Liver disease in anti-hepatitis C virus-positive Norwegian blood donors.

In a prospective study of 16,756 consecutive blood donors, we found 54 donors (0.3%) to be anti-hepatitis C virus (HCV)-positive by a first-generation enzyme-linked immunosorbent assay. After retesting, 18 donors were confirmed positive or indeterminate by a second-generation recombinant immunoblot assay. Sixteen of these donors were found positive by a second-generation enzyme-linked immunosorbent assay, and 15 of these were positive by HCV polymerase chain reaction with two primer sets. Nine donors (50%) had a history of drug abuse. In 15 donors found positive by a second-generation enzyme-linked immunoblot assay liver biopsy specimens were taken after at least 6 months' follow-up. In all except one hepatitis C RNA-negative donor, histologic abnormalities were observed, even when alanine aminotransferase (ALAT) levels were continuously normal or only moderately elevated. The abnormalities were less pronounced in these donors (n = 5) than in donors with ALAT levels increased more than twice the upper normal limit (p < 0.05). In conclusion, we found the proportion of previous drug abusers in anti-HCV-positive blood donors to be high. We confirm that the presence of anti-HCV (second generation) usually, and HCV-RNA always, seems to indicate ongoing infection--also when ALAT levels are normal. Our study further suggests that low-activity hepatitis, evaluated by ALAT levels, may indicate a milder disease.

Genital human papilloma virus infection in Oslo studied by dot blot DNA hybridization and the polymerase chain reaction.

Samples from patients with genital condyloma acuminata or with cervical condylomas and/or dysplasia and from women without cytological/clinical evidence of cervical affection were examined by dot blot DNA hybridization or the polymerase chain reaction (PCR). The PCR was much more sensitive than dot blot, more than doubling the human papilloma virus (HPV) findings. HPV DNA, mainly HPV 6/11, was detected in 18 of 19 biopsies of condyloma acuminata, whereas HPV 16 was most frequently detected in the 21 cervices (76%) with condyloma and/or dysplasia. HPV 16 was detected in eight of 103 cervical smears with no signs of infection. The prevalence of HPV 16 in cervical samples was somewhat higher than expected. This suggests that, in Oslo, HPV 16 is a common HPV type in women with cytologically normal cervices. HPV 18 was relatively rare and was detected only in combination with other HPVs.

[Hepatitis A-, B- and C-markers among Norwegian drug addicts in the period 1975-89]. / Hepatitt A-, B- og C-markører hos norske stoffmisbrukere i perioden 1975-89.

The prevalence of hepatitis A-, B- and C-markers has been studied in patients at a Norwegian rehabilitation centre for drug addicts. The prevalence of hepatitis C-antibodies was fairly constant in the years 1976 (56%), 1985 (78%) and 1988-89 (73%), but may be decreasing in younger addicts. The data suggest a highly variable incidence of HAV with few infections in recent years. The prevalence of hepatitis B-markers, which has been calculated from 1975 to 1988-89, reached a maximum of 93% in 1986. Since then a significant decrease in prevalence has been observed among younger patients, suggesting that the HIV campaign has led to improved hygiene precautions among intravenous drug addicts. A strong correlation was observed between positive markers for HBV and presence of anti-HCV, and, similarly, between the presence of anti-HAV and markers for HBV and HCV. Anti-HCV was significantly associated with pathological ALT-values.

Immunogenicity of yeast-derived hepatitis B vaccine from two different producers.

The immunogenicity and reactogenicity of two preparations of yeast-derived hepatitis B vaccines were compared in healthy adult populations. The two groups were vaccinated in parallel, but they were not matched for age and sex. All subjects seroconverted, and 9 months after the first vaccine dose, all had anti HBs titres of at least 10 IU/l. The anti-HBs titres were higher in the group of subjects given 20 micrograms vaccine antigen made by Smith Kline & RIT (GMT 2943 at 9 months) compared to those who received 10 micrograms of vaccine made by Merck, Sharp & Dohme (GMT 729 at 9 months). Adverse effects were recorded in 32.0 and 44.7% of the participants, but these were limited to minor local and general reactions. In the present study both preparations were safe and efficient.

