Wataru Kajiyama

Sex- and age-specific prevalences of HBeAg and anti-HBe among HBsAg carriers with or without liver function abnormalities in Okinawa, Japan.

We investigated sex‐ and age‐specific prevalences of hepatitis B e antigen (HBeAg) and antibody to HBeAg (anti‐HBe) in 1,163 carriers of hepatitis B surface antigen (HBsAg) in Okinawa, Japan, and followed them up for longer than one year in correlation with liver function abnormalities. Elevated serum transaminase levels were found in 160 (13.8%) of them. The prevalence of liver function abnormalities was significantly higher in male carriers (127/690, 18.4%) than in female carriers (33/473, 7.0%) at a P value of 0.001. In asymptomatic carriers, the prevalence of HBeAg was 13.2% and that of anti‐HBe 80.0%, significantly different from 41.9% and 54.4%, respectively, in carriers with elevated transaminase levels (P<0.001). In asymptomatic carriers, the mean age of HBeAg‐positive carriers was 16.7 years which was much lower than the 22.8 years in carriers with liver function abnormalities. The prevalence of elevated transaminase levels was significantly higher in carriers with HBeAg than in those with anti‐HBe (33.8% vs. 9.7%, P<0.001). Based on these results, the prolonged positivity for serum HBeAg would qualify as a predictor for deteriorating liver function among HBsAg carriers.

Intradermal hepatitis B vaccination for mentally retarded patients

We investigated immune responses in 63 mentally retarded patients each given a low-dose (4 micrograms) intradermally of plasma-derived hepatitis B vaccine made in Japan and which was repeated after 1 and 6 months. Two doses of the vaccine induced antibodies in 85.5% these patients. A further dose 6 months later induced antibodies in 93.5% of the recipients and markedly increased the proportion of recipients with acceptable or high concentrations of antibody. The numbers of acceptable and high responders decreased slightly during a period of 12 months. The rate of acquiring antibody was significantly higher in the males. No significant differences in antibody response with regard to age and type of disease were observed. One patient with Downs syndrome, who acquired a low concentration of antibody after vaccination, was infected with hepatitis B virus. Supplementary vaccination may be necessary for poor responders in order to obtain protection. Side-effects resulting from the vaccination were not severe in any patients. These results suggest that low-dose, intradermal hepatitis B vaccination is safe and effective.

Age-Specific Prevalence of Hepatitis B e Antigen (HBeAg) and Antibody to HBeAg (Anti-HBe) among Asymptomatic Hepatitis B Surface Antigen (HBsAg) Carriers in Okinawa and Kyushu, Japan

A total of 1,741 asymptomatic hepatitis B surface antigen (HBsAg) carriers in two areas (Okinawa and Kyushu) in Japan were surveyed for the presence of hepatitis B e antigen (HBeAg) and the corresponding antibody (anti‐HBe) to determine the age‐specific prevalence of these markers and the mean age of carriers with HBeAg. Prevalence of HBeAg was significantly higher in Kyushu (36.4% of 755 carriers) than in Okinawa (20.0% of 986 carriers) (P<0.001). The mean age of carriers with HBeAg was 25.5 years in Kyushu and 16.1 years in Okinawa, suggesting that HBeAg converted to anti‐HBe earlier in Okinawa than in Kyushu. In contrast, the prevalence of anti‐HBe was significantly higher in Okinawa (74.6% of 986) than in Kyushu (56.3% of 755) (P<0.001). The prevalence of HBeAg decreased with age up to 40–49 years of age and then increased in both areas. Prevalence of anti‐HBe was inversely related to the prevalence of HBeAg in both areas. These data suggest that HBeAg and anti‐HBe are chronological markers of chronic hepatitis B virus infection and that the duration of HBeAg persistence can be different in different area, even in the same country.

