Modulation of serum interleukin-18 concentrations and hepatitis B virus DNA levels during interferon therapy in patients with hepatitis B e-antigen-positive chronic hepatitis B.

The aim of this study was (1) to determine plasma values of interleukin-18 (IL-18) in patients with different clinical manifestations of hepatitis B (HB) and (2) to analyze the correlation between presence of circulatory levels of IL-18 and levels of HB virus (HBV) DNA during interferon-alpha (IFN-α)-induced HBe seroconversion in patients with chronic HB (CHB). The IL-18 levels in serum did not significantly differ between healthy control subjects (99 ± 25 pg/mL), HB-immune patients (85 ± 33), and asymptomatic carriers of HB surface antigen (144 ± 44 pg/mL). In contrast, anti-HBe (HBV DNA <104 copies/mL, 555 ± 248, P < 0.05), anti-HBe (HBV DNA >104 copies/mL, 280 ± 85, P < 0.05), and HBe-antigen-reactive (373 ± 108, P < 0.0001) patients with symptomatic CHB had significantly elevated levels in circulation compared with healthy control subjects (99 ± 25 pg/mL). An inverse correlation was found between serum HBV DNA copies and IL-18 levels during therapy (r = -0.54, P < 0.001). We consistently observed an IFN-α-induced suppression of viral replication, which was followed by the alanine aminotransferase (ALT) flare. There was a significant increase in IL-18 production after the ALT flare, where the peak of IL-18 preceded or coincided with the time of HBe seroconversion in patients who cleared the virus. These results suggest that IL-18 is involved in the pathogenesis of CHB and that IFN-α therapy can augment the production of IL-18 in patients with CHB.

Anti-preS responses influence the anti-HBs response in newborns after vaccination with the third generation Sci-B-Vac vaccine.

We analysed the specificity and significance of the antibody response towards the linear preS1 sequence that has been shown to represent the "hepatocyte binding site" comprising amino acids preS1 (21-47) or the specific preS2 (131-140) antibody response to the "polymerised albumin receptor" in relation to the antibody response to hepatitis B surface antigen during immunisation of healthy children with the preS-containing Sci-B-Vac vaccine. Twenty-eight healthy newborns received three doses of the Sci-B-Vac vaccine according to a 0-, 1-, and 6-month scheme. Seventeen (61%) of the 28 newborns had detectable levels of anti-preS1 (21-47) antibodies and 14 (50%) were anti-preS2 (131-140) reactive at 6 and/or 9 months after initiation of the vaccination. The mean levels of anti-HBs were significantly higher in the anti-preS2 (131-140) non-reactive (24580+/-7815IU/l, mean+SEM) compared with the reactive sera (7287+/-2317IU/l, p<0.025). The highest anti-HBs levels were found in newborns who exhibited reactivity towards the aa 21-47 of the preS1 but lacked anti-preS2 (131-140) reactivity.

Effect of influenza and pneumococcal vaccines in elderly persons in years of low influenza activity.

BACKGROUND: The present prospective study was conducted from 2003-2005, among all individuals 65 years and older in Uppsala County, a region with 300 000 inhabitants situated close to the Stockholm urban area.The objective of this study was to assess the preventive effect of influenza and pneumococcal vaccination in reducing hospitalisation and length of hospital stay (LOHS) even during periods of low influenza activity. The specificity of the apparent vaccine associations were evaluated in relation to the influenza seasons. RESULTS: In 2003, the total study population was 41,059, of which 12,907 (31%) received influenza vaccine of these, 4,447 (11%) were administered the pneumococcal vaccine. In 2004, 14,799 (34%) individuals received the influenza vaccine and 8,843 (21%) the pneumococcal vaccine and in 2005 16,926 (39%) individuals were given the influenza vaccine and 12,340 (28%) the pneumococcal vaccine.Our findings indicated that 35% of the vaccinated cohort belonged to a medical risk category (mainly those persons that received the pneumococcal vaccine). Data on hospitalisation and mortality during the 3-year period were obtained from the administrative database of the Uppsala county council. During the influenza seasons, reduction of hospital admissions and significantly shorter in-hospital stay for influenza was observed in the vaccinated cohort (below 80 years of age). For individuals who also had received the pneumococcal vaccine, a significant reduction of hospital admissions and of in-hospital stay was observed for invasive pneumococcal disease and for pneumococcal pneumonia. Effectiveness was observed for cardiac failure even in persons that also had received the pneumococcal vaccine, despite that the pneumococcal vaccinated mainly belonged to a medical risk category. Reduction of death from all causes was observed during the influenza season of 2004, in the 75-84-year old age group and in all age-groups during the influenza season 2005. CONCLUSION: The present study confirmed the additive effect of the two vaccines in the elderly, which was associated with a reduced risk in hospitalisation and a reduction in mean LOHS in seasons with low influenza activity.

Screening and genotyping of genital Chlamydia trachomatis in urine specimens from male and female clients of youth-health centers in Stockholm County.

BACKGROUND: The current study was conducted in the context of the current increase in cases of Chlamydia trachomatis infections, the development of new diagnostic strategies, and an outreach to community-based youth center screening sites. GOAL: The goal was to define the prevalence of genital C trachomatis infection among clients of youth-health clinics and to evaluate the feasibility of implementing genotyping as a tool for epidemiologic studies with use of urine specimens. STUDY DESIGN: This was a prospective pilot study at two community-based youth-health clinics for teenagers and adolescents. Enrollment followed a high school educational program and public advertising campaign on the common occurrence of nonsymptomatic or only mildly symptomatic chlamydial infection among sexually active young people. Voluntary, confidential, free screening of first-void urine was provided, and the samples were tested by polymerase chain reaction (PCR). Demographic and behavioral data were obtained. Positive samples were differentiated into genovars by genotyping with restriction fragment length polymorphism analysis of the PCR-amplified omp1 gene. RESULTS: The prevalence of nonsymptomatic or mildly symptomatic chlamydial infection was 6.0% among women and 9.3% among men. A significant increase in the risk of infection was associated with a history of sexually transmitted disease (STD) (P < 0.01). There was no statistical risk correlating with partner change during the past year, infrequent or inconsistent condom use during the past year, present use of contraceptive pills, smoking habits, or recent alcohol consumption. Genotype E was most common (60%) among both sexes. Genotypes F and K were second most prevalent for men (20%), and genotype D was second most prevalent for women (15%). Genotype K or F was found in 23% of cases. CONCLUSION: Screening programs targeting sexually active adolescents attending youth-health clinics are important for detection of C trachomatis. Genotyping might become an efficient tool in epidemiologic studies. The impact of educational school- and community-based programs on STD among young people needs further evaluation.