Letter: Salivary HBAg detected by radioimmunoassay

Risk of transmission of the human immunodeficiency virus to health care workers exposed to HIV-infected patients: a review

The possibility of transmission of the human immunodeficiency virus (HIV) to health care workers with occupational exposure to infected patients has caused concern since the beginning of the AIDS crisis. This report summarizes both national surveillance data for AIDS among health care workers and the results of prospective studies on the risk of HIV transmission in the health care professions. All the available evidence indicates that HIV infection in health care workers in the United States results primarily from exposure outside the health care setting, and is acquired by one of the conventional routes of transmission. A small number of health care workers have been infected with HIV through occupational exposure. Prospective surveillance studies indicate that the risk of seroconversion after needlestick exposure to HIV-infected blood is about 0.5%. The level of risk associated with exposure of mucous membranes or nonintact skin is far less.

Low occupational risk of human immunodeficiency virus infection among dental professionals

We studied 1309 dental professionals (1132 dentists, 131 hygienists, and 46 assistants) without behavioral risk factors for the acquired immunodeficiency syndrome (AIDS) to determine their occupational risk for infection with human immunodeficiency virus (HIV). Subjects completed questionnaires on behavior; type, duration, and location of their dental practice; infection-control practices; and estimated numbers of potential occupational exposures to HIV. Serum samples were tested for antibodies to HIV and to hepatitis B surface antigen (unvaccinated subjects). Fifty-one percent of the subjects practiced in locations where many cases of AIDS have been reported. Seventy-two percent treated patients who had AIDS or were at increased risk for it. Ninety-four percent reported accidental puncturing of the skin with instruments used in treating patients. Adherence to recommended infection-control practices was infrequent. Twenty-one percent of unvaccinated subjects had antibodies to hepatitis B surface antigen. Only one dentist without a history of behavioral risk factors for AIDS had serum antibodies to HIV. We conclude that despite infrequent compliance with recommended infection-control precautions, frequent occupational exposure to persons at increased risk for HIV infection, and frequent accidental puncturing of the skin with sharp instruments, dental professionals are at low occupational risk for HIV infection.

Epidemiologic study of hepatitis B in pregnant Korean women

The positive rates of hepatitis B viral markers according to many epidemiologic factors were analyzed in 2,873 pregnant women who delivered at St. Columban’s Hospital in Mokpo City from April 1st, 1985 to March 31st, 1986.

The following results were obtained: The overall HBsAg positivity in all pregnant women was 8.3%. The positive rate of HBsAg was unrelated to age. It was 13.2% in the 11–20 year age group. 12.5% in the 31–40 year age group, 7.8% in the 21–30 year age group and 0.0% in the 41–50 year age group. The positive rate of HBsAg was slightly related to locality. It was a little higher in women who grew up in rural areas (8.6%) than in urban areas (7.7%). The positive rate of HBsAg was unrelated to educational background. The positive rate of HBsAg was unrelated to economic status. It was 8.7% in the highest income group and 8.6% in the lowest income group. The positive rate of HBsAg was higher in cases who had injections more than four times. The positive rate of HBsAg was higher, but not significantly, in cases who had received blood transfusion. The positive rate of HBsAg was higher, but not significantly, in cases who had more than three siblings (0.05

Collapse

Localization of hepatitis B surface antigen in the human parotid gland

Localization of hepatitis B surface antigen (HBsAg) and hepatitis B core antigen (HBcAg) in the human parotid gland and liver was studied by an immunohistochemical method in four cases with seropositive HBsAg. Neither HBsAg nor HBcAg could be detected in the parenchymal cells of the parotid gland in any of the cases. However, one of four cases, which had the highest titer of serum HBsAg, showed HBsAg immunoreactivity in the vascular wall and luminal fluid of the parotid gland. In liver, HBsAg was detected in three and HBcAg in two of the four cases, respectively. HBsAg was localized in the cytoplasm of hepatocytes, while HBcAg was localized mainly in their nuclei. The detection of HBsAg in the parotid gland and liver was correlated with the serum titer of the antigen. The results indicate that the HB virus does not have an affinity for or a replicate in the parotid gland. Also, it is suggested that the HBsAg found in saliva is derived from HBsAg circulating through the oral mucosa by capillary leakage and not from secretion into the mouth by the salivary gland.

Origin of salivary hepatitis B surface antigen

Low titers of hepatitis B surface antigen (HBsAg) is often found in mixed saliva of antigenemic individuals. In the present study the occurrence of antigen in saliva was correlated to the content of albumin, which is not synthesized by the salivary glands, but represents a leakage into the oral cavity due to hemorrhage, exudation or transudation. The presence of antigen in saliva was also correlated to the titer of antigen in serum.

