Hepatitis B and C markers among alcoholics in Israel: high incidence of HCV infection.

Patients with alcoholic liver disease have an increased prevalence of viral hepatitis. However, the role of demographic characteristics has not been adequately delineated. Therefore, we examined and compared the seroprevalences of hepatitis B and C in Israeli alcoholic patients to that of blood donors control group by their country of birth and origin. Hepatitis B surface antigen, hepatitis B core antibody and hepatitis C virus antibody testing (second generation ELISA) and a confirmatory recombinant immunoblot assay was performed on 496 alcoholic attending an alcoholic abstinence program and compared to 193,806 randomly non-alcoholic blood donors on the basis of their country of birth. Three hundred twenty-eight alcoholic patients (66%) were immigrants and Israeli born Jews and 168 (34%) were Israeli Arabs. Of the 496 alcoholic patients, 24 (4.8%) were HBsAg positive, 38 (7.6%) were anti HCV positive, and 2 (North African Jews) were positive for both markers. HBsAg was detected in 13 (3.9%) immigrant and Israeli Jews and 11 (6.5%) Israeli Arabs, significantly higher than in the adjusted non alcoholic blood donors (p < 0.01). Anti-HCV was detected in 33 (10%) immigrants and Israeli Jews and 5 (2.9%) Israeli Arabs, significantly higher than in the control group (p < 0.005). In the subgroup alcoholic Jews there was no significant difference in hepatitis B seropositivity among alcoholic that were native Israeli, Eastern Europe and former USSR, and Western Europe and American immigrants comparing to the control group. In contrast, anti-HCV recombinant immunoblot assay seropositivity in alcoholic Jews from all subgroups was significantly greater than in non alcoholic blood donors (p < 0.001). Odds analysis of all ethnic groups revealed that alcoholism requiring detoxification have a significant risk factor for hepatitis C more than hepatitis B (p < 0.001). The increased seroprevalence of hepatitis C among Israeli alcoholic patients, regardless their country of birth and origin, suggest that alcoholism is likely to have a predisposing factor for HCV infection.

Prevalence of specific IgA and IgM anti-HBc antibodies compared with HBV DNA in the sera of HBsAg chronic carriers.

OBJECTIVE: We evaluated the significance of IgA antibodies directed against the hepatitis B virus core antigen (IgA anti-HBc) as a marker for viral replication. STUDY DESIGN/METHODS: Serum samples of 143 hepatitis B surface antigen (HBsAg) carriers and 189 HBsAg-negative subjects were studied. Hepatitis B virus (HBV) DNA was detected by polymerase chain reaction. IgA anti-HBc was determined by a capture enzyme-linked immunosorbent assay developed in our laboratory. The results were compared with those for IgM anti-HBc, which were determined by a commercially available method. RESULTS: IgA anti-HBc was detected in 57 (40%) and HBV DNA in 38 (27%) of the HBsAg carriers. Among the HBsAg-negative subjects, IgA anti-HBc and HBV DNA were detected simultaneously in four samples. All 42 HBV DNA-positive samples were IgA anti-HBc positive. IgM anti-HBc was detected in 27 (64%) of them. CONCLUSIONS: IgA anti-HBc is a sensitive marker for HBV replication, and its absence may exclude HBV replication. The role of IgA anti-HBc in monitoring response to therapy and predicting clinical course is being evaluated.

HBsAg confirmation: an experimental test.

BACKGROUND: The specificity of HBsAg testing is to be confirmed with antibody blocking to avoid false positive results. OBJECTIVE: To test the experimental HrAb HBsAg-blocking activity and to use this new antibody in the verification of repeatedly reactive HBsAg blood serum samples. STUDY DESIGN: HbsAg screening of three quality control panels was followed by a comparative confirmatory test with commercial HuAb and experimental HrAb. The HrAb was used in subsequent HBsAg confirmation trials. RESULTS: A good agreement in the results obtained using the two antibodies was found, independently of the type of HBsAg neutralization step performed (either preincubation or competitive inhibition). Of the 97 repeatedly reactive HBsAg blood serum samples, 79 were 'confirmed positives'. On repeated confirmations by two antibodies, 13/18 'not confirmed' converted to 'confirmed positives', while the same five samples still remained false positive. CONCLUSION: The results suggest that (1) HrAb is as good as HuAb in HBsAg confirmation and (2) HBsAg confirmatory testing is essential in the laboratory examinations of the HBsAg repeatedly reactive samples.

False positive tests for anti-hepatitis C antibodies and the problem of notifying blood donors.