Large-scale survey of hepatitis B virus infection in families

To investigate HBV transmission in families on three islands in Okinawa, Japan, prevalence of HBV markers in two groups of inhabitants was determined. One group consisted of members of families in which there was at least one HBsAg carrier (carrier families); the other group consisted of members of families in which there were no HBsAg carriers (non‐carrier families). A total of 3,261 serum samples were collected from subjects on Iriomote Island, Hateruma Island, and Yonaguni Island. These samples were tested for HBsAg by reversed passive hemagglutination (RPHA) and for antibody to hepatitis B core antigen (anti‐HBc) by radioimmunoassay. Overall prevalences of HBsAg and anti‐HBc were 8.2 and 65.8 per cent respectively. The prevalence of anti‐HBC among members of carrier families (80.8%) was significantly higher than that among members of non‐carrier families (61.6%) (P< 0.001). The prevalence of anti‐HBc among members of carrier families was higher in all age groups, and was particularly so in children. Within carrier families, the prevalence of anti‐HBc was significantly higher in families in which there was at least one HBsAg carrier with HBeAg (94.5%) than in families with no HBeAg‐positive carriers (76.1%). This difference was especially marked in young children. These data suggest that in families with HBsAg carrier(s), the risk of transmitting HBV to members, particularly to young children, is higher than in families without carriers, and that the risk is further increased in families with HBeAg‐positive carrier(s).

Glycyrrhizin withdrawal followed by human lymphoblastoid interferon in the treatment of chronic hepatitis B

SummarySeventeen patients with chronic hepatitis B were treated with a 4-week administration of glycyrrhizin followed by a 4-week treatment with human lymphoblastoid interferon, then followed for 6 months after the end of treatment. All were positive for hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), and hepatitis B virus-associated DNA polymerase (DNA-p) for at least 6 months before entry. All patients were Japanese and none of them were homosexuals. Eleven patients lost DNA-p activity and 10 of them lost HBeAg. Three of these 10 patients had antibody to HBeAg. In 10 patients who became HBeAg-negative, alanine aminotransferase levels after glycyrrhizin administration were higher and initial DNA-p activities relatively lower than the levels found in seven patients who remained HBeAg-positive. The immunomodulater provided by a short course of glycyrrhizin before administration of human lymphoblastoid interferon may be an effective treatment for patients with chronic hepatitis B.

Seroepidemiologic study of adult T-cell leukemia virus (ATLV) and hepatitis B virus infection in Okinawa, Japan.

A total of 2,283 serum samples were collected from healthy subjects in three islands of the Yaeyama district of Okinawa, Japan. These sera were tested for the presence of hepatitis B surface antigen (HBsAg), for antibody to hepatitis B core antigen (anti‐HBc), and for antibody to adult T‐cell leukemia‐associated antigen (anti‐ATLA). Correlation between hepatitis B virus infection and adult T‐cell leukemia virus (ATLV) infection was determined by using the prevalence rates for three virus markers. Overall prevalence of HBsAg, anti‐HBc and anti‐ATLA was 6.5%, 57.4%, and 17.9%, respectively. Age‐specific prevalence of anti‐HBc and anti‐ATLA increased with age, but that of HBsAg did not. Sex‐specific prevalence of HBsAg was significantly higher in males than in females, but that of anti‐ATLA was significantly higher in females than in males. Statistical analysis revealed that prevalence of anti‐ATLA was significantly higher in HBsAg‐positive persons and HBsAg‐negative/anti‐HBc‐positive persons than in those negative for HBsAg and anti‐HBc. These data suggest that hepatitis B virus‐infected persons have a significantly higher chance of adult T‐cell leukemia virus infection than those without hepatitis B virus infection in the area studied.

Study of Seroconversion of Antibody to Human T‐Cell Lymphotropic Virus Type‐I in Children of Okinawa, Japan

From 1983 to 1986, 1,813 children in nursery schools in Ishigaki Island and 1,228 children under 15 years old in the rural area in the Yaeyama District of Okinawa, Japan. were tested for anti‐HTLV‐I; 18 children (1.0%) in Ishigaki Island and 39 children (3.2%) in the rural area were positive. In order to survey when anti‐HTLV‐I developed in these children, their older serum samples were investigated retrospectively for 1 to 5 years. Two cases of seroconversion from anti‐HTLV‐I negative to positive were found between the age of 2 and 4, and there were no cases of seroconversion over 4 years old. Among the children who suffered maternal transmission of HTLV‐I and developed anti‐HTLV‐I before the age of 15, about 80% of the children were considered to have anti‐HTLV‐I before the age of 2, and the remainder developed anti‐HTLV‐I before the age of 4.

