Familial clustering of hepatitis B infection

Intrafamilial spread of hepatitis B virus infection. (Role of chronic hepatitis and of the hepatitis B e antigen)

Two hundred and forty household contacts of 85 chronic HBsAg carriers were studied to assess the relationship between liver histology and 'e' antigen or antibody positivity in the index carrier, and evidence of HBV infection within the family. Liver biopsy results were available in 54 index carriers. The prevalence of HBsAg and anti-HBs in the families of 29 carriers with chronic hepatitis and 25 carriers with either a normal liver or minimal inflammatory changes was not significantly different. Serum from 72 index carriers was available for HBeAg and anti-HBe testing. The prevalence of HBsAg and anti-HBs in the families of 5 HBeAg positive carriers, 59 anti-HBs positive subjects, and 8 carriers negative for both HBeAg and anti-HBe was again not significantly different. Infectivity of a carrier thus does not appear to correlate either with histological evidence of liver damage or with the 'e' antigen or antibody positivity of the carrier.

Mentally retarded hepatitis-B surface antigen carriers in NYC public school classes: a public health dilemma

The placement of retarded children who have been institutionalized and are asymptomatic hepatitis-B surface antigen carriers into public school classes for the retarded has caused controversy and presented the New York City Health Department with an unusual medical-ethical dilemma. In this situation, the cost of interfering with deinstitutionalization, an important social advance, must be balanced against the benefit of controlling the unquantified but real risk of transmitting a potentially serious disease. The Health Department guidelines for managing this problem recommended serological surveillance, promotion of classroom hygiene where possible, and teaching of carriers in classes separate from their susceptible peers. A federal court disallowed the cohorting provisions of these guidelines. Changing policies and practices towards the mentally retarded, such as deinstitutionalization, raise important public health issues which will have to be faced by the involved communities.

[Spread of hepatitis B virus infection among family contacts of asymptomatic HBsAg carriers (author's transl)]

Family members of 34 asymptomatic HBsAg carriers were tested for different hepatitis B virus (HBV) markers. Among 67 family members tested 24 (36%) presented signs of a past or ongoing HBV-infection. Spread of HBV-infection was particularly high in those families in which the HBsAg carrier was positive for HBeAg and Dane particle-associated DNA polymerase activity. Non-parenteral "horizontal" transmission of HBV among spouses and brothers and sisters and probably parenteral vertical transmission of HBV from carrier mothers to their infants occurred in approximately the same frequency. Fathers transmitted HBV unfrequently to their offsprings. The results show that the risk to acquire a HBV-infection from an asymptomatic HBsAg carrier is closely linked to the serological findings in the HBe/anti-HBe-system of the index HBsAg carrier and not to the family relationship to the HBsAg carrier.

Sexually transmitted infections in homosexual men

Because of the form of sexual contact and the number of such contacts among homosexual men, physicians should be watchful for sexually transmitted infections in the homosexual community. Hepatitis B, anorectal gonorrhea, shigellosis, amebiasis, and giardiasis are now known to be among these infections. For treatment to be effective and epidemics avoided, physicians should question affected male patients about their sexual habits and advise abstinence from sexual contact until treatment is finished and cultures or smears are negative.

The epidemiology of hepatitis B infection in housestaff

Ninety-nine medical and surgical house officers were prospectively evaluated during internship and residency for the development of hepatitis B virus (HBV) infection. The overall incidence of hepatitis B was 10.2% per year. Eighty-six percent of episodes were subclinical. The greatest risk factor appeared to be frequent hand-to-mouth activity such as smoking or licking requisition labels. The presence of a hemodialysis or transplantation unit may be an additional institutional risk factor. HBV infection was not associated with a history of needle-sticks or contact with known antigen-positive patients. Educational efforts to minimize HBV infection should concentrate on handwashing techniques and discouragement of hand-to-mouth activity in patient care areas.

