[Hepatitis B in Poland in 1999]. / Wirusowe zapalenie watroby typu B w 1999 roku.

A total of 3,508 of hepatitis B cases (including 152 cases of mixed HBV and HCV infections) were reported in Poland in 1999. For the first time since 1979, when registration has began, the incidence decreased below 10.0 and was 9.1 per 100,000. The program of eradication of hepatitis B in Poland has been introduced in 1993 and since then the fourfold decrease in number of hepatitis B cases has been noticed. During the past 7 years there has been a steady decline in hepatitis B incidence. In 1997 the incidence decreased 23% as compared to 1996, followed by 16.8% decrease in 1998 and 13.9% in 1999; the marked differences in incidence in particular voivodeships have been observed. The overall rate of hospitalized hepatitis B cases in Poland reached 98.1%. A total of 25 cases of hepatitis B (rate 1.2 per 100,000) occurred among children under 4 years of age, who should be vaccinated. Among children aged 5-9 years, of which many could not be vaccinated, the incidence rate was 6 times higher, ranging from 4.9 per 100,000 in girls to 9.8 per 100,000 in boys. The increase of incidence from 5.3 to 9.2 was observed in young people (14-24 years old). Data from the study of serological markers of hepatitis B, conducted among 4,500 health care workers during 1998-2000, have indicated that about 22% of health care workers have been infected with HBV (in 21% of persons anti-HBc and in 1% anti-HBc together with HBsAg were detected).

Evaluation of HBV and HCV antigens expression in correlation with HBV DNA and HCV RNA occurrence in liver biopsy specimens of patients with chronic hepatitis type B and chronic hepatitis type C, respectively.

MATERIAL AND METHODS: The material studied consisted of single liver biopsy specimens and serum samples from 97 patients diagnosed by clinical and serological criteria as having chronic hepatitis of either type B (38 patients seropositive for HBsAg) or type C (59 patients seropositive for anti-HCV). Diagnosis of chronic hepatitis, including grading and staging of the process, was established by histopathological examination of routinely stained serial paraffin sections. The expression of HBV and HCV antigens was detected in frozen sections by amplified immunoperoxidase method (EnVision, DAKO) with the use of monoclonal anti-HBs antibodies (DAKO), polyclonal anti-HBc antibodies (Biogenex) and FITC-labeled human antibodies to HCV antigens. HBV DNA and HCV RNA were searched for in tissue homogenates with PCR (In Gen; Terpol, Sieradz) and RT PCR (Cobas Amplicor HCV RNA, Roche), respectively. RESULTS: HBsAg was detected in all and HBcAg in 26 of the 38 biopsy specimens with chronic hepatitis type B from patients who were seropositive for HBsAg and anti-HBc, and for either HBeAg (25 cases) or anti-HBe (13 cases). HBV DNA was identified in 32 out of 38 liver biopsy specimens. Out of the 32 HBV DNA positive specimens, 6 that had been obtained from patients seropositive for anti-HBe, lacked HBcAg expression. HCV antigens were found in 27 (50%) out of 54 specimens which showed the presence of HCV RNA. CONCLUSIONS: These results are indicative for a strong positive correlation between the expression of HBV antigens and that of HBV DNA in liver biopsy specimens. The detection of HCV antigens has proved to positively correlate with that of HCV RNA in 50% of the specimens examined. It appears, therefore, that testing of liver biopsy specimens for HBV and HCV antigens may, in a significant proportion of cases, extend the histopathological diagnosis as to include identification of the etiologic factor.

[Hepatitis B in 1998]. / Wirusowe zapalenie watroby typu B w 1998 roku.

In 1998 in Poland 4074 new cases of viral hepatitis B were noted (including 149 mixed infections with HBV and HCV). Incidence was 10.5 per 100,000 and it was 2.2 lower than year ago. In 1997 the infection with HBV was observed in 4896 persons, including 66 mixed infections (incidence rate 12.7/100,000). Constant decrease in number of new cases and incidence was observed in both sexes gender and all age groups after introduction of the intensive program of prevention and control of hepatitis B in 1993. It lead to almost 4 fold decrease of the number of new cases. There are still significant differences in incidence between particular voivodeships. For example between voivodeships Lodz and Warsaw the difference is twofold (20.6 and 10.2). The incidence of hepatitis B is still higher in cities (11.8) then in rural areas (8.6). It is dependent on gender and age. The lowest incidence is among children 0-4 years old 2.8/100,000 (61 cases). Twofold increase of incidence (from 4.6 to 9.8) is observed between ages 14 and 24; it is mainly due to higher incidence among young men especially those living in cities.

[Humoral response to HBV antigens in acute and chronic hepatitis B]. / Odpowiedz humoralna na antygeny HBV w ostrym i przewleklym wir usowym zapaleniu watroby typu B.

Sera of patients with acute and chronic hepatitis B and antigenemia were tested for the presence of anti-HBe and anti-HBs antibodies, free or bound in immune complexes. The possible occurrence of immune complexes of HBcAg in these sera was also investigated. Immune complexes were identified by antigen specific enzyme immunoassay, in which polyclonal antibodies against synthetic fragments of proteins S and C of HBV and mono- and polyclonal anti-HBc antibodies were used as a solid phase. Free and/or antigen bound anti-HBe antibodies were detected in 100% of patients with acute (81% HBeAg positive) and in 37% of patients with chronic hepatitis, all HBeAg positive. Anti-HBs antibodies or their immune complexes were found in 83% and 37% of patients, respectively. In not any patient circulating complexes of HBcAg could be identified. The results obtained support the observations that humoral immune response to HBeAg and HBsAg can be detected earlier than generally accepted; they also suggest that the detection of anti-HBs in a single sample of serum should not be considered as the evidence of elimination of infection.

