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Efficacy of hepatitis B immune serum globulin after accidental exposure. Preliminary report of the Veterans Administration Cooperative Study.

A randomised, double-blind, controlled trial has been undertaken to compare the efficacy of hepatitis B immune globulin (H.B.I.G.) with that of immune serum globulin (I.S.G.) for the prophylaxis of viral hepatitis. Participants in the trial were individuals exposed accidentally to material infectious for hepatitis (primarily viral B hepatitis). Preliminary evaluation of the first 302 of the 561 individuals entered into the study indicates that H.B.I.G. significantly reduced the frequencies of both clinical and subclinical hepatitis during the first 3--4 months after the injection. Less than 10% of H.B.I.G. recipients had detectable anti-HBs at the sixth month after the injection, suggesting that H.B.I.G. might need to be given every 3--4 months to continually exposed individuals. Further long-term evaluation is required in order to define more clearly those most likely to benefit from H.B.I.G.

Clinical Trials as Topic↗

Prophylactic efficacy of immune serum globulin against hepatitis A.

A remarkable decline in the morbidity of hepatitis A was observed in the members of the Japan Overseas Cooperation Volunteers (JOCV) following inoculation of these volunteer workers with human immune serum globulin (ISG) once every 4-6 months, a program which was started in 1981 on a voluntary basis. The morbidity rate of hepatitis A declined from 3.5% in 1980 to 0.6% in 1983 and 1984. A significant difference in the morbidity of hepatitis A was observed among those who were not. In addition to precautions about drinking water and fresh or uncooked foods, inoculation with ISG for the prophylaxis against hepatitis A is recommended when non-immune subjects from a developed country travel to or stay in developing countries.

Adult↗

The influence of vaccines and hyper immune serums on protein/platelet interaction towards an artificial surface.

Protein adsorption and platelet adhesion are two important biological processes arising at the blood prosthetic interface. The effect of certain commonly used vaccines and hyper immune serums namely tetanus toxoid, tetanus immunoglobulin, polyvalent anti-snake venum serum and anticholera vaccine to modulate the surface induced platelet adhesion to polycarbonate substrate was investigated using washed calf platelets in presence and absence of fibrinogen. This study also demonstrated the changes in protein-surface binding with few of these vaccines, using SDS - polyacrylamide gel electrophoresis. It seems, the addition of tetanus toxoid to the polymer-protein system increased the level of surface-bound albumin and reduced the fibrinogen-surface attachment. On the other hand, tetanus immunoglobulin reversed the effect. This itself may be one of the parameters for the observed reduction in platelet-surface attachment due to tetanus toxoid. The enhanced platelet adhesion with other vaccines, may be correlated with the availability of more fibrinogen receptors for the platelets to attach. A better understanding of the mechanism of these vaccines is needed in vivo conditions for interrelating these findings.

Adsorption↗

Does immune serum globulin confer protection against skin diseases?

BACKGROUND: Following a case of serologically proven hepatitis A in a food-handling worker serving several military bases in the same vicinity, the entire military population was vaccinated with immune serum globulin (ISG). OBJECTIVE: To evaluate the effectiveness of ISG in preventing skin disease. METHODS: The data for this study were drawn from the military archives of the Medical Corps. The population of the bases was followed for a period of 3 months after immunization. Rates of selected skin diseases were compared with those of a nearby base during the same period, and with those in the population of the same bases a year earlier. RESULTS: The rates of several skin diseases (bacterial skin infections, dermatitis and eczema, fungal infections, acne, warts, nail disorders, and nonspecific skin diseases) among the vaccinated population were significantly lower when compared to the historical control group and to the contemporary control group of the nearby base. CONCLUSIONS: ISG provides a protecting effect for skin diseases, especially those of infectious origin.

Adolescent↗

Induction of crisis forms in cultured Plasmodium falciparum with human immune serum from Sudan.