Familial clustering and immune response in family contacts of patients with HBsAg-positive liver cirrhosis

Families of 11 patients with hepatitis B surface antigen (HBsAg)-positive cirrhosis were studied to evaluate the immunologic correlates and extent of intrafamilial HBsAg clustering. Of 76 family contacts, 12 were identified to be asymptomatic carriers of HBsAg and two were diagnosed to have HSsAg-positive cirrhosis. The over-all HBsAg prevalence for the 76 contacts was 18% and that for all 87 members studied 29.0%. Serologic evidence of hepatitis B virus (HBV) infection (either HBsAg, anti-HBs, or both) was detected in 59% of all family members. HBsAg was more prevalent in males (47%) compared with females (16%), and anti-HBs was more prevalent in females (42%) compared with males (18%). Evidence of an immunologic response in clinically unaffected HBsAg-negative family contacts consisted of elevated serum IgG levels (mean 1660 mg/100 ml) and increased prevalence of anti-smooth muscle and antimitochondrial antibodies (16% and 6%, respectively). The prevalence of one or more autoantibodies in all HBsAg-negative family contacts was 20%, and it was higher in females (25%) than in males (13%). The present study demonstrates that HBsAg clustering occurs in families of patients with cirrhosis in the Jerusalem area and indicates that HBsAg-negative family contacts may have increased B-cell activity.

The risk of hepatitis B to hospital personnel. A prospective study among personnel exposed to patients without isolation precaution

During a two-week period 54 ward personnel were exposed to two patients with severe type B hepatitis. No specific isolation precautions were used other than separate collection of hypodermic needles. During a 22-week follow-up period, there was no evidence of either overt or subclinical hepatitis in development of hepatitis B surface antigen or antibody to the surface antigen that could be attributed to exposure to the patients. This data does not support requirements for cumbersome and complicated isolation procedures during the care of patients with type B hepatitis.

The prevalence of ay and ad subtypes of the hepatitis B surface antigen in Belgium

Subtyping in various groups of persons positive for hepatitis B surface antigen gave the following results: Among asymptomatic blood donors (healthy carriers) subtype ad was found in 20, subtype ay in 24. Among symptomatic patients with acute hepatitis B ad was found in 25, ay in 29. Among patients of an institution for the mentally retarded ad was found in 9, ay in 23. Among patients of a Among patients of a geriatric institution ay was found in 9; among medical personnel of the same geriatric institution ay was found in 3 persons. Among symphilis patients ad was found in 6, ay in 29; and in patients of a dialysis centre ay was found in 6. These data show that neither subtype is really dominant in Belgium.

Hepatitis-B surface antigen and antibody in Black and White patients with venereal diseases

The prevalence of both the hepatitis-B surface antigen (HBsAg) and its specific antibody (anti-HBs) was significantly greater in the sera of White patients suffering from sexually transmitted diseases than that in White blood donors. However, Black patients with venereal diseases did not show an increased prevalence of either HBsAg or anti-HBs. These findings support the view that heterosexual transmission of the hepatitis-B virus is less likely to occur in populations in whom this infection is largely acquired before the age of sexual maturity.

Hepatitis B prevalence within a dental student population

In this descriptive epidemiologic study, prevalence rates of hepatitis B surface antigen (HBsAg) and its antibody (anti-HBs) among fourth-year dental students and second-year dental hygiene students were found to be comparable to those of a control population and a local age-adjusted blood donor group. This observation contrasts with the rates reported for practicing dentists, especially oral surgeons, and indicates that the increased risk experienced by dentists after dental school may be attributable to potentially greater exposure to the hepatitis B virus resulting from an expanded patient load. No significant correlation was found between a positive serologic response and several potential risk factors: previous liver disease, prior contact with hepatitis patients, parenteral injections, facial hair, and punctures sustained during dental procedures. In contrast, prevalence of HBsAg and anti-HBs was increased significantly among black students.

