Immunogenicity and safety of a virosomal hepatitis A vaccine (Epaxal) in healthy toddlers and children in Chile.

UNLABELLED: In this open study, 20 toddlers and 80 schoolchildren received an intramuscular dose of Epaxal and a booster dose 12 mo later to assess the efficacy and safety of this aluminium-free, virosomal hepatitis A vaccine. Four weeks after primary vaccination, 94% of toddlers and 99% of schoolchildren had seroconverted, and all toddlers and 94% of schoolchildren remained seroprotected for 12 mo. CONCLUSION: After vaccination with Epaxal and booster, all subjects were seroprotected. Epaxal was very well tolerated by both age groups.

[Hepatitis B and C infection in late repatriates]. / Hepatitis B und C bei Spätaussiedlern.

105 late repatriates returning to Germany mostly from Russia, Ukraine and Kazakhstan were tested for present or past viral hepatitis B and 97 of them also for hepatitis C. Anti-HBc was found in 20% (95%-CI: 12,3-31,6%) and Anti-HCV in 3% (95%-CI: 1,3-8,0%) of tested individuals. 5% of tested persons were positive by PCR for HBV-DNA or HCV-DNA and therefore probably source of infection forthese viruses. All PCR positive individuals were not aware of their infection. Prevalence of hepatitis B and C infection was significantly higher than in the general population of Germany. Testing for viral hepatitis Band C should be offered to all late repatriates returning from areas with elevated prevalence of parenterally transmitted viral hepatitis. Further monitoring of the prevalence of viral hepatitis should be done in this group.

Role of hepatitis E and other hepatotropic virus in aetiology of sporadic acute viral hepatitis: a hospital based study from urban Delhi.

Major hepatotropic virus continues to be an important cause of acute viral hepatitis (AVH) in developing countries like India. While epidemics of AVH have been well studied few serious sporadic cases from developing countries have been reviewed. We studied prospectively 75 cases of sporadic AVH who reported to our hospital and were evaluated for the presence of various hepatotropic viruses. The seroprevalence of IgG anti-HEV antibodies was studied in the general population as a control. We found 53.3% (40/75) of sporadic AVH cases were due to hepatitis E virus while 11% (8/75) were due to hepatitis B virus. Hepatitis C virus was responsible for 8% (6/75) of the sporadic AVH cases and hepatitis A was found in 5% (4/75) of the cases. No causative agent was found in 23% (17/75) of the sporadic AVH cases. The sporadic AVH cases due to HEV were not clinically or biochemically not different from AVH due to other viruses. We found a high prevalence of IgG anti-HEV in 35.6% (178/500) among the general population of urban Delhi. The study suggested that hepatitis E was the most common cause of sporadic AVH in urban Delhi. High seroprevalence of IgG anti-HEV antibodies in the general population and amongst the sporadic AVH cases suggests that it is unlikely to be protective antibody. IgM anti-HEV positive serology is considered diagnostic of acute hepatitis E infection in India, where hepatitis E is endemic.

Epidemiological study of viral hepatitis types A, B, C, D and E among Inuits in West Greenland.

A descriptive study was performed to evaluate the relative frequencies and molecular epidemiological features of viral hepatitis types A to E among the Inuit population in West Greenland. Serum samples were collected from 503 Inuits (186 males and 317 females; mean age 35 years; range 7-79 years) and were tested for markers of viral hepatitis infection. The hepatitis A prevalence averaged 54%, with a significant rise from 9% to 50% between the second and third decade of life. As for hepatitis B, 42% of the total study population showed serological evidence of current or past hepatitis B virus (HBV) infection and 7% were hepatitis B surface antigen (HBsAg) carriers. Among the carriers, 6% were also positive for hepatitis B e antigen (HBeAg), and HBV DNA could be detected in 49% of carriers by polymerase chain reaction. Typing of the HBV isolates revealed genomic group D in 83% (serotype ayw2) and group A in 17% (serotype adw 2). Less than 1% of the study population had antibodies to the hepatitis C virus. None were positive for HCV RNA. Serological evidence of hepatitis D infection was found in 7% of those with hepatitis B helper virus infection markers and in 40% of the HBsAg carriers. As for hepatitis E, 3% of the Inuits showed reactivity in an enzyme immunoassay that detected hepatitis E virus antibody. HEV RNA could not be detected.

High immunogenicity and good tolerability of a new hepatitis A vaccine candidate.

