Varicella zoster virus in health care workers in northern Israel: seroprevalence and predictive value of history of varicella infection

Health care workers (HCWs) are susceptible to hospital acquired varicella zoster virus (VZV). We evaluated seroprevalence and predictive value of a history of varicella disease (VD) with VZV serology in HCWs in northern Israel. A total of 200 HCWs were enrolled. A high rate of seropositivity for VZV-IgG was found: 98.5% seropositive and only 1.5% seronegative. A positive history of VD was an excellent predictor for the presence of VZV-IgG; however, a negative history of VD does not rule out the presence of VZV-IgG.     

Another case of human gnathostomiasis in Indonesia.

A male Gnathostoma spinigerum was removed from the abdominal wall of a 29-year-old woman, who was in the habit of eating "naniura", a dish containing raw carp (Cyprinus carpio). After the removal of the worm she still had pain in her chest and noticed intermittent swelling of her right lower arm. Probably the patient still had one or more Gnathostoma worms migrating in her body.     

Long-term seropositivity for human T-lymphotropic virus type III in homosexual men without the acquired immunodeficiency syndrome: development of immunologic and clinical abnormalities. A longitudinal study

The long-term effects of seropositivity for human T-lymphotropic virus type III (HTLV-III) on T-lymphocyte subsets and health status were evaluated in longitudinal studies of 250 initially healthy homosexual men. The relative risk of having an inverted T-lymphocyte helper-to-suppressor ratio rose from 14.3-fold among short-term seropositive subjects (less than 19 months) to 46.9-fold among long-term seropositive subjects (greater than 29 months) in comparison with the risk among seronegative subjects. Overall, 91.7% of long-term seropositive men had inverted ratios, compared with 12.9% of seronegative men. None of the seropositive men who developed an inverted ratio later reestablished a normal ratio. Both decreased T-helper cell number and percentage (p = 0.003) and increased T-suppressor cell number and percentage (p = 0.03) were significantly correlated with duration of seropositivity. Among seropositive persons, lymphadenopathy was a highly significant short-term as well as long-term consequence, whereas diarrhea, oral thrush, and herpes zoster were correlated with long-term seropositivity. Overall, 50% of long-term seropositive men compared with 16% of seronegative men developed at least one of five clinical symptoms (p less than 0.003). We conclude that a high proportion of persons infected with HTLV-III will develop measurable immunologic and clinical abnormalities.     

A comparative study of clinico-radiological spectrum of tuberculosis among HIV seropositive and HIV seronegative patients

BACKGROUND: A study to determine the prevalence of human immunodeficiency virus (HIV) infection among tuberculosis patients and to compare the clinico-radiological spectrum of tuberculosis among HIV seropositive and seronegative patients was carried out in the Department of TB and Chest Diseases, CSM Medical University, Lucknow (Uttar Pradesh), India. METHODS: A total of 1105 radiologically and/or bacteriologically confirmed patients of tuberculosis were screened for HIV infection during the years 1995 to 1997 and from 2000-2001. RESULTS: Out of a total 1105 patients screened, 31(2.8%) were found to be HIV seropositive. Tuberculin positivity was less among HIV seropositive patients as compared to HIV seronegative patients (22.6% vs 76.4%; p < 0.001). There was no statistically significant difference in sputum smear positivity for acid-fast bacilli (AFB) among HIV seropositive and seronegative patients. Among HIV seropositive patients, mid and lower zone involvement, exudative lesions and mediastinal lymphadenopathy was more common as compared to the seronegative patients. CONCLUSION: HIV seropositivity rates among tuberculosis patients was 2.8 percent. The presentation of tuberculosis was more often atypical among these patients.     