Serums from 90 individuals from three areas in Sudan were tested for inhibitory activity against cultures of Plasmodium falciparum. In addition to inhibitory activity against merozoite invasion, all of the serums demonstrated, in varying degrees, the ability to retard intraerythrocyte development, leading to crisis forms and parasite deterioration. These retardation factors could be removed by absorption of immune serum with parasite-infected erythrocytes and were demonstrable in purified immunoglobulin fractions. Serum from donors in hypoendemic Khartoum did not retard parasite development.

Antibodies↗

Extracellularly proteolysing Aspergillus fumigatus and its interaction with specific immune serum in the serum-albumin agar. A preliminary report.

Serum-Albumin Agar with the initial pH values of 5.0 or 7.0 allows diffusion and precipitation of A. fumigatus antigens (culture filtrate) and antibodies. In the zone of extracellular proteolysis by a living culture of an atypical A. fumigatus strain, precipitin bands only against a specific immune serum were found in this medium with an initial pH of 7.0. How far under such complex substrate conditions including active extracellular proteolysis, an immune reaction can take place is open to discussion.

Agar↗

Cost-benefit of mass prophylaxis with immune serum globulin to control waterborne hepatitis A: a case study.

Following a point-source epidemic of more than 8,000 cases of Shigella sonnei, which was caused by a sewage-contaminated water supply, immune serum globulin (ISG) was administered to 11,306 children, aged 5 to 9 years, and to 1,338 pregnant women to prevent a possible outbreak of hepatitis A. A cost-benefit analysis showed that the estimated cost of preventing one possible case of hepatitis in a child was $362.50, and in a pregnant women $11,514. The benefit:cost ratios were 0.45 and 0.28, respectively. These relatively low ratios call for reconsideration of the guidelines that recommend ISG administration to children and pregnant women following an exposure to contaminated water.

Child↗

An autoantibody targeting glycated IgG is associated with elevated serum immune complexes in rheumatoid arthritis (RA).

Advanced glycation end-products (AGE) play a role in diabetes complications and in RA. An autoantibody to IgG-AGE has been shown to correlate with RA disease activity. Thus we sought to analyse serum immune complexes (IC) and AGE-modified proteins in Caucasians and North American Indians to see if the presence of anti-IgG-AGE influenced their composition. Polyethylene glycol precipitation of IC from the serum of anti-IgG-AGE-positive or -negative RA patients, and healthy and diabetic controls were examined. Concentrations of circulating IC were highest in anti-IgG-AGE+ RA patients, followed by anti-IgG-AGE- RA patients, which were greater than healthy controls. IC amounts in the Ojibwe were consistently higher than in Caucasians. Affinity purification of AGE-modified proteins from IC and immunoblotting with antibodies against Ig gamma and mu heavy chains, kappa and lambda light chains, and AGE Nepsilon(carboxymethyl)lysine and imidazolone yielded similar results: anti-AGE+ RA patients had elevated levels relative to those without the autoantibody. Levels in both RA groups were higher than in controls. Glycated albumin amounts followed a similar distribution, but were not influenced by the presence of anti-AGE antibodies. A heavily glycated kappa-chain was present primarily in IC from anti-IgG-AGE+ patients. These studies indicate that anti-AGE antibodies have a direct impact on the accumulation of IgG-AGE but not glycated albumin, and may block the normal clearance of IgG-AGE through AGE receptors.

Antibodies, Anti-Idiotypic↗

Intravenous and standard immune serum globulin preparations interfere with uptake of 125I-C3 onto sensitized erythrocytes and inhibit hemolytic complement activity.

