Hepatitis B vaccination of blood donors--a cost-benefit analysis

In an analysis comparing the costs of hepatitis B vaccination for blood donors versus the preventable expenses for post-transfusion hepatitis B (PTH-B), the price of a vaccine dose, the duration of protection, the number of components transfused per blood donation, the incidence of symptomatic PTH-B, and the costs induced by the different courses of hepatitis B infection are included as relevant factors. It is concluded that universal hepatitis B immunization of blood donors is desirable to ensure a safer blood supply and is already today cost-effective for repeat donors.

Accelerated Schedule for Hepatitis B Immunization

Background: A considerable number of people remain unprotected against hepatitis B. These people may require immunization at short notice before being exposed to situations or locations where a risk of infection is present. Currently, full active immunization against hepatitis B, when administered according to recommended schedules, takes 2-6 months. This open, randomized multicentric study evaluated the reactogenicity and immunogenicity of a recombinant hepatitis B vaccine in adults when it was administered according to three different rapid vaccination schedules. Methods: Five hundred and twenty four healthy adults (aged 18-59 years) were randomly divided into three groups. Hepatitis B vaccine was given intramuscularly in the deltoid muscle at months 0, 1, and 2 (group A); weeks 0, 14, and 28 (group B); and weeks 0, 7, and 21 (group C). Symptoms were recorded by the subjects on individual diary cards. AntiHBs were measured using radioimmunoassay (Ausab-Abbott); a seroprotective titer was defined as 10 IU/L. Results: At day 28, no significant difference in seroprotection rates (SPRs) i.e., seroconversion >= 10 IU/L,was observed, between groups B (55.6%) and C (65.2%), but both these groups had significantly greater SPRs than group A (15.0%). Although not significant (p=.07), groups B and C also had higher SPRs than group A (78.5% and 76.4% versus 65%) at day 56. One month after completing the three dose schedules, the SPRs were as follows: 89.0% (group A); 78.5% (group B); and 76.4% (group C), increasing to > 94% at month 7 to 8 in all three groups. The SPRs at month 13 were 95.8%, 98.9%, and 98.6%, respectively. Among the three groups, no significant differences were observed from month 2 onwards in either SPRs or geometric mean titers. In groups A, B, and C, 3.7%, 5.0%, and 7.1% of the vaccine injections were associated with local symptoms. Also 8.3%, 6.2%, and 6.3% of subjects exhibited general symptoms following each vaccine dose; all symptoms were transient and resolved spontaneously. Conclusions: This recombinant hepatitis B vaccine administered at weeks 0, 7, 21, or at weeks 0, 14, 28, rapidly elicits high rates of seroprotection, which persist at least until month 12.

Quantification of hepatitis B vaccine-induced antibodies as a predictor of anti-HBs persistence

Hepatitis B vaccine-induced antibodies (anti-HBs) were quantified in 35 subjects (study group) and in an additional 24-59 subjects (controls) during a period of 82 months after vaccination against hepatitis B and the values used as a basis to develop a logarithmic formula to describe the post-booster antibody kinetics. The actual anti-HBs titres are shown to be proportional to the peak titre one month post-booster but inversely proportional to the number of months between the time of booster and of retesting. Using this model and an anti-HBs quantification more than a month post-booster, the individual persistence of vaccine-induced anti-HBs antibodies can be calculated.

Anti-HBs antibody kinetics--a 4-year follow-up after hepatitis B vaccination

To describe anti-HBs kinetics after hepatitis B vaccination, a logarithmic function was established using anti-HBs determinations in sera drawn from 97 to 147 vaccinees at 5 times during a 4 year follow-up period. A comparison with 2 published mathematical models showed that the logarithmic formula was less complex, and computed values correlated better with real anti-HBs titres.

Reactogenicity and immunogenicity of three different lots of a hepatitis A vaccine

To study the immunogenicity and reactogenicity of an inactivated hepatitis A vaccine, 204 healthy individuals were randomized into three equal groups, each to receive a different vaccine lot. Each subject received a total of three doses, each of 720 ELISA units of hepatitis A vaccine HM175, according to a 0 and 1 month primary vaccination schedule, with a booster dose given at month 6. Side effects were low and were < 30% after the second injection. All subjects but one had antibodies to hepatitis A virus two months after the first dose of vaccine. At month 6 all vaccinees had seroconverted. There were no differences between the three vaccine lots with respect to side effects, seroconversion rates and geometric mean titre of antibodies. We conclude that the three lots of inactivated hepatitis A vaccine are safe, well tolerated and equally immunogenic.