Clinicopathologic features of patients with hepatocellular carcinoma seropositive for alpha-fetoprotein-L3 and seronegative for des-gamma-carboxy prothrombin in comparison with those seropositive for des-gamma-carboxy prothrombin alone

BACKGROUND: There has been no study of the clinicopathologic features of patients with hepatocellular carcinoma (HCC) who are seropositive for lectin-reactive alpha-fetoprotein (AFP-L3) alone, or seropositive for AFP-L3 and seronegative for des-gamma-carboxy prothrombin (DCP) in comparison with those who are seropositive for DCP alone. Thus, the present comparative study was performed. METHODS: The clinicopathologic features of HCC patients with either one or two tumors who underwent a hepatectomy (n = 88) were compared among the following five groups according to the seropositivity of AFP, AFP-L3 and DCP: (i) group A, seropositive for AFP above 100 ng/mL, AFP-L3 above 15% and DCP above 100 mAU/mL; (ii) group B, seropositive for AFP-L3 and seronegative for DCP below 40 mAU/mL; (iii) group C, seronegative for AFP below 20 ng/mL, AFP-L3 below 15% and seropositive for DCP; (iv) group D, seropositive for AFP and seronegative for AFP-L3 and DCP; and (v) group E, seronegative for AFP, AFP-L3 and DCP. RESULTS: Group B patients showed a higher incidence of infiltrative-type HCC with an irregular margin (P < 0.05) and a higher frequency of poorly differentiated HCC (P < 0.01) compared with group C patients. Group A patients had larger tumors and more massive-type tumors than group B patients. Our HCC cases showed that advanced clinicopathologic features were demonstrated in the order of group B, group C and group D. Group A and B patients and group D and E patients showed similar characteristics. CONCLUSIONS: Hepatocellular carcinoma patients who were seropositive for AFP-L3 and seronegative for DCP demonstrated clinicopathologic features of more advanced HCC compared with those who were seropositive for DCP alone.     

Evaluation of staining techniques, antigen detection and nested PCR for the diagnosis of cryptosporidiosis in HIV seropositive and seronegative patients

The study was designed to determine the efficacy of modified Ziehl-Neelsen (ZN), safranine methylene blue (SM) staining, antigen detection ELISA and a nested PCR assay (specific for Cryptosporidium parvum) for detection of Cryptosporidium in HIV seropositive and seronegative patients with diarrhoea. Cryptosporidium was detected in 10 (4.9%), 9 (4.4%), 39 (18.9%) and 27 (13.1%) of 206 HIV seropositive and 7 (4.6%), 6 (3.9%), 21 (13.7%) and 17 (11.1%) of 153 HIV seronegative patients by ZN staining, SM staining, antigen detection ELISA and PCR, respectively. None of the 50 apparently healthy control subjects was found to be infected with Cryptosporidium by any of the techniques. Based on the criteria of 'true positive' samples positive by at least any two techniques out of ZN staining, antigen detection and PCR, sensitivity of ZN and SM staining techniques was 37% and 33.3% in HIV seropositive and 41.2% and 35.3% in seronegative patients, respectively. Sensitivity of antigen detection ELISA was 92.6% and 94.1% in HIV seropositive and seronegative patients, respectively, while sensitivity of PCR was 100% each in HIV seropositive and seronegative patients. Specificity of all three techniques, i.e. ZN, SM staining and PCR was 100% in both HIV seropositive and seronegative patients while specificity of antigen detection was 92.2% and 96.3% in HIV seropositive and seronegative patients, respectively. The staining techniques were found less sensitive as compared to antigen detection and PCR for detection of Cryptosporidium in HIV seropositive patients with CD4 count >200cells/microl.     

Duration and specificity of antibodies to hepatitis C virus in chronic active hepatitis.

