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MENSTRUAL BLOOD AS A VEHICLE OF AUSTRALIA-ANTIGEN TRANSMISSION
749 suggests that children have a much higher chance of being infected by their mothers than by other members of their
Hypothesis
family.
MENSTRUAL BLOOD AS A VEHICLE OF AUSTRALIA-ANTIGEN TRANSMISSION SCOTT MAZZUR Institute for Cancer Research, 7701 Burholme Avenue, Fox Chase,
Philadelphia, Pennsylvania 19111, U.S.A. It is
suggested that
some infectious be transmitted agents may by menstrual blood. These agents would be expected to have a prolonged blood phase, to produce relatively unaffected carriers, to be infectious by oral, parenteral, or venereal routes, to be transmitted by transfusion, to exhibit a clustering around women carriers, and to vary in frequency in different cultures. Australia antigen has all of these characteristics and may be transmitted by menstrual blood.
Sum ary
6. The frequency of carriers and disease should vary in different cultures.-The frequency of symptom-free carriers varies sharply between different cultures. The frequency of carriers in the non-hospital population of the United States and Northern Europe is 0-1%. In Asia it ranges from 0-5% in Japan to 6-2% in Vietnam." However, in certain Melanesian societies in the Pacific the frequency can be as high as 24-9% in Lau or Maliatia our as low as 1-9% in New Caledonia.
I suggest that menstrual transmission is one of several transmission routes which are involved in the spread of Australia antigen and probably contributes to the observed maternal effect. If this idea is correct, menstrual transmission would be directly related to the frequency of carriers of Australia antigen.
3. The agent should be infectious by oral, parenteral, or venereal routes.-Material containing Australia antigen is infectious by both oral and parenteral routes.33
Australia-antigen transmission could serve as a model for the study of menstrual transmission. In addition to hepatitis, other diseases might be expected to travel by this route. These include blood-borne such as agents cytomegalic inclusion virus, monoand nucleosis, syphilis. Animal cancer viruses such as mouse leukaemia, mouse mammary tumour, and avian lymphomatosis viruses persist in the blood of infected animals.1O If there are human cancer viruses analogous to these animal cancer viruses, they might be transmitted by the menstrual route. Repeated early exposure of infants to these agents and/or Australia antigen by the menstrual route may help to establish a carrier state. Assuming that menstrual discharge is infectious, the effectiveness of this route of transmission would be extremely sensitive to manipulation by cultural factors. Culturally conditioned behaviour surrounding the phenomenon of menstruation varies considerably in different cultures and is regulated by taboos about food preparation, child care, and sexual contact. These taboos probably modify the transmission of agents by the menstrual route and may themselves be a subconscious adaptation to disease. This possible route of disease transmission should be investigated by a study of family interactions in cultures with different attitudes to menstruation.
4. The agent should be transmitted by transfusion.Hepatitis is transmitted by transfusion of blood which contains Australia antigen.4 5. Infections caused by such an agent should cluster round
This work was supported by United States Public Health Service grants CA-06551, CA-06927, and RR-05539 from the National Institutes of Health and an appropriation from the Commonwealth of Pennsylvania.
MENSTRUAL blood may be a vehicle for the transmission of blood-borne diseases in general and of Australia antigen in particular. The following are characteristics which would be expected of an infectious agent capable of being transmitted by the menstrual route:
1. The agent should have a prolonged blood phase.Australia antigen is found in the blood of patients with acute viral hepatitis for from one day to several months.1 However, symptom-free carriers may carry the antigen for 2 up to 20 years. 2. The agent should produce relatively unaffected carriers.Symptom-free carriers of Australia antigen who do not
have
other underlying diseases are clinically well and carrier state can only be detected by testing their blood. some
healthy. The
?1)omen
carriers.-10 of 26 infants born
to women
who had
Australia-antigen-positive hepatitis during pregnancy or within six months of delivery developed the antigen in their own blood, although they were clinically symptom-free.5 In genetic studies in Cebu, the Philippines, Italy, and several places in the Solomon Islands, a maternal effect was observed. Children born into families in which the mother was the chronic carrier of Australia antigen were much more likely to become carriers themselves than children born into families in which the father carried the antigen (P== 0-55 x 10-1°).° Sera were collected from children with Australia antigen from Bougainville (Solomon Islands) who were members of families in which more than one person carried the antigen. All of these sera were examined for Australia-antigen subtypes. The children had the same subtype as their mothers more commonly than they had the same subtype as their fathers (P= 0-006).’ This
REFERENCES
London, W. T., Sutnick, A. I., Blumberg, B. S. Ann. intern. Med. 1969, 70, 55. 2. Zuckerman, A. J., Taylor, P. E. Nature, 1969, 223, 81. 3. Krugman, S., Giles, J. P. J. Am. med. Ass. 1970, 212, 1019. 4. Gocke, D. J., Greenberg, H. B., Kavey, N. B. ibid. 1970, 212, 1.
877.
Schweitzer, I. L., Wing, A., McPeak, A., Spears, R. L. ibid. 1972, 220, 1092. 6. Blumberg, B. S. in Hepatitis and Blood Transfusion (edited by G. N. Vyas, H. A. Perkins, and R. Schmid); p. 63. New York,
5.
1972.
Mazzur, S., Blumberg, B. S. Unpublished. Blumberg, B. S., Sutnick, A. I., London, W. T., Millman, I. C.R.C. Crit. Rev. clin. Lab. Sci. 1971, 2, 473. 9. Mazzur, S., Falker, D., Blumberg, B. S. Unpublished. 10. Gross, L. Oncogenic Viruses; pp. 195, 248, 393. New York, 7. 8.
