D C Wong

Epidemic and endemic hepatitis in India: evidence for a non-A, non-B hepatitis virus aetiology.

69 serum pairs from two common-source water-borne outbreaks and one series of endemic cases of hepatitis in three parts of India were tested for hepatitis A and hepatitis B virus infections. None of the patients had evidence of HAV infection and only 10.1% had evidence of HBV infection. A large proportion of hepatitis in India seems to be caused by previously unrecognised agents.

Hepatitis type A, B, and non-A non-B in fulminant hepatitis.

Serological investigations for hepatitis B surface and e antigen, antibody to hepatitis B surface, core and e antigen and antibody to hepatitis A virus were carried out in 22 patients with fulminant hepatitis admitted to Medical Department A, Rigshospitalet, Copenhagen, in 1970-77. Nine patients had hepatitis type B and four type A. One patient had evidence of both type A and B infection, whereas the remaining eight patients showed no evidence of type A or B infection. Two of these had been treated with disulfiram and a drug aetiology could not be excluded, but in six patients no known cause of fulminant hepatitis could be determined and these patients were classified as having hepatitis type non-A non-B. The survival rate was not statistically different for patients having type A, B, or non-A non-B hepatitis.

MODIFICATION OF CHRONIC HEPATITIS-B VIRUS INFECTION IN CHIMPANZEES BY ADMINISTRATION OF AN INTERFERON INDUCER

Chimpanzees chronically infected with hepatitis-B virus showed transient changes in several markers of infection when treated with the interferon inducer polyriboinosinic-polyribocytidylic acid-poly-l-lysine carboxymethyl cellulose. Serum Dane-particle-associated D.N.A. polymerase, e antigen and hepatitis-B surface antigen, and intrahepatic hepatitis-B surface and core antigens diminished during treatment. Defective (D.N.A.-polymerase-negative) Dane particles increased in titre transiently during treatment; these may play a role in the modulation of hepatitis-B virus infection. Humoral immune responses in chronic hepatitis-B carrier chimps were unaffected. Interferon inducers (or exogenous interferon) may be useful for the treatment of chronic hepatitis-B virus infection.

MUSSEL-ASSOCIATED VIRAL HEPATITIS, TYPE A: SEROLOGICAL CONFIRMATION

7 members of a family of 14 developed acute viral hepatitis approximately one month after a family outing. Epidemiological investigation incriminated incompletely cooked mussels (Mytilus edulis) as the vehicle of infection and revealed a statistically significant difference in attack-rates between mussel-ingesters (70%) and non-ingesters (0%) (P=0-035). The aetiological role of hepatitis-A virus, suspected on epidemiological grounds, was serologically confirmed by the demonstration of rises in titres of serum-antibody to hepatitis-A antigen (serologically related to the MS-1 strain of hepatitis-A virus), determined by immune adherence haemagglutination.

The Role of Acute Hepatitis Type A, B, and Non-A Non-B in the Development of Chronic Active Liver Disease

In 19 patients followed from biopsy-verified acute viral hepatitis to chronic active liver disease and 74 patients followed to complete resolution verified by a normal liver biopsy, sera from the acute phase were studied for serologic evidence of hepatitis type A and B. Eleven of the 19 patients who developed chronic active liver disease progressed from acute hepatitis type B and 7 from acute hepatitis type non-A non-B. One patient could not be classified because the sera were exhausted. None had serological markers of actual hepatitis type A infection. Of the 74 patients with a histologically complete resolution, the acute episode could be classified as type B hepatitis in 47 and type A hepatitis in 13 patients. The remaining 14 patients were classified as having acute viral hepatitis type non-A non-B. Our findings confirm that type B and non-A non-B hepatitis may give rise to chronic liver disease, whereas type A hepatitis so far has not been demonstrated to initiate a chronic liver disease.