The detection in urine specimens of IgG and IgM antibodies to hepatitis A and hepatitis B core antigens.

The use of urine as a noninvasive specimen for the diagnosis of hepatitis A (HAV) and hepatitis B (HBV) virus infections was investigated. Specimens of urine were collected at the same time as blood or saliva specimens, or singly in cases of previously serologically confirmed recent infection. The specimens were tested for IgG and IgM anti-HAV and anti-HBc by immunoglobulin class-specific capture radioimmunoassays (GACRIA and MACRIA). On the basis of assays on urine specimens it was possible to distinguish between individuals who were susceptible or immune to HAV or who had recently been infected with HAV. Using assays on 327 corresponding saliva specimens as reference tests, the observed sensitivity and specificity of tests on urine specimens by anti-HAV GACRIA were 98.9% and 99.1%, respectively, and by anti-HAV MACRIA were 95.8% and 99.6%, respectively. IgM and IgG anti-HBc were detected readily in the urine of 35 acute or recent cases of hepatitis B but were not found in the urine of seronegative individuals. Of the urine specimens from 52 individuals who were HBsAg carriers or who had had long past HBV infections, 49 contained detectable IgG anti-HBc. Of urine specimens from 42 HBsAg carriers, 11 contained raised IgM anti-HBc levels. Urine, which is a convenient specimen to collect, can be used to study outbreaks of hepatitis A, to ascertain the HAV immune status of individuals, to differentiate hepatitis A from hepatitis B, and to identify individuals who have been naturally exposed to HBV.

Horizontal transmission of hepatitis B virus amongst British 2nd World War soldiers in South-East Asia.

Infection with hepatitis B virus (HBV) is much more common in tropical than in temperate countries. Visitors to the tropics are thus at risk from HBV, though the degree of risk, and the routes of infection involved are uncertain. We report serological markers of HBV in two groups of 2nd World War soldiers, who served in the Thai/Burma jungles. The groups comprised 100 ex-prisoners of the Japanese (POW), and 100 Burma Campaign Veterans (BCV). Surface antigen to HBV (HbsAg) was positive in 0% of POW and 2% of BCV (P = not significant). Surface antibody (anti-HBs) and core antibody (anti-HBc) were both positive in 40% POW and 13% BCV (P less than 0.001). Quoted UK prevalence rates for these markers are 0.1% for HBsAg, 1.5% for anti-HBs and 0.7% for anti-HBc. Both groups thus show very high rates of past HBV infection. For the POW there were many possible reasons, including contaminated surgical instruments and needles, blood transfusions, and multiple beatings with common weapons. None of these factors operated significantly for BCV. Malarial transmission was, however, intense in both groups, though more so in POW. The data thus again raise the possibility of horizontal transmission of HBV by biting insects in tropical countries.

Delta infection and drug abuse in Merseyside.

Delta agent is a small RNA virus which depends on hepatitis B virus for replication. Infection with delta virus in Britain and other countries in Northern Europe and North America is largely confined to drug abusers and their social contacts. In Merseyside, between 1982 and 1987, we found evidence of delta virus infection in 10 (4.4%) of 224 cases of acute hepatitis B in drug abusers. Among carriers of hepatitis B surface antigen (HBsAg) with a history of drug abuse, however, the proportion with delta antibody rose from 10% in 1984 to 30.8% in 1987. Among all HBsAg carriers identified in 1986 and 1987, delta antibody was detected in 11 (32.4%) of 34 with a history of drug abuse but in only 3 (1.6%) of 183 in whom drug abuse was not admitted. Long-term delta infection in these carriers is often associated with development of chronic active hepatitis and represents a major problem not only in countries where hepatitis B and delta virus infections are endemic but also potentially among drug abusers in Britain. Control of delta virus infection depends on social action to curb drug abuse and on the use of hepatitis B vaccine where appropriate to prevent hepatitis B in those at risk. In order to monitor the prevalence of delta virus infection in the community, priority should be given to testing for delta antibody HBsAg carriers with a history of drug abuse.

Immunisation of neonates at high risk of hepatitis B in England and Wales: national surveillance.

The results of a voluntary programme of immunisation against hepatitis B in neonates at high risk (mother being positive for hepatitis B surface antigen and without hepatitis B e antibody or having had acute hepatitis B late in pregnancy) are reported. The programme was offered in England and Wales from November 1982. Passive immunisation alone was available in the first six months of life until 1985, after which infants received passive and active immunisation from birth; in addition, some infants received passive immunisation for six months followed by a course of hepatitis B vaccine. All but a few infants received the first immunising dose within 48 hours after birth. Blood samples for analysing markers of hepatitis B virus were available at 1 year from 147 of the 223 infants given passive immunisation, 54 of the 72 given passive followed by active immunisation, and 102 of the 155 given passive and active immunisation at birth. At 1 year 11 of the 127 (9%) infants given four or more doses of specific hepatitis B immunoglobulin were positive for hepatitis B surface antigen compared with four of the 20 given three or fewer doses; 11 had levels of hepatitis B surface antibody greater than 50 IU/l. Only one of the 54 infants given passive then active immunisation was positive for hepatitis B surface antigen at 1 year and four infants had low (less than or equal to 50 IU/l) levels of hepatitis B surface antibody. Four of the 102 infants who received passive and active immunisation at birth were positive for hepatitis B surface antigen. Two had received the fill course of vaccine, whereas in the other two vaccination was incomplete or unstated. In 79 of the 89 infants who received a complete course of vaccination the level of hepatitis B surface antibody was known, and 70 had levels at 1 year greater than 100 IU/1. Reactions to immunisation were not severe at any age. The incidence of side effects was 8% for the immunoglobulin, 11% for the vaccine, and 9% when immunoglobulin and vaccine were given together. Wider collaboration in the programme is requested.

