Pierino Ferroni

Immune response to hepatitis B vaccine in staff and patients in renal dialysis units

Anti-HBs response was detected in 96 per cent of staff members in three haemodialysis units after three 20 microgram doses of hepatitis B vaccine and in 82 per cent of adult patients treated with three 40 microgram doses. The percentage of responders and levels of antibody remained unchanged at 12 months from the beginning of the trial. Three out of six children injected with three 20 microgram doses in a paediatric haemodialysis unit remained free from markers of HBV infection and had high levels of anti-HBs after the second dose of vaccine. The other three children who developed serological markers of HBV infection seroconverted to anti-HBc within six months from the first dose and, in one of them, antigenaemia at three and four months was detected.

Antibodies to hepatitis C virus in blood donors

Recently a recombinant polypeptide of hepatitis C virus (HCV) has been developed by the Chiron Corporation in California. This antigen has been used to develop an ELISA test (Ortho Diagnostic Systems) for serum anti-HCV antibodies. Preliminary data have shown that this virus is the major cause of NANB hepatitis in the world. We examined differences in anti-HCV prevalence among subgroups of blood donors (total sera examined 639) classified for past or present exposure to HBV or not, and for ALT levels. The anti-HCV prevalence found in regular blood donors with normal ALT levels and no antibody to HBcAg was 1.2%. No significant difference in the anti-HCV prevalence was found among other subgroups of blood donors except that a higher prevalence (10%) was found in a group with both elevated ALT and HBV markers.These preliminary findings suggest that the policy of blood supply should take into account the advent of HCV antibody test.

Radioimmunoassay in the detection of the hepatitis B e antigen/antibody system in asymptomatic carriers of hepatitis B surface antigen. Correlation with serum Dane particle associated DNA polymerase activity.

SummaryA radioimmunoassay for hepatitis e antigen (HBeAg) and antibody to e (anti-HBe) was developed and sera of 71 asymptomatic chronic carriers of hepatitis B surface antigen (HBsAg), in 44 of whom liver biopsy was obtained, were tested. In addition, testing for Dane particle associated DNA polymerase activity was performed in all sera. HBeAg was detected in 14 subjects (19.7%) and anti-HBe in 46 (64.8%). The highest proportion of HBeAg positivity (40%) was found among carriers with histological evidence of chronic hepatitis, whereas anti-HBe was present in 80% of carriers with normal liver histology, in 58% of carriers with nonspecific reactive hepatitis and in 60% of carriers with chronic liver lesions. DNA polymerase activity was present in 92.8% of sera positive for HBeAg, in 13% of sera positive for anti-HBe, and in 9% of sera negative for both markers. Our results demonstrate that not all HBsAg carriers reactive to HBeAg show evidence of chronic hepatitis nor, conversely, that anti-HBe is invariably associated with the healthy carrier state of HBsAg. Finally, circulating Dane particles, as revealed by the presence of serum specific DNA polymerase activity, may also be present in anti-HBe positive sera other than those of some HBsAg carriers lacking both HBeAg and anti-HBe.ZusammenfassungEin Radioimmunoassay für das Hepatitis „e“ Antigen (HBeAg) wurde entwickelt und Seren von 71 asymptomatischen Trägern von Hepatitis-B-Oberflächen-Antigen (HBsAg) wurden untersucht; bei 44 von ihnen wurden Leberbiopsien entnommen. Zusätzlich wurden bei allen Seren der Test auf Dane-Partikel-assoziierte DNS-Polymerase-Aktivität durchgeführt. HBeAg wurde bei 14 Patienten (19,7%) entdeckt, anti-HBe bei 46 (64,8%). Der größte Anteil HBeAg-positiver Seren (40%) fand sich bei Trägern mit den histologischen Zeichen der chronischen Hepatitis, während anti-HBe bei 80% der Träger mit normaler Leberhistologie vorhanden war, bei 58% der Träger mit unspezifischer reaktiver Hepatitis und bei 60% der Träger mit chronischem Leberschaden. Die DNS-Polymerase-Aktivität war bei 92,8% der HBeAg-positiven Seren vorhanden, bei 13% der anti-HBe-positiven und bei 9% der bezüglich beider Marker negativen Seren. Unsere Ergebnisse zeigen, daß nicht alle HBsAg-Träger, die HBeAg-reaktiv sind, Zeichen einer chronischen Hepatitis aufweisen und daß umgekehrt auch nicht anti-HBe ausnahmslos mit dem gesunden Träger-Status von HBsAg assoziiert ist. Schließlich können, wie durch die Anwesenheit von spezifischer Serum-DNS-Polymerase-Aktivität gezeigt wurde, zirkulierende Dane-Partikel auch in anderen anti-HBe-positiven Seren vorhanden sein als in denjenigen einiger HBsAg-Carrier, bei denen sowohl HBeAg als auch anti-HBe fehlen.