To determine the duration and specificity of antibodies to hepatitis C virus in hepatitis B surface antigen-negative chronic active hepatitis, sera from 19 patients seropositive by enzyme immunoassay were assessed by recombinant immunoblot assay. Only 12 of the 19 patients were reactive by immunoblot assay (63%). Patients nonreactive by immunoblot assay had lower signal-cutoff ratios by enzyme immunoassay (1.3 +/- 0.2 vs. 6.5 +/- 0.1; P less than 0.05), higher serum immunoglobulin G levels (4082 +/- 301 vs. 1760 +/- 143 mg/dL; P less than 0.05), and higher serum gamma globulin levels (3.3 +/- 0.5 vs. 2.04 +/- 0.1 g/dL; P less than 0.05) than reactive patients. Twelve of 14 patients with serial studies remained seropositive after 39 +/- 11 months of follow-up (range, 7-113 months). Only patients nonreactive by immunoblot assay became seronegative by enzyme immunoassay during corticosteroid therapy (2/3 vs. 0/6 patients). It is concluded that seropositivity by enzyme immunoassay may not be documented by immunoblot assay. Patients nonreactive by immunoblot assay have lower signal-cutoff ratios and higher gamma globulin levels than reactive patients, and their seropositivity may be nonspecific. Patients nonreactive by immunoblot assay may lose seropositivity by enzyme immunoassay during corticosteroid therapy.     

Changes in antibody titers against Chlamydia pneumoniae after coronary angioplasty

OBJECTIVES: The potential role of common infectious agents in the pathogenesis and progression of atherosclerosis has been studied increasingly over the last decade. The evidence for Chlamydia pneumoniae as a potential causative agent is strong and is based on the findings of numerous sero-epidemiological studies, examination of atheromatous plaque specimens, in vitro animal models. We performed a prospective study in percutaneous transluminal coronary angioplasty (PTCA) patients to investigate whether the angioplasty procedure influenced the specific humoral immune response reaction against C. pneumoniae antigens. METHODS: We studied 76 patients who successfully underwent PTCA for de novo lesions. Blood samples were drawn immediately before PTCA and 1 month after PTCA. IgG and IgA antibodies against C. pneumoniae (strain CDC/CWL-029) were determined by an in-house developed enzyme immunoassay. RESULTS: At the time of angioplasty 75% and 34% of the patients had seropositive antibodies to elementary bodies (EBs) of classes IgG and IgA, respectively. Mean titers of IgG antibodies before and 1 month after PTCA were 46+/-31 and 50+/-28 relative units (RU/ml) (P>0.05). One month after PTCA, 97% and 34% of the patients had seropositive antibodies to EBs of classes IgG and IgA, respectively. We divided our patients into two groups on the basis of IgG seropositivity (group I: Chlamydia antibody IgG seronegative patients, group II: Chlamydia antibody IgG seropositive) before PTCA. Significant increase in the antibody titers of IgG (12+/-5 vs. 40+/-18, P<0.001) and IgA (0.6+/-0.33 vs. 1.15+/-0.83, P=0.007) was observed in group I patients 1 month after PTCA and 88% of them gained IgG seropositivity. There were no significant changes in IgG and IgA antibody levels in group II after PTCA. CONCLUSION: We have demonstrated a statistically significant rise in C. pneumoniae antibodies (especially IgG) induced by PTCA in patients previously seronegative.     

Helicobacter pylori seropositivity and atherosclerosis risk factors

Certain viral and bacterial infections may contribute to the initiation and progression of atherosclerosis. The aim of this study is to determine whether Helicobacter pylori (HP) seropositivity contributes to conventional atherosclerosis risk factors in the development of an early sign of atherosclerosis: intima-media thickness (IMT) of the carotid artery. Eighty-four patients who had at least two conventional atherosclerosis risk factors and a control group of 50 patients having no risk factors for atherosclerosis were enrolled in the study. None of the patients had ever received HP eradication treatment. HP IgG antibodies were determined by enzyme-linked immunosorbent assay. Carotid artery IMT was measured 1 cm before the carotid bifurcation. Seventy-five percent of the study group was HP seropositive. HP seropositive (n=64) and seronegative (n=21) groups were identical in terms of sex distribution, smoking pattern, mean age, hemoglobin, leukocyte, platelet, C-reactive protein, erythrocyte sedimentation rate, glucose, cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein, systolic blood pressure and diastolic blood pressure levels. There was no significant difference between the mean carotid IMT of HP seropositive (0.8+/-0.3 mm) and negative (0.8+/-0.3 mm) patients in the study group. Similar to the study group, there was no statistically significant difference between mean carotid IMT of HP seropositive (0.56+/-0.19 mm) and negative patients (0.67+/-0.13 mm) in the control group (p=0.2). Future studies concerning virulent strains are needed to determine the probable role of HP in atherosclerosis.     