Immunogenicity and tolerability of a new formalin-inactivated, alum-adjuvanted whole virus vaccine against hepatitis A (VAQTA, MSD, West Point, USA) were evaluated by immunizing 52 healthy, anti-HAV negative volunteers with a 1 ml dose. A booster dose was given 6 months later. In these young adult vaccinees [27 males and 25 females, 19-34 (mean 26) years of age] VAQTA proved to be well tolerated and highly immunogenic. Two weeks after administration of one vaccine dose, all but one of the recipients (98%) had anti-HAV concentrations above the presumed minimum protective level of 10 IU l-1 with a geometric mean concentration (GMC) of 165 IU l-1. After 4 weeks, a 100% seroconversion rate could be demonstrated with a fourfold increase of the GMC to 728 IU l-1. Six months after vaccination, all but one of the 50 volunteers coming back for booster (98%) showed anti-HAV levels within the protective range. The antibody concentrations had decreased in the majority of vaccinees to a GMC of 362 IU l-1. The booster dose given at that time was shown to be very effective, leading to a pronounced rise of anti-HAV levels in all recipients with a 17-fold increase of the GMC to 6040 IU l-1. Six months after the booster, all vaccinees were still seropositive with a GMC of 3444 IU l-1. Higher antibody levels were found in females, the difference being significant 4 weeks and 6 months after vaccination and 4 weeks after booster. No serious local or systemic adverse reactions were observed.

Relative importance of the enterically transmitted human hepatitis viruses type A and E as a cause of foreign travel associated hepatitis.

Hepatitis contracted during a stay abroad may be caused by a wide range of pathogens including viruses, bacteria, protozoa or helminths. In many cases, the etiological agent primarily infects other target organs and tissues, involving the liver either as part of a disseminated infection or secondarily to mechanical biliary tract obstruction. The article focuses on enterically transmitted hepatitis caused by the primarily hepatotropic human hepatitis viruses type A and E and discusses their importance in travel-related disease.

Accumulation and persistence of hepatitis A virus in mussels.

Accumulation and persistence of hepatitis A virus (HAV) in the mussel Mytilus chilensis was evaluated. Under optimal filtration activity of mussels (temperature 12 degrees C, salinity 3%, feeding twice a day with Dunaliella marina), HAV was concentrated 100-fold from the surrounding water. Similar concentrations of HAV were reached in the filtration apparatus and in the digestive system (hepatopancreas). HAV persisted for about 7 days in mussels. Elimination of HAV from mussels was slower than elimination of poliovirus. Without feeding of mussels (causing low filtration activity), there was no measurable uptake of HAV into mussels, and depuration of HAV from mussels was slower. The ability of mussels to concentrate HAV was used successfully to monitor fecally contaminated river water for the presence of HAV.

Placebo-controlled efficacy study of hepatitis A vaccine in Valdivia, Chile.

A placebo-controlled, double-blind study on the efficacy of a hepatitis A vaccine (SmithKline Beecham Biologicals) was started in a region of Chile in September 1990, using hepatitis B vaccine as control. A total of 260 healthy children, 6-15 years of age, negative for antibody to hepatitis A virus (anti-HAV), antibody to HAV immunoglobulin M (IgM), hepatitis B surface antigen, and antibody to hepatitis B surface and core antigens by ELISA tests within 7 days before vaccination, were randomly assigned to two study groups: 128 children received the vaccine with a yellow label (group 1), and 132 children the vaccine with an orange label (group 2) at months 0, 1 and 6. Blood for serology and transaminase determination was drawn at months 1, 2, 6, 7 and 12. Both vaccines were tolerated equally well and no serious side effects were seen. In group 1 (presumed hepatitis A vaccine group), anti-HAV was detected (20% inhibition was used as the cut-off level) in 122 of 128 children (95.5%) tested at month 1, in 126 of 127 (99.2%) at month 2, in 126 of 127 (99.2%) at month 6 and in 126 of 126 (100%) at month 7. One anti-HAV seroconversion seen at month 1 was associated with presence of anti-HAV IgM and therefore probably represents HAV infection. Geometric mean anti-HAV concentration of the other children was 128, 342, 214 and 2301 mIU/ml at months 1, 2, 6 and 7, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost reduction of unlinked testing for anti-HIV by investigation of pooled sera.