Comparison of results of recombinant and plasma-derived hepatitis B vaccines in Japanese nursery-school children.

Results obtained with a recombinant hepatitis B vaccine were compared with those obtained with a plasma-derived hepatitis B vaccine in separate studies conducted in nursery schools in which at least one child had hepatitis B e antigen associated with surface antigen. Recombinant vaccine (5 micrograms), made in Japan and prepared from antigen expressed in yeast, was given to 118 children (aged 0-5 years of age, mean age 2.9 years). Plasma-derived vaccine (10 micrograms) was given to 243 children. Side-reactions were not observed with either vaccine. Seroconversion rates for the recombinant vaccine group were 8.5% after 1 month, 98.3% after 9 months and 100% after 12 months. For the plasma-derived vaccine group, the rate after 1 month was 26.3% after 9 months 82.3%, and after 12 months 77.9%. Although in the recombinant vaccine group the immune response developed more slowly during the early phase, seroconversion rates were significantly higher than in the plasma-derived vaccine group after 6 months. Titres of antibodies also were significantly higher in the recombinant vaccine group after the third injection. None of the children in either group became infected with hepatitis B virus. These results confirm the high immunogenicity, safety and efficacy of the recombinant vaccine given to these nursery school children.

Prevalence of IgM anti-HBc among HBsAg carriers in Okinawa, Japan

SummaryTo evaluate the presence of IgM antibody to hepatitis B core antigen (IgM anti-HBc) in hepatitis B surface antigen (HBsAg) carriers, serial serum specimens of 698 carriers in Okinawa, Japan, from infants to adults, were studied by radioimmunoassay. IgM anti-HBc was detected in 7.6% of these carriers, with no difference between the sexes. The prevalence of IgM anti-HBc was higher in the age groups 0–9, 50–59 and over 60 than in the age group 20–29 and 30–39 years. In hepatitis B e antigen (HBeAg) positive carriers, the prevalence of IgM anti-HBc was 15.4%, a value significantly higher than in the HBeAg-negative carriers at 6.6%. In carriers with liver damage, the prevalence of IgM anti-HBc was 33.3%, a level significantly higher than the 6.3% in carriers without damage. However, IgM anti-HBc was detected in 34 carriers with neither HBeAg nor liver damage. These carriers are being closely followed. We discussed the presence of IgM anti-HBc in association with HBeAg or liver damage. The presence of IgM anti-HBc among HBsAg carriers was closely associated with liver damage.

Prevalences of hepatitis C and B virus infections in hemodialysis patients.

九州および沖縄地区における透析患者883例についてC型肝炎ウイルス (HCV) およびB型肝炎ウイルス (HBV) の感染状況を調査し, 危険因子の検討を行った. HCV関連抗体としては, C100-3抗体およびGOR抗体を用い, 少なくとも一方が陽性のものをHCV抗体陽性とした.全体の陽性率は, HCV抗体31.4%, HBc抗体48.9%で, 地区別にみると, HCV抗体陽性率は九州が, HBc抗体陽性率は沖縄が, 有意に高率であった. 輸血群のHCV抗体陽性率は非輸血群に比べて有意に高率で, 輸血回数の増加と共に上昇が認められたが, HBc抗体陽性率は, 輸血群と非輸血群とで有意差はなく, 輸血群のHBc抗体陽性率は1978年以降の透析開始者で有意に減少していた. 非輸血群のHCV抗体陽性率は献血者に比べ有意に高く, 透析開始期間が長いほど高率であったが, HBc抗体陽性率は献血者と有意差がなかった. HCV抗体, HBs抗原, およびHBc抗体陽性率いずれも, 疾患との関連は認められなかった.以上より, 透析患者におけるHCV感染は輸血が最も重要であるが, 非輸血群でも感染率が高く, 輸血以外の透析に起因する感染が考えられた. また, HBV感染は, 献血者スクリーニングによる感染率の減少が示唆された.