Denis J. Miller

Identification of lymphocytes in percutaneous liver biopsy cores. Different T:B cell ratio in HB sAg-positive and -negative hepatitis

The lymphocytes infiltrating the liver were isolated and characterized as T or B cells in three groups of patients: 20 patients with hepatitis B surface antigen (HB sAg)-positive acute and chronic hepatitis, 8 patients with HBsAg-negative chronic hepatitis with prior evidence for hepatitis B virus (HBV) infection, and 5 patients with HBsAg-negative chronic hepatitis without prior evidence for HBV infection. The predominant cell infiltrating the liver was shown to be a T cell in all categories; however, the ratio of T:B cells was significantly lower (1.96) in the patients without evidence for HBV infection than in the patients who were HBsAg-positive at (7.86), or before (8.85) the time of study. The significantly (P less than 0.001) higher number of B cells in the patients with chronic hepatitis of unknown etiology suggests that a different immunopathogenetic mechanism is operative in this group. A peripheral T lymphocytopenia was observed in patients with both antecedent and existent HBs-antigenemia, but not in the patients without evidence for HBV infection.

Hepatitis B Infection in Hospital Personnel During an Eight-Year Period Policies for Screening and Pregnancy in High Risk Areas

From 1972 through 1979, acute hepatitis, type B, or asymptomatic hepatitis B surface (HBs) antigenemia developed in 34 employees at Yale-New Haven Hospital. The average yearly incidence of the infection was 1.2 cases per 1,000 employees. The incidence was highest in those administering venipunctures followed, respectively, by those in the emergency room, hemodialysis unit, housestaff, laboratory, general nursing, and support service personnel. Three cases were detected during eight years of routine screening of personnel; in 1972, one of these, a pregnant nurse working in the hemodialysis unit, was moved from that unit. Subsequently, seven personnel in the unit have been transferred during pregnancy. However, staphylococcal pneumonia was acquired by one of them on a medical floor, and another nurse, seeking work in oncology, was not hired while pregnant. Both cases resulted in administrative complaints. Currently, we screen personnel in the hemodialysis and venipuncture units quarterly for hepatitis B surface antigen (HBsAg) and antibody (anti-HBs) (participation is optional for those in the emergency room and oncology) and strongly urge seronegative pregnant women to transfer from these areas.