BACKGROUND: All donated blood in Israel is tested for anti-hepatitis C virus (HCV) antibodies by enzyme immunoassay (EIA) and donors are notified of the result. There is evidence that at low antibody titres, the percentage of false positives may be high, with consequent labelling of healthy people as being infected with HCV. AIM: In this study we examined the correlation between anti-HCV antibody titres determined by a second generation EIA test with supplemental EIA tests and evidence of abnormal liver function. METHODS: Blood samples of 201 Israeli civilians who donated blood during 1992 and were repeat reactive for anti-HCV antibody based on second generation EIA, were tested by a supplemental test. Follow-up data were obtained from the donors and their family physicians. RESULTS: Results of anti-HCV EIA tests on two separate occasions of blood donation were highly correlated with each other (r = 0.86). Positive supplemental tests and abnormal liver function tests were found only in those subjects with high antibody titres. Furthermore low antibody titres were more prevalent during the winter months, suggesting that seasonal intercurrent infections may increase the percentage of false positives. CONCLUSIONS: A high proportion of blood donors labelled as anti-HCV antibody positive based on low antibody titres, may not be at increased risk of carrying HCV. Since labelling would result in creating unnecessary anxiety among blood donors, it is important to confirm such results with test such as radioimmunoblot assay (RIBA).

Helicobacter pylori infection and blood groups.

OBJECTIVES: Bacterial attachment is a prerequisite for colonization of the gastric epithelial surface. Recently, it was demonstrated that the receptor for Helicobacter pylori is the blood group antigen Lewis b, which is exposed only in blood group O. We prospectively examined the prevalence of blood groups in H. pylori-positive and -negative patients. To avoid a genetic bias, we compared blood group prevalence of our patients with the general population of Israel. METHODS: In the 187 consecutive patients we studied, in addition to regular upper endoscopy, H. pylori status and blood group. Exposure to H. pylori was diagnosed when the results of two or more of three methods were found to be positive. RESULTS: Exposure was found in 123 patients and 64 negative. The groups were similar in average age and origin, and no significant difference was demonstrated for blood group. Blood group distribution between any given origin was not significantly different in our patients and in a sample of 182,701 blood donors. CONCLUSIONS: Positivity for H. pylori was not associated with blood group O. Our observation does not support the conclusion that the receptor for H. pylori in the gastric mucosa is the blood group antigen Lewis b.

Ethnic differences in the prevalence of anti-hepatitis C antibodies and hepatitis B surface antigen in Israeli blood donors by age, sex, country of birth and origin.

The presence of anti-hepatitis C virus (HCV) antibodies frequently indicates both persistent infection and infectivity. Consequently, blood donors found to be anti-HCV positive, are excluded from the donor pool. The aim of this study was to compare age, sex and ethnic differences in the prevalence of anti-HCV antibodies with that of hepatitis B surface antigen (HBsAg) among immigrant and Israeli-born blood donors. Anti-HCV antibodies were assayed by a second-generation enzyme-immunoassay (EIA) and HBsAg by a standard EIA in a sample of 136,977 blood donors in Israel during 1992. The overall age-adjusted prevalence of anti-HCV antibodies was 0.66% in men and 0.55% in women, and for HBsAg, 0.85% and 0.44%, respectively. There was a significant increase in the prevalence of anti-HCV antibody with age, and significant differences by country of birth, with the highest prevalence found among those born in the former USSR and eastern Europe. This contrasted with the findings for the prevalence of HBsAg, where the highest rates were among those born in northern Africa. Among Israeli-born donors, differences in the prevalence of anti-HCV antibodies by parental country of origin were minimal and much less than for HBsAg. Hence the prevalence of anti-HCV antibodies in Israel is strongly associated with age and country of birth but not with country of origin. There is little evidence of substantial vertical or intrafamilial transmission of HCV infection in Israel.

Clinical, serological and molecular characteristics of 471 hepatitis B virus carriers.

A total of 471 Israel Defense Forces (IDF) blood donors identified as hepatitis B virus (HBV) carriers were examined a few months after blood donation. When compared to the general population of IDF blood donors the HBV carriers were older, belonged to certain ethnic groups and were predominantly males. Physical examination revealed minimal findings: 1 (0.3%) had splenomegaly and 5 (1.6%) had hepatomegaly. Fifty-two individuals (11.1%) had elevated liver enzymes. E antigen was present in 3.2% of HBV carriers, 94% had anti-e antibodies and 1.9% had anti-delta antibodies. Of 258 carriers tested for HBV DNA, 29 (11.2%) were positive. Abnormal liver enzymes were significantly associated with the presence of e antigen as well as with the presence of HBV DNA.

Vaccination against hepatitis B in a general hospital in Israel: antibody level before vaccination and immunogenicity of vaccine.