Prevalence of and changes in hepatitis C virus antibodies in 64 patients with liver transplant

The aim of this retrospective study was to assess the prevalence of hepatitis C virus antibodies and their follow-up in a series of 64 orthotopic liver transplantation patients. Indications for transplantation were cirrhosis in 28 cases, primary biliary cirrhosis in 6 cases, liver cancer in 11 cases, fulminant hepatitis in 2 cases, and alveolar echinococcosis in 17 cases. The prevalence of serum antibodies to hepatitis C virus was assessed by an ELISA test (Ortho-Diagnostic-Systems). Sera were tested before liver transplantation and every two months after. Twenty-nine patients seronegative before transplantation remained negative. Four patients seropositive before liver transplantation remained seropositive. Twenty-eight patients seropositive before transplantation, became seronegative after, and 3 patients seronegative before transplantation became seropositive after. The prevalence of seroconversion was 9.3 percent. The prevalence of seropositive patients after transplantation was 11 percent. The high number of seropositive patients before transplantation (50 percent) could be explained by false positive results. Seropositivity before transplantation appeared to be related to hypergammaglobulinemia (p less than 0.001). This hypothesis was confirmed a posteriori by a concomitant disappearance of both seropositivity and hypergammaglobulinemia after transplantation in 62 percent of patients.     

Comparison of clinicopathological features of patients with hepatocellular carcinoma seropositive for alpha-fetoprotein alone and those seropositive for des-gamma-carboxy prothrombin alone

BACKGROUND: There has been no comparative study of the clinicopathological features of HCC patients who are seropositive for alpha-fetoprotein (AFP) alone and those who are seropositive for des-gamma-carboxy prothrombin (DCP) alone. The authors, thus, performed this comparative study. METHODS: The clinicopathological features of patients with solitary hepatocellular carcinoma (HCC), who underwent a hepatectomy were compared among the four below groups according to the seropositivity of AFP and DCP: group A, seronegative for both AFP below 20 ng/mL and DCP below 40 mAU/mL; group B, seropositive for AFP above 100 ng/mL and seronegative for DCP; group C, seronegative for AFP and seropositive for DCP above 100 mAU/mL; and group D, seropositive for both AFP and DCP. RESULTS: Group B patients showed a higher incidence of HCC with an indistinct margin, and a somewhat higher incidence of small HCC less than 2 cm in greatest dimension compared with group C patients. By contrast, group C patients had a higher frequency of HCC with a distinct margin compared with that of an indistinct margin, large tumors more than 3 cm compared with that of small tumors less than 2 cm, and a somewhat higher frequency of moderately to poorly differentiated HCC compared with that of well-differentiated HCC. Our HCC cases showed advanced clinicopathological features in the order of group C, group B and group A. Groups C and D patients showed similar characteristics. CONCLUSIONS: Hepatocellular carcinoma patients who were seropositive for AFP alone demonstrated clinicopathological features of less advanced HCC compared with those who were seropositive for DCP alone.     

Progression of peripheral arterial occlusive disease is associated with Chlamydia pneumoniae seropositivity and can be inhibited by antibiotic treatment

A possible influence of Chlamydia pneumoniae seropositivity on the clinical course of peripheral arterial occlusive disease (PAOD) has not been investigated previously. Though roxithromycin therapy was found to inhibit progression of PAOD, the nature of this effect (antibiotic or anti-inflammatory) has remained elusive. The course of PAOD was prospectively assessed in elderly men during 4 years, comparing 51 C. pneumoniae seropositive (IgG>/=1:128) with 46 seronegative patients (IgG<1:64 and IgA<1:32). Twenty of the seropositive patients were treated with roxithromycin (400 mg daily) for 4 weeks. Limitation of the walking distance to 200 m or less was observed in 55% of the seropositive untreated patients as compared to 30% of both, seronegative and macrolide-treated patients. The number of invasive revascularizations per patient was 1.7 in the seropositive untreated group as compared to 0.5 in the seronegative and the macrolide-treated group. Considering possible confounding variables, such as classical vascular risk factors, ordinal regression analyses showed a significant association of C. pneumoniae seropositivity with limitation of the walking distance (p=0.027) and need for invasive revascularization (p=0.037). The effect of macrolide treatment on these outcome measures was marked (p<0.001 and p=0.040, respectively) during 2.7 years but decreased in the second part of the observation period. This study provides good evidence that C. pneumoniae are involved in the progression of PAOD and that antibiotic treatment directed against C. pneumoniae is effective in inhibiting this process.     