Hepatitis B antigen: a review of its importance in the practice of obstetrics and gynecology

Surgeons engaged in the practice of obstetrics and gynecology should have a clear understanding of the hepatitis B antigen (Australia antigen) serologic test. When positive, it serves as a marker either for the carrier state or for subclinical to overt hepatitis B (serum hepatitis). Patients or health personnel with a positive test are potentially infectious and appropriate precautions should be taken. Surgeons are at increased risk for hepatitis B and, when acutely exposed, should receive standard serum globulin, or perhaps high-titer hepatitis B immune globulin in the future. Infants born to mothers with a positive test may become hepatitis B antigen positive and develop chronic hepatitis.

Hepatitis-B: a review

The recent literature on various aspects of hepatitis-B is reviewed with emphasis on the interrelationships of viral structure, antigenic components, and host immune response in acute, chronic, and asymptomatic carrier states of the infection. The mode of replication and mechanisms of transmission are discussed. Special attention is paid to potential non-parenteral routes of spread. The role of hepatitis-B in associated immune complex diseases and in hepatoma is outlined. A guide to the interpretation of serologic tests for hepatitis-B associated antigen and antibody patterns is presented in relation to the clinical stage and prognosis of the infection. Therapy, except in conceptual terms, is not covered but a summary of the current status of active and passive immunization is given. The unresolved question of the infectivity of carrier medical staff for their patient contacts, and the reverse, is discussed.

Hepatitis B infection in health care personnel of an institution for mentally handicapped children and adults

The health care personnel (HCP) of an institution for the mentally handicapped were serially tested for the presence of hepatitis B surface antigen (HBSAg) and antibody over a period of 1.5 years. HBSAg was present in 1.8% and anti-HBS in 20.8% of HCP. The prevalence of seropositive HCP appeared to be related to the age and the prevalence of seropositive residents cared for by the HCP. The occurrence of seropositivity was higher in the HCP who cared for children under 15 years of age, who demonstrated a high prevalence of HBSAg or anti-HBS. Although the prevalence of HBSAg-positive subjects was 4- to 8-fold lower in HCP than in residents, the degree of seroconversion in susceptible seronegative HCP and residents was strikingly similar. These observations suggest that HCP working in a closed institutional setting are at considerable risk of contacting hepatitis B infection.

Hepatitis B in Australian Aborigines and Torres Strait Islanders: georgraphical, age and familial distribution of antigen subtypes and antibody

Hepatitis B antigen of subtype ay is prevalent in Australian Aboriginal populations, but only subtype ad was found in Torres Strait Islanders. Both subtypes were found in Caucasion hepatitis patients and blood donors from Brisbane. Antigenaemia in Aborigines was more prevalent in Northern Territory than in Queensland, and in males in all areas, but different age distributions were found in Queensland (maximal over 30 years) and Northern Territory (maximal under 30 years). Family clustering was striking in all populations where genealogies were known. In a limited survey antibody was found to be more common than antigen in all Aboriginal groups, the prevalence increasing with age with a peak at 11 to 30 years. Hepatitis B virus infection was equally common in some areas of high and low arbovirus activity providing some evidence against arthropod transmission of hepatitis B virus in these areas.

Transmission of hepatitis type B from healthy HBsAg-positive mothers

Seventeen mothers, all apparently healthy carriers of hepatitis-B surface antigen (HBsAg) during pregnancy, and their children were studied for four to five years to determine the transmission rate of hepatitis-B virus infection. All the mothers had antibody against hepatitis-B core antigen in addition to HBsAg. One of them, a renal transplant recipient, was persistently positive for hepatitis-B-associated e antigen (HBeAg), while the remaining 16, who were detected during screening of healthy pregnant women were positive for anti-HBe. Evidence of infection was found in the child and husband of the woman positive for HBeAg, while none of the 29 children and five husbands of the anti-HBe-positive women became infected.

Viral hepatitis--a primer: 1. Epidem.iology

Hepatitis A is most often transmitted by the fecal-oral route under conditions of crowding, poor hygiene, and prolonged exposure to infected persons. Direct spread of hepatitis B via person-to person contact has only recently been proved. Hepatitis B is usually transmitted indirectly proved. Hepatitis B is usually transmitted indirectly by percutaneous routes, and the increase in drug abuse has brought about a change in its epidemiologic pattern.

