Prevalence of Antibodies to Hepatitis E Virus in Veterinarians Working with Swine and in Normal Blood Donors in the United States and Other Countries

Hepatitis E virus (HEV) is endemic in many developing and some industrialized countries. It has been hypothesized that animals may be the source of infection. The recent identification of swine HEV in U.S. pigs and the demonstration of its ability to infect across species have lent credence to this hypothesis. To assess the potential risk of zoonotic HEV infection, we tested a total of 468 veterinarians working with swine (including 389 U.S. swine veterinarians) and 400 normal U.S. blood donors for immunoglobulin G anti-HEV. Recombinant capsid antigens from a U.S. strain of swine HEV and from a human HEV strain (Sar-55) were each used in an enzyme-linked immunosorbent assay. The anti-HEV prevalence assayed with the swine HEV antigen showed 97% concordance with that obtained with the human HEV antigen (kappa = 92%). Among the 295 swine veterinarians tested from the eight U.S. states (Minnesota, Indiana, Nebraska, Iowa, Illinois, Missouri, North Carolina, and Alabama) from which normal blood donor samples were available, 26% were positive with Sar-55 antigen and 23% were positive with swine HEV antigen. In contrast, 18% of the blood donors from the same eight U.S. states were positive with Sar-55 antigen and 17% were positive with swine HEV antigen. Swine veterinarians in the eight states were 1.51 times more likely when tested with swine HEV antigen (95% confidence interval, 1.03 to 2.20) and 1.46 times more likely when tested with Sar-55 antigen (95% confidence interval, 0.99 to 2.17) to be anti-HEV positive than normal blood donors. We did not find a difference in anti-HEV prevalence between veterinarians who reported having had a needle stick or cut and those who had not or between those who spent more time (> or = 80% of the time) and those who spent less time (< or = 20% of the time) working with pigs. Similarly, we did not find a difference in anti-HEV prevalence according to four job categories (academic, practicing, student, and industry veterinarians). There was a difference in anti-HEV prevalence in both swine veterinarians and blood donors among the eight selected states, with subjects from Minnesota six times more likely to be anti-HEV positive than those from Alabama. Age was not a factor in the observed differences from state to state. Anti-HEV prevalence in swine veterinarians and normal blood donors was age specific and paralleled increasing age. The results suggest that swine veterinarians may be at somewhat higher risk of HEV infection than are normal blood donors.     

Further studies on intestinal active transport during semistarvation

1. The effect of semistarvation (sufficient to produce a loss of 18-28% of initial body weight) on the active transport of D-glucose and L-histidine by the rat, the guinea-pig and the golden hamster has been investigated by the use of sacs of everted small intestine (from upper jejunum to lower ileum).2. In the rat and the guinea-pig the dietary restriction resulted in increased active transport in all regions of the small intestine. In contrast, it caused no alteration in active transport in the hamster.3. The response in the rat was most impressive in the middle-to-lower ileum during D-glucose uptake. Whereas normal sacs from this area appeared unable to move the sugar against its concentration gradient, sacs from semistarved rats did so quite well.4. Although there was a considerable loss (24-29%) of intestinal dry weight in all three species when the food intake was reduced, shortening of the small intestine was not detectable in the guinea-pig or the hamster and was present to only a minor extent in the rat.5. Evidence is presented indicating that the enhanced active transport is not merely a reflexion of the thinning of the intestinal wall and that it occurs during complete as well as in partial starvation.     

The prevalence of serum neutralizing antibodies to infectious bovine rhinotracheitis virus in Scotland.

The prevalence of serum neutralizing antibodies to infectious bovine rhinotracheitis virus in 1152 serum samples from adult cattle in 114 dairy and beef herds in different regions of Scotland was 12%. In the Grampian region, the number of seropositive cattle in the self-contained herds was significantly less (P less than 0.01) than in the "other" herds. Holstein cattle had been introduced into five of these "other" herds, and significantly more (P less than 0.01) of the samples from these five herds were seropositive compared with the samples from the rest of the "other" herds in the same region into which recently purchased cattle had been introduced. The introduction of Holstein cattle was also a major factor in the association between the prevalence of antibodies and herd size in the Grampian region. The prevalence of serum neutralizing antibodies to infectious bovine rhinotracheitis virus was significantly greater (P less than 0.001) in this survey than in those previously undertaken in the United Kingdom.     

TRISS unexpected survivors--a statistical phenomenon or a clinical reality?

Data from patients treated in Pennsylvania-accredited trauma centers during 1989 were analyzed. TRISS expected and unexpected survivors (1.6% of all survivors) differed in many ways. Unexpected survivors were more than twice as likely to have been transferred from a nondesignated trauma center (45.8% vs. 22.8%, p < 0.001). Unexpected survivors had significantly higher frequencies of motor vehicle injuries (56.2% vs. 38.3%, p < 0.001), pedestrian injuries (9.6% vs. 5.4%, p < 0.01), and gunshot wounds (7.3% vs. 4.7%, p < 0.01). Expected survivors were injured more frequently in falls (26.1% vs. 10.8%, p < 0.001) and were less frequently male (64.5% vs. 75%, p < 0.001). Unexpected survivors had significantly longer average hospital stay (29.6 s vs. 9.3 days, p < 0.001) and more frequent (98.8% vs. 36.8%, p < 0.001) and longer average stays in the ICU (13.3 s vs. 4.1 days, p < 0.001). The percentage of unexpected survivors discharged to rehabilitation centers (61.9%) was significantly greater than that for expected survivors (8.7%), (p < 0.001). Unexpected survivors were more frequently judged "completely dependent" in five measures of functional disability than expected survivors. We conclude that unexpected survivors are a seriously injured and clinically relevant patient set, not just a statistical phenomenon.