We offered hepatitis B vaccine (Heptavax B) to 809 of the health care personnel of a 650-bed regional hospital; 290 accepted the offer. Anti-HBs measurement was done by enzyme immunoassay (AUSAB EIA, Abbott, UK) and expressed in mIU/ml. Seroconversion was determined at a level of 2.1 mIU/ml. Of 290 employees 58 (20%) were found positive for hepatitis B antibodies before vaccination. Of the laboratory technicians, 40.9% were found positive for antibodies before vaccination, as were 26.5% of nurses and 10.9% of physicians. Among vaccine recipients 35.8% responded after the first dose, 86.6% after the second and 92.7% after the third. Seventeen workers (7.3%) were nonresponders, of whom 14 received the whole vaccine series. There was no difference in immune responses to the vaccine between men and women. The present study confirms the relatively high prevalence of HBV infection in health care workers. Furthermore, vaccination of employees has been highly effective and well tolerated. The present data, therefore, support the introduction of active vaccination against HBV in health care workers in Israel.

Human immunodeficiency virus infection among intravenous drug addicts in Israel--stable low prevalence over 34 months.

A serological survey of 300 Israeli intravenous drug addicts in 1988-1989, showed a 2.3% prevalence of antibodies to human immunodeficiency virus (HIV), very similar to the finding of a previous study (2%) performed in the same population in 1986. Travel and drug injection abroad continue to be the most significant predictors of HIV seropositivity in this group. The relatively uncommon use of cocaine and the absence of 'shooting galleries' in Israel, appears to explain best the stable low prevalence of HIV infection among parenteral drug addicts in this country.

Prevalence of sexually transmitted pathogens among women attending a methadone clinic in Israel.

OBJECTIVE: To assess the prevalence of sexually transmitted pathogens in drug-addicted women in Tel Aviv, Israel. DESIGN: A prospective study conducted between March and July 1987. SETTING: A methadone clinic in Tel Aviv, Israel. SUBJECTS: Sixty four asymptomatic female drug addicts were studied; 38 of them were declared practising prostitutes. METHODS: Cervical specimens were obtained for cultures, and blood samples were drawn for serological tests. Demographic data and sexual histories were obtained using a standard questionnaire. RESULTS: Chlamydia trachomatis was detected in the cervix of 25% of women; 98% had antibody titres (greater than 1:64). Mycoplasma hominis and Ureaplasma urealyticum were isolated in 57% and 65% respectively. Gardnerella vaginalis was detected in 17% of women, and herpes simplex virus was cultured from two prostitutes. Five per cent of women were carriers of HBsAg, while 57% had HBSs and/or HBc antibodies. Only one prostitute had specific treponemal antibodies. In no case were gonococci or group B streptococci isolated, and HIV serology was invariably negative. CONCLUSION: Chlamydia and genital mycoplasmas appear to be the prevailing pathogens in Israeli drug-addicted women, while gonococci and Treponema pallidum occur only rarely.

Ethnic differences in the prevalence of hepatitis B surface antigen among Israeli blood donors: changes between 1972 and 1988.

The prevalence of hepatitis B surface antigen (HBsAg) carriers among blood donors in Israel during 1988 was compared with that in a similar survey carried out on donors during 1972. The overall age- and sex-standardized prevalence of HBsAg declined from 1.22% to 1.01%. The ethnic differences previously observed were much diminished in native Israelis. The age of highest prevalence shifted from 18-21 to 31-40 years of age, probably due to a cohort effect. The higher prevalence among males has persisted. These findings indicate that the strong ethnic differences in the prevalence of HBsAg previously observed in Israel probably reflect the high rate of infections in the country of birth, and although intra-family spread may have persisted, the overall infection rate in Israel is much lower.

Prevalence of antibodies to human immunodeficiency virus among intravenous drug users in Israel--association with travel abroad.

A serological survey of 400 Israeli intravenous drug users showed a 2% prevalence of antibodies to human immunodeficiency virus (HIV). No difference was found between seropositive and seronegative subjects regarding mean age, duration of intravenous drug use, and needle sharing. Seropositivity was, however, significantly associated with travel abroad since 1980 (P less than 0.001), and with intravenous drug injection abroad (P = 0.04). These data indicate that Israel is a pre-endemic area for HIV infection, and transmission of the virus among Israeli intravenous drug users seems to be infrequent at the current level of exposure.

The Yt blood groups in Israeli Jews, Arabs, and Druse.

The Yta and Ytb allelic frequencies were determined by examining the red cells of 1683 blood samples from Israeli Jews, Arabs, and Druse with anti-Yta and -Ytb. The Ytb allelic frequencies ranged between 0.1005 and 0.1522 in the Jewish communities and were 0.1294 and 0.1429 in the Arab and Druse communities, respectively. These are the highest Ytb allelic frequencies observed so far in any population tested, so the Yt blood group system can be used as a genetic marker in these populations. No factors were recognized that may have influenced the selection for the Ytb allele.

