemistry (elevated aminotransferase levels) and liver biopsy. The last is important to assess the severity of disease, its stage and prognosis, and to exclude other hepatic diseases. The outcome of chronic HBV infection varies between individuals, with estimated 5-year survivals of 97% for chronic persistent hepatitis, 86% for chronic active hepatitis, and 55% for chronic active hepatitis with cirrhosis. Treatment with interferon alpha is effective in up to 40% of cases, but in view of the very large number of infected people worldwide, vaccination to prevent spread of the disease is a more cost-effective option.

Fulminant hepatitis B following bone marrow transplantation in an HBsAg-negative, HBsAb-positive recipient; reactivation of dormant virus during the immunosuppressive period

It is widely accepted that seroconversion of HBsAg to HBsAb indicates clearance of hepatitis B virus. We describe a 50-year-old man with chronic myelocytic leukemia who developed lethal hepatitis B 22 months after allo-BMT. He had been negative for HBsAg and positive for HBsAb before BMT. Hepatitis B virus latently existing in the liver cells before BMT proliferated during the immunosuppressed period causing fatal hepatitis. Recipients with positive HBsAb should be considered to have the potential for active hepatitis B to emerge after BMT. Bone Marrow Transplantation (2000) 25, 105-108.

Acute hepatitis B after autologous stem cell transplantation in a man previously infected by hepatitis B virus

We report a case of acute hepatitis B after autologous stem cell transplantation (ASCT) in a patient with low-grade non-Hodgkin's lymphoma. At diagnosis of the hematological disease, the patient had the characteristic serology of a previous hepatitis B infection, being Ag HBs negative, hepatitis B virus core antibody positive (anti-HBC) and hepatitis B virus surface antibody weakly positive. He developed fatal hepatitis B after autologous stem cell transplantation, suggesting reactivation consequent to immunosuppression.

Role of lamivudine in the treatment of chronic hepatitis B virus infection

OBJECTIVE

To examine the evidence regarding the therapeutic effectiveness of lamivudine in the treatment of chronic hepatitis B virus (HBV) infection in immunocompetent patients.

DATA SOURCES

Using chronic hepatitis B and lamivudine as MeSH headings, MEDLINE was searched from 1966 to September 1998 for all published randomized controlled trials evaluating lamivudine in chronic HBV infection. Relevant articles from selected bibliographies were also retrieved.

STUDY SELECTION

Only randomized, single- and double-blind trials in human HBV carriers published in the English language were included.

DATA SYNTHESIS

Evidence from the controlled trials suggests that lamivudine has a therapeutic effect in suppressing HBV replication in immunocompetent patients. Lamivudine 100 mg/d appears to suppress HBV replication in as many as 97% of patients within two weeks after the initiation of therapy and is capable of suppressing histologic damages. However, viral suppression is effective only during the therapy; on discontinuation of lamivudine therapy, most patients return to the pretreatment condition. Viral resistance to lamivudine has been observed. Most patients with chronic HBV infection appear to tolerate 100 mg/d of lamivudine therapy.

CONCLUSIONS

Evidence has shown that oral lamivudine 100 mg/d will produce rapid and significant suppression of viral replication in immunocompetent patients with chronic HBV infections. Treatment periods up to one year have been effective and well tolerated. The suppression of viral replication may not be sustained after cessation of lamivudine therapy, and very few patients have complete elimination of HBV during therapy. Therefore, long treatment periods may be necessary. Efficacy and tolerability of treatment beyond one year need to be investigated. Resistance to lamivudine has been reported in patients receiving therapy. A combination anti-HBV regimen using lamivudine and other agents with different mechanisms of action should be investigated to maximize the elimination of the viral infection while minimizing or preventing damage to the liver cells and tissues and the development of viral resistance.

Hepatitis B and C virus markers among new entrant medical students

AIM

To investigate the presence of hepatitis B and C virus markers in new entrant medical students at the Faculty of Medicine, University of Kelaniya.

