Safety and immunogenicity of hepatitis A vaccine in infants: a candidate for inclusion in the childhood vaccination programme

Forty-eight infants received a single dose (720 ELISA units = 0.5 ml) of inactivated hepatitis A vaccine at the fifth month of age with booster at the 11th month of age, together with the second and third doses of the vaccines compulsory under Italian law (diphtheria, tetanus, oral polio and hepatitis B). Overall, the seroconversion rate was 100%. The anti-HAV geometric mean titre (GMT) reached 3,021 mIU/ml in infants born to anti-HAV-negative mothers, but only 399 mIU/ml in infants born to anti-HAV-positive mothers. Hepatitis A vaccine was immunogenic, safe and well tolerated without significant side-effects. There seems to be no reason for not including it in childhood vaccination programmes particularly in low endemic HAV areas.

Persistence of anti-HBs in children vaccinated against viral hepatitis B in the first year of life: follow-up at 5 and 10 years

The persistence of anti-HBs protective levels in groups of children who had been immunized against Hepatitis B 5 and 10 years earlier, in their first year of life, has been studied. The results were analyzed according to the type of vaccine (both plasma-derived and DNA recombinant) and the number of doses administered (three or four doses). In addition, the protective effect of the vaccine in vaccinated subjects was studied in relation to the anti-HBc presence. The serologic results suggest that, in cohorts of children vaccinated 5 years earlier, a higher prevalence of subjects with anti-HBs protective levels was found, when the DNA recombinant vaccines were administered (97.6% for MSD Recombivax and 97.1% for SKF Engerix B); a lower one when the plasma-derived vaccine was used (80.4% Pasteur Merieux, Hevac B). Moreover, in cohorts of children vaccinated with plasma derived vaccine (hevac B) 10 years earlier, a higher prevalence of subjects with anti-HBs protective levels was demonstrated when four doses were administered (76.9%); a lower one when three doses were inoculated (57.5%). The absence of core antibody (anti-HBc) in responders to the vaccination shows the protective efficacy of both the DNA recombinant and plasma derived vaccines. On the other hand the presence of anti-HBc in some anti-HBs negative non-responders subjects shows the susceptibility of these people to infection. In anti-HBs negative vaccinated subjects the appearance of levels of anti-HBs in 95.9% of subjects, 1 week after the administration of a booster dose, demonstrates the presence of a solid immunologic memory.

Effective antibody response in newborn babies living in Maldives to simultaneous vaccination against hepatitis B, poliomyelitis, diphtheria and tetanus

The antibody responses of Maldivian infants early in their life to simultaneous immunization against hepatitis B virus, poliomyelitis, diphtheria and tetanus were investigated. The vaccines were given at 6, 10 and 14 weeks of age. Among 243 newborn babies from HBsAg-negative mothers, 103 received three doses of oral poliomyelitis (OPV) and diphtheria and tetanus (DTV) vaccines; 105 were similarly immunized but received in addition the recombinant hepatitis B vaccine (HBV); 35 were immunized with the HBV recombinant vaccine alone. The antibody response to all of the vaccines was effective. No significant differences among the groups were observed. Hepatitis B vaccination of infants neither affected nor was affected by the contemporary administration of OPV and DTV vaccines.

Detection of hepatitis C virus-RNA by polymerase chain reaction in dental surgeries