Prevalence of antibody to human T lymphotropic virus type III by risk group and area, United Kingdom 1978-84.

Antibody to human T lymphotropic virus type III (anti-HTLV-III) was sought in 2150 patients in three groups at risk with a radioimmunoassay and an immunofluorescence test. Results by the two methods were closely concordant. Anti-HTLV-III was already present in some British homosexuals in 1980 and in some British haemophiliacs in 1981, and since then its prevalence has increased. Of homosexual patients needing laboratory tests for hepatitis B virus infection in 1984, 34% of 282 in London and 5% of 955 in five centres outside London were positive for anti-HTLV-III. Of haemophiliacs sampled in 1984, 38% of 81 were anti-HTLV-III positive. Most of the seropositive haemophiliacs were regular recipients of commercial factor VIII concentrates. Few British intravenous drug abusers sampled in 1984 (2.5% of 203) were positive for anti-HTLV-III. These results show that infection with HTLV-III has rapidly become widespread among homosexuals attending sexually transmitted disease clinics and among haemophiliacs receiving pooled blood products. Thus, while many anti-HTLV-III positive individuals may remain asymptomatic, there may soon be a considerable increase in the incidence of the acquired immune deficiency syndrome and related disease in Britain.

Enzyme-linked immunosorbent assay (ELISA) for the detection of hepatitis Be antigen and antibody: report of a field trial.

A field trial of an enzyme-linked immunosorbent assay (ELISA) for the detection of the hepatitis Be markers is reported. It is simple to perform, is designed to be read by eye and does not require any expensive apparatus. When compared with a commercially available RIA kit for the detection of the same markers, ELISA was shown to be as sensitive as RIA for the detection of anti-HBe but slightly less sensitive for the detection of HBeAg. However if all specimens negative for both HBeAg and anti-HBe by ELISA are considered to be potentially infectious, the ELISA should prove to be as useful as RIA for determining the "e" status of HBsAg-positive patients and, therefore, provide a reliable indication of the risk of secondary spread of hepatitis B infection to contacts by needle stick accident, close personal contact or perinatal transmission.

Acute hepatitis: significance of antibody to hepatitis B core antigen.

The value of testing for core antibody (anti HBc) in acute hepatitis was assessed in 503 patients. All hepatitis B surface antigen (HBsAg) positive patients tested were also anti HBc positive. Of the 110 HBsAg negative, anti HBc positive patients, 32 were found to have surface antibody, indicating previous infection with hepatitis B virus (HBV). Of the remaining 78 patients in whom anti HBc alone was detectable, follow-up specimens were received from 28 and, of these, 21 were then found to be anti HBc negative. Thus in acute hepatitis non-specific transient reactions to core antigen may appear, and the presence of anti HBc alone cannot be considered adequate evidence for a diagnosis of HBV infection.

Commercial factor VIII associated hepatitis, 1974-75, in the United Kingdom: a retrospective survey.

A retrospective survey of transfusion hepatitis associated with a brand of commercial Factor VIII was carried out in 24 Haemophilia Centres from January 1974 until December 1975. Of 371 patients who were transfused with this product, and were followed up, 78 cases of hepatitis affecting 66 patients were found (17.7%). Two types of hepatitis were observed: hepatitis B and non-B hepatitis, the latter with an incubation period of between 8 and 60 days. Twelve patients contracted two types of hepatitis, non-B followed by hepatitis B. Only one patient died after contracting hepatitis B. Four of the suspect batches of concentrate were found to be positive for HBsAg by radioimmunoassay. There was evidence that the presence of hepatitis B surface antibody in a patient's serum prior to exposure was associated with immunity to hepatitis B. Evidence was presented suggesting that the non-B hepatitis observed was not due to hepatitis A. The factors affecting the incidence of transfusion hepatitis in haemophiliacs were discussed.

Laboratory diagnosis of EB virus infection in some cases presenting as hepatitis.

In 1975 and 1976, 7580 serum specimens were tested for HBsAg by the passive haemagglutination test, Hepanosticon. Serum from 38 people gave a positive result after absorption with the absorbent provided, but the presence of HBsAg could not be confirmed by other tests. Tests for current infection with EB virus, namely, the presence of heterophil antibody and EB virus specific IgM, were performed and were positive in 11 of the 38. In six of these the clinical picture was of hepatitis rather than infectious mononucleosis.