Screening of pregnant women and hepatitis B prophylaxis in newborns

Abstract Prevention of perinatal hepatitis B includes: (1) screening ol pregnant women for hepatitis B surface antigen, and (2) immunoprophylaxis of babies at risk. HBIG treatment seems to be of some efficacy in preventing the HBsAg carrier state while it permits passive active immunization to occur. The disadvantage of HBIG is that it confers only temporary immunity. Therefore, it infection does not occur, babies will still be susceptible to the virus when passively administered anti-HBs will no longerbe circulating. On the other hand, vaccine provides a long term but not immediate protection. Therefore the ideal approach in post-exposure prophylaxis is a combination of passive plus active immunization. The aim is to provide an immediate protection, with the HBIG, and a long term immunity, with the vaccine, to babies born to HBsAg carrier mothers.

HIV antibody screening and confirmatory testing of italian blood donors

Abstract. During the first year (1986) of blood donor screening for antibody to HIV, 201, 750 subjects were tested in 40 blood banks of Lombardia (Italy). All sera repeatedly positive by ELISA were submitted to our reference center for confirmation by Western blot (WB). Only 40 (0.02%) of 286 repeatedly reactive donors were positive by WB, whereas another 45 (0.022%) gave atypical antibody reactivities on WB, mainly directed against HIV core proteins. Of the 16 donors with inconclusive WB results followed for 4–12 months, 3 developed a full‐blown antibody response, 5 maintained the anti‐core reactivity throughout the follow‐up period, and 8 lost all reactivities. The use of recombinant env and core antigen ELISAs seems to decrease the proportion of sera with inconclusive WB reactions, and to identify as true positive all seroconverting donors in advance of the WB test. The large majority (35 out of 40) of WB‐positive donors and all seroconverters for antibody to HIV admitted to belong to a group at risk for AIDS. Among the 19 first‐time donors with HIV infection, we found 3 subjects with serological evidence of LAV‐2 infection. We describe also the diagnostic and ethical issues when a donor notification policy is based on WB confirmatory procedures.

Anti-LAV/HTLV-III antibodies in groups of individuals at high risk for infection in Italy

SummaryWe have studied anti-LAV/HTLV-III antibody prevalence in individuals at high risk for infection, such as intravenous drug addicts, hemophiliacs and homosexual men. Among intravenous drug addicts, LAV/HTLV-III infection was first recognized in 1981 and positive serum reactions for anti-LAV/HTLV-III antibody rose in successive years to 53%. Anti-LAV/HTLV-III antibody prevalence was 13.5% in the group of homosexual men, while in hemophiliacs treated with commercial concentrates it was 37% in 1984 and had increased to 45% in 1985. There was a significant correlation between antibody status and concentrate consumption in these patients. Results of studies of anti-LAV/HTLV-III antibody patterns with the Western blot technique suggest that antibodies against core proteins (mainly p25 and p18) and the envelope protein gp40 are always present in asymptomatic individuals and in patients with the lymphadenopathy syndrome, but usually not inpatients with full-blown AIDS. These last patients have typical positive reactions only against the envelope proteins gp110 and gp40.

Factor XIII deficiency due to lack of both the S and A subunits. (Classification of factor XIII deficiency in 2 groups)

SummaryHBeAg/anti-HBe and Dane particle-associated DNA polymerase activity were detected in serum samples from 358 HBsAg asymptomatic carriers found during normal routine screening of 11,200 blood donors (HBsAg prevalence 3.1%). Since virus specific DNA polymerase activity and HBeAg seem to be associated in some way with hepatitis B virus infectivity and liver damage, 5% of the HBsAg carriers examined, as detected by the presence of HBeAg, and 9.5%, as shown by DNA polymerase activity, can be expected to have liver damage and a potential risk of transmitting hepatitis B to contacts. On the other hand, 48% of subjects were theoretically healthy and non-infective because of the presence of anti-HBe in their blood. The differentiation of groups of asymptomatic HBsAg carriers, on the basis of these serological markers, may have important clinical and epidemiological implications.HBeAg/anti-HBe and Dane particle-associated DNA polymerase activity were detected in serum samples from 358 HBsAg asymptomatic carriers found during normal routine screening of 11,200 blood donors (HBsAg prevalence 3.1%). Since virus specific DNA polymerase activity and HBeAg seem to be associated in some way with hepatitis B virus infectivity and liver damage, 5% of the HBsAg carriers examined, as detected by the presence of HBeAg, and 9.5%, as shown by DNA polymerase activity, can be expected to have liver damage and a potential risk of transmitting hepatitis B to contacts. On the other hand, 48% of subjects were theoretically healthy and non-infective because of the presence of anti-HBe in their blood. The differentiation of groups of asymptomatic HBsAg carriers, on the basis of these serological markers, may have important clinical and epidemiological implications.