Enumeration of T, B and natural killer peripheral blood cells of patients with multiple sclerosis and controls

The median percentages of peripheral blood immunoglobulin-positive (Ig+) lymphocytes (8%, n = 46), CD8+ (12%, n = 49) and CD57+ cell numbers (5%, n = 37) of patients suffering from multiple sclerosis (MS) were significantly (p less than 0.05) lower than the values of age- and sex-matched healthy individuals (Ig+ cells: 13%, n = 46; CD8+ cells: 17%, n = 49; CD57+ cells: 9%, n = 37). Comparison of calculations on decreased peripheral blood cell counts and increased brain cell counts in MS patients revealed that sequestration of blood cells into the MS brain is a possible explanation of these findings.

Immunogenicity, reactogenicity and consistency of a new, inactivated hepatitis A vaccine--a randomized multicentre study with three consecutive vaccine lots

We investigated immunogenicity, reactogenicity and consistency of three consecutive lots of an inactivated hepatitis A vaccine in 204 seronegative volunteers. Each volunteer received a total of three doses of vaccine (720 EIU) according to a 0, 1 month primary vaccination schedule with a booster dose given at month 6. Mild, moderate and mostly local side effects were reported in 49.7% after the first and in less than 30% after the third injection. Seroconversion rate after one vaccine dose was as high as 91%. All subjects but one had already seroconverted by 1 month after the second injection, corresponding to a seroconversion rate of 99%. The geometric mean titres (GMT) increased with each dose of vaccine administered. Our results show that this inactivated hepatitis A vaccine is highly immunogenic, safe and well tolerated. Furthermore, there were no significant differences between the three vaccine lots in respect to seroconversion rate, size of antibody titre or reactogenicity.

Kinetics of anti-HBs after hepatitis B vaccination: a comparison of two recombinant and one plasma-derived vaccines

Geometric mean titers were determined for three groups of medical students who had been vaccinated against hepatitis B with two different yeast-derived recombinant vaccines and one plasma-derived vaccine. The antibody kinetics for the three groups were similar over a period of 4 years. A formula for prediction of titers from the post-booster anti-HBs concentration is provided.

Persistence of antibodies after immunization with a recombinant yeast-derived hepatitis B vaccine following two different schedules

Four years after vaccination of healthy adults with either a recombinant yeast-derived (YDV) or plasma-derived (PDV) hepatitis B vaccine, the persistence of antibodies to hepatitis B surface antigen (anti-HBs) was examined. Subjects received three 20 micrograms doses in the deltoid region according to either a 0, 1, 6 month or 0, 1, 2 month vaccination schedule, with a 20 micrograms booster dose of YDV administered at month 12 for subjects on the second schedule. The recombinant vaccine was found to be immunologically comparable to the PDV, with anti-HBs persisting equally in both groups.

The immunomodulatory potency of cimetidine in healthy volunteers

The effect of cimetidine, a histamine H2 receptor antagonist, was investigated in 12 healthy volunteers over a period of six weeks. Cimetidine was administered orally in a daily doses of 1,600 mg during the first three weeks of evaluation. Significant alterations in values of immunoglobulins (IgG, IgA), complement (C3), B-lymphocytes and T-helper cell counts were found after cimetidine intake. The in vitro lymphocyte proliferation response to plant mitogens was increased. In contrast to results obtained from a previous study with healthy volunteers who were given 800 mg cimetidine, we found no significant increase in the CD4/CD8 ratio and no decrease in the CD8 but a significant increase in the CD4 cell count. Whereas the peripheral blood immune system showed signs of immune system activation following 800 and 1,600 mg cimetidine intake, reactivity patterns of skin immune system, however, differed in both studies. The data suggests that cimetidine has a dose and time dependent effect on the immune system.

