High prevalence of antibody to human herpesvirus-6 and decrease in titer with increase in age in Japan

Seroprevalence of 13 common pathogens in a rapidly growing U.S. minority population: Mexican Americans from San Antonio, TX

Background

Infection risks vary among individuals and between populations. Here we present information on the seroprevalence of 13 common infectious agents in a San Antonio-based sample of Mexican Americans. Mexican Americans represent the largest and most rapidly growing minority population in the U.S., and they are also considered a health disparities population.

Methods

We analyzed 1227 individuals for antibody titer to Chlamydophila pneumoniae, Helicobacter pylori, Toxoplasma gondii, cytomegalovirus, Epstein-Barr virus, herpes simplex virus-1, herpes simplex virus-2 (HSV-2), human herpesvirus-6 (HHV-6), varicella zoster virus (VZV), adenovirus-36, hepatitis A virus, and influenza A and B. Seroprevalence was examined as a function of sex, age, household income, and education.

Results

Seroprevalence estimates ranged from 9% for T. gondii to 92% for VZV, and were similar in both sexes except for HSV-2, which was more prevalent in women. Many pathogens exhibited a significant seroprevalence change over the examined age range (15-94 years), with 7 pathogens increasing and HHV-6 decreasing with age. Socioeconomic status significantly correlated with serostatus for some pathogens.

Conclusions

Our findings demonstrate substantial seroprevalence rates of these common infections in this sample of Mexican Americans from San Antonio, Texas that suffers from high rates of chronic diseases including obesity and type-2 diabetes.

Geographical distribution of the herpes simplex virus type 1 BgKL variant in Japan suggests gradual dispersion of the virus from Shikoku Island to the other Islands

Restriction endonuclease fragment length polymorphism (RFLP) is useful for the epidemiological study of herpes simplex virus type 1 (HSV-1). We report here the identification of a major BglII RFLP variant of HSV-1, designated BgKL, found in 27.0% of 636 HSV-1 clinical isolates. We have also established its geographic distribution in Japan. BgKL has an unusually large BglII K fragment. SalI cleavage analyses showed that 97% of BgKL variant isolates lack both the SalI C-J and the F-J cleavage sites and have an unusually large SalI D or E fragment, and 91% of the BgKL variants lack both SalI G and H fragments. Furthermore, 96% of BgKL isolates have an unusually small KpnI M fragment. Therefore, BgKL is a marker for these five mutations in most HSV-1 isolates and is a useful HSV-1 RFLP marker. The BgKL variant was found in 59% of HSV-1 isolates from Shikoku Island, 44% of HSV-1 isolates from the Chugoku region of Honshu Island, 31% of HSV-1 isolates from Kyushu Island, 0% of HSV-1 isolates from Okinawa Island, 49% of HSV-1 isolates from Osaka, 27% of HSV-1 isolates from Shiga, 13% of HSV-1 isolates from the Chubu Region, and 9% of HSV-1 isolates from the Tohoku Region of Honshu Island. Differences in the frequency of BgKL between the Shikoku-Chugoku-Osaka area (49%) and Kyushu, between Kyushu and Okinawa, between the Shikoku-Chugoku-Osaka area and Shiga, and between Shiga and Tohoku are all statistically significant. The BgKL frequency decreases in a geographical gradient suggest that this HSV-1 variant was dispersed from Shikoku to the surrounding regions and then to more distant regions. The BgKL frequency in Tokyo was similar to the nationwide average. These are the first data to suggest a geographic and demographic dispersion pattern of HSV-1. Implications for the epidemiology and diversification of HSV-1 are discussed.

Pretransplant human herpesvirus 6 infection of patients with acute liver failure is a risk factor for posttransplant human herpesvirus 6 infection of the liver

BACKGROUND

Acute liver failure (ALF) is a significant cause of liver transplantation. We have previously reported that human herpesvirus-6 (HHV-6) was found in most livers of patients with ALF of unknown origin ending up with liver transplantation. In this study, we investigated the posttransplant HHV-6 infection of the liver graft in these patients.

METHODS

Thirty-two patients transplanted due to ALF were included in this retrospective study. Twelve of the 15 patients with unknown cause and four of 17 patients with a known cause of ALF had HHV-6 antigens in the explanted liver. Altogether, 18 patients had some pretransplant evidence of HHV-6. After transplantation, the patients were frequently monitored for the viruses, and biopsy histology was performed in every case of graft dysfunction. HHV-6 was demonstrated in liver tissue by immunohistochemistry.