1970.
Hypothesis
family.
MENSTRUAL BLOOD AS A VEHICLE OF AUSTRALIA-ANTIGEN TRANSMISSION SCOTT MAZZUR Institute for Cancer Research, 7701 Burholme Avenue, Fox Chase,
Philadelphia, Pennsylvania 19111, U.S.A. It is
suggested that
some infectious be transmitted agents may by menstrual blood. These agents would be expected to have a prolonged blood phase, to produce relatively unaffected carriers, to be infectious by oral, parenteral, or venereal routes, to be transmitted by transfusion, to exhibit a clustering around women carriers, and to vary in frequency in different cultures. Australia antigen has all of these characteristics and may be transmitted by menstrual blood.
Sum ary
6. The frequency of carriers and disease should vary in different cultures.-The frequency of symptom-free carriers varies sharply between different cultures. The frequency of carriers in the non-hospital population of the United States and Northern Europe is 0-1%. In Asia it ranges from 0-5% in Japan to 6-2% in Vietnam." However, in certain Melanesian societies in the Pacific the frequency can be as high as 24-9% in Lau or Maliatia our as low as 1-9% in New Caledonia.
I suggest that menstrual transmission is one of several transmission routes which are involved in the spread of Australia antigen and probably contributes to the observed maternal effect. If this idea is correct, menstrual transmission would be directly related to the frequency of carriers of Australia antigen.
3. The agent should be infectious by oral, parenteral, or venereal routes.-Material containing Australia antigen is infectious by both oral and parenteral routes.33
Australia-antigen transmission could serve as a model for the study of menstrual transmission. In addition to hepatitis, other diseases might be expected to travel by this route. These include blood-borne such as agents cytomegalic inclusion virus, monoand nucleosis, syphilis. Animal cancer viruses such as mouse leukaemia, mouse mammary tumour, and avian lymphomatosis viruses persist in the blood of infected animals.1O If there are human cancer viruses analogous to these animal cancer viruses, they might be transmitted by the menstrual route. Repeated early exposure of infants to these agents and/or Australia antigen by the menstrual route may help to establish a carrier state. Assuming that menstrual discharge is infectious, the effectiveness of this route of transmission would be extremely sensitive to manipulation by cultural factors. Culturally conditioned behaviour surrounding the phenomenon of menstruation varies considerably in different cultures and is regulated by taboos about food preparation, child care, and sexual contact. These taboos probably modify the transmission of agents by the menstrual route and may themselves be a subconscious adaptation to disease. This possible route of disease transmission should be investigated by a study of family interactions in cultures with different attitudes to menstruation.
4. The agent should be transmitted by transfusion.Hepatitis is transmitted by transfusion of blood which contains Australia antigen.4 5. Infections caused by such an agent should cluster round
This work was supported by United States Public Health Service grants CA-06551, CA-06927, and RR-05539 from the National Institutes of Health and an appropriation from the Commonwealth of Pennsylvania.
MENSTRUAL blood may be a vehicle for the transmission of blood-borne diseases in general and of Australia antigen in particular. The following are characteristics which would be expected of an infectious agent capable of being transmitted by the menstrual route:
1. The agent should have a prolonged blood phase.Australia antigen is found in the blood of patients with acute viral hepatitis for from one day to several months.1 However, symptom-free carriers may carry the antigen for 2 up to 20 years. 2. The agent should produce relatively unaffected carriers.Symptom-free carriers of Australia antigen who do not
have
other underlying diseases are clinically well and carrier state can only be detected by testing their blood. some
healthy. The
?1)omen
carriers.-10 of 26 infants born
to women
who had
Australia-antigen-positive hepatitis during pregnancy or within six months of delivery developed the antigen in their own blood, although they were clinically symptom-free.5 In genetic studies in Cebu, the Philippines, Italy, and several places in the Solomon Islands, a maternal effect was observed. Children born into families in which the mother was the chronic carrier of Australia antigen were much more likely to become carriers themselves than children born into families in which the father carried the antigen (P== 0-55 x 10-1°).° Sera were collected from children with Australia antigen from Bougainville (Solomon Islands) who were members of families in which more than one person carried the antigen. All of these sera were examined for Australia-antigen subtypes. The children had the same subtype as their mothers more commonly than they had the same subtype as their fathers (P= 0-006).’ This
REFERENCES
London, W. T., Sutnick, A. I., Blumberg, B. S. Ann. intern. Med. 1969, 70, 55. 2. Zuckerman, A. J., Taylor, P. E. Nature, 1969, 223, 81. 3. Krugman, S., Giles, J. P. J. Am. med. Ass. 1970, 212, 1019. 4. Gocke, D. J., Greenberg, H. B., Kavey, N. B. ibid. 1970, 212, 1.
877.
Schweitzer, I. L., Wing, A., McPeak, A., Spears, R. L. ibid. 1972, 220, 1092. 6. Blumberg, B. S. in Hepatitis and Blood Transfusion (edited by G. N. Vyas, H. A. Perkins, and R. Schmid); p. 63. New York,
5.
1972.
Mazzur, S., Blumberg, B. S. Unpublished. Blumberg, B. S., Sutnick, A. I., London, W. T., Millman, I. C.R.C. Crit. Rev. clin. Lab. Sci. 1971, 2, 473. 9. Mazzur, S., Falker, D., Blumberg, B. S. Unpublished. 10. Gross, L. Oncogenic Viruses; pp. 195, 248, 393. New York, 7. 8.
1970.