Revisiting the Holy Cross football team hepatitis outbreak (1969) by serological analysis

Clinical and biochemical data collected during the Holy Cross College football team hepatitis A outbreak in 1969 suggested that 32 team members had icteric hepatitis, 58 had anicteric illness, and only seven were not infected. Using a currently available radioimmunoassay, we tested stored serum samples obtained during the outbreak for IgM antibody to hepatitis A virus (IgM anti-HAV). Only individuals with icteric hepatitis were found to have IgM anti-HAV in serum; those with presumed anicteric illness were shown not to be infected with hepatitis A virus. The attack rate was thus only 34%, not 93% as originally reported, and the incidence of icteric illness in those infected was 100%, not 33%. This serological analysis of a classic outbreak of hepatitis A illustrates the utility and importance of IgM anti-HAV testing in seroepidemiologic investigations of hepatitis outbreaks.     

某部队急性病毒性肝炎的血清流行病学调查分析

作者于1987年12月至1988年3月对某部队急性病毒性肝炎进行了血清流行病学调查。发现该部队共发病10例,其中甲肝9例,乙肝1例;9例甲肝中,5例散在发生于5个连队,其余4例为1个连队暴发所致。结果表明:该部队急性病毒性肝炎的发生以甲肝为主,多以散发形式出现,在一定条件下也可造成部队内小暴发,而无续发病例。这些特征与该人群抗-HAV流行率达80％以上,已具有免疫屏障作用有关。当前,部队对甲肝的防治不容忽视。     

以RFIL消除慢性乙型肝炎血清RF致的抗HAV-IgM假阳性反应

为了解HAV/HBV双重感染的发生情况,作者检测了121例慢性乙型肝炎患者血清抗HAV-IgM,其中经类风湿因子免疫胶乳(RFIL)处理后抗HAV-IgM仍阳性的7例,未经处理的12例阳性,有5例为假阳性,占41.7％(5/12)。用RFIL能消除因血清中RF所致的抗HAV-IgM假阳性反应,不出现假阴性结果。认为RFIL中和反应是一种简单,经济而有效的排除RF干扰的方法。本组慢性乙型肝炎患者重叠感染甲肝病毒7例,占5.8％,均为慢性活动性肝炎。     

重型病毒性肝炎的血清病原学研究

为了解重型病毒性肝炎（重肝）的病原分型及其与预后的关系，应用酶联免疫法对120例重肝患者进行了甲型肝炎病毒抗体（抗-HAV）IgM、HBV标志（HBVM）、丙型肝炎病毒抗体（抗-HCV）的检测。结果显示：抗HAV－IgM阳性19例（15．8％）；HBVM阳性90例（75．0％）；抗-HCV阳性29例（24．2％），其中19例合并HBV感染，单纯抗-HCV阳性6例；三型病毒标志阴性者16例（13．3％）。乙型重肝较甲型重肝、丙型重肝病死率高。慢性重肝、急性重肝较亚急性重肝预后差。HBV复制标志阳性患者预后较差。提示HBV是本地区重肝的主要病原，且预后较差。     

甲型肝炎早期实验诊断的研究

以人胚肺二倍体细胞分离出的甲型肝炎病毒作抗原,以马抗人IgM经纯化后的抗体为捕捉抗体,以纯化甲型肝炎恢复血清为特异性抗体,过碘酸钠法标记酶,以OPD为底物制成抗-HAV IgM诊断试剂盒,建立了ELISA捕捉法检测抗-HAV IgM,结果:甲型肝炎暴发点84例均为阳性,流行性出血热及健康成人各30例均为阴性。322例急性黄疸型肝炎住院患者中192例阳性(占59.6%)。12例第一病日患者11例阳性(占91.6%),证明该方法对甲型肝炎早期诊断有重要价值。     

HAV，HBV与HCV感染相互关系的研究

目的　探讨甲乙丙三型肝炎病毒感染的相互关系。方法　应用国产试剂盒 ,采用EIA法对 515例肝炎患者的血清标本同时测定了甲乙丙三型肝炎病毒感染的血清学标志。结果　在抗 -HAVIgM阳性和阴性者之间 ,HBsAg、HBeAg阳性率无显著差异 ;HBsAg阳性者的抗 -HAVIgM阳性率和抗 -HCV阳性率显著低于HBsAg阴性者 (分别为 4 .0 %对 2 3.5%和 3.4 %对 2 4 .2 % ,P <0 .0 0 0 1) ;HBeAg阳性者的抗 -HCV阳性率明显低于阴性者 ( 1.3%对 14.0 % ,P <0 .0 0 0 1) ;抗 -HCV阳性者的HBeAg阳性率明显低于抗 -HCV阴性者 ( 9.6%对 32 .8% ,P <0 .0 1)。结论　HBV复制与HCV感染之间可能存在一定的交互抑制作用     

