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UNRECOGNISED SPREAD OF HEPATITIS-B ANTIGEN
259 HEPATITIS-B ANTIGEN IN MOSQUITOES SlR,—It was interesting to read the paper1 by Dr Prince and his co-workers on the detection of hepatitis-B antigen (Australia antigen) in mosquito homogenates. We allowed a volunteer (a man of 38) to be bitten by a number of mosquitoes (Aedes aegypti). The mosquitoes were then killed on successive days and tested for hepatitisB antigen in the homogenate by immunodiffusion and counter-electrophoresis methods. We could detect the antigen by immunodiffusion for 2 days and by counterelectrophoresis for 7 days after the bite. Perhaps the high concentration of antigen in our subject made it detectable by relatively insensitive methods. Hepatitis-B antigen could not be detected in the fa:ces of the mosquitoes throughout the test period. Further studies with separated anatomical parts of A. agypti are in progress. Division of Experimental Medicine, KHIN MAUNG TIN Department of Medical Research, S. SEBASTIAN 5 Zafar Shah Road, AYE KYAW. Rangoon, Burma.
UNRECOGNISED SPREAD OF HEPATITIS-B ANTIGEN
SIR,-From October, 1971,
to
March, 1972,
we
sought
for hepatitis-B antigen and antibody in a rural community, among whom tattooing and drug abuse were unknown. Among 1984 sera from adults, hepatitis-B antigen was detected in 25 by immune adherence h2emagglutination.1 Hepatitis-B antibody was found in 398 (20%) by passive haemagglutination.3 Follow-up revealed that 8 became negative within three months. Among them antibody was detected in 1. Only 1 had had a blood-transfusion or other
serum-protein derivatives.
NHBAb
identified by an indirect immunofluorescent technique (I.F.T.) 6 The antigenic substrate for this test was cryostat liver sections obtained at necropsy from a chronic HBAg carrier. The nuclei of hepatocytes in this substrate were previously shown to contain abundant HBAg material by direct immunofluorescence; and virus-like particles (20-24 nm. diameter) were identified. In the patients with A.V.H., serum samples were collected during the first week of overt disease. The c.H. patients were children with clinical symptoms for more than six months. Of the 200 patients with A.V.H., 191 (95-5%) were negative for both HBAg and NHBAb. The remaining 9 patients (4-5 %) were positive for NHBAb; 6 of them were also positive for HBAg. Of the 50 patients with c.H., 11 who were negative for HBAg were excluded from this study because of the presence in sera of antinuclear antibodies which made detection of NHBAb by I.F.T. impossible. In the remaining 39 patients, HBAg was found in 27 (69%) and NHBAb in all 39. This preliminary evidence indicates that about 95% of cases of A.V.H. in children are not related xtiologically to hepatitis virus type-B infection. Conversely, virtually all cases of C.H. in children seem to be related to type-B infection. These findings point to the validity of testing the sera of children with c.H. for both HBAg and NHBAb, the latter apparently being the most reliable serological sign of infection with hepatitis type B virus. was
Department of Immunopathology, State Institute of Hygiene, Warsaw 36, 00-791. Department of Infectious Diseases of Children, Medical Academy in Warsaw 10-201.
Department of Diseases of
This winter the survey was repeated and 1404 persons were re-examined. 10 new B-antigen-positive individuals were found. Serum-glutaminic-oxalacetic-transaminase levels were normal in all, including those who had B antigen constantly throughout the study and those who had B antigen transiently. These findings suggest that about 0-8% of the population were B-antigen carriers and 0-4% or more became antigen positive in turn. The rate may vary from area to area. Icteric hepatitis may be rather exceptional in this
Children, Medical Academy in Wroclaw. Children’s Infectious Diseases
Hospital no. 3, Warsaw 00-825, Poland.
W. J. BRZOSKO B. E. MIKULSKA. R. BIEDRZYCKA K. ROSZKOWSKA.
Z. RUDKOWSKI C. RABENDA. H. OZIEMSKA-LOZINSKA R. DEBSKI.
FENESTRATED TRACHEOSTOMY TUBES
SIR,—The advantages of tube with
an
a fenestrated tracheostomy expiratory valve are well recognised, especially
community. Reports have suggested the spread of hepatitis-B antigen via saliva, urine, and fseces, and by insects. There was no epidemic of hepatitis here. Saku Central Hospital, Minamisaku Usuda,
Nagano, Japan. Jichi Medical School, Minamikochi, Tochigi, Japan.
KIMIO FUJITA SHIGENOBU TERASHIMA. MAKOTO MAYUMI.
HEPATITIS B IN CHILDREN
SIR,-In an attempt to determine the type of hepatitis virus responsible for acute viral hepatitis (A.V.H.) and chronic hepatitis (c.H.) in children, we examined 200 cases of A.V.H. and 50 cases of C.H. for the presence in sera of
hepatitis-B antigen (HBAg) and anti-HBAg antibody specificity (NHBAg).4 HBAg was detected by immunoelectroosmophoresis.5
of " nuclear" 1.
2. 3. 4. 5.