RESULTS

During the follow-up of 6 months, hepatic HHV-6 infection was demonstrated in 9 of the 18 patients, at a mean 19 days (6-38 days) after transplantation. All patients with posttransplant HHV-6 showed graft dysfunction. In biopsy histology, seven out of these nine patients demonstrated viral infection, one of them also having CMV antigens in the liver. None of those patients without evidence of pretransplant HHV-6 showed HHV-6 in the posttransplant biopsies. Posttransplant HHV-6 was not treated and the virus had no effect on 1-year patient or graft survivals.

CONCLUSION

Pretransplant hepatic HHV-6 infection of patients with ALF is a risk factor for posttransplant HHV-6 infection and liver dysfunction, but has no effect on 1-year graft or patient survival.

Human herpesvirus-6 and acute liver failure

BACKGROUND

In patients with acute liver failure (ALF) of unknown cause, viral infections are believed to be involved. This study investigates the involvement of human herpesvirus-6 (HHV-6).

METHODS

Thirty-two patients with ALF who underwent transplantations during a 6-year period were studied for viruses in biopsies from their explanted livers. Non-A to non-E hepatitis (unknown) ALF was the reason for transplantation in 15 patients, and another 17 patients with a known disease from the same time period served as controls. The explanted livers were examined for hepatitis viruses and other possible viral agents. HHV-6 antigens were demonstrated in the livers and blood mononuclear cells by immunoperoxidase staining.

RESULTS

Of the 15 patients with ALF of unknown cause, 12 (80%) demonstrated HHV-6 antigens in the liver. Most of these patients (10/12) also demonstrated HHV-6 antigenemia. The predominant histologic finding of HHV-6 infection was moderate to severe portal lymphocytic infiltration. HHV-6 was found in 4 of 17 control patients, and cytomegalovirus was found in 2 of 17 control patients (in the blood and explanted liver). No other viruses were found in the livers of the patients with ALF.

CONCLUSIONS

HHV-6 was found in most explanted livers of patients with ALF of unknown cause. HHV-6 antigenemia was associated with HHV-6 antigens in the liver. Only a few control patients displayed HHV-6 in the liver. These observations indicate that HHV-6 may be one of the causes of ALF.

Human herpesvirus-6 modulates RANTES production in primary human endothelial cell cultures

Human herpesvirus 6 (HHV6) is a beta-herpesvirus capable of infecting several cell types from different origins. HHV6 is the etiological agent of exantem subitum and has been associated with several diseases, all characterized by an inflammatory response triggered by chemokines. We show that strain U1102 of HHV6 is able to infect persistently human endothelial cells obtained from umbilical veins, adult aorta and adult heart microvessels, without apparent cytopathic effect. Analysis by in situ PCR showed that HHV6 sequences were present in 20% of HUVEC, 10% of aortic, and 1% of heart microvascular endothelial cells. Regardless of endothelial cell origin, HHV6 infection induced de novo synthesis of the RANTES CC-chemokine. It was found, however, that microvascular endothelial cells, despite their lower susceptibility to HHV6 infection, showed the highest RANTES expression. Chemokine production occurred also in the absence of viral DNA synthesis. Furthermore, RANTES synthesis required an active viral genome, as UV-inactivated HHV6 infection of endothelial cells did not lead to chemokine production. We investigated the expression of HHV6 U51 gene, which encodes a chemokine receptor that is already known to sequester and down modulate RANTES in epithelial cells. HHV6-infected endothelial cells co-expressed RANTES and U51 mRNAs starting from 12 hr up to 48 hr post-infection. Then, RANTES transcripts disappeared whereas U51 messages continued to be expressed. In conclusion, this study highlights the major role of HHV6 in endothelial cell biology and the development of inflammatory processes.

Human herpesvirus-6 infection is associated with adhesion molecule induction and lymphocyte infiltration in liver allografts

BACKGROUND/AIMS

Human herpesvirus-6 (HHV-6) infection has been recently described in liver transplants. HHV-6 may infect the transplant and cause graft dysfunction. Some association between HHV-6 and rejection has also been recorded. We have now investigated the possible involvement of HHV-6 in the intragraft immunological processes, adhesion molecules induction and lymphocyte activation.