Hepatitis B immune globulin as a prophylactic measure for spouses exposed to acute type B hepatitis

Because the value of usual immune globulin preparations in preventing Type B hepatitis is doubtful, we carried out a double-blind comparison of a control human immune globulin preparation with one--identified as HBIG--that had a high concentration (442 mug per milliliter) of antibodies to surface components of hepatitis B virus. Effectiveness was tested in spouses of patients with acute Type B hepatitis. Within 150 days after injection, nine of 33 spouses in the control group had symptomatic Type B hepatitis, compared with one of 25 spouses receiving HBIG. One non-B case also occurred in the HBIG group. Five control globulin recipients had evidence of subclinical hepatitis B infection, compared with one HBIG recipient. Thus, HBIG appeared effective in suppressing not only disease, but also infection itself. Prophylactic value has been demonstrated in persons who should now be recognized as being at exceptionally high risk.

Familial clustering of hepatitis B antigen and liver diseases in families with a high incidence of viral hepatitis

In each of 23 families in which two or more cases of acute hepatitis-like jaundice (index cases) occurred, all family members were studied to evaluate HBAg clustering and the incidence of asymptomatic liver disease. There were 49 "index cases" of hepatitis-like jaundice: 38 cases of acute viral hepatitis, 5 of chronic agressive hepatitis and 6 of active cirrhosis. The overall number of members in these families (excluding index cases) was 170 and 155 of which were tested by clinical examination, laboratory tests and needle liver biopsy. In 27 out of the 155 subjects there was evidence of liver diseases (10 non icteric hepatitis cases, 12 CAH cases and 5 cirrhosis cases). HBAg was present in the serum of 19 of these patients, and twof the cirrhotic patients were positive. Furthermore, 33 of the 155 cases were healthy HGAg carriers showing no abnormality in liver function tests. In the majority of these carriers liver histology showed slight damage (pin-head necrosis or portitis) sometimes compatible with resolving viral hepatitis. A long-term follow-up of the HGAg carriers showed that three of these subjects progressed to acute viral hepatitis.

Hepatitis B antigen in saliva, urine, and stool

A survey of hepatitis B patients, asymptomatic hepatitis B antigen (HBsAg) carriers, and control subjects was conducted to determine the relationship between antigenemia and antigen excretion in saliva, urine, and stool. Radioimmunoassay was used to detect HBsAg. Specificity-confirmed HBsAg was detected in the saliva of 6 (30%) of 20 antigenemic patients, 1 (5%) of 20 nonantigenemic patients, 14 (34%) of 41 carriers, and 0 of 112 controls. HBsAg was detected in urine only after 100-fold concentration of first-morning specimens. Specificity-confirmed HBsAg was present in the urine of 7 (16%) of 43 carriers; unconfirmed HBsAg was found in the urine of 5 (13%) of 38 patients and 5 (5%) of 112 controls. Unconfirmed HBsAg was detected in concentrated stool specimens from 5 (46%) of 11 patients and 3 of 8 carriers and controls. Longitudinally collected specimens from antigenemic subjects showed no consistent patterns of antigen excretion.

Familial clustering of hepatitis B antigen: a study in relatives of patients with liver diseases and hepatitis B antigenaemia

Twelve of the 100 family contacts of 29 patients with transient and persistent hepatitis B antigenaemia were found to be positive for hepatitis B antigen (HBAg). No relation was found between familial clustering and the nature of liver disease or the duration of antigenaemia in the index cases.Eight affected relatives were apparently healthy carriers of HBAG, one had cirrhosis, and three (in the same family) developed acute viral hepatitis.The absence of parenteral exposure in the HBA,-positive family contacts and the identity in antigenic determinants d or y with those of the index cases, suggest a non-parenteral spread of HBAg in families of patients with HBAg-associated liver diseases.