The prevalence of hepatitis A and B in Norwegian merchant seamen--a serological study.

The prevalence of viral hepatitis in Norwegian merchant seamen in overseas trade was studied in 523 volunteers during compulsory health control before embarkation from the port of Oslo. The prevalence of hepatitis B markers was 9.4%, which is significantly higher than in the general Norwegian population. The prevalence increased with the number of years of occupation. It was associated with frequent casual sexual contacts in foreign countries, but not significantly increased in participants who had been exposed to tattooing or different types of medical treatment under poor hygienic conditions in foreign areas. The prevalence of antibodies against hepatitis A (HAV) was 36% in seamen born in 1945 or earlier and 5% in younger individuals, an age-dependent pattern which is essentially similar in the general Norwegian population. However, the prevalence of hepatitis A antibodies seemed to increase with years in foreign trade. The incidence of viral hepatitis infections in the occupation was noticeably high, suggesting that vaccination of seamen in certain areas of trade should be considered.

Hepatitis A in young Norwegian drug addicts and prison inmates.

Prevalence of antibodies against hepatitis A (anti-HAV) among young Norwegian drug addicts in 1983 and the relative incidence of specific IgM against hepatitis A (anti-HAV IgM) during the years 1973-1983 have been studied. The survey is based on 1,689 serum samples from 561 persons submitted to hepatitis B screening or clinical hepatitis testing. The prevalence of anti-HAV in such groups was 43% in 1983 versus about 5% in corresponding age groups in the general population and 1% in the Norwegian U.N. soldiers in Lebanon. Presence of anti-HAV clearly correlated with presence of hepatitis B markers. Considerable fluctuations in the incidence of hepatitis A seemed to occur among drug addicts, with pronounced epidemic peaks in 1975 and 1979, coinciding with epidemics in Malmö, Sweden. Though the incidence varied, hepatitis A may have persisted among addicts for some years after 1979 in a semi-endemic manner. Although relatively young, most of them seem to have been in the milieu for some time before catching the infection. Drug addicts seem to be a target group for future hepatitis A vaccination programs.

Prevalence and clinical effects of delta agent. Infections in Norwegian population subgroups.

The distribution of antibodies against the delta agent was studied in different groups of hepatitis B patients in Norway. Such antibodies were detected only in drug addicts, predominantly among chronic HBsAg carriers. The results support the notion that the delta agent was introduced into Scandinavia in 1970-75. Although the proportion of anti-delta positive individuals among chronic HBsAg carriers increased, the annual increase of new anti-delta carriers was essentially stable. One death caused by hepatic failure was registered among 43 anti-delta negative and none among 21 anti-delta positive chronic HBsAg carrier addicts.

Efficacy of post-exposure prophylaxis with hepatitis B immunoglobulin in Norway.

The efficacy of hepatitis B immunoglobulin (HBIG) in preventing infection by hepatitis B virus (HBV) after exposure to blood or blood-containing secretions that carried hepatitis B surface antigen (HBsAg), was studied in an uncontrolled trial in Norway from 1976-1983. Of the 177 HBIG recipients, followed up for 5-24 months, 166 were exposed by needle-stick, splash on mucous membranes or open wounds, sexual contact or medical investigation. With few exceptions, this group was given a single injection of 1250 IU of antibody to HBsAg (anti-HBs) within 7 days after exposure. One person developed clinical hepatitis B (HB) of short duration and two others developed anti-HBs. Six infants with perinatal exposure were injected with three or four doses of about 1250 IU anti-HBs at intervals of 2-3 months. The first dose was given immediately after birth. One child developed clinical HB at the age of 14 months and recovered. Of five patients exposed by blood transfusion, four developed clinical HB; the fifth apparently developed passive-active immunity. One of the four probably became an HBsAg carrier. These patients, except the one without clearance of HBsAg, received one to seven doses of HBIG within 2 days after exposure. Administration of HBIG after needle-stick and similar types of exposure, as well as administration to infants at risk of contracting HB, seems to be of great value.