TIM-1 和TIM-4 mRNA 在HAV 患者中的表达及其临床意义

目的 观察典型病程甲型病毒性肝炎（HAV）患者外周血中T 细胞免疫球蛋白域蛋白-1 （TIM-1）和T 细胞免疫球蛋白域蛋白-4（TIM-4）mRNA 的表达水平,探讨HAV 患者病情进展的不同时 期TIM-1 和TIM-4 mRNA 水平与HAV RNA 含量,HAV 免疫球蛋白M（IgM）、免疫球蛋白G（IgG）浓度 及肝功能指标的关系。方法 选取HAV 典型病程的30 例患者作为HAV 组,分别于潜伏期或黄疸前期、黄 疸期及恢复期留取血液标本,以同期30 例健康体检者作为对照组,收集血液标本。采用实时荧光定量聚合 酶链反应检测TIM-1 和TIM-4 mRNA 表达水平,同时检测HAV 患者外周血HAV RNA 含量,酶联免疫 吸附法检测HAV 患者外周血HAV 抗体IgM、IgG 滴度水平,全自动生化分析仪检测肝功能指标谷丙转氨 酶、谷草转氨酶及总胆红素。结果 HAV 组患者外周血TIM-1 和TIM-4 mRNA 表达水平高于对照组患者 （P <0.05）。随着疾病进程的继续,TIM-1 及TIM-4 mRNA 表达水平于黄疸期达峰值,恢复期下降。TIM- 1 mRNA 表达水平与HAV 患者IgM 滴度、AST 及TBIL 呈正相关（P <0.05）,与IgG 滴度无关（P >0.05）。 结论 HAV 患者外周血中TIM-1 和TIM-4 mRNA 的表达水平与HAV 的疾病进展有较好的拟合性,TIM-1 和TIM-4 mRNA 可能在HAV 的发生、发展中发挥作用。     

Posttransfusion hepatitis type A

Hepatitis A virus (HAV) transmission through blood is a rare but potential cause of posttransfusion hepatitis. We can now document such a case supported by laboratory evidence of HAV in the donor blood. A 10-year-old girl manifested icteric hepatitis A 31 days after receiving a single unit of packed RBCs from a donor who subsequently experienced hepatitis A and died in hepatic failure. Hepatitis A virus antigen was detected in the donor's hepatocytes and in plasma obtained from the original donor unit. The density in cesium chloride of the HAV antigenic activity from the liver and plasma ranged from 1.33 to 1.37 g/cu cm, which is similar to that reported for infectious HAV particles. The implicated donor plasma had normal aminotransferase levels and was negative for antibody to HAV. Inoculation of this plasma into a chimpanzee resulted in the development of hepatitis A 23 days later based on the appearance of fecal HAV antigen, hepatitis, and IgM anti-HAV seroconversion. These data clearly document the presence of HAV in the donor sample that produced posttransfusion hepatitis A.     

Epidemiologic investigation on an outbreak of hepatitis C.

An outbreak of hepatitis in plasma donors occurred in a village of Hebei Province in the period of September to October 1985. The morbidity rate was 40.0% (26/65) in the plasma donors, which was significantly higher than that in whole blood donors (1/88) and in persons who were not blood donors (1/400). One to one paired survey was carried out, and the incidence was 46.4% (26/56) in the plasma donors, while there were no such outbreak in the control group. The distribution of cases showed positive correlation with the number of plasma donors from the production brigade. No secondary infection was found in their families. The peak of outbreak was about 2 months later than the peak of plasma donation. 26 cases of hepatitis in plasma donors all showed negative results for anti-HAV IgM, HBsAg, anti-HBC IgM, anti-CMV IgM and anti-EBV IgM. Sera of 25 cases were selected and sent to CDC, USA to confirm with Chiron C100 reagent. 24 cases were anti-HCV positive. This outbreak of hepatitis was demonstrated to be related to cross contamination during plasma donation.