Electrocardiographic characteristics in a population with high rates of seropositivity for Trypanosoma cruzi infection

This study was conducted in Posse, a rural community in Goiàs, Brazil. Persons were recruited into the study through house-to-house sampling of all houses in the sampled area. Blood samples were collected for seropositivity assessments for Trypanosoma cruzi and an electrocardiogram was assessed using a portable system. The results demonstrate significant differences between seropositive and seronegative persons for electrocardiographic (ECG)-derived traits. Seropositive persons had substantially longer QRS and QT intervals than seronegative persons. The PR interval was significantly different between seropositive and seronegative persons. Conduction abnormalities were observed more frequently in seropositive than seronegative persons. Right bundle branch block, an ECG abnormality typical of Chagas disease, was observed in 15% of seropositive persons compared with less than 1% of seronegative persons. Results indicate that T. cruzi infection and subsequent Chagas disease will continue to be major health problems for the foreseeable future in this typical rural area of Brazil.     

Antibodies against HTLV-III in Danish haemophiliacs: relation to source of factor VIII used in treatment and immunological parameters

18 out of 40 healthy Danish type A haemophiliacs had antibodies against HTLV-III as measured by an enzyme linked immunosorbent assay (ELISA). The overall seropositivity was 45%. A significant positive correlation was found between seropositivity and total lifetime dose of factor VIII and the age of the patients. 63% and 79% of the patients predominantly treated with commercial American and European preparations, respectively, had antibodies, compared with 11% among patients predominantly treated with Danish cryoprecipitate. Patients exclusively treated with preparations from a single source in the year prior to investigation showed 69% seropositivity when treated with American and European preparations. None of the patients treated with Danish cryoprecipitates prepared from voluntary Danish donors had antibodies. No difference between seropositive and seronegative groups was found in total lymphocyte count, leu 2+ cells, leu 3+ cells and leu 2+/leu 3+ ratio but the seropositive group had significantly higher total IgG and lower skin test score. It is concluded that treatment with local European preparation carries less risk of HTLV-III infection compared with commercial preparations from either the USA or Europe. The results also suggested that T-cell subset alterations among haemophiliacs are not primarily due to HTLV-III infection.     

Symptom response and healing of erosive esophagitis with proton-pump inhibitors in patients with Helicobacter pylori infection

OBJECTIVES: The aim of this article is to determine the severity of esophagitis and the response to treatment with proton-pump inhibitors in patients with and without evidence of Helicobacter pylori infection. METHODS: This retrospective analysis evaluated data collected in a randomized, double-blind clinical trial that assessed the efficacy and safety of once-daily esomeprazole 40 mg (n = 2,624) versus lansoprazole 30 mg (n = 2,617) for up to 8 wk in the treatment of reflux-associated erosive esophagitis. At baseline, erosive esophagitis was graded using the Los Angeles (LA) classification; serologic testing for H. pylori was performed using a FlexSure HP serum test. RESULTS: There were 14.7% of patients who were seropositive for H. pylori. The percentages of seropositive and seronegative patients with each grade of esophagitis were: LA grade A, 38%, 36%; LA grade B, 41%, 39%; LA grade C, 16%, 19%; and LA grade D, 5%, 6%, respectively. Severe heartburn was present at baseline in 42% of H. pylori-positive and 42% of H. pylori-negative patients. Life-table healing rates with esomeprazole were not influenced by H. pylori status (seropositive 92.6% (95% confidence interval: 89.8-95.4); seronegative 92.6% (95% confidence interval: 91.4-93.7)). The rates with esomeprazole were significantly higher than those with lansoprazole (seropositive 90.5% (95% confidence interval: 87.5-93.5); seronegative 88.5% (95% confidence interval: 87.1-89.8)) after adjusting for baseline H. pylori status (p = 0.001). CONCLUSIONS: The severity of erosive esophagitis at baseline was similar regardless of H. pylori seropositivity. Healing rates were not influenced by H. pylori status.     