METHODS

HHV-6 was detected in liver biopsies of 19 patients transplanted in the period from 1996 to 2000. Patients with other infections or rejection were excluded from the study. Finally, 19 biopsies of eight allografts with pure HHV-6 infection were available. Adhesion molecules (ICAM-1, VCAM-1, ELAM-1) and their ligands (LFA-1, VLA-4, sLeX) and lymphoid activation markers (MHC class II, IL-2R) were demonstrated in liver biopsies by immunohistochemistry. Five biopsies from patients with normal graft function and without rejection or infection were used as controls for immune staining, and ten biopsies with acute rejection but without infection were used as positive controls.

RESULTS

Biopsy histology demonstrated mild to moderate lymphocyte infiltration associated with HHV-6 infection. HHV-6 significantly (P < or = 0.05) increased the vascular expression of ICAM-1 and VCAM-1, and the number of graft infiltrating lymphocytes positive for LFA-1, VLA-4 and class II antigens. A total of 3/8 grafts developed chronic rejection.

CONCLUSIONS

HHV-6 infection increased adhesion molecule expression and lymphocyte infiltration in liver allografts.

High incidence of human herpesvirus 6 infection with a high viral load in cord blood stem cell transplant recipients

Human herpesvirus 6 (HHV-6) infection in recipients of cord blood stem cell transplants (CBSCTs) was estimated by semiquantitative and real-time quantitative polymerase chain reaction (PCR) and reverse-transcription PCR. Of the CBSCT recipients, 7 (70%) of 10 had active HHV-6 infection after transplantation, and all 7 were inferred from their age to have already had a primary infection. Because HHV-6 DNA is seldom detected in cord blood, these cases were considered likely to represent reactivation. In contrast, the 3 patients without HHV-6 infection were all believed to be naive regarding HHV-6 primary infection because of their age and the results of PCR assays given before the transplantation procedure. The incidence of HHV-6 infection after transplantation was significantly higher (P < .05) than after bone marrow (BM) transplantation and peripheral blood stem cell (PBSC) transplantation, when recipients without primary HHV-6 infection prior to transplantation were excluded (CBSCT, 100%; BMT/PBSCT, 56.3%). Real-time PCR revealed a higher level of viral DNA in the peripheral blood mononuclear cells from CBSCT recipients than from BMT/PBSCT recipients or patients with exanthem subitum (P < .05). HHV-6 mRNA of the U79/80gene was also detected by reverse-transcription PCR in all analyzed patients with HHV-6 infection. Its detection was correlated with the emergence of viral DNA in the plasma and symptoms such as fever and rash. Thus, HHV-6 infection was more frequent and the viral load was higher in CBSCT recipients with prior primary infection.

High incidence of human herpesvirus 6 infection with a high viral load in cord blood stem cell transplant recipients

Human herpesvirus 6 (HHV-6) infection in recipients of cord blood stem cell transplants (CBSCTs) was estimated by semiquantitative and real-time quantitative polymerase chain reaction (PCR) and reverse-transcription PCR. Of the CBSCT recipients, 7 (70%) of 10 had active HHV-6 infection after transplantation, and all 7 were inferred from their age to have already had a primary infection. Because HHV-6 DNA is seldom detected in cord blood, these cases were considered likely to represent reactivation. In contrast, the 3 patients without HHV-6 infection were all believed to be naive regarding HHV-6 primary infection because of their age and the results of PCR assays given before the transplantation procedure. The incidence of HHV-6 infection after transplantation was significantly higher (P < .05) than after bone marrow (BM) transplantation and peripheral blood stem cell (PBSC) transplantation, when recipients without primary HHV-6 infection prior to transplantation were excluded (CBSCT, 100%; BMT/PBSCT, 56.3%). Real-time PCR revealed a higher level of viral DNA in the peripheral blood mononuclear cells from CBSCT recipients than from BMT/PBSCT recipients or patients with exanthem subitum (P < .05). HHV-6 mRNA of the U79/80gene was also detected by reverse-transcription PCR in all analyzed patients with HHV-6 infection. Its detection was correlated with the emergence of viral DNA in the plasma and symptoms such as fever and rash. Thus, HHV-6 infection was more frequent and the viral load was higher in CBSCT recipients with prior primary infection.