The mean prevalence of anti-hepatitis C virus (HCV) in Italy is 0.87%. It reaches 2% in Campania, Southern Italy. Approximately 50% of community acquired non-A, non-B (NANB) hepatitis cannot be associated with known parenteral exposure. A recent Italian study has shown that the only demonstrable risk factor in 9% of acute C/NANB hepatitis is dental treatment. There are no data on direct contamination by HCV of dental surgeries. Possible environmental contamination by HCV-RNA was investigated in dental surgeries after treatment of anti-HCV and HCV-RNA positive patients. Thirty-five anti-HCV and HCV-RNA positive patients with chronic hepatitis underwent dental treatment and were enrolled in this study. Eight had chronic persistent hepatitis (CPH), 23 chronic active hepatitis (CAH), and 4 cirrhosis. A total of 328 samples collected from instruments and surfaces were tested after dental treatment of 35 anti-HCV positive patients. The presence of HCV-RNA was determined by polymerase chain reaction (PCR) to evaluate contamination of instruments and surfaces in dental surgeries. Twenty (6.1%) out of 328 collected samples were positive for HCV-RNA. The positive samples were from work benches (two), air turbine handpieces (one), holders (four), suction units (one), forceps (four), dental mirrors (two), and burs (six). Our data indicate that there is extensive contamination by HCV of dental surgeries after treatment of anti-HCV patients and that if sterilisation and disinfection are inadequate there is the possible risk of transmission to susceptible individuals.

HCV-RNA survival as detected by PCR in the environment

We have shown that HCV-RNA is resistant to drying at room temperature for at least 48 hours. This is a factor which could influence the diffusion of the virus in the general population, which epidemiological studies have shown to be surprisingly high. It should be considered in evaluating the importance of the inapparent parenteral routes of transmission.

Blood in saliva of patients with acquired immunodeficiency syndrome: possible implication in sexual transmission of the disease

The presence and concentration of haemoglobin in saliva of anti-human immunodeficiency virus (HIV) positive subjects, anti-HIV-negative subjects at high risk of infection, and healthy controls were studied. One hundred eighty-eight subjects were anti-HIV-positive intravenous drug abusers (IVDA), 22 were anti-HIV-positive homosexual men, 23 were anti-HIV-positive heterosexual contacts, 132 were anti-HIV-negative IVDA, 35 were anti-HIV-negative homosexual men, and 154 were healthy controls. Two milliliters of saliva was collected in the morning before brushing teeth, and the presence and the concentration of haemoglobin were determined. Based on hemoglobin, the data show that the anti-HIV-positive IVDA have the highest tendency to bleeding. The difference between this group with respect to anti-HIV-negative IVDA (P < 0.05) and compared with healthy controls (P < 0.01) is statistically significant. This is also true of anti-HIV-positive heterosexual contacts with respect to healthy controls (P < 0.01). Our data show that all at-risk groups, both anti-HIV positive and anti-HIV negative, have higher haemoglobin concentration than the control group; this difference reaches statistical significance only between anti-HIV-positive IVDA and controls (P < 0.01). The concentration of haemoglobin is significantly higher in subjects with CD4+ lymphocytes < 200/mm3 compared to subjects with CD4+ lymphocytes > 200/mm3 (P < 0.01), in subjects with AIDS-related complex (ARC)/AIDS compared to asymptomatic/PGL subjects (P < 0.01), and in subjects with stomatitis compared to subjects without stomatitis (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Demonstration of the interchangeability of 2 types of recombinant anti-hepatitis-B vaccine]

A vaccination cycle cannot always be completed with the same type of vaccine with which it was initiated because the same type of vaccine is not always available at the vaccination centers. For this reason we have verified the possibility of substituting one of two anti hepatitis B DNA-recombinant vaccines [Engerix B (SK&F); Recombivax HB (MSD)] both available in Italy in the vaccination protocol. A study was performed on 480 subjects using both types of DNA recombinant vaccine and on 160 using only one type of vaccine. Our data show that there is no difference in immunogenic potency of the two DNA recombinant vaccines available in Italy and that a cycle begun with one vaccine can be completed with the other with no effect on the percentage of seroconversion or the mean anti-HBs titre.