Persistence of antibodies following vaccination with a yeast-derived recombinant hepatitis B vaccine

The persistence of anti-HBs antibodies elicited in response to vaccination with a recombinant yeast-derived hepatitis B vaccine was examined. Three years after vaccination following two different schedules (0, 1, 6 months and 0, 1, 2, 12 months), anti-HBs antibody titres obtained after vaccination with the yeast-derived vaccine were similar to those observed using a plasma-derived vaccine. At this time, nearly 100% of all vaccinees had anti-HBs antibody titres over the protective limit of 10 mIU ml-1. These results suggest that the yeast-derived vaccine will confer protection against hepatitis B infection for about the same length of time as the plasma-derived vaccine.

Immunomodulatory properties of cimetidine in ARC patients

The immunomodulatory potency of cimetidine, a histamine H2 receptor antagonist, was investigated in 33 AIDS-related complex (ARC) patients performing detailed immunological and clinical evaluations. Cimetidine was administered orally in daily doses of 1200 mg for a period of 5 months with an interruption of therapy after the first 3 months for an interval of 3 weeks. Significant (P less than 0.05) elevations of immunoglobulins (IgG, IgA), complement C4, B-lymphocytes, and OKT4+ (helper/inducer) cells were found after cimetidine intake. The in vitro lymphocyte proliferative response to plant mitogens was significantly increased, and the in vivo cell-mediated hypersensitivity reaction assessed by intradermal application of seven recall antigens improved significantly. These effects were both reversible with the discontinuation of cimetidine and reproducible with repeated administration of the drug. Clinical data such as performance status, body weight, and fever were influenced favorably (P less than 0.05) by cimetidine. The frequency of diarrhea and the lymph node size were also diminished significantly. The data suggest that cimetidine may at least partially restore immunofunctions in AIDS-related complex.

Age-associated T-lymphocyte activation through mitogens in patients with multiple sclerosis and blood donors

In 128 patients with multiple sclerosis (MS) and 204 blood donors (control persons) the in vitro activation of 'Ficoll-purified' peripheral blood T lymphocytes was measured using the 3H-thymidine incorporation rate without (spontaneous proliferation) and with mitogen addition (concanavalin A, phytohemagglutinin). Mitogen responsiveness in control persons and MS patients decreased with age, reflecting a T-lymphocyte inherent mechanism for the diminution of responsiveness. The MS patients, ranging in age between 20 and 30 years, showed decreased mitogen responsiveness and a tendency to increased spontaneous proliferation compared to the control persons. These results could be an expression of a viral infection.

Intrathecal production of HIV antibodies in suspected AIDS encephalopathy

Thirty-one serum and CSF samples from 21 HIV-antibody-positive patients with neurological deficits were examined to prove or exclude intrathecal production of HIV antibodies. By dilution, sera were adjusted to the IgG concentration of the corresponding CSF samples. Both samples were then serially diluted in log2 steps down to the detection limit and were tested in an anti-HIV ELISA. From the dilution obtained at the cut-off level, a quotient QHIV was derived as an indicator of intrathecal production of HIV antibodies. Six of a total of eight samples with a QHIV value of greater than or equal to 2 were correlated which the clinical diagnosis of AIDS-related dementia complex (ARDC). However, a QHIV less than 1 did not exclude the development of ARDC, as was shown during follow-up in one case. Different methods are compared for the determination of intrathecal production of IgG and anti-HIV. A quotient QHIV greater than or equal to 2 is suggested to be highly indicative of intrathecal production of anti-HIV as well as of the development of ARDC.

Adult respiratory distress syndrome as a specific manifestation of a general permeability defect in trauma patients

To establish whether a general dysfunction, i.e., an increase in permeability, had occurred in 16 trauma patients (6 with adult respiratory distress syndrome [ARDS]), we measured beta 2-microglobulin (beta 2MG), myoglobin (MG), immunoglobulin G (IgG), and transferrin (TF) concentrations in bronchoalveolar lavage fluid (BAL), serum, and urine as well as extravascular lung water content (EVLW) over a period of 14 days. Our results show a positive correlation (p = 0.03) between increases of EVLW, reflecting lung edema, and beta 2MG concentrations in urine of all patients with ARDS, indicating systemically increased permeability. Generalized increase of permeability can also explain the elevation of MG urine concentrations (p = 0.03) together with an EVLW increase, and an increase of BAL protein concentrations (IgG, TF, p less than 0.01) in the early post-trauma phase during the first 48 h after admission. In contrast, commonly used kidney function tests remained unchanged over the time course of 14 days.