Loss of maternally derived human herpesvirus-6 immunity and natural infection in Argentinian infants

BACKGROUND

Human herpesvirus-6 (HHV-6) infection is widespread throughout the world. No data are available in Argentina about the loss of maternally derived HHV-6 immunity and natural infection in infants.

METHODS

A population of 100 pregnant women and 407 children between 1 and 15 months of age were assayed by indirect immunofluorescence to detect and quantify specific IgG anti-human herpesvirus-6 (anti-HHV-6) antibodies in Córdoba City, Argentina.

RESULTS

There was no significant difference in the positive rate between infants aged 1 to 9 months (range, 43.6 35.5%) and pregnant women (37%). Seropositive ratio dropped in the 10-month group (23.33% seropositive) and rose sharply in the 11-month group (38.89%), 12-month (60.61%), and 13- to 15-month group (63.46%). The geometric mean titer (GMT) for infants in the 12 to 15 months age group (23.4 41.64) was significantly higher than the GMT for infants 10 months of age (11.04) (P < 0.05 with the Tukey-HSD test).

CONCLUSIONS

This study shows a significant association between loss of passive HHV-6 antibody and age among infants. The results support evidence that HHV-6 enters the susceptible population at 11 months, leading to a high prevalence of antibodies in children between 13 and 15 months of age.

HHV-6, 7 and their related diseases

Human herpesvirus 6 (HHV-6) and human herpesvirus 7 (HHV-7) are relatively recently discovered beta-herpesvirus. They are prevalent in the human population. Primary infection of HHV-6 has been associated with exanthem subitum and febrile illness. Little information is known about the clinical characteristics of primary infection with HHV-7, although some cases of exanthem subitum have been linked to it. HHV-6 has been recently recognized as an opportunistic pathogen in patients with HIV infection and in transplant recipients. The techniques now available to detect these two viruses remain limited, though putative roles for HHV-6 and HHV-7 in several diseases linked to viral infection have been reported. This report reviews the current knowledge of HHV-6 and HHV-7 biology and their pathogenesis.

Human herpes virus-6 seroprevalence and leukaemias: a case-control study. GIMEMA (Gruppo Italiano Malattie Ematologiche dell' Adulto)

The relationships between acute myeloid leukaemia (AML), acute lymphocytic leukaemia (ALL), chronic myeloid leukaemia (CML) and refractory anaemia with excess of blasts (RAEB) and human herpes virus (HHV)-6 antibody level were investigated in a multicentre case-control study. An association between increased HHV-6 seropositivity and geometric mean titre ratio with AML was shown: P for trend = 0.022, adjusted odds ratio 1.20, 95% confidence interval 1.07-1.33 respectively. No association was found between HHV-6 and ALL, CML or RAEB.

U94 of human herpesvirus 6 is expressed in latently infected peripheral blood mononuclear cells and blocks viral gene expression in transformed lymphocytes in culture

Human herpesvirus 6 (HHV-6) like other herpesviruses, expresses sequentially immediate early (IE), early, and late genes during lytic infection. Evidence of ability to establish latent infection has not been available, but by analogy with other herpesviruses it could be expected that IE genes that regulate and transactivate late genes would not be expressed. We report that peripheral blood mononuclear cells of healthy individuals infected with HHV-6 express the U94 gene, transcribed under IE conditions. Transcription of other IE genes (U16/17, U39, U42, U81, U89/90, U91) was not detected. To verify that U94 may play a role in the maintenance of the latent state, we derived lymphoid cell lines that stably expressed U94. HHV-6 was able to infect these cells, but viral replication was restricted. No cytopathic effect developed. Furthermore, viral transcripts were present in the first days postinfection and declined thereafter. A similar decline in the level of intracellular viral DNA also was observed. These findings are consistent with the hypothesis that the U94 gene product of HHV-6 regulates viral gene expression and enables the establishment and/or maintenance of latent infection in lymphoid cells.

A practitioner's guide to human herpesvirus-6 (HHV-6) and human herpesvirus-7 (HHV-7)

Human herpesvirus-6 (HHV-6) and HHV-7 are newly recognized ubiquitous human viruses first discovered in patients with AIDS or lymphoproliferative disorders. Much more information is available about the clinical characteristics of infection with HHV-6 than HHV-7. Primary infection with HHV-6 occurs in early childhood and is most commonly manifested as an undifferentiated highly febrile illness, with seizures noted to be the most common complication. A subset of children develop the classic manifestations of roseola infantum or exanthem subitum. Other neurologic diseases in adults such as encephalitis and multiple sclerosis also have been linked to HHV-6; however, the role of HHV-6 in these clinical entities has not been fully elucidated. Although HHV-6 and HIV are both tropic for CD4+ lymphocytes and interact in vitro, there is no evidence at present that HHV-6 plays a role in HIV disease. HHV-7 is similar to HHV-6 in genetic organization and structure. Little is known of the clinical characteristics of infection with HHV-7 or its ability to cause disease in children or reactivation in adults.

