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Acute hepatitis B infection and hepatitis B surface antigen positivity reported in the Department of Veterans Affairs: occurrence in a population seeking medical assistance.

In the United States, reported acute hepatitis B infections steadily declined from 18,003 cases in 1991 to 8,036 cases in 2000. Despite this decline, hepatitis B is a significant concern to the Veterans Health Administration (VHA) of the Department of Veterans Affairs because of the need for care of veterans afflicted with this disease and the VHA health care workers at risk for occupational exposure to hepatitis B virus. On an annual basis from federal fiscal year (FY) 1991 through FY 2001, the VHA Infectious Diseases Program Office requested information from patient care sites regarding hepatitis B. The reported number of patients with acute hepatitis B ranged from 446 to 749 during this period. This translates into a case rate per 100,000 veterans served of 29.15 and 12.68 for FYs 1991 and 2001, respectively. The number of persons with a positive hepatitis B surface antigen test during this 11-year period ranged from 2,688 to 3,100, suggesting a sizeable pool from which occupational exposure may occur. The rate of decline in the cases of acute hepatitis B in the VHA is more than that seen nationally in the United States.

Hepatitis B↗

Risk of hepatitis C infection in neonates transfused with blood from donors infected with hepatitis C.

This look-back study was undertaken to identify newborn infants who had been infected with the hepatitis C virus (HCV) as a result of transfusions received before the introduction of routine screening in 1991 and to determine the transmission rates and persistence of transfusion-transmitted HCV infection acquired in the neonatal period. A total of 24 infants, transfused between 1980 and 1991, were identified as having received potentially infected blood from 11 blood donors. Ten of the donors had been administered batches of anti-D in 1977 known to have transmitted HCV genotype 1b infection. HCV RNA was detected in five of these donors when tested in 1994-95; the past donations of five of the donors, who had received anti-D immunoglobulin and had serological evidence of previous HCV infection but who were PCR negative when tested in 1994-95, were considered of lower risk. The source and time of acquisition of HCV infection for the one remaining donor in the study was not determined. Twenty-one (88%) of the 24 children were living at time of lookback. The median age at transfusion was 12 days. The median age at time of testing was 6.3 years. One child, who tested negative, was excluded from further analysis of HCV transmission, due to incomplete transfusion records. Overall, 12 of 20 (60%) children tested were positive for anti-HCV and seven (35%) were HCV RNA positive. Twelve (71%) of the 17 recipients of viraemic blood were ELISA positive and seven (41%) were PCR positive. Resolved HCV infection, as determined by ELISA pos, RIBA pos or indeterminate and PCR negativity, occurred in five of 12 (42%). In many instances there was more than one recipient per HCV infected donation. All of the reported children are clinically asymptomatic. However, the duration of HCV infection is relatively short and there is evidence of a degree of hepatitis in five of the seven children who are HCV RNA positive as judged by mildly elevated transaminase levels. The three who have undergone liver biopsy show mild hepatitis. The lower rates of persistence of HCV infection in this study may be due to the young age at exposure or to the source of infection which for all but one of the children was linked to one HCV genotype from female donors. Sharing of units of blood among multiple infants should be discouraged.

Adolescent↗

Complete genome sequence of hepatitis B virus (HBV) from a patient with fulminant hepatitis without precore and core promoter mutations: comparison with HBV from a patient with acute hepatitis infected from the same infectious source.

BACKGROUND/AIMS: There is a paucity of information regarding hepatitis B virus (HBV) from patients with fulminant hepatitis (FH) without precore (pre-C, nt 1896) and core promoter (CP, nt 1762, 1764) mutations. METHODS: Pre-C and CP mutations were studied in eight patients with FH and 26 patients with acute hepatitis (AH) due to HBV. One patient with FH (FH1) was infected with HBV without these mutations. Interestingly, the sera of the infectious source (IS1) and of a patient with AH (AH1) infected from IS1 were available. Complete HBV genomes from these three patients were analyzed. RESULTS: These mutations were found in seven of eight FH and five of 26 AH (P<0.01). HBV from FH1, IS1 and AH1 belonged to genotype D. Nucleotide difference between FH1 and AH1 was six of 3182 bases (nt 493, 998, 1173, 2928, 3067, and 3078). Two and five substitutions of deduced amino acid sequences were found in the pre-S1 and polymerase regions, respectively. The same nucleotide substitutions at nt 493, 1173, 2928 and 3067 were found in several patients with FH in our laboratory or GenBank. CONCLUSIONS: These six nucleotide substitutions of HBV DNA could be candidates of mutations relating to FH.

Acute Disease↗

Evaluation of seroepidemiological associations between HIV-infection, hepatitis B and other sexually transmitted diseases in African patients.