METHOD

456 students (mean age 24 years, SD 3.5, 257 men) were investigated before they were exposed to clinical work, using a questionnaire to assess sociodemographic factors and possible risk factors for contracting hepatitis B or C. Blood samples were tested for HBs Ag and anti HBs (n = 456), and anti-HCV (n = 162 randomly selected samples) with a third generation sandwich radioimmunoassay technique.

RESULTS

The students were from 20 of the 25 districts in the country, although their distribution was not inform. A past history of hepatitis or jaundice was obtained from 24 (5.3%) and 6 (1.3%) students respectively. None of them had been vaccinated against hepatitis B. At least one risk factor for hepatitis B or C was present in 32 (7%) of them. None of the samples were positive for HBsAg or anti-HCV, and only two (0.44%) were positive for anti-HBs.

CONCLUSION

Our results support the view that exposure to hepatitis B and C seems to be uncommon in this country, at least up to young adulthood. As most new entrant medical students are not immune to these infections there is a strong case to vaccinate them against hepatitis B before they are exposed to clinical work.

Seroprevalence of viral hepatitis in an older nursing home population

OBJECTIVES

To assess the prevalence of current or previous infection with viral hepatitis agents in an older nursing home population.

DESIGN

A prospective cohort study.

SETTING

Three nursing homes in the greater St. Louis area affiliated with Saint Louis University.

SUBJECTS

Older residents admitted to these facilities.

MEASUREMENTS

Residents were interviewed and examined for evidence of hepatitis or liver disease. Serum samples were tested for hepatitis B surface antigen (HBsAg), antibody to hepatitis B core and surface antigens (anti-HBc and anti-HBs), antibody to hepatitis A virus (anti-HAV), antibody to hepatitis C virus (anti-HCV), and hepatitis G virus RNA (HGV RNA).

RESULTS

Of 329 residents queried, 199 gave consent and were able to participate. The seroprevalence of hepatitis was: HBsAg 0%, anti-HBc 24.1%, anti-HBs 19.5%, anti-HAV 79.9%, anti-HCV 4.5%, and HGV-RNA 10.6%. Frequency of HAV infection increased significantly with age whereas HBV infection correlated with ethnic status and former occupation as a manual worker. A history of blood transfusion was associated with a higher rate of anti-HCV. End stage renal disease, present in 17 patients, was associated with anti-HBc, anti-HCV, and HGV RNA positivity but not with anti-HBs or anti-HAV positivity

CONCLUSIONS

The seroprevalence of anti-HCV was surprisingly high in this population residing in skilled nursing facilities, and we recommend that all new patients admitted to this type of institution be screened for anti-HCV. The prevalence of HGV RNA was higher than in the general US blood donor population, but the significance of this finding remains uncertain.

Clinical significance of prior hepatitis B virus infection in patients with hepatitis C virus-related hepatocellular carcinoma

BACKGROUND

The effect of prior hepatitis B virus (HBV) infection on the clinicopathologic findings for patients with hepatitis C virus (HCV) RNA and hepatocellular carcinoma (HCC) is still unclear.

METHODS

Of 59 patients who underwent liver resection for HCV-related HCC (</=2.0 cm in greatest dimension) without metastases between 1990 and 1997, 38 patients had anti-HB core antibody (anti-HBc) and did not have HB surface antigen in their sera (Group 1). Their clinicopathologic findings and outcomes after surgery were compared with those of the remaining 22 patients without anti-HBc (Group 2).

RESULTS

The proportion of well-differentiated HCC was significantly lower in Group 1 than in Group 2 (P = 0.0214). The percentage of patients with cirrhosis was significantly lower in Group 1 than in Group 2 (P = 0.0228). The cumulative survival rate was significantly lower in Group 1 than in Group 2 (P = 0.0224). The risk ratio of anti-HBc for shorter survival time was 3.817.

CONCLUSIONS

HCC more often developed before cirrhosis in patients with HCV RNA and anti-HBc than in patients positive for HCV RNA alone. Prior HBV infection was a risk factor for poor outcome after liver resection for patients infected with HCV.