Multicentre dose range study of a yeast-derived hepatitis B vaccine

Healthy young adult volunteers, 778 in number, without HBV markers were randomly distributed into groups and administered different lots of a yeast-derived hepatitis B vaccine (YDV) at different dose levels or a commercial plasma-derived vaccine (PDV), according to a 0, 1, 2, 12-month vaccination schedule. The YDV proved to be safe and well tolerated, even when partly purified lots were given. Reactions were mild and transient, comparable to those observed after PDV. One month after three YDV doses, 0-7% of subjects overall had failed to seroconvert; all those evaluated one month after the booster dose had seroconverted. No significant difference was found between the two vaccine types as far as seroconversion rates were concerned. Geometric mean anti-HBs levels following three vaccine doses were higher in seroconverters of the PDV groups. However, a booster dose of YDV resulted in high anti-HBs levels in all groups varying from 11,474 to 51,404 IU l-1 (purified YDV lot), 4915 to 18,832 IU l-1 (partly purified YDV lots) and 11,008 to 15,805 IU l-1 (PDV lots). Of seroconverters to the purified lots of YDV 93% attained 1000 IU l-1 after the booster dose, thus ensuring protection for a number of years. Dose-response studies provided a basis for the selection of 20 micrograms of highly purified YDV as the standard dose.

Reactogenicity and immunogenicity of the newly developed purified chick embryo cell (PCEC)-rabies vaccine in man

Purified Chick Embryo Cell (PCEC) rabies vaccine was given to 88 healthy adults according to six different vaccination schedules. Local side effects were reported on reactivity forms after 16.4% of PCECV injections, general symptoms were recorded after 15.1% of the 292 doses administered. IgE antibodies specific for chicken proteins determined by the Radio Allergo Sorbens Test (RAST) could not be shown before and after the vaccinations. With no exception, all 88 vaccinees developed high titres of complement-fixing and neutralizing antibodies as determined by the Rapid Fluorescent Focus Inhibition Test and Serum Mouse Neutralization Test. For the first time, induction of serum interferon by PCEC rabies vaccine has been shown in man. In rabies vaccination, PCEC vaccine seems to be as effective as Human Diploid Cell Strain (HDCS) vaccine.

Relative and absolute numbers of human lymphocyte subpopulations. A comparison of immunofluorescence microscopy and flow cytometric methodologies with special reference to precision and reference values

Lymphocyte subpopulations were determined in blood samples from blood donors (40 women and 45 men) using immunofluorescence microscopy and flow cytometric methodologies. The study demonstrates the value of both methods for the enumeration of lymphocyte subpopulations. The advantages of employing an automated flow cytometer system are better precision and speed. The automated systems require a large initial technical and financial burden and are therefore probably destined to be reserved for the larger laboratory. There is a need for an adequate lymphocyte standard which shows little variation between aliquots and can be used for interlaboratory comparisons.

[Follow-up of immunological parameters and therapy of systemic lupus erythematosus]

In a longitudinal study of a female patient with systemic lupus erythematosus, we determined numbers of T-lymphocytes and subpopulations (OKT4+- and OKT8+-lymphocytes), B-lymphocytes, production of anti-double-stranded DNA antibody (anti-ds-DNA-Ab), and we investigated the effects of corticosteroids and cyclophosphamide on these parameters and clinical disease activity. The results demonstrate that an increase of OKT4+-T-lymphocytes/OKT8+-T-lymphocytes ratio apparently augments B-lymphocyte numbers resulting in anti-ds-DNA-Ab production. Whereas steroids exerted limited, possibly dose-dependent effects on this sequence, cyclophosphamide seemed to cause normalization of OKT4+/OKT8+ ratio, precipitous drop of anti-ds-DNA-Ab titers, and dramatic clinical improvement.

[Incidence of hepatitis B virus infection in the medical personnel of physicians' offices]

Serological examination to determine anti-HBc antibodies in 1487 medical personnel working with practitioners in Essen revealed a hepatitis B virus incidence rate of 12.8%. The incidence rate depended on age, years of service, and nature of duties. Anti-HBc examination of medical personnel is cost-saving in view of high cost of vaccination. It can be omitted only in beginners if certain conditions are fulfilled (anti-HBc rate below 5%).