Human herpesvirus 6 infection and associated pathogenesis following bone marrow transplantation

Human herpesvirus 6 (HHV-6) infections following bone marrow transplantation (BMT) have been shown to be associated with fever, skin rash, graft versus host disease, encephalitis, delay in engraftment, marrow suppression, and pneumonia. Unfortunately several of these studies were case reports and although the results were suggestive they prompted us to study these pathological events systematically. These associations were primarily based on either HHV-6 isolation, HHV-6 DNA detection, antigen detection or increases in HHV-6 specific antibodies. HHV-6 activity was more frequent during the post- rather than the pre-transplantation period. All HHV-6 isolates from BMT patients have been shown to be variant B. A better understanding of HHV-6 associated pathogenesis gained by larger prospective trials is needed to facilitate proper treatment of cases of idiopathic illnesses or those associated with symptoms (fever, skin rash) similar to those caused by HHV-6.

Development of a dot blot neutralizing assay for HHV-6 and HHV-7 using specific monoclonal antibodies

To elucidate further immune responses to human herpesviruses 6 and 7 (HHV-6 and -7), a neutralizing antibody assay was established for these viruses using a dot blot method. Three monoclonal antibodies against HHV-6 and 12 monoclonal antibodies against HHV-7 were developed and characterized by radio-immunoprecipitation. One monoclonal antibody which recognizes the 135 kDa late polypeptide of HHV-6 and several which recognize the 125 kDa late polypeptide of HHV-7 were selected to monitor virus growth by a dot blot antigen-detection method. The dot blot method was then used for the assay of HHV-6 and -7 neutralizing antibodies in human serum samples. The neutralization endpoints determined by the dot blot were comparable to those determined by immunofluorescence (IF). The neutralizing antibody titers appeared to correlate with the antibody titers determined by the indirect IF antibody test. The dot blot neutralization assay is easy to perform, is highly reproducible and objective when compared with the conventional methods based on cytopathology or IF for determining neutralization endpoints.

Enzyme-linked immunosorbent assay for detection of antibody to human herpesvirus 6

The results obtained with an enzyme-linked immunosorbent assay (ELISA) for detection of human herpesvirus 6 (HHV-6) immunoglobulin G using a single 1:100 dilution of serum correlated well with those found by an indirect fluorescence microscopic assay (IFA) (r = 0.71). Concordant results were found in all 7 paired serum samples obtained from patients with acute primary infections and in 37 of 41 (90.24%) single serum samples. Fourteen serum samples (25%) which yielded nonspecific results by IFA were evaluable by ELISA. In a serologic survey using the ELISA, a disproportionate number of 12-month-old infants had low difference-of-optical-density values, suggesting that maternal antibody might persist beyond a year of age. This finding and the rises in antibody to HHV-6 found in patients with primary cytomegalovirus infections might lead to overestimation of HHV-6 infection rates in young children in seroprevalence studies. Other herpesvirus infections produced lesser effects on anti-HHV-6.

Prevalence of human herpesvirus 6 antibody in the population of Belém, Pará, northern Brazil

A total of 497 serum samples obtained from residents of 2 neighbourhoods (Terra-Firme and Guamá) in Belém, Pará, Brazil was tested for the presence of antibody to human herpesvirus 6 (HHV6), using an indirect immunofluorescence assay. The overall seroprevalence was 90%, with seropositivity rates ranging from 75% to 100% in the different age groups and sexes. There was a significant difference between the antibody prevalences in Terra-Firme and Guamá, 94% and 87%, respectively (P = 0.01). The geometric mean titres (GMT) of antibody to HHV6 declined from the first (< or = 2 years) to the sixth (31-40 years) age groups, and slightly increased (GMT > 50) among individuals older than 40 years.