[Adaptability of the anti-hepatitis-B vaccine Recombivax HB to the Piazza protocol for the mass vaccination of newborn infants]

27 healthy babies born to HBsAg, antiHBs and antiHBc negative mothers were given three doses of hepatitis B vaccine "Recombivax HB" (5 micrograms/dose/0.5 ml) at 3, 5 and 11 months of age (Piazza's protocol). AntiHBs response was highly satisfactory. Since both in terms of seroconversion rate and of mean antiHBs titre immunogenicity of other hepatitis B vaccines given at 3, 5 and 11 months of age was already demonstrated, it is possible to conclude that Piazza's protocol is valid for all hepatitis B vaccines available in Italy and will certainly facilitate the compulsory hepatitis B vaccination in infants in Italy.

A pilot model of vaccination against hepatitis B virus suitable for mass vaccination campaigns in hyperendemic areas

A hepatitis B vaccination campaign was carried out in a town of 60,000 inhabitants, Afragola, Campania, Italy, a hyperendemic area for hepatitis B where HBsAg prevalence was 13.4% and anti-HBc prevalence was 64.7%. This experimental pilot project aimed to reduce the incidence of both acute and asymptomatic viral hepatitis B and of related chronic liver complications. From 1983-1989, 8,400 subjects were vaccinated: 6,900 children up to 10 years of age and 1,500 subjects from 11-60 years of age. High seroconversion rates were observed: 99.0% in all children under one year of age, 96.0% in the older children, and 86.7% in adults. The rate of infection in Afragola has diminished from 63/100,000 in 1983 to 10/100,000 in 1989. Carriers of HBsAg decreased in the general population (7.3% compared to 13.4%), especially in children up to 10 years of age (1.0% compared to 9.0%). In babies who received hepatitis B vaccine at the same time as compulsory vaccinations compliance was 98% while it was 80% in babies who were vaccinated separately. In June 1991 the Italian Parliament promulgated a decree which imposes hepatitis B vaccination for all newborn babies at 3, 5, and 11 months of age, at the same times as the mandatory childhood vaccinations (diphtheria, tetanus, and polio) according to a new protocol (Piazza scheme) which has been in use since January 1987 in our pilot vaccination campaign in Afragola.

Blood in saliva of HIV seropositive drug abusers: possible implication in AIDS transmission

We have studied hemoglobin concentration in saliva of anti-HIV positive and anti-HIV negative intravenous drug abusers (IVDA) and normal controls and the relationship between hemoglobin concentration in saliva and number of CD4+ cells and clinical status of AIDS in anti-HIV positive IVDA. 120 anti-HIV positive IVDA, 112 anti-HIV negative IVDA and 116 normal healthy subjects not belonging to any risk group for HIV infection completed the study. Saliva was collected at awakening before brushing teeth and the concentration of hemoglobin was determined. Hemoglobin concentration in saliva in basal conditions is higher in anti-HIV positive IVDA with respect to anti-HIV negative IVDA (p less than 0.05) and controls (p less than 0.01). In anti-HIV positive IVDA hemoglobin concentration in saliva is higher in subjects with CD4+ cells less than 200/10(6) l with respect to subjects with CD4+ greater than 200/10(6) l (p less than 0.05) and in subjects with ARC/AIDS with respect to subjects with PGL or who are asymptomatic (p less than 0.01). Subjects with ARC/AIDS have a mean concentration of hemoglobin of 19 micrograms/0.1 ml saliva (range 0-153) which corresponds to 1.3 microliters of blood/ml saliva. If 10 ml of saliva are exchanged during kissing an average of 13 microliters of blood are transferred (110 microliters of whole blood at extreme range). Blood of symptomatic patients has an HIV titer of 7 TCID/microliters which for 10 ml saliva containing an average of 1.3 microliters blood/ml saliva corresponds to an average of 90 TCID (770 TCID at the extreme range).(ABSTRACT TRUNCATED AT 250 WORDS)

A modified immunisation schedule for the hepatitis B vaccine Recombivax HB suitable for mass vaccination in childhood