Hepatocellular carcinoma not related to hepatitis B virus infection among Alaska natives

Chronic infection with hepatitis B or C viruses is a common underlying condition in patients with hepatocellular carcinoma worldwide. We studied serum and liver tissue from a cohort of Alaska natives with hepatocellular carcinoma (HCC) for evidence of hepatitis B, C and G viral infection using conventional serological tests as well as the sensitive polymerase chain reaction. Evidence of HBV infection was found in 25 and possible HCV infection in two cases. Among the remaining 11 patients, four had a history of recent or remote alcoholism while seven had no recognizable risk factors for HCC. Only one was seropositive for HGV RNA and that was an individual with a history of alcoholism. Non-tumorous liver tissue was available for study in six of these seven cases. Histological features of chronic hepatitis were present in five. Thus, at least five of 38 (13%) Alaska natives with HCC appeared to have chronic hepatitis not related to HBV or HCV infection, suggesting the possibility of some form of previously unrecognized chronic liver disease predisposing to HCC.

HBV and proteinuria in relatives and contacts of children with hepatitis B virus-associated membranous nephropathy

BACKGROUND

Hepatitis B virus (HBV)-associated membranous nephropathy (HBVMN) is an important cause of childhood nephrotic syndrome in regions endemic for the virus, but little is understood of the biosocial context in which the disease develops. We evaluated HBV status and proteinuria in family members and household contacts of index children with HBVMN to test the hypothesis that HBV carriage and asymptomatic proteinuria are closely linked and may be causally associated.

METHODS

Thirty-one black children with biopsy-proven HBVMN were the index cases. One hundred and fifty-two family members and 43 black household contacts were the subjects of the study. We assessed HBV carrier status by testing for HBV antigens and antibodies using enzyme-linked immunosorbent assays (ELISA) and for HBV DNA by using slot-blot hybridization and the polymerase chain reaction. Sequencing of the precore region of HBV was done in a subset of both index cases and subjects. Proteinuria was assessed by measuring the urinary protein/creatinine ratio.

RESULTS

Seventy-two (37%) of the 195 family members and household contacts were HBV carriers, and 53 (27%) had a protein/creatinine ratio greater than the physiological limit. The frequency of abnormal proteinuria was not significantly different in those with [22 out of 72 (30.5%)] or without [33 out of 104 (32%)] HBV carriage. This lack of association remained when carriers were classified into those who were HBsAg positive only and those with active viral replication (HBsAg and/or HBeAg and/or HBV DNA; P = 0.01). Family members were more predisposed to HBV carriage than household contacts, but abnormal proteinuria was present with equal frequency (P = 0.48). Age had a significant impact on proteinuria, with children less than five years being more likely to have abnormal proteinuria (P = 0.008). The prevalence of abnormal proteinuria in family members and household contacts of the index cases was more than that in community-based controls. The 10 index HBVMN cases and the 14 family members and household contacts who were tested all had HBV of genotype A.

CONCLUSION

These results suggest that the family members and household contacts of children with HBVMN are at very high risk of HBV carriage; they also have asymptomatic proteinuria at a significantly higher rate than community-based controls. The HBV carrier status was not associated with proteinuria, a finding supported by peak prevalences of proteinuria in those under five years but no corresponding peak for HBV carriage. Proteinuria may indicate glomerular basement membrane dysfunction. Environmental and social factors may underpin development of these two covert disorders, but are insufficient to account for the index cases of HBVMN. The emergence of children with HBVMN from such households additionally depends on unidentified and possibly genetic factors.