Human herpesvirus 6

Human herpesvirus 6 variant A (HHV-6A) and human herpesvirus 6 variant B (HHV-6B) are two closely related yet distinct viruses. These visuses belong to the Roseolovirus genus of the betaherpesvirus subfamily; they are most closely related to human herpesvirus 7 and then to human cytomegalovirus. Over 95% of people older than 2 years of age are seropositive for either or both HHV-6 variants, and current serologic methods are incapable of discriminating infection with one variant from infection with the other. HHV-6A has not been etiologically linked to any human disease, but such an association will probably be found soon. HHV-6B is the etiologic agent of the common childhood illness exanthem subitum (roseola infantum or sixth disease) and related febrile illnesses. These viruses are frequently active and associated with illness in immunocompromised patients and may play a role in the etiology of Hodgkin's disease and other malignancies. HHV-6 is a commensal inhabitant of brains; various neurologic manifestations, including convulsions and encephalitis, can occur during primary HHV-6 infection or in immunocompromised patients. HHV-6 and distribution in the central nervous system are altered in patients with multiple sclerosis; the significance of this is under investigation.

Human herpesvirus 6 and pneumonia

Studies of lung tissues and bronchoalveolar lavage specimens from patients with pneumonia have led some investigators to propose that human herpesvirus 6 (HHV-6) can cause pneumonia. As the etiologic role of HHV-6 in pneumonia remains poorly defined, cases of pneumonia that are associated with pulmonary HHV-6 infection are best described as HHV-6-associated pneumonias. The clinical spectrum of HHV-6-associated pneumonia encompasses both mild and severe cases. Most cases reported so far occurred in immunosuppressed individuals following bone marrow transplantation or HIV infection. Some studies have identified coinfections with HHV-6 and other viruses in a surprising number of HHV-6-associated pneumonias. Although no systematic evaluation of treatment regimens is available at this time, coincidental administration of antiviral drugs did not generally result in clinical improvement. Controlled, prospective studies are needed to understand the clinical presentation, clinical course, etiology, diagnosis and treatment of HHV-6-associated pneumonias.

Low-incidence latent infection with variant B or roseola type human herpesvirus 6 in leukocytes of healthy adults

Nested primer-based polymerase chain reaction was employed to determine the frequency of latent infection with human herpesvirus 6 (HHV-6) among healthy adults from Bratislava, Slovak Republic. A 592-bp region, upstream from the gene encoding the putative large tegument protein of HHV-6, was amplified from DNA extracted from peripheral blood mononuclear cells (PBMC) of only one of 29 seropositive adults, suggesting that as few as 1 in 10(5) PBMC may be infected with the virus. Direct sequencing of the 592-bp fragment indicated that the virus harbored by the seropositive Slovak subject (designated B38) differed by only 3 nucleotides from an HHV-6 variant B strain (R-147) isolated from an American infant with a roseola-like illness and by 32 bases from the variant A strain GS isolated from a patient with lymphadenopathy (5.4% sequence divergence). None of these strains had a deoxyadenosine at base position 1251, when compared to the published sequence of strain GS clone pZVH14. Although this discrepancy did not affect the large tegument protein gene, it altered the predicted amino acid sequences of two putative proteins coded by open-reading frames 1 and 2 (ORF 1 and ORF 2) located upstream from this gene.

Human herpesvirus-6 infection in children. A prospective study of complications and reactivation

BACKGROUND

Infection with human herpesvirus-6 (HHV-6) is nearly universal in infancy or early childhood. However, the course of this infection, its complications, and its potential for persistence or reactivation remain unclear.

METHODS

We studied infants and children under the age of three years who presented to our emergency department with acute illnesses. Infants and young children without acute illness were studied as controls. HHV-6 infection was identified by blood-mononuclear-cell culture, serologic testing, and the polymerase chain reaction (PCR).

RESULTS

No primary HHV-6 infection was found among 582 infants and young children with acute nonfebrile illnesses or among 352 controls without acute illness. Of 1653 infants and young children with acute febrile illnesses, 160 (9.7 percent) had primary HHV-6 infection, as documented by viremia and seroconversion. They ranged in age from 2 weeks to 25 months; 23 percent were under the age of 6 months. HHV-6 infections accounted for 20 percent of 365 visits to the emergency department for febrile illnesses among children 6 to 12 months old. Of the 160 infants and young children with acute HHV-6 infections, 21 (13 percent) were hospitalized, and 21 had seizures. Often the seizures appeared late and were prolonged or recurrent. HHV-6 infections accounted for one third of all febrile seizures in children up to the age of two years. In follow-up studies over a period of one to two years, the HHV-6 genome persisted in blood mononuclear cells after primary infection in 37 of 56 children (66 percent). Reactivation, sometimes with febrile illnesses, was suggested by subsequent increases in antibody titers in 16 percent (30 of 187) and by PCR in 6 percent (17 of 278). No recurrent viremia was detected. Of 41 healthy newborns studied, 12 (29 percent) had the HHV-6 genome in their blood mononuclear cells; nevertheless, 6 of these newborns subsequently had primary HHV-6 infections.