Active hepatitis B immunization with an experimental German vaccine. IV. Reactogenicity studies in healthy adults and in hemodialysis patients

Reactogenicity testing was performed accompanying vaccination with the experimental German Hepatitis B Vaccine. 509 individuals, among them 343 healthy adults and 166 hemodialysis patients, were vaccinated with three doses of vaccine. The evaluation of questionnaires indicated that local and systemic adverse reactions were of low intensity and short duration. The rates of reactions were highest following the first and lowest after the third vaccination. The vaccine did not induce immunopathological alterations. The vaccine was non-infectious and thus not the cause of hepatitis B infections nor of other viral or bacterial infections.

Active hepatitis B immunization with an experimental German vaccine. I. Immunogenicity studies in healthy adults. II. The primary 19 S and 7 S responses to HBsAg in healthy adults. III. Immunogenicity studies in hemodialysis patients

The immunogenicity of an experimental german hepatitis B vaccine has been evaluated in 343 healthy adults. Three doses of vaccine induced anti-HBs antibodies in 94 to 100% of the vaccines. Different batches and doses of vaccine did not significantly influence the seroconversion rates at the end of the vaccine trial. Higher doses were followed by more rapidly and more vigorously occurring anti-HBs-levels. Significant differences were noticed between the 40 micrograms- und the 10- or 8 micrograms-doses. Variation of schedules (0-1-6 or 0-1-5) did not result in significant differences. Batch-no. I/B 070881 induced significant lower anti-HBs levels than batch-no. II/310781. Females developed significant higher anti-HBs values than males, younger vaccinees higher than older vaccinees. Rate zonal ultracentrifugation analysis of anti-HBs-positive sera collected after vaccination regularly revealed anti-HBs of the IgM class in case of early and high immune response to the vaccine. Individuals characterized by a late onset of anti-HBs production developed anti-HBs antibodies of the IgG class only. The vaccine induced an anti-HBs response in 64 to 75% of hemodialysis patients. The conversion rates and the achieved anti-HBs levels were significantly higher in young and/or female patients than in old and/or male patients.

[Demonstration and occurrence of IgM-type hepatitis A viral antibodies]

Hepatitis-A antibody of the IgM class can be demonstrated in serum by radio-immunoassay quickly, relatively cheaply and simply. The diagnosis of fresh or recent hepatitis-A virus infection can be made from a single serum sample in a single test. Epidemiological analysis of the positive findings obtained in 1981 gave the following results: 1. Hepatitis-A is, in Germany, largely a disease of young adults, with an average age of 24 years. But cases still occurred above the age of 50.2. Among foreigners positive results were obtained already in children (average age 7 years). 3. While in foreigners the disease predominantly occurred in the last four months of the year, among Germans the distribution had three peaks related causally to the holiday months of April, July and October.

Uptake and elimination of hepatitis B immunoglobulins after intramuscular application in man

Hepatitis B immunoglobulins of 4 different manufacturers were administered intramuscularly into 37 healthy adults. Each person received an amount of 0.1 ml per kg bodyweight. Blood samples were taken on days 3, 7, 14, 21, 28, 63, 98 and 126 after passive immunization. The anti-HBs serum levels were determined using the International Reference Preparation of anti-HBs as standard reagent. The highest serum levels were seen on day 3 (38.9% of the test persons), day 7 (41.7%), day 14 (11.1%), and day 21 (8.3%) after application of the immunoglobulins with mean values between 138 and 355 mU anti-HBs/ml. The half-life of the preparations in man showed mean values between 17.5 and 25 days. The shortest half-life was 5.9 and the longest 35 days. Four months after passive immunization the anti-HBs levels had decreased to a percentage of 1.2 to 2.5 of the maximum serum concentration (1.7 to 8.9 mU anti-HBs/ml). The passive immunization via the intramuscular route does not accomplish an instantaneously available, maximum anti-HBs titer. There seems to be a great range of variation in uptake and elimination of the immunoglobulins in man. Still, since preparations for intravenous application are not at hand, hepatitis B immunoglobulins for intramuscular use must play a major role in post-exposure prophylaxis of hepatitis B virus infection.