     

一起甲型病毒性肝炎暴发的流行病学调查研究

目的明确本次甲肝暴发的原因。方法采用病例对照研究方法,根据预调查结果,设计统一调查表,对14岁儿童进行调查,同时采集血清检测甲肝抗-IgM抗体,以抗HAV-IgM抗体阳性儿童为病例组,以抗HAV-IgM抗体阴性且HAV-IgG抗体阴性的儿童为对照组。将调查结果用EPIDATA软件建立数据库,并用SPSS13.0进行分析。结果本次暴发历时2个常见甲肝潜伏期,共感染20例幼儿。统计结果显示,经常去幼儿园玩耍和与首发病例共餐及经常去首发病例家玩耍为本次感染的主要危险因素(P<0.001)。结论本次为典型的人传人连续性传播,患病儿童对幼儿园玩具的污染导致甲肝病毒的播散,而儿童没有良好的卫生习惯如饭前不洗手、喝生水等是其得以发病的重要条件。     

Survey of 34 pregnant women with hepatitis A and their neonates.

Thirty-four pregnant women with hepatitis A and their neonates were investigated on serum anti-HAV IgM, ALT (GPT) and clinical manifestations (with 34 randomized controls) during the outbreak of viral hepatitis A in Shanghai. The result showed no evidence of maternal-infant transmission of hepatitis A, and no birth defect was found. Sufficient rest and proper diet for and close surveillance of the pregnant woman were suggested to ensure the well-being of mother and child. In addition, we found immune gamma-globulin given to the neonates born of mothers with hepatitis A may be beneficial to avoid horizontal transmission of hepatitis A.

     

甲型肝炎灭活疫苗和冻干减毒活疫苗接种后1年的免疫原性研究

目的评价甲型肝炎灭活疫苗和冻干减毒活疫苗接种1剂1年后的免疫原性。方法采用单一中心随机双盲试验设计,对18月龄~4岁健康幼儿受试者随机接种1剂设盲的甲肝灭活疫苗或甲肝减毒活疫苗。接种前及接种后12个月,采用微粒子酶免法（MEIA）定量检测受试者甲型肝炎抗体（抗-HAV）。结果免疫后1年,甲肝灭活疫苗组和甲肝减毒疫苗组分别有124人和135人完成试验,抗-HAV阳转率分别为95.2%和91.1%,抗-HAV的几何平均浓度（GMC）分别为101.7 IU/L和65.5 IU/L,甲肝灭活疫苗免疫的抗体水平明显高于甲肝减毒活疫苗（P〈0.001）。结论接种1剂甲肝灭活疫苗或甲肝减毒活疫苗后12个月,均可产生良好的免疫效应,甲肝灭活疫苗免疫的抗体水平明显高于甲肝减毒活疫苗。     

血清、白细胞HBV－DNA的PCR检测结果与HBV血清复制标志的关系

３０例慢性乙型肝炎患者中，有５３．３％的病人用ＰＣＲ可从清和白细胞中检测出ＨＢＶ－ＤＮＡ；ＨＢｅＡｇ阳性和抗－ＮＢｃ－ＩｇＭ阳性的患者１００％可以检出ＨＢＶ－ＤＮＡ，而仅抗－ＨＢｃ－ＩｇＭ阳性的患者ＨＢＶ－ＤＮＡ的检出率为６６．７％。１３例乙肝血清学复制标志阴性的病人中有５例（３８．５％）也可检测出ＨＢＶ－ＤＮＡ。在ＨＢｓＡｇ转阴的３例病人中有１例可从白细胞中检测出ＨＢＶ－ＤＮＡ。     

邯郸市2010年病毒性肝炎血清流行病学调查分析

目的了解目前我市1～59岁人群中甲、乙、丙、戊型肝炎病毒的血清学流行状况。方法采用多阶段随机抽样方法选取研究样本,用ELISA方法检测血清学抗体。结果我市HBsAg、抗-HBs、抗HBC、抗-HAV、抗-HCV、抗-HEV的阳性率分别为3.5%、26.8%、29.6%、71.6%、1.1%和22.1%。HAV、HBV的感染率小年龄组很低;HBV感染率城镇高于农村,感染率较高的职业为行政事业、商业服务业者;抗HEV阳性标本中98.8%抗HAV阳性。结论随着免疫规划的开展,小年龄组HAV、HBV的感染率很低,高暴露人群各型肝炎感染率较高,应继续加强重点人群中病毒性肝炎的防控,强化成人及重点人群的疫苗接种工作。     