To assess the possible role of sexually transmitted diseases as cofactors for the spread of AIDS, 248 adult patients were tested for the presence of antibodies against human immunodeficiency virus (HIV), hepatitis B virus (HBV) and syphilis. The survey was conducted in a hospital at Kagondo, Kagera Region, Northwest Tanzania, Africa. Subjects were randomly chosen from the outpatient clinic to include those with and without sexually transmitted diseases, as well as AIDS/pre-AIDS patients. The data were univariately and multivariately analysed by linear logit models, including interactions of demographic parameters. The results obtained reveal a strong association between the presence of antibodies against HIV, syphilis and HBV, respectively. The HBV/HIV-correlation remained stable in the multivariate analysis including interactions of social parameters, in contrast to the syphilis/HIV-correlation. We assume that this reflects the lower virulence of HBV as compared to that of syphilis. The prevalence of anti-HBV antibodies seems to be a more reliable marker for high sexual activity than those against syphilis. The possibility that HBV and HIV act as cofactors for each other's transmission could not be ruled out.

Acquired Immunodeficiency Syndrome↗

The risk of type B hepatitis infection in flexible fiberoptic endoscopy.

In Nigeria, where the carrier rate of hepatitis B antigen (HBsAg) is between 5 and 10%, it must be assumed that the instrument used for upper gastrointestinal endoscopy has had contact with an HBsAg-positive patient. The risk of type B hepatitis transmission via upper gastrointestinal endoscopy was evaluated, therefore, in 61 patients who were followed for 1 year after the procedure. Four of these patients were "carriers" of HBsAg. None of the study group developed jaundice or hepatomegaly during the follow-up period. In 21 patients, serial liver function tests and screening for HBsAg were obtained. None of the 19 seronegative patients developed abnormal liver function tests or converted to HBsAg-positive. It is concluded that, while transmission of HBsAg is theoretically possible, the risk appears minimal. HBsAg positivity should not be a contraindication, therefore, in patients who need endoscopic assessment for definitive management.

Adolescent↗

Hepatic infections. Part I. A serological evaluation of Fab antigens (Fab' and F (ab)2) and antibodies in patients and asymptomatic carriers of hepatitis B virus.

Evidence for the association of Fab (antigen-binding) fragments of IgG and antibodies directed against receptors of these fragments (Fab' and F(ab)2) has been found in patients and asymptomatic carriers of hepatitis B antigen. Fab fragments of IgG are often detected in hepatitis B surface antigen (HBsAg)-positive sera where the intensity of antibody activity to these determinants is significantly reduced. The formation of strong antibodies to Fab fragments is often observed in association with the presence of hepatitis B surface antibodies (HBsAb). Comparative studies show that the appearance of Fab fragments in HBsAg-positive sera is not linked to the presence of hepatitis e antigen. This observation was supported by the finding of autologous Fab fragments of IgG in e antibody-positive sera. It was also established that the amount of Fab fragment in the serum is closely associated with the detection of high HBsAg titres. Preliminary investigations suggest that the Fab fragments of IgG detected in the serum of HBsAg-positive patients represent in vivo-digested HBsAb attached to the surface membrane of virus B particles. Further studies are in progress to determine the relationship of Fab fragments with a variety of other immunological events, especially the role of liver enzymes in the cleavage of intact antibodies.

Acute Disease↗

Survey of HBag hepatitis infection in a semi-closed community.

The presentation of one individual with HBAg-positive hepatitis in a semi-closed community led to the testing of 262 intellectually-handicapped persons and staff-members and to the detection of 12 others who were HBAg-positive. Only the presenting case and one other became unwell with hepatitis. Three other HBAg-positive individuals became negative within three months, none showing clinical or biochemical evidence of hepatitis. The remaining eight persons were still HBAg-positive six months later. Four of these had biochemical abnormalities suggesting they had suffered anicteric hepatitis while the remainder, three of whom had Down's syndrome, had no such changes and are therefore considered to be carriers of the infective agent.

Carrier State↗

HCV infection, hepatic HLA display and composition of the mononuclear cell inflammatory infiltrate in chronic alcoholic liver disease.

Viral infection may play a role in alcoholic liver disease with histological features of chronic active hepatitis (CAH). Human leucocyte antigen (HLA) hepatocellular display is supposed to allow HLA-restricted T-lymphocyte cytotoxicity in chronic viral hepatitis. We studied the presence of serum anti-hepatitis C virus (HCV) antibodies, the hepatic HLA display and the composition of the mononuclear cell infiltrate in 16 patients with alcoholic liver disease and histological features of CAH and in 11 patients with alcohol-related degenerative changes. All patients were negative for hepatitis B virus (HBV) markers. Anti-HCV were tested by microplate ELISA. Class I HLA A, B, class II HLA DR, lymphocytes pan T, T helper/inducer, T suppressor/cytotoxic, B, and K NK cells were stained on liver cryostat sections by monoclonal antibodies and double indirect immunoperoxidase. Anti-HCV were present in all the patients with features of CAH and absent in those with only degenerative changes. In livers with features of CAH the mononuclear cell infiltrate consisted largely of T lymphocytes with marked prevalence of suppressor/cytotoxic cells in periportal and lobular areas. K NK cells were rare. Class I HLA, diffusely displayed on bile duct epithelium and on sinusoidal cells, also appeared on liver cells in the areas of periportal and lobular necrosis, namely on the hepatocytes in close contact with suppressor/cytotoxic T cells. In livers with only degenerative changes class I HLA were diffusely displayed on bile duct epithelium and on sinusoidal cells but absent on the hepatocytes. In all the specimens HLA DR antigens were expressed on sinusoidal and inflammatory cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