Hepatitis. A review of the disease and its significance to dentistry

The report is a review of the literature related to hepatitis B and its implications for dental practitioners. Hepatitis B represents a serious health risk among dentists and simple preventive measures can greatly reduce the risk of transmission or contraction of the disease. Certain positive findings in a healthy history should alert the dentist that he may be treating a carrier of hepatitis B. If so, the wearing of gloves, a mask and protective eyewear will almost totally protect one from contracting the disease. To guard against transmission of hepatitis B to other patients in the dental practice, all instruments should be sterilized and all environmental surfaces should be appropriately treated. A person with a confirmed exposure to hepatitis B should be inoculated with immune serum globulin.

Salivary HBsAg in hepatitis B infection

Hepatitis B surface antigen (HBsAg) was detected by solid phase radioimmunoassay (RIA) in mixed saliva of 15 out of 50 antigenemic patients. The salivary antigen was present in low titers for a short period of time in the acute stage of illness. Occult blood was detected in most mixed saliva samples. In parotid saliva neither HBsAg nor occult blood was found. Salivary HBsAg is probably due to admixture of blood or exudate.

[Spread of hepatitis B virus infection among family contacts of asymptomatic HBsAg carriers (author's transl)]

Family members of 34 asymptomatic HBsAg carriers were tested for different hepatitis B virus (HBV) markers. Among 67 family members tested 24 (36%) presented signs of a past or ongoing HBV-infection. Spread of HBV-infection was particularly high in those families in which the HBsAg carrier was positive for HBeAg and Dane particle-associated DNA polymerase activity. Non-parenteral "horizontal" transmission of HBV among spouses and brothers and sisters and probably parenteral vertical transmission of HBV from carrier mothers to their infants occurred in approximately the same frequency. Fathers transmitted HBV unfrequently to their offsprings. The results show that the risk to acquire a HBV-infection from an asymptomatic HBsAg carrier is closely linked to the serological findings in the HBe/anti-HBe-system of the index HBsAg carrier and not to the family relationship to the HBsAg carrier.

Dane particles and associated DNA-polymerase activity in saliva of chronic hepatitis B carriers

To investigate furhter the problem of salivary transmission of type B hepatitis, salivas free of blood contamination from three HBsAg-positive carriers with chronic active hepatitis were examined by CsCl equilibrium density gradients and electron microscopy (EM). In the CsCl gradient HBsAg of whole salivas distributed in a band centered at 1.19gm/cm3 with a clearly defined shoulder at 1.24 gm/cm3; the HBsAg was found mainly in the mucous component. On EM examination, fractions from the 1.19 gm/cm3 peak contained spherical HBsAg particles of 22 +/- 3 nm diameter, whereas in the 1.24 gm/cm3 shoulder Dane particles 43 nm in diameter with 28 nm cores were found. Specific hepatitis B virus associated DNA-polymerase activity also was found in the 1.24 gm/cm3 shoulder where the Dane particles occurred and was absent from the saliva of healthy controls. When salivas were incubated for three hours at 37 degrees C the total amount of HBsAg diminished and the 1.24 gm/cm3 shoulder disappeared, probably as a result of endogenous degradation of the Dane particles and the free HBsAg. These findings clearly indicate that the hepatitis B viral particle is present in the saliva of chronic HBsAg carriers with active disease and further confirm that saliva is an important vehicle of infection.

Detection of hepatitis B surface antigen in the saliva of patients with acute hepatitis B, and of chronic carriers

Hepatitis B surface antigen was detected by radioimmunoassay in the saliva of 11 of 25 patients with hepatitis B, for periods of up to 23 days after the onset of illness. It was also detected in the saliva of three of five chronic carriers. The presence of this antigen in the saliva may be an important factor in non-parenteral transmission of hepatitis B.

Hepatitis-B: a review

The recent literature on various aspects of hepatitis-B is reviewed with emphasis on the interrelationships of viral structure, antigenic components, and host immune response in acute, chronic, and asymptomatic carrier states of the infection. The mode of replication and mechanisms of transmission are discussed. Special attention is paid to potential non-parenteral routes of spread. The role of hepatitis-B in associated immune complex diseases and in hepatoma is outlined. A guide to the interpretation of serologic tests for hepatitis-B associated antigen and antibody patterns is presented in relation to the clinical stage and prognosis of the infection. Therapy, except in conceptual terms, is not covered but a summary of the current status of active and passive immunization is given. The unresolved question of the infectivity of carrier medical staff for their patient contacts, and the reverse, is discussed.