[Etiology of chronic hepatitis as evaluated by liver biopsy and serum samples submitted to the Department of Immunopathology of the National Institute of Hygiene in 1993-1995]. / Etiologia przewleklych zapalen watroby na podstawie badan biopsji watroby i surowic nadeslanych do Zakladu Immunopatologii Panstwowego Zakladu Higieny w Latach 1993-1995.

The purpose of this study was to assess the relative incidence of chronic hepatitis in a population of patients with chronic liver disease and to determine the etiological spectrum of this syndrome with special reference to its defined histopathological forms. Histopathology aided by immunohistochemistry, and serology aided by the PCR method were employed in studies of liver biopsy specimens and serum samples, respectively. Out of 1150 patients with chronic liver disease examined, chronic hepatitis was diagnosed in 685 (60% of all cases examined). In this group, there were 308 males aged 18-74 yrs (mean 32 yrs), 153 females aged 18-71 yrs (mean 43 yrs), and 213 children aged 1-17 yrs (mean 8 yrs). Viral infections documented in these patients included HBV (50.4%), HCV (36.2%), HBV/HCV (7.2%) and HBV/HDV (0.7%); cryptogenic and autoimmune hepatitis (AIH) accounted for 2.9% and 2.6% all cases, respectively. In the group of minimal hepatitis (16.1%), HBV infection was documented in 66.4% of cases, HCV-in 29.1%, HBV/HCV-in 3.6% (one case of AIH was included into this group). In the group of mild hepatitis (44.2%), HBV infection accounted for 47.3% of cases, HCV-for 41.9%, HBV/HCV-for 9.9%, and 0.9% was diagnosed as cryptogenic. In the group of moderate hepatitis (19.6%), HBV infection accounted for 50% of cases, HCV-for 37.3%, and HBV/HCV-for 4.5%; cases of cryptogenic and AIH accounted for 3.7% and 4.5%, respectively. In the group of severe hepatitis (20.1%), HBV etiology was found in 44.9% of cases, HCV-in 28.3%, HBV/HCV-in 6.5% and HBV/HDV-in 3.6%; cryptogenic and AIH accounted for 6.5% and 8.0% of cases, respectively. There was a high incidence of low-titer autoantibodies (SMA, ANA and LKM) ranging from 75% in cryptogenic hepatitis and 51% in each HBV and HBV/HCV hepatitis to 46.3% in HCV hepatitis.

[Anti-idiotypic antibodies against antibodies to HBsAg and against antibodies to pre-S1 and pre-S2 fragments of HBV in patients with chronic HBs antigenemia]. / Przeciwciala anty-idiotypowe skierowane przeciwko pezciwcialom dla HBsAg oraz przeciwcialom dla fragmentów pre-S1 i pre-S2 otoczki HBV u chorych z przewlekla antygenemia HBs.

Anti-idiotypic antibodies (anti-Id Ab) against antibodies to HBs, pre-S1 and pre-S2 antigenic domains of the HBV surface protein were searched for by enzyme-linked immunosorbent assay in single serum samples of 57 patients, chronic HBsAg carriers. IgG and/or IgM anti-Id Ab were detected in 15 patients (26%). IgG and / or IgM anti-[anti-HBs] anti-Id Ab were found in 8 serum samples (14%) and they appeared to occur more frequently in patients seropositive for HBeAg than in these seropositive for anti-HBe. IgG and / or IgM anti-[pre-S1] anti-Id Ab and IgG and / or IgM anti-[anti-pre-S2] anti-Id Ab were detected in 5 (9%) and 8 (14%) patients, respectively. Both these anti-Id Ab were found more frequently in patients seropositive for anti-HBe than in patients seropositive for HBeAg. Anti-[anti-pre-S2] anti-Id Ab occurred more frequently in patients with sever liver damage than in these with near normal liver or established cirrhosis.

[Diagnostic value of antibodies against HIV-1 proteins in seropositive drug addicts tested by the western blotting method]. / Ocena wartosci diagnostycznej wzorów przeciwcial przeciwko bialkom HIV-1 u badanych metoda western blot seropozytywnych narkomanów.

The incidence of various patterns of antibodies against HIV 1 proteins was tested by Western blot in EIA--positive serum samples from intravenous drug abusers. The presence of anti-p24, anti-gp160 and anti-gp120 antibodies was the most typical pattern suggestive for early humoral response. In most instances of indeterminate results subsequent WB tests performed during 4 to 6 week period showed whole spectrum of anti-HIV 1 antibodies.

Follow-up studies of healthy blood donors. Anti-HBs antibody carriers.

10 healthy blood donors persistently seropositive for anti-HBs and without a history of clinically overt viral hepatitis were observed for periods of time ranging from 46 to 57 months. Physical examinations and biochemical liver function tests were normal in all cases. Immunologic studies of their immune response to hepatitis B virus antigens are suggestive for a late period of convalescence from clinically inapparent hepatitis B.

Clinical and immunological studies on healthy blood donors hepatitis B antibody carriers.

Ten healthy blood donors persistently seropositive for anti-HBs and without a history of clinically overt viral hepatitis were studied. While physical examination and biochemical liver function tests exhibited normal values in all cases, immunologic studies revealed coexistence of a long-term anti-HBs carrier state with the presence of cell-mediated immunity to HBV antigens and autoantibodies in some. These results suggest a complex immunologic phenomenon underlying the development of the anti-HBs carrier state.