CONCLUSIONS

In infants and young children HHV-6 infection is a major cause of visits to the emergency department, febrile seizures, and hospitalizations. Perinatal transmission may occur, with possible asymptomatic, transient, or persistent neonatal infection.

Prevalence of human herpesvirus 6 antibody among isolated Amazonian Amerindian communities in Brazil

Human herpesvirus 6 (HHV6) antibody was detected by the anticomplement immunofluorescence test in 65 of 592 serum samples (10.9%) obtained from Amerindians belonging to 4 remote communities inhabiting the Amazon Region of Brazil. Seropositivity rates ranged from 5.4% in the Oyampí to 14.9% in the Tucano. Among the Mekranoiti and Tiriyo, the seroprevalence rates were 12.5% and 11.8%, respectively. In children aged 0-10 years, the prevalences of HHV6 antibody ranged from 5.2% to 24.2%, among the Oyampí and Mekranoiti tribes, respectively. In the 11-20 and > 20 years old age groups, percentages of positivity ranged, in the former group, from 9.5% to 17.5% in the Oyampí and Tucano, respectively and, in the latter group, from 1.3% in the Oyampí to 14.8% in the Tucano. The prevalences of HHV6 antibody decreased regularly through the first 3 age-groups in the Mekranoiti and Tiriyo. In addition, frequencies of seropositivity were consistently higher in males than in females in the Mekranoiti (P < 0.05), Oyampí and Tiriyo tribes.

Growth characteristics of human herpesvirus-6: comparison of antigen production in two cell lines

In order to optimize viral antigen production, the growth characteristics of human herpesvirus-6 (HHV-6) (strain AJ) were studied in two cell lines: HSB-2 and JJHAN. The cells were infected with different multiplicities of infection (moi) and viral growth was monitored by appearance of cytopathic effect (CPE), total and viable cell count, immunofluorescence test, immunoblotting, and electron microscopy. Although > or = 70% of JJHAN cells showed CPE when infected at high moi, only 5% of the cells contained viral antigens when tested with immunofluorescence. In contrast the percentage of cells showing fluorescence in HSB-2 cells reached > or = 30% when infected at > or = 1:50. More than 10 polypeptides of molecular weight ranging between 31-140 kD appeared in the HSB-2 cultures by immunoblotting while only 3 polypeptides were detected in the JJHAN cultures at high moi. Different stages of virus maturation were seen in the HSB-2 cells by electron microscopy but the replication of the virus in JJHAN cells appeared to be restricted. For the purpose of antigen production the optimal conditions for the AJ strain of HHV-6 were found to be culturing in HSB-2 cells at a concentration of 1:25-1:50 infected to uninfected cells and harvesting after 7 days.

IgG antibodies to human herpesvirus-6 in young children: changes in avidity of antibody correlate with time after infection

Sera from 321 children aged 0-179 weeks and 196 adult blood donors were examined for IgG antibodies to human herpesvirus-6 (HHV-6) using an indirect immunofluorescence test. After birth, antibody prevalence declined to a minimum between 20 and 29 weeks. Thereafter the percentage of individuals with antibody increased up to the age of 60-69 weeks after which the prevalence of antibody in the children remained stable at about 88%; in contrast, the seroprevalence in blood donors was 98%, indicating that some individuals remain susceptible to infection after early childhood but that virtually all are infected by the time they reach adulthood. The HHV-6 antibody titre increased steadily over the first 70 weeks of life and then remained stable up to 179 weeks old at a level significantly higher than that of the adults. Two hundred and eighteen of the 321 sera whose HHV-6 antibody titres were 40 or greater were tested for antibody avidity using a modification of the immunofluorescence test whereby low avidity antibody was eluted with urea. The results show that the age distribution of low avidity antibody closely parallels the known distribution of exanthem subitum and, moreover, that the mean antibody avidity increased with time after primary infection. The method was further validated because well-characterised convalescent sera taken from seven children within 3 weeks of exanthem subitum all contained low avidity antibodies. The data presented in this study indicate that low avidity IgG to HHV-6 may be detected after primary infection and that this should prove useful in diagnosis and for seroepidemiological surveys.