Hepatitis B vaccination in hospital personnel and medical students

We determined the prevalence of hepatitis B markers and the compliance to hepatitis B vaccination in a University Hospital of Santa Maria, Lisbon. The program was begun in 1989 for all hospital personnel and students of the medical school. The screening included 2,360 health care workers and 1,153 students; 57% (2,360/4,103) of hospital personnel and 41% (1,153/2,779) of medical students appeared for vaccination. The prevalence of hepatitis B markers was 16.8% (397/2,360) for hospital personnel and 5.5% (64/1,153) for students, the chronic carrier appearing in 0.95% (22/2,360) of hospital personnel and 0.3% (4/1.153) of students. The departments with the highest prevalence were the Biochemical Laboratory (64%, 7/11), Surgery (42%, 13/31), Pulmonary (39%, 9/23), Emergency (29%, 7/24), Hematology Laboratory (29%, 7/24), and Orthopedics (29%, 10/35). The prevalence was higher in students in the last 3 years of medical school than those in the first 3 years (12.2% [22/181] vs. 7.2% [8/110], p = NS). Adverse effects to vaccination occurred in 14.5%, with local pain the most frequent in 8.6%. The serologic efficacy was 95% (1,044/ 1,097). A nonresponse was observed in male workers, 13% (26/200) compared with 5% (45/897) for females (p < 0.05). Older employees also showed higher nonresponse: The average age of workers with anti-HBs of 0 IU/l was 52.3 years and those with anti-HBs of more than 100 IU/l was 38.4 years (p < 0.02). Hepatitis B vaccination is safe and effective. Our study shows the need for a more aggressive approach to the vaccination of health care workers because a significant percentage of them are not protected.

Cationic lipid DC-Chol induces an improved and balanced immunity able to overcome the unresponsiveness to the hepatitis B vaccine

Th1 and Th2 immune responses against antigens can be modulated by the use of adjuvants. Since antibody isotypes (IgG1 and IgG2a) and cytokines induced may reflect the Th differentiation taking place during the immune response, the humoral and cellular immune responses induced in mice against hepatitis B virus surface antigen (HBsAg) were examined when the antigen was either adsorbed to aluminum hydroxyde or administered with a new adjuvant the cationic lipid 3beta-[N-(N',N'-dimethylaminoethane)carbamoyl]cholesterol (DC-Chol). The use of DC-Chol increased antibody responses in responding BALB/c mice, induced more consistent IgG1 and IgG2a antibody responses in OF1 mice and overcame the nonresponse to HBsAg in B10.M mice. Furthermore, DC-Chol was able to induce cellular immune responses to HBsAg. The DC-Chol induced a balanced Th1/Th2 response, which enabled mice to overcome the inherited unresponsiveness to HBsAg encountered with aluminum-adjuvanted vaccine. Thus, the DC-Chol provides a signal to switch on both Th1 and Th2 responses, which may have important implications for vaccination against hepatitis B virus, as well as for enhancing weak immunogenicity of other recombinant purified antigens in a nonresponder population.

[Transient blood surface antigens of hepatitis B in patients on hemodialysis]

BACKGROUND

The presence of surface antigen of hepatitis B (HBsAg) virus in serum from recently vaccinated adults has been scarcely investigated. In this work, after the detection by chance of seven HBsAg-positive patients on hemodialysis who reported recent hepatitis B vaccination, a prospective study was undertaken to verify the presence and duration of post-vacunal antigenemia.

PATIENTS AND METHODS

Nineteen non-selected patients on hemodialysis were followed for serologic markers of hepatitis B, after receiving a dose of the recombinant vaccine (Engerix B) according to their vaccination schedule. Enzyme-immunoassay techniques were used for the study of serologic markers, and the reactivity of HBsAg was confirmed by means of a neutralization assay with specific anti-HBs antibodies.

RESULTS

After the administration of one vaccine dose, 31.5% of patients were HBsAg positive at least once. Antigenemia was identified more frequently 2 to 4 days (83.3%) after immunization. In all cases antigenemia was transient and had cleared after 11 days of vaccination. The follow-up of serologic markers revealed the absence of infection with virus B. Only 16.6% of patients with transient antigenemia responded to vaccination (titer of anti-HBs > or = 10 mIU/ml), while the corresponding percentage in the group of HBsAg-negative patients was 69.2% (p < 0.05). All patients were HCV and HIV negative.

CONCLUSIONS

A high frequency of post-vacunal antigenemia is reported in patients on hemodialysis, in absence of virus B infection as well as the possible relationship between the presence of transient antigenemia and the non-responder status.