Following the demonstration of a fully satisfactory immunogenic activity of a hepatitis B vaccination protocol consisting of three doses of Hevac B Pasteur vaccine given at 3,5 and 11 months of age, it was possible to administer this vaccine at the same times as the vaccinations for diphtheria, tetanus and polio which are mandatory in Italy at those ages. We have also shown that both another plasma-derived vaccine, H-B-VAX (MSD), as well as the DNA-recombinant Engerix B (SK&F) are highly immunogenic when given at the same times as the mandatory childhood vaccinations. In this paper we demonstrate that the same schedule can be used for another hepatitis B vaccine prepared by a DNA-recombinant technique, Recombivax HB (MSD) recently introduced in Italy. In fact two doses of this vaccine, the first given at three months of age and the second two months later, resulted in a 100% seroconversion rate and a mean anti-HBs titre of 440 mUI/ml. Although the date are incomplete since the third dose will be given at 11 months of age, we conclude that this hepatitis B vaccine can also be used in the mass vaccination campaigns of infants in Italy, the first of which was initiated in January 1987 in an hyperendemic area near Naples (HBsAg prevalence about 14%). We underline that this mass vaccination campaign is the first in Europe.

Immunogenicity of a DNA-recombinant hepatitis B vaccine (Engerix B) given at 3, 5 and 11 months of age with a new schedule suitable for mass vaccination programmes

Following the demonstration of a fully satisfactory immunogenic activity of a hepatitis B vaccination protocol consisting of three doses given at the 3rd and 5th months of age with a booster at 11, it was possible to administer this vaccine at the same times as the vaccinations for diphtheria, tetanus and polio which are mandatory in Italy at those ages. A field trial of this protocol in a hyperendemic area near Naples (prevalence of HBsAg about 14%) started on January 1987. The French vaccine, Hevac B, Pasteur, was used. At this time compliance is 99%, and fully satisfactory results both in terms of seroconversion rate (96.3%) and of mean anti-HBs titre (4,352 mIU/ml) two months after the booster dose have been obtained. In this paper we demonstrate that even for a new hepatitis B vaccine prepared by a DNA-recombinant technique (Engerix B, SK & F) recently introduced in Italy, the same schedule can be used. In fact two doses of this vaccine, the first given at three months of age and the second two months later, resulted in a 100% seroconversion rate and a mean anti-HBs titre of 560 mIU/ml. Two months after the booster given at 11 months of age the mean anti-HBs titre was 12,100.

[From a randomized assay, Francisella turned out to be epidemiologically present in the studied areas]

In the past Tularemia has largely affected animals, nowadays' in our country it could become actual one more because of wild animals repopulation actuated in many areas. Unlike the other countries, in Italy it's not well known if there are any consequences on population. The authors has conducted a research on this subject studying seroimmunologically samples taken randomly in some areas of south-central Italy. Their results confirm endemism and therefore announce the problem and the consequent pathology.

[Randomized epidemiologic assay of Campylobacter infections in various areas of central-south Italy]

The authors on the basic of the diffusion of pediatric and gastroenterological pathologies in Italy, have conducted a research on the epidemiology diffusion of Campylobacter infection analyzing seroimmunologically sample randomly chosen and coming from some areas of central-south Italy. Their results confirm that in such areas the infection is endemic therefore they hypothesize that enteric vascular, bacterial pathologies and spontaneous abortions are related with it.

Hepatitis B immunisation with a reduced number of doses in newborn babies and children

74 healthy babies born to mothers positive for hepatitis B surface antigen (HBsAg) were randomly divided at birth to receive either HB immunoglobulin and 2 doses of HB vaccine 2 months apart, or HB immunoglobulin and 3 doses of HB vaccine 1 month apart. 80 healthy babies born to HBsAg, anti-HBs, and anti-HB core (c) negative mothers were randomly divided at birth to receive either 2 doses of vaccine 2 months apart or 3 doses 1 month apart. The seroconversion rates and the geometric means of anti-HBs titres were lower in both groups of babies given 2 doses of vaccine than in the groups given 3 doses. 60 pairs of children at risk, aged 1 to 12 years and HBsAg, anti-HBs, and anti-HBc negative, were randomly divided to receive either the 2-dose regimen or the 3-dose regimen. The seroconversion rates and the geometric means of anti-HBs titres were satisfactory in both groups.