Seroprevalence of Toxoplasma gondii antibodies in a healthy population from Slovakia

BACKGROUND: Toxoplasma gondii is a ubiquitous parasite of warm-blooded animals that causes one of the most common parasitic infections in humans. Toxoplasmosis is not a frequently reported disease and its prevalence is based on regional studies. METHODS: This prospective, cross-sectional study was conducted to evaluate the seroprevalence of T. gondii antibodies in a non-endemic area among 508 healthy individuals in Slovakia. ELISA was used to detect the levels of IgG, IgA, and IgM antibodies. Epidemiological factors and clinical symptoms associated with seropositivity were investigated using questionnaires. RESULTS: An IgG antibody prevalence of 24.2% (123/508) was found in the study population, while examination of specific IgA and IgM antibodies was negative. A significant increase in toxoplasmosis prevalence with increasing age was confirmed (p=0.001). There were no significant differences between genders or between inhabitants of rural and urban areas (p=0.079 and p=0.291, respectively). An increased consumption of raw meat (40.7%) and raw vegetables or fruit (30.8%) was observed in serologically positive women. This difference between serologically positive and negative women was significant (p=0.042). A significant difference between men and women eating raw vegetables and fruit was also found (p=0.049). There was no difference in clinical symptoms between serologically positive and negative patients (p=0.658). Lymphadenopathy with or without other symptoms (influenza, arthralgia, ocular symptom, dermatosis), 40.7%, was the most common clinical symptom in seropositive patients. CONCLUSION: An increased prevalence of T. gondii was observed in the age group over 40 years and in women who consume raw meat, vegetables, or fruit.     

Immunoglobulin classes in plasma cells of the synovial membrane in chronic inflammatory joint disease.

The histological features of the synovial membrane in rheumatoid arthritis (RA) are shared by other chronic inflammatory joint diseases, so that diagnostic differentiation is impossible. Examination of the immunoglobulin class in the plasma cells present in inflamed synovial membranes, however, has shown differences. Synovial membranes from 12 patients were seropositive RA, eight with seronegative RA, eight with ankylosing spondylitis, five with psoriatic arthritis, and three with Reiter's syndrome have been compared by peroxidase-antiperoxidase (PAP) staining for immunoglobulin classes on routinely paraffin wax embedded sections. There were no significant differences in the percentages of plasma cells containing IgG of IgA between the diseases studied. There were, however, significantly more plasma cells containing IgM in patients with seropositive RA (2-34%) compared with those with seronegative RA (0-10%; p less than 0.002) and with other chronic synovitides (0-9%; p less than 0.002). The results show that it is possible to distinguish seropositive RA from other chronic inflammatory joint diseases by PAP staining for immunoglobulin classes in the plasma cells present in the inflamed synovial membrane.     

Epidemiological aspects and risk factors of toxocariasis in a pediatric population in Sri Lanka

