Mary Dimitrakakis

The increased risk of fatal liver disease in renal transplant patients who are hepatitis Be antigen and/or HBV DNA positive.

To determine whether active viral replication is associated with increased morbidity and mortality in chronic carriers of hepatitis B virus (HBV) undergoing renal transplantation, we reviewed 23 years of experience at our hospital. Over the period 1966-1989, 42 chronic carriers of hepatitis B surface antigen (HBsAg) received renal transplants, 32 of whom had functioning grafts for 12 months or longer. Stored sera were tested for markers of hepatitis B virus, hepatitis C virus (HCV), and hepatitis delta virus (HDV) infection, and the serologic findings were correlated with clinical and biochemical data. The presence of HBV DNA and/or hepatitis Be antigen (HBeAg) in serum samples collected prior to transplantation was associated with an increased probability of death from liver disease. Whereas 5 of 10 patients in this group died of chronic liver disease, only 1 of 15 patients who were HBV DNA and/or HBeAg negative prior to transplantation died of liver disease. This difference is highly significant (P less than 0.02). No difference in outcome was attributable to age at transplantation, gender, country of birth, or the presence of abnormal hepatic transaminase levels prior to transplantation.

VERY-LOW-DOSE HEPATITIS B VACCINE IN NEWBORN INFANTS: AN ECONOMIC OPTION FOR CONTROL IN ENDEMIC AREAS

Three 1 microgram or 2 micrograms doses of Merck, Sharp and Dohme plasma vaccine were given to 119 infants of mothers negative for antibody to hepatitis B surface antigen (anti-HBs). Anti-HBs antibodies developed in 25/29 (86%) infants given 1 microgram and in 86/90 (96%) given 2 micrograms doses. Levels of anti-HBs achieved by three 2 micrograms doses were similar to those that have been reported for conventional 10 micrograms doses. Similar levels were recorded from infants of anti-HBs-positive mothers, which suggests that maternal antibody does not interfere with the infants immune response to low doses of vaccine. Three 2 micrograms doses of vaccine in infancy produce satisfactory immunogenicity and make possible economic control of hepatitis B in endemic areas.

Hepatitis B Infection in Vanuatu: Age of Acquisition of Infection and Possible Routes of Transmission

Seroepidemiological studies of hepatitis B were carried out on diverse groups of children (477) and adults (629) from the Pacific Island country of Vanuatu. In children under 14 years, prevalences of HBsAg and of all markers were 6% and 53.3% respectively; in adults 20 years the prevalences were 15% and 70%. Age specific prevalence of hepatitis B infection (all markers) was low in infancy (< 1 year) but rose sharply afterwards, suggesting that the main mechanism of transmission was horizontal spread. This finding is consistent with other developing country studies from the Pacific Islands and elsewhere. In view of the main ages and mechanisms of transmission of hepatitis B in children in developing countries and the need for simple and inexpensive immunisation strategies in this context, it is recommended that mass vaccination of all infants with hepatitis B vaccine be undertaken in hyperendemic areas.

Factors affecting the prevalence of infection with hepatitis B virus among non-pregnant women in the Alexishafen area of Papua New Guinea

The prevalence of hepatitis B viral markers was studied in 673 women of childbearing age in 17 villages (12 indigenous and five plantation villages) on the north coast of Papua New Guinea. Some 7.9% of women were HBsAg positive and 41.3% were positive for anti-HBs. There was significant variation in prevalence between villages, ranging from 0 to 13.9% for HBsAg and 26.0 to 71.0% for all markers. The 12 indigenous villages were classified into three groups according to language (Austronesian or non-Austronesian), location (inland or coastal), and marriage patterns. The prevalence of hepatitis B was significantly higher in Austronesian than in non-Austronesian villages (P less than 0.01), and it remained significant after controlling for age differences and for possible effects on prevalence caused by women marrying into the three village groups from other areas. Interactions between malaria and hepatitis B were also investigated. Non-Austronesian villages with the highest spleen rates had the lowest prevalence of hepatitis B infection, and there was no correlation with parasitaemia. These results may reflect a lower exposure of women to hepatitis B infection in non-Austronesian villages, or may indicate different genetic or immunological responses to infection between Austronesians and non-Austronesians.

Changing Patterns in the Distribution of Hepatitis B Subtypes

Abstract. From July 1, 1969, to June 30, 1977, 4,413 patients with acute viral hepatitis were admitted to Fairfield Hospital, Melbourne, of whom 1,129 (25.6%) had hepatitis type B. Only two of the four major subtypes of hepatitis B surface antigen (HBsAg) were detected, HBsAg/ ayw and HBsAg/adw, and of these HBsAg/ayw was present in 80.4% of cases. Over the 8‐year period, hepatitis B became more common in Melbourne and the proportion of patients infected with the ayw subtype increased from 75 to 91%. Approximately 50% of the patients with hepatitis B were intravenous drug abusers. In most of the others the source of infection was unknown.

Humoral immune responses in mice using gamma inulin preparations as adjuvants for hepatitis B vaccines

There is an urgent need for new, powerful adjuvants suitable for use with sub‐unit and peptide vaccines in humans. We have measured the humoral immune response in BALB/c mice to vaccine formulations using recombinant HBsAg antigens, and gamma inulin and alum adjuvants. Using Merck, Sharpe & Dohme(MSD) HBsAg at 10 μg/mL, high levels of anti‐HBs were generated and geometric mean S/N ratios of 88, 133 and 107 were obtained for alum absorbed vaccine, gamma inulin, and a mixture of the two adjuvants, respectively. A dilution series produced ED50 values of 0·08, 0·15 and 0·22 μg/mL respectively. In a second series of experiments comparing alum and algamulin (a complex of gamma inulin and alum), MSD HBsAg induced anti‐HBs levels of 81 and 52, and ED50 values of 0·1 and 0·4 when used in conjunction with alum and algamulin, respectively. SKF HBsAg induced anti‐HBs levels of 126 and 111 with alum and algamulin, and ED50 values of 0·11 and 0·075. The class, subclass and level of antibody produced in mice boosted with a second dose of vaccine at 21 days was also examined. Both alum and gamma inulin induced higher levels of total antibody, IgGI and minor IgG subclasses than algamulin, or HBsAg alone. Overall, gamma inulin appears to be an equivalent adjuvant to alum, although their mechanisms of action arc different. Mixtures or complexes of the two adjuvants appear to be less effective in inducing humoral immune responses in mice than either alone.

Detection of delta infection using reagents obtained from the serum of patients infected with HBV

A microtitre solid-phase radioimmunoassay (SPRIA) was developed for the detection of delta antigen (delta Ag) and antibody (anti-delta) using sera from subjects who had been infected with this agent as the source of antigen and antibody. The assay was compared with reference tests, which use delta antigen extracted from liver tissue obtained at autopsy, and found to be equally sensitive and specific.

An Outbreak of Hepatitis B and D in Butchers

This report documents an outbreak of hepatitis B (HB) and hepatitis D (HD) in a group of butcher shop employees. During the 13-month period from September 1983 to October 1984, 8 employees from 2 establishments developed acute HB. Epidemiological investigation suggested that the first case, who was also an intravenous drug user, was the source of infection for other employees. This person and 2 others were found to have concurrent HD. In November 1984 the wife of one of the infected butchers also developed HB.