[Uptake and elimination of hepatitis B immunoglobulin after intramuscular administration]

After intramuscular administration of four different hepatitis B immunoglobulins at a dose of 0.1 ml/kg body weight, serum anti-HBs antibody titres were followed over four months in 37 healthy persons. Highest serum concentration averaged 138-355 mU anti-HBs/ml and was generally observed on the third or seventh day after passive immunisation. Immunoglobulins were eliminated with a half-life of 17.5-25 days. Four months after injections their concentration was still 1.2-2.5% of the maximally reached serum level. Intramuscular administration of hepatitis B immunoglobulin does not at once achieve effective optimal viral antibody levels in blood. But since there are no special preparations for intravenous use and active immunization is unlikely to be able to provide immediate protection against hepatitis B virus, intramuscular injection remains further on the method of choice in the prevention of hepatitis B after exposure.

[Passive immunization against hepatitis B: state of development, comments and recommendations for clinical use]

A review is given on recent developments in preexposure and postexposure prophylaxis for the prevention of hepatitis type B. The results of various clinical studies applying normal and special immunoglobulins are discussed. Recommendations are made especially for the clinical use of hepatitis B immunoglobulin in postexposure prophylaxis.

[Local and systemic antibody response after vaccination with 3 different types of vaccines against influenza I. Hemagglutinationinhibiting antibodies (author's transl)]

A comparative study on the formation of hemagglutination inhibiting antibodies after vaccination with 3 different types of Influenza Vaccines (Whole virion, Splitvirion, and Subunit type) was performed in adults and children. The study populations were homogeneous as regards age and pre-immunization antibody profile. The following results were obtained: 1) Strain specific conversion rates for the A component (A/Victoria/3/75 H3N2) were 77% with the whole virion vaccine, 79% with the Splitvirion vaccine and 91% with the Subunit vaccine. The antibody conversion factors calculated on the basis of the geometric mean titers (GMT) were 5.0, 6,7 and 9.0 respectively. A fourfold increase in titers was observed in 68% of vaccinees with the whole virion vaccine, in 55% of vaccinees with the Splitvirion vaccine, and in 70% of vaccinees with the Subunit vaccine. 2) Local antibody formation on the basis of conversion rates yielded values of 18% (whole virion), 22% (Splitvirion), and 28% (Subunit vaccine). 3) Systemic antibody responses revealed predominantly strain and subtype specificity as opposed to local antibody formation which was also directed towards older sybtypes. This phenomenon was more pronounced in adults than in children. 4) A significant correlation was found between the local antibody production and the concentration of hemagglutination inhibiting serum antibodies as well as between the IgA concentration in nasal wash fluid and the percentage of individuals exhibiting local antibody formation in the upper respiratory tract system. 5) In children 6-14 years of age the antibody conversion rates were found to be 91-100% for the A component with the 3 vaccines under study. The GMT for the respective vaccines A, B and S ranged from 1:170 over 1:139 to 1:211. 6) With regard to the induction of hemagglutination inhibiting antibodies to the B component of the vaccine (B/Hongkong/8/73) either vaccine proved to be of insufficinet potency. Though conversion rates of 6/ to 77% (60-90% in children) were observed the GMT range was only 1:17 to 1:21 (1:21 to 1:35 in children). Only 29 to 35% of the adults and about one half of the children developed antibodies of greater than or equal to 1:40 after vaccination. With regard to this observation it has to be discussed whether one shouldn't consider monovalent A vaccines for future use in influenza vaccination campaigns.

[Studies on human immunoglobulin preparations: II. Purity and composition (author's transl)]

16 human immunoglobulin preparations for intravenous and/or intramuscular use of 4 different manufacturers were tested with regard to their purity and composition. Anticomplementary activity was detected in preparations for i.m. application, but surprisingly also in some preparations for intravenous use, a fact which may possibly cause allergic or anaphylactic reactions. Besides IgG, which accounted for the main part of the protein content, small amounts of IgA, IgD, and IgM were found. IgE was detected in every batch studied. Some contained IgE-concentrations, usually seen in atopic persons.

[On the infectiousness of HBs-antigen-positive medical personnel (author's transl)]

Electronmicroscopic study of 29 HBs-antigen-positive personnel of a large hospital demonstrated virus material in the blood in all instances. In nine cases Dane particles, which are the infectious principle of the hepatitis B virus, were also seen. Dane-particle-positive personnel in a hospital could well be a risk to the patients if the carrier status or infectiousness of the person is not known.