This cross-sectional study, carried out over a period of 11 months, investigated the relationship between Toxocara seropositivity, socio-demographic and environmental variables in a pediatric population. Risk factors for Toxocara infection were assessed by direct interview of parent or guardian using a structured pre-tested questionnaire. Eosinophilia and presence of helminth eggs or protozoan cysts in a fecal smear were recorded. Diagnosis of Toxocara seropositivity in children was based on IgG Toxocara Microwell Serum Elisa Kits. The ELISA test was regarded as positive if the optical density was 0.3 units or above. Unadjusted and adjusted odds ratios were calculated to determine risk factors for disease. The proportion of children who were positive for Toxocara antibodies in the study population was 20%. Children being exposed to a puppy of less than 3 months at home, visiting a playground frequently, living in a poorly constructed house and dogs having access to playgrounds were significant risk factors on univariate analysis. Of these four variables, only the first three variables (OR 19, OR 4 and OR 3, respectively) remained significant risk factors on the multivariate model. Presence of eosinophilia in seropositive children was significantly higher than the seronegative group (77% vs 40%; p < 0.001). This study indicates that dogs contribute significantly to children being seropositive for toxocariasis in Sri Lanka. Implementation of public health programs specifically focused on anti-parasitic treatment of dogs is recommended.     

Hepatitis C virus infection: prevalence,predictor variables and prevention opportunities among drug users in Italy

Summary. The study assessed rates and predictor variables of hepatitis C virus (HCV) infection among drug users receiving pharmacological treatment for opiates addiction.
There was a large cohort study in 16 public centres for drug users in north-eastern Italy, with data collected by standardized face-to-face interviews between February 2001 and August 2001.
Of 1095 participants, 74.2% were HCV seropositive. Anti-HCV status was independently associated with duration of drug use of over 10 years, injecting as a route of drug administration, and hepatitis B virus (HBV) and human immunodeficiency virus (HIV) seropositivity. Further statistical analysis was conducted by dividing the subjects on the basis of the duration of heroin use: more or <10 years. In the multivariate analyses, route of drug administration and HBV status were associated with HCV seropositivity among both groups. Less education was associated with HCV among the shorter term drug users. HIV status and having a sexual partner with a history of drug use were associated with HCV seropositivity among the longer term drug users.
Half of the short-term heroin users were still HCV seronegative when starting treatment, suggesting opportunities for reducing new HCV infections. Remarkable was the relationship between vaccination for hepatitis B and HCV serostatus. Being HBV seropositive was strongly associated with being HCV seropositive. But heroin users who had been vaccinated for HBV were not significantly more likely to be HCV seropositive than heroin users who were HBV seronegative. HBV vaccination does not provide biological protection against HCV; however, vaccinating heroin users against HBV may help to create a stronger pro-health attitude among heroin users, leading to a reduction in HCV risk behaviour.     

How reliable is the history of chickenpox? Varicella serology among children up to 14 years of age.

OBJECTIVES: The aim of this study was to assess the seroprevalence of antibodies to varicella-zoster virus (VZV) in children of northern Greece and to estimate the reliability of varicella history. METHODS: A serosurvey of 632 children, aged 13 months to 14 years (median 5.2 years), was conducted between April 1999 and July 2001. Serum samples were tested by enzyme-linked immunosorbent assay (ELISA) for IgG antibodies to VZV (IgG Genzyme Virotech GmbH). A history of varicella in these children was obtained from the parents of all these patients. Also, a check of state health cards of the patients was done. RESULTS: Two hundred and forty-eight (39%) of the children were seropositive for VZV. Two hundred and thirty (36%) of the 632 children claimed to have had previous varicella infection; 87.8% were seropositive, and 12.2% lacked antibodies to VZV. One hundred and seven of the 230 children with a history of varicella had the information about the disease confirmed, as it was reported on their state health card by a pediatrician; 10.2% were seronegative for VZV. Absence of history of varicella was reported in 402 (63.6%) of the 632 children; 88.6% of those were seronegative, and 11.4% were seropositive. The percentage of incorrect negative history ranged from 6% (13-60 months of age) to 48% (120-168 months of age). CONCLUSIONS: A large proportion of the study group (61%), mainly below 7 years of age, is susceptible to varicella. The positive predictive value of a history of varicella is 87.8%, whereas the negative predictive value of a negative history is 11.4%, which means that there is an 88.6% probability of a negative history being correct. Varicella serology may be reasonable prior to vaccination in children >10 years old with a negative chickenpox history. However, if one excludes cost considerations, it is also reasonable to vaccinate all children, irrespective of serostatus.