Use of immunosorbent electron microscopy for detection of rota- and hepatitis A virus in sucrose solutions.

Immunosorbent electron microscopy was used to demonstrate rotavirus in solutions of varying sucrose concentrations after 18, 42 and 66 h of incubation. About 50% of adsorption of virus particles to the grid was achieved after 18 h incubation and nearly 100% after 42 h when compared to trapping of virus from sucrose free solutions. Hepatitis A virus was purified in a 10-30% sucrose gradient and each fraction was examined by immunosorbent electron microscopy, direct electron microscopy, immune electron microscopy and radioimmunoassay. The sensitivities of immunosorbent electron microscopy and radioimmunoassay were essentially similar and considerably greater than direct electron microscopy and conventional immune electron microscopy.

Prevalence of viral hepatitis in the staff in Norwegian anaesthesiology units.

The prevalence of markers for present or past hepatitis B infection has been studied in 1230 staff members of anaesthesiology units throughout Norway. HBsAg was not detected in any of the participants in the study. The prevalence of antibodies against hepatitis B in the younger participants was similar to that in the control group, but was significantly increased among the older participants and in those with longer seniority in medical work. This result was to some extent influenced by a fairly large number of staff members who had grown up or had had professional experience in countries with a higher prevalence of hepatitis B. The results may be interpreted as reflecting a very moderate incidence of hepatitis B infections in anaesthesiology units during the last 15 years. However, relevant to the discussion of vaccination programs for these units are three reported cases of hepatitis B infections with a fatal outcome among Norwegian anaesthesiologists, suggesting a greater severity of hepatitis B infections within this occupational group.

Prevalence of hepatitis A antibodies in a normal population and some selected groups of patients in Norway.

The prevalence of hepatitis A virus antibodies was tested by radioimmunoassay in Norway in healthy blood donors, in patients without clinical signs of liver diseases and in two selected groups of patients. The presence of hepatitis A antibodies was highly age-dependent in 625 normal persons. A major reduction occurred from 50 per cent or more in those born before 1938 to 10 per cent or less among those born after 1943. The decline of hepatitis A antibody prevalence was correlated to the history of infectious hepatitis epidemics in the entire country during World War II. The prevalence was not different from controls in a group of patients with various liver disorders. Hepatitis A antibodies were more prevalent in males than in females in blood donors, patients with chronic liver disorders and their controls. Hepatitis A antibodies were frequently present in prison inmates; their presence was associated with the presence of antibodies against hepatitis B virus and with anamnestic data on drug addiction.

HBsAG transmission from a cardiac surgeon incubating hepatitis B resulting in chronic antigenemia in four patients.

A cardiac surgeon experienced an uneventful course of acute hepatitis B. HBsAg was transmitted to 11 persons: 5 of 72 patients operated on during his incubation of hepatitis B, three relatives of the infected patients, one laboratory technician, and two of the surgeon's family members. Two years later, 4 of the 5 operated patients are still infectious, whereas the 7 non-operated persons have cleared their antigenemia. This study demonstrates the significant risk of hepatitis B transmission from a cardiac surgeon incubating the disease. Furthermore, it indicates that patients who have been infected during open heart surgery and cardiopulmonary bypass run a particular risk of becoming chronic HBs antigen carriers.

Viral hepatitis among prisoners in Norway.

The present survey reveals high frequencies of hepatitis B surface antigen and antibody in criminals committed to prison in Norway compared to the general population. The high rate of antigen carriers and the intramural supply of illicit drugs constitute a threat to fellow prisoners regarding viral hepatitis as well as drug addiction.

Experiences with radioimmunoassay in the detection of HBsAg in the presence of anti-HBs.

Interference from anti-HBs present during hepatitis B antigenemia caused the appearance of several false negative reactions in a competition radioimmuno-precipitation procedure. The results indicate that such interference is considerably less in the solid-phase radioimmunoassay (Ausria II) and probably causes few false negative tests. The use of pepsin treatment as a means to destroy interfering antibodies is discussed.