Avidity of IgG antibodies to human herpesvirus-6 distinguishes primary from recurrent infection in organ transplant recipients and excludes cross-reactivity with other herpesviruses

A newly developed IgG antibody avidity test for human herpesvirus-6 (HHV-6) was used in a study of primary and recurrent HHV-6 antibody responses in immunocompromised solid organ graft recipients. In a primary HHV-6 infection low avidity antibody was detected which matured to high avidity within 5 months whereas, in contrast, high avidity antibody was found in three recurrent infections thus showing the ability of the test to discriminate between primary and recurrent infection in immunosuppressed patients. Six HHV-6 seropositive transplant patients who experienced a subsequent primary human cytomegalovirus (CMV) infection had high avidity concurrent HHV-6 antibody rises, thus excluding a cross-reaction from the low avidity antibodies generated in the primary CMV response and providing evidence of recurrent HHV-6 infection. Four further HHV-6 seropositive patients with proven primary Epstein-Barr virus (EBV) infection were also studied; in each of these cases high avidity HHV-6 antibody rises were seen likewise suggesting recurrent HHV-6 infection. The test is therefore of value in the investigation of herpesvirus infections in transplant patients.

Prevalence of herpesvirus, human T-lymphotropic virus type 1, and treponemal infections in Southeast Asian refugees

Sera obtained for treponemal serology (VDRL) from 193 Southeast Asian refugees representing five ethnic groups seen in a primary care clinic were examined for antibodies to human T-lymphotropic virus type 1 (HTLV-1), human herpes-virus-6 (HHV-6), Epstein-Barr virus (EBV), and cytomegalovirus (CMV). The seroprevalence was highest for EBV (99%), followed in decreasing order by CMV (95%), HHV-6 (26%), and HTLV-1 (0.6%). The VDRL was positive in 15% of patients. The highest seroprevalence to HHV-6 was noted in the Chinese (33%) and the lowest in the Laotian hilltribes, the Mien and Hmong (14%). Antibody to HHV-6 was most prevalent among patients under 20 and those between 60 and 69 years of age. Differences were not found among ethnic groups in the seroprevalence of HTLV-1, EBV, or CMV.

Seroprevalence of human herpesvirus 6 infection in Brazilian and Japanese populations in the north-east of Brazil

The seroprevalence of human herpesvirus 6 (HHV-6) infection was examined for 434 Brazilians and 250 Japanese immigrants living in Recife and its vicinity, in the North-East of Brazil. A total of 684 sera from the healthy individuals were screened for IgG antibodies to HHV-6 by anticomplement immunofluorescence (ACIF) test. The seropositivity rate to HHV-6 showed little difference between the two groups: namely, it was 76.5% for Brazilians and 77.2% for Japanese immigrants. The seropositivity rate was constantly higher in females than in males. The high prevalence of anti-HHV-6 antibodies among children indicates that HHV-6 infection occurs very early in life.

Seroepidemiology of human herpesvirus-6 in pregnant women from different parts of the world

The prevalence of HHV-6 IgG was studied in 11 different countries across several continents: Morocco, Burkina-Faso, Congo, Ivory Coast, Mali, Niger, Senegal, Togo, Ecuador, Martinique, and France. The study group consisted of 550 pregnant women, representative of the general adult population in each country. Antibodies were detected by immunofluorescence assay on HSB-2 cells infected with HHV-6. Each serum was tested at nine dilutions (1:20 to 1:5,120), sera greater than or equal to 20 being considered positive. For the negative antigen control, we used mock-infected HSB-2 cells. Great differences were seen between separate areas: Morocco showed both low prevalence (20%) and a low geometric mean titer (12), whereas sub-Saharan Africa displayed high prevalences (60% to 90%) and variable geometric mean titers (34 to 229). This study revealed a prevalence of 92% for Ecuador, significantly higher than the prevalence for Martinique (50%), yet both countries had very low antibody titers compared with those found in Africa. The prevalence in France (76%) was similar to previous results from other European countries.