Prince, A. M., Metselaar, D., Kafuko, G. W., Mukwaya, L. G., Ling, C. M., Overby, L. R. Lancet, 1972, ii, 247. Mayumi, M., Okochi, K., Nishioka, K. Vox sang. 1971, 20, 178. Vyas, G. N., Shulman, N. R. Science, 1970, 170, 332. Brzosko, W. J., Madaliński, K., Krawczyński, K., Skwarska, H., Nowostawski, A. J. infect. Dis. 1971, 123, 251. Prince, A. M., Burke, K. Science, 1970, 169, 593.
for the treatment of neonates and infants. The silver fenestrated tracheostomy tubes such as the Alder Hey pattern (Down Bros. Mayer and Phelps Ltd., Mitcham, 6. Brzosko, W. J., Madaliński, K., J. infect. Dis. (in the press).
Krawczyński, K., Nowostawski, A.
UNRECOGNISED SPREAD OF HEPATITIS-B ANTIGEN
SIR,-From October, 1971,
to
March, 1972,
we
sought
for hepatitis-B antigen and antibody in a rural community, among whom tattooing and drug abuse were unknown. Among 1984 sera from adults, hepatitis-B antigen was detected in 25 by immune adherence h2emagglutination.1 Hepatitis-B antibody was found in 398 (20%) by passive haemagglutination.3 Follow-up revealed that 8 became negative within three months. Among them antibody was detected in 1. Only 1 had had a blood-transfusion or other
serum-protein derivatives.
NHBAb
identified by an indirect immunofluorescent technique (I.F.T.) 6 The antigenic substrate for this test was cryostat liver sections obtained at necropsy from a chronic HBAg carrier. The nuclei of hepatocytes in this substrate were previously shown to contain abundant HBAg material by direct immunofluorescence; and virus-like particles (20-24 nm. diameter) were identified. In the patients with A.V.H., serum samples were collected during the first week of overt disease. The c.H. patients were children with clinical symptoms for more than six months. Of the 200 patients with A.V.H., 191 (95-5%) were negative for both HBAg and NHBAb. The remaining 9 patients (4-5 %) were positive for NHBAb; 6 of them were also positive for HBAg. Of the 50 patients with c.H., 11 who were negative for HBAg were excluded from this study because of the presence in sera of antinuclear antibodies which made detection of NHBAb by I.F.T. impossible. In the remaining 39 patients, HBAg was found in 27 (69%) and NHBAb in all 39. This preliminary evidence indicates that about 95% of cases of A.V.H. in children are not related xtiologically to hepatitis virus type-B infection. Conversely, virtually all cases of C.H. in children seem to be related to type-B infection. These findings point to the validity of testing the sera of children with c.H. for both HBAg and NHBAb, the latter apparently being the most reliable serological sign of infection with hepatitis type B virus. was
Department of Immunopathology, State Institute of Hygiene, Warsaw 36, 00-791. Department of Infectious Diseases of Children, Medical Academy in Warsaw 10-201.
Department of Diseases of
This winter the survey was repeated and 1404 persons were re-examined. 10 new B-antigen-positive individuals were found. Serum-glutaminic-oxalacetic-transaminase levels were normal in all, including those who had B antigen constantly throughout the study and those who had B antigen transiently. These findings suggest that about 0-8% of the population were B-antigen carriers and 0-4% or more became antigen positive in turn. The rate may vary from area to area. Icteric hepatitis may be rather exceptional in this
Children, Medical Academy in Wroclaw. Children’s Infectious Diseases
Hospital no. 3, Warsaw 00-825, Poland.
W. J. BRZOSKO B. E. MIKULSKA. R. BIEDRZYCKA K. ROSZKOWSKA.
Z. RUDKOWSKI C. RABENDA. H. OZIEMSKA-LOZINSKA R. DEBSKI.
FENESTRATED TRACHEOSTOMY TUBES
SIR,—The advantages of tube with
an
a fenestrated tracheostomy expiratory valve are well recognised, especially
community. Reports have suggested the spread of hepatitis-B antigen via saliva, urine, and fseces, and by insects. There was no epidemic of hepatitis here. Saku Central Hospital, Minamisaku Usuda,
Nagano, Japan. Jichi Medical School, Minamikochi, Tochigi, Japan.
KIMIO FUJITA SHIGENOBU TERASHIMA. MAKOTO MAYUMI.
HEPATITIS B IN CHILDREN
SIR,-In an attempt to determine the type of hepatitis virus responsible for acute viral hepatitis (A.V.H.) and chronic hepatitis (c.H.) in children, we examined 200 cases of A.V.H. and 50 cases of C.H. for the presence in sera of
hepatitis-B antigen (HBAg) and anti-HBAg antibody specificity (NHBAg).4 HBAg was detected by immunoelectroosmophoresis.5
of " nuclear" 1.
2. 3. 4. 5.
Prince, A. M., Metselaar, D., Kafuko, G. W., Mukwaya, L. G., Ling, C. M., Overby, L. R. Lancet, 1972, ii, 247. Mayumi, M., Okochi, K., Nishioka, K. Vox sang. 1971, 20, 178. Vyas, G. N., Shulman, N. R. Science, 1970, 170, 332. Brzosko, W. J., Madaliński, K., Krawczyński, K., Skwarska, H., Nowostawski, A. J. infect. Dis. 1971, 123, 251. Prince, A. M., Burke, K. Science, 1970, 169, 593.
for the treatment of neonates and infants. The silver fenestrated tracheostomy tubes such as the Alder Hey pattern (Down Bros. Mayer and Phelps Ltd., Mitcham, 6. Brzosko, W. J., Madaliński, K., J. infect. Dis. (in the press).
Krawczyński, K., Nowostawski, A.