High risk groups for hepatitis B virus infection in a university hospital staff as determined by detection of HB antigens, antibodies, and Dane particles

The prevalence of HBsAg and anti-HBs has been determined by solid-phase radioimmunoassay in 1815 university hospital employees and compared with the results obtained by investigating 131 metal workers and 86 laboratory technicians. Hospital personnel and here especially dialysis staff members and laboratory workers is at higher risk to acquire a hepatitis B virus infection than population compartments without contact to patients or blood. Electronmicroscopic studies revealed that a considerable number of the blood samples of HBsAg-positive staff members contained Dane-particles. These employees have to be considered infectious and possibly present a hazard to the patients they take care of.

[Risk of infection with hepatitis B virus in laboratory staff (author's transl)]

Considerable differences were discovered when 61 student technicians and 86 qualified laboratory staff were investigated for presence of hepatitis B (surface) antigen and hepatitis B (surface) antibodies in the blood. HBs antigen was not found in the trainees whereas 4.7% of the qualified personnel were HBs antigen positive. Anti-HBs could be demonstrated in 6.6% of the trainees and in 36.1% of qualified technicians. These data demonstrate the considerable risk of medical personnel from hepatitis B virus particularly in laboratories. For prophylaxis of virus hepatitis B in laboratory personnel special hygienic measures, routine blood investigations for HBs antigen and anti-HBs, the planned placing of anti-HBs positive personnel and the value of passive immunisation with anti-HBs immunoglobulins are stressed.

[Reactions to inactivated influenza vaccines (alorbat and begrivac s) (author's transl)]

Possible side effects to two commercial influenza vaccines (Alorbat and Begrivac S) were investigated in 893 adults (18-60 years). Both vaccines, administered by jet injections, were similarly tolerated. About 90% of vaccinated subjects had neither subjective nor objective reactions. Swelling or pain at the site of injection was reported by 11.5% of those vaccinated by Alorbat, 4.5% complained of not feeling well but only 1.1% had verifiable disorders. Local reactions occurred in 12.4% of those receiving Begrivac S, with 7.7% systemic reactions of which 1.1% were verifiable. Those re-vaccinated had a similar incidence of side reactions to those with primary vaccinations. Reactions which did occur were obviously due to the vaccination method. One person had urticaria and oedema, possibly due to reaction to foreign protein; this would suggest that the degree of purity of the vaccine should be checked by the manufacturers.

Neuraminidase antibodies in serum and nasal washings after immunization by means of live and killed whole virion, split virion and subunit (HA and N) influenza vaccines

Anti-neuraminidase antibody (ANAB) formation was determined in serum and nasal washing fluids pre- and post-vaccination in 278 adult healthy volunteers vaccinated with different types of current experimental and conventional influenza vaccines. The best systemic ANAB formation expressed as conversion rate (CR) was observed with the subunit vaccine "Sandovac" (CR = 90%) followed by the split virion vaccine "Begrivac S" (CR = 66%), the whole virion vaccine "Alorbat" (CR = 65%) and the live attenuated vaccine "Alice" (CR = 58%). The best local ANAB formation was obtained with live attenuated vaccines (CR = 47-50%) followed by "Begrivac S" (CR = 34%) and "Alorbat" (CR = 17%). The subunit vaccine, unfortunately, could not be tested for ANAB formation. On the basis of this data the optimal method of immunization against influenza would consist of simultaneous topical and parenteral application of live attenuated and inactivated subunit or split vaccine.

[Permeability of dialysis membranes for hepatitis-B virus: on the prophylaxis of hepatitis in a haemodialysis centre (author's transl)]

Dialysis fluids of two hepatitis-Bs (HBs) antigen-positive dialysis patients were tested for hepatitis-B virus. Total dialysate volume of 5.5 litres each - as obtained on haemodialysis with the Redy-recirculation system - was concentrated by ultrafiltration and trap and rate-zonal ultracentrifugation, followed by fractionation, and purified. Electron-microscopic evidence of permeability of an intact dialysis membrane for hepatitis-B was obtained. Concentration of hepatitis-B virus was at least 10(3) to 10(4) particles per total volume. Because of the potential infectiousness of the dialysis apparatus by effective heat sterilisation after every dialysis is essential.