STRAIN OF HEPATITIS A VIRUS CAUSING CYTOPATHIC EFFECTS ISOLATED IN A549 CELL LINE

A strain (named BJ-1) of hepatitis A virus (HAV) causing cytopathic effects (CPE) has been isolated in A549 cell cultures from a fecal specimen of an infant with hepatitis A. Hepatitis A antigen (HAAg) w3s detectable in about 50To of the cells by immunofluo- rescence (IF) assay. The viral antigenicity was spe- cifically identified by monoclonal anti-HAV and chim- panzee reference antiserum to HAV (NIH). HAV particles in crystal arraDgement were observed in cell cytoplasm by electron microscopy in ultrathin sec tions. The particles appeared both "empty" and "full". It was observed that many 27-30 nm virtts particles were aggregated by convalescent human he- patitis A sera and chimpanzee HAV antisera observ- ed by immune electron microscopic (IEM) ex- amination. BJ-1 HAAg could be detected on day 34 after inoculation at the initial passage. The virus titers increased and the virus replication cycle short- ened with serial passages. The highest TCID 50 was 10-5/0.1 ml and the shortest replication cycle 2-3 days. IF kit consisting of BJ-1 HAV infected A549 coverslip culture and sheep fluorescence antibody to human IgM were made to detect anti-HAV IgM. Comparing the BJ-t IF with the Abbott EIA HAVAB- M kit. the coincidence rate was 98.4% (246/250).     

病毒性肝炎相关性骨髓抑制：附27例报告

目的：探讨病毒性肝炎对骨髓造血功能的影响。方法：检测肝功能、免疫学、血液学、骨髓象或活检，对２７例肝炎伴骨髓抑制患者，其中１７例再障（ＡＡ），１０例纯红再障（ＰＲＣＡ）进行临床分析。结果：２７例住院患者中急性肝炎１２例，慢性肝炎８例，淤胆型３例，重症型肝炎４例。骨髓抑制属急性２１例、慢性６例．病毒检测示ＨＡＶＩｇＭ：ＡＡ１３／１３例（－），ＰＲＣＡ５／１０例（＋）。ＨＲＶＭ：ＡＡ７／１７例（＋），     

189例急性病毒性肝炎患者的血清学调查

目的研究我国部分地区189例急性病毒性肝炎患者5种病毒性肝炎的分型构成。方法用酶免疫法(EIA)检测2007-2008年吉林(59例)、河北(54例)、山东(28例)、江苏(28例)、新疆(20例)等地急性病毒性肝炎门诊及住院的189例患者抗-HAV IgM、抗-HBc IgM、抗-HCV IgM、抗-HDV IgM和抗-HEV IgM。结果 189例急性病毒性肝炎患者甲型肝炎(HA)7例(3.70%),乙型肝炎(HB)65例(34.39%),丙型肝炎(HC)17例(8.99%),戊型肝炎(HE)71例(37.57%),未分型肝炎11例(5.82%),重叠感染18例(9.53%)。重叠感染以HBV/HEV常见。甲、乙、丙、戊及未分型肝炎患者的平均发病年龄分别为39.43、36.42、45.23、50.24及32.91岁。各型肝炎男女性发病比为1.83∶1~6.00∶1。结论在本研究群体中HBV和HEV是急性散发性病毒性肝炎最主要的病原体。各型急性病毒性肝炎男女性发病性别比均为男性多于女性,平均发病年龄与以往相比有后移现象,其中HE最为明显,集中在中老年人群。     

类风湿因子与甲型肝炎病毒抗体IgM假阳性关系的实验研究

目的 探讨类风湿因子(RF)浓度与甲型肝炎病毒抗体(抗HAV-IgM)假阳性之间的关系，为排除该抗体的假阳性提供客观依据。方法RF采用透射比浊法测定，抗HAV-IgM采用酶联免疫法检测。结果 实验组RF明显增高，且与抗HAV-IgM检测的光密度OD值之间存在直线回归关系。结论 抗HAV-IgM阳性的确定应依据临床症状、病史、年龄及RF水平来综合判定以降低假阳性。     

Prevalence of antibody to hepatitis A virus in a Canadian Inuit community.

To determine the prevalence of hepatitis A in a Canadian Inuit population, serum from 85% of the 850 inhabitants of Baker Lake, Northwest Territories, was tested by radioimmunoassay for antibody to the hepatitis A virus (anti-HAV). The overall prevalence of anti-HAV in the community was 71%. Exposure to the virus occurred early in life, such that by the age of 6 years 53% of the children had anti-HAV in their serum. The rate approached 100% by the age of 50 years. These findings document the ubiquitous nature of the hepatitis A virus in this northern Inuit settlement and suggest that immunoprophylaxis be considered for individuals taking short-term employment in such places.     

小儿急性黄疸型肝炎中的甲、乙型肝炎病毒的重叠感染

49例小儿急性黄疸型肝炎的特异性血清学检查结果表明:甲型肝炎37例(75.5％),甲乙型肝炎病毒重叠感染9例(18.4％),乙型肝炎1例(2％)。肝功能检查除 SGPT 恢复正常天数多于甲型肝炎,其余均无明显差异。