Anti-HIV-1 testing of pooled sera was found to be an excellent method of considerably reducing the costs and workload of public health surveillance programmes without the loss of important information. All 54 sera found anti-HIV-1 positive in diagnostic testing and 61 out of 70 sera (87%) found positive in surveillance studies were detected when tested at a dilution of 1:10 with anti-HIV-1-negative human sera. This acceptable loss of sensitivity could be reduced further by lowering the cut-off at which single sera of pools were tested: 96% of the above 70 anti-HIV-1-positive sera were detected. During testing of 618 pools containing 6180 sera from a low-risk population, lowering of the cut-off increased the number of pools with testing of individual sera from five (containing one confirmable anti-HIV-1-positive serum each) to only six (containing no anti-HIV-1-positive serum). Therefore, testing of pooled sera from a low-prevalence population group reduced the costs of testing about ninefold and technician time by about 25-50%.

[General insecurity, "false" and "real" security: arguments for the routine study of hospital patients for anti-HIV]. / Allgemeine Unsicherheit, "falsche" und "echte" Sicherheit: Argumente für die routinemässige Untersuchung von Krankenhauspatienten auf anti-HIV.

HIV infection has become an important risk for medical personal. Use of sufficient preventive measures with all patients and patient materials is time consuming, expensive and impracticable. In the present epidemiological situation anti-HIV testing of all hospital patients will give correct information on the presence or absence of HIV infection for 999 of 1000 patients. In addition to the increased safety of medical personal, testing will have several other advantages, some for the HIV infected persons: (1) In patients with HIV-related diseases time consuming delays in diagnosing the disease can be avoided. An earlier start of therapy will improve prognosis. (2) In HIV-infected persons a therapy can be chosen which exerts the least stress to the immune system. This may delay manifestation or progression of HIV-related diseases. (3) By medical surveillance of HIV-infected persons prophylaxis and immediate therapy of opportunistic infections is possible, which may prolong survival time. (4) Counselling of persons previously unaware of their HIV infection will slow down spread of HIV in the population. (5) Missing data on prevalence and incidence of HIV infection in different geographical areas will be available. Apart from the considerable cost reduction by reducing the use of extensive preventive measures to less than 10% of patients, routine screening of all patients is already economic if testing of 10,000 patients will prevent one single new infection by counselling of people with previously unknown HIV infection.

[Occupationally-induced risk of HIV infection in medical personnel]. / Die berufsbedingte HIV-Gefährdung des medizinischen Personals.

Since hepatitis-B immune prophylaxis is possible, HIV infection could become the most important risk of infection facing medical personnel. Today, it must be assumed that HIV infection almost always leads to the fatal disease AIDS. The principal source of infection for medical personnel is patients' blood. The disease is usually transmitted parenterally, as a result of inoculation by a needle prick or similar injury. Blood contact with non-intact skin or mucosae can also lead to infection. In prospective studies, HIV infection was found in approximately 0.5% of cases following needle-prick injuries with anti-HIV-positive blood. The HIV infection risk for medical personnel thus ultimately depends on the frequency of needle prick-type injuries and the number of anti-HIV-positive patients. Assuming that there are 50,000-100,000 anti-HIV-positive persons in the Federal Republic of Germany (Federal Health Authority estimate) the occupational risk to the life of a surgeon sustaining 40 injuries per year could be over 1%. In densely-populated areas with above average contamination of patients a higher HIV infection risk must be expected. An increase in contamination in the next few years would also lead to an increased risk of infection.

Prevalence of serological markers for viral hepatitis and AIDS in rural Punjab.

PIP: Sera from 385 healthy people aged 1-76 years from rural Punjab, India, were assayed in 1985-1986 for antibodies to hepatitis A, hepatitis B virus (anti-HBc) and hepatitis B serum antigen, and 175 of these sera were screened for HIV antibodies by ELISA. Commercial kits Havab, Ausrah II, and Ausab Test, (Abbott Laboratories, North Chicago, Ill, USA) were used. In cases of positive HBsAG, HBe-Antigen and HBV-DNA were determined by radioimmunoassay. over 98% of persons 20, 89% of those 10-19 and 88% of children 1-9 had hepatitis A antibodies. Markers for hepatitis B virus, anti-HBc, ranged from 3.12-36.9% over the age groups, with a total of 100 or 30% positive. HBsAG positives averaged 3.37%. These data are typical of Indian populations in which everyone 10 years has been exposed to hepatitis A. None of the sera were positive for HIV.^ieng