Presence of delta antigen in liver biopsies of HBsAg positive patients with chronic liver diseases living in the Naples area

In a study of the presence of delta-Ag in liver biopsies of HBsAg positive patients with chronic liver diseases living in the Naples area, delta-Ag has been found only in patients with HBsAg positive chronic active hepatitis and in none of HBsAg positive patients with other liver diseases including those with chronic persistent hepatitis. The data obtained support the hypothesis that the simultaneous infection with HBV and delta-agent, and superinfection with delta-agent in HBsAg positive patients predispose the outcome of chronic hepatitis.

[Aspecificity of the immunodiffusion reaction for the diagnosis of non-A non-B viral hepatitis]

A precipitating antigen-antibody system was detected by immunodiffusion using acute and convalescent sera from patients with non-A, non-B (NANB) viral hepatitis in which the diagnosis was made by exclusion. The system showed identity with reference sera. Positivity for antigen was found in 5 out 13 patients with acute NANB hepatitis, but also in 3 out 8 patients with acute A hepatitis, in 6 out of 15 with acute B hepatitis and in 95 out of 221 voluntary blood donors. Antibody was detected in all the above mentioned categories of patients and also in normal subjects in percentages ranging from 9.1 to 25.0 percent. The lack of specificity observed is in contrast with results of other reported serological NANB related systems.

[Effect of heroin administration on MHV-3 virus experimental hepatitis in mice]

Administration of heroin (5mg/Kg/day) in mice for a period of time sufficient to induce dependence and continued during the experiment did not increase susceptibility to MHV-3 virus infection, did not cause more serious forms of hepatitis and did not increase mortality with respect to the controls.

[Effect of the administration of Cardiostenol on experimental hepatitis in mice induced with MHV-3 virus]

Treatment with Cardiostenol (commercial name of a pharmaceutical product containing morphine chloridrate+atropine+sparteine) does not modify the course of hepatitis in mice infected with MHV-3 virus. Similar results were previously obtained by treatment with morphine chloridrate alone.

[Greater concentration of anti-hepatitis B antibodies (anti-HBs) in specific hyperimmune human gamma globulins (non-anti-hepatitis B) as compared with normal human gamma globulins]

Twenty-seven lots of standard immunoglobulin from 5 different producers and 18 lots of specific immunoglobulin (non anti-Hepatitis B) were titrated by RIA test for anti-HBs content. The highest titre in lots of standard IG (1:40) was lower than the lowest titre of the lots of specific IG (non anti-Hepatitis B) (1:44). The difference between means (1:17 and 1:42) was statistically significant (p less then 0,01). The reasons for the difference are discussed.

[Homologous and heterologous antibody response induced in man by anti-influenza vaccine containing A/England/42/72 and b/Massachusetts/71]

In november 1973, 43 subjects living in a home for aged were given one dose of influenza vaccine, containing A/England/42/72 and B/Massachusetts/71. After 4 and 20 weeks, sera were tested for antibody contentto the homologous and to A/port Chalmers/1/73 viruses by haemoagglutination inhibition technique. Control group included 23 untreated subjects. The satisfactory increase in the anti-A/England/42/72 antibodies induced by vaccine indicated a good antigenic potency of the A component. The satisfactory cross-reacting response suggests that the "drift" in antigenic content between A England/42/72 and A/Port Chalmers/1/73 was moderate. On the contrary the increase in anti-B/Massachusetts/71 antibodies after vaccination was observed only in a limited number of cases. Twelve subjects (9 treated and 3 controls) experienced upper respiratory tract infections which appeared to be not related to infuenza viruses.