Tx polyagglutination in three members of one family.

A case of acute haemolytic anaemia is described in a child. Tx polyagglutination of his red cells was observed, but no direct association with the anaemia could be proved. Polyagglutination was suspected because of irregularities in the AB0 blood grouping. Confirmation of the cryptantigen Tx was made when the patient's red cells were tested with lectins including Arachis hypogaea, Glycine soja, and Vicia cretica. Examination of family members showed Tx polyagglutination on the red cells of 2 siblings. The Tx polyagglutination was a transient phenomenon lasting 4-5.5 months, and could have been caused as the result of some unidentified bacterial or viral infection. Guidelines for transfusion therapy are suggested in patients in whom polyagglutination is recognised.

Human T-cell lymphotropic virus type-I antibodies in Falashas and other ethnic groups in Israel.

Epidemiological studies of the human T-cell leukaemia/lymphoma virus type I (HTLV-I), a type-C retrovirus of the human T-lymphotropic virus family, have used serological surveys to identify population subgroups possessing a high prevalence of naturally occurring HTLV-I-specific antibodies. Studies carried out to delineate the global distribution of the virus have demonstrated natural antibodies to HTLV-I in the serum of healthy donors from specific geographical areas, and have defined viral endemic areas in Japan, the Caribbean basin, Africa and the southeastern United States. Such studies have suggested that the prevalence of HTLV-I antibodies is directly correlated with age, is associated with the clinical syndrome of adult T-cell lymphoma, and is associated with transmission from mother to child. A separate subtype of the human retrovirus, HTLV-II (refs 21, 22), has also been identified. The population of Israel in part comprises groups of immigrants of various ethnic and geographical origins. Because of this, and the fact that Israel has a highly developed public health system, we surmised that the ethnic groups in Israel could be used in a seroepidemiological survey of HTLV infection. The serological survey reported here demonstrates a high prevalence of HTLV-I antibodies in new immigrants from Ethiopia. This previously ethnically and geographically isolated group, the 'Black Jews' or 'Falashas', from the Gondar region in the northern rural highlands of Ethiopia, has the highest endemic rate of HTLV-I yet reported outside Japan.

Serological hepatitis A virus infections and ratio of clinical to serological infections in a controlled trial of pre-exposure prophylaxis with immune serum globulin.

Seroconversion to hepatitis A virus was studied in a sub sample of 802 Israeli military recruits (611 men and 191 women) who were taking part in a randomised controlled trial of pre-exposure immune serum globulin (ISG) for the prevention of viral hepatitis. On intake into the service 35% of the men and 47% of the women were negative to hepatitis. A virus antibody (anti-HAV). After three years 7 of 71 men (9.9%) who had not received pre-exposure ISG had become positive to anti-HAV compared to 2 of 83 (2.4%) who had received it; the statistical significance of this difference was p = 0.052. At two years 2 of 30 women (6.7%) who had not received ISG had converted compared to 1 of 43 (2.3%) who had received ISG (p = 0.37). Pooling the sexes gave conversion rates of 8.9% in those not immunised and 2.4% in those immunised (p = 0.029). The sex adjusted odds ratio was 4.0 (95% confidence limits 1.3-19.0). The morbidity rates for clinical non B hepatitis over the three year period among 12 835 men were 7.2 per 1000 in those not immunised and 3.6 per 1000 in those immunised (p = 0.004). Point estimates of the ratio of clinical hepatitis to seroconversion in men ranged from 0.25 to 0.30. It is concluded that pre-exposure administration of ISG effectively prevented clinical expression of viral hepatitis, apparently reduced seroconversion, and did not induce passive-active immunisation.

Improved detection of hepatitis B surface antigen (HBsAg) in blood donors by monoclonal radioimmunoassay.

We evaluated the performance of a monoclonal radioimmunoassay (M-RIA) with enhanced sensitivity and high specificity for hepatitis B surface antigen (HBsAg) in blood donors. The results were compared to a conventional RIA that used polyvalent antibodies (P-RIA). Analysis of 6409 American blood donors not reactive by P-RIA revealed an additional 1.4 HBsAg-positive donors per 1000 by M-RIA, or an approximate 60 percent, improvement in HBsAg detection rate. Furthermore, in 995 Israeli blood donors negative by P-RIA, 11 additional HbsAg-positive donors were identified. The 55 percent improvement in detection rate was similar to that observed with American blood donors. Since several of the newly identified HBsAg-positive blood donors had antibodies to the core antigen (anti-HBc) as the only serologic evidence of recent or past hepatitis B exposure, we studied an additional 68 anti-HBc-positive individuals with the M-RIA. It was found that 26 percent (18/68) reacted only by M-RIA and not by P-RIA. These findings suggest that there are blood donors with HBsAg undetectable by P-RIA.