Antibody-sensitized sheep erythrocytes were used as a model to determine the effects of therapeutic immune serum globulin (ISG) preparations on the ability of this particulate activator to fix C3 and initiate hemolysis. Both standard and intravenous forms of ISG inhibit uptake of 125I-C3, presumably by competing for the deposition of "nascent" C3b molecules onto the erythrocytes. Both forms of ISG also inhibit hemolytic activity of whole serum or purified complement components. The inhibition appears to be a specific property of IgG itself, since similar inhibition was not caused by equivalent concentrations of human serum albumin, and was not affected by the buffer in which the ISG was dissolved. Interference with C3 uptake onto antibody-sensitized platelets and/or inhibition of hemolytic complement activity could contribute to the efficacy of high dose intravenous ISG in idiopathic thrombocytopenic purpura.

Complement Activation↗

Open trial of intravenous immune serum globulin for chronic sinusitis in children.

BACKGROUND: Chronic sinusitis in children is a complex clinical problem. Some patients do not improve with medical therapy and some fail surgery as well. OBJECTIVE: A therapeutic trial of intravenous immune serum globulin (IVIG) was given to children whose sinus disease was recalcitrant to the usual therapeutic modalities. The objective of IVIG administration was to modulate the inflammatory process contributing to the chronicity of the sinusitis. METHODS: Six patients were given a 12-month trial of monthly (400 mg/kg) IVIG infusions. Entry criteria included persistence of sinusitis after 3 months of full course antibiotics, or two episodes of sinusitis within a 3-month period while on prophylactic antibiotics. All patients had abnormal sinus CT (computerized tomography) scans at entry. Three of the six patients remained symptomatic despite prior sinus surgery. Patients with primary immune deficiencies were excluded. Each patient served as his own control based on their previous 12-month history and clinical course. Four of the 6 patients were atopic as demonstrated by prick skin testing; however, all patients had nasal eosinophilia. RESULTS: Full course antibiotic use decreased in five of the six patients (183 to 84 days); correspondingly, the episodes of sinusitis decreased (average 9 to 4 per year). In addition, sinus CT scans showed significant improvement. CONCLUSION: This preliminary open-trial of IVIG suggests its usefulness as adjunct therapy to medical management in selected patients with chronic sinus disease. The mechanism(s) by which IVIG may be helpful is probably not based on the concept of replacement therapy, but more likely as an immune or inflammatory modulating agent.

Anti-Bacterial Agents↗

Serological hepatitis A virus infections and ratio of clinical to serological infections in a controlled trial of pre-exposure prophylaxis with immune serum globulin.

Seroconversion to hepatitis A virus was studied in a sub sample of 802 Israeli military recruits (611 men and 191 women) who were taking part in a randomised controlled trial of pre-exposure immune serum globulin (ISG) for the prevention of viral hepatitis. On intake into the service 35% of the men and 47% of the women were negative to hepatitis. A virus antibody (anti-HAV). After three years 7 of 71 men (9.9%) who had not received pre-exposure ISG had become positive to anti-HAV compared to 2 of 83 (2.4%) who had received it; the statistical significance of this difference was p = 0.052. At two years 2 of 30 women (6.7%) who had not received ISG had converted compared to 1 of 43 (2.3%) who had received ISG (p = 0.37). Pooling the sexes gave conversion rates of 8.9% in those not immunised and 2.4% in those immunised (p = 0.029). The sex adjusted odds ratio was 4.0 (95% confidence limits 1.3-19.0). The morbidity rates for clinical non B hepatitis over the three year period among 12 835 men were 7.2 per 1000 in those not immunised and 3.6 per 1000 in those immunised (p = 0.004). Point estimates of the ratio of clinical hepatitis to seroconversion in men ranged from 0.25 to 0.30. It is concluded that pre-exposure administration of ISG effectively prevented clinical expression of viral hepatitis, apparently reduced seroconversion, and did not induce passive-active immunisation.

Clinical Trials as Topic↗

Serum immune complexes and disease.

The solid phase Clq radioimmunoassay was used to detect immune complexes in sera from patients with systemic lupus erythematosus (14/25), rheumatoid arthritis (4/5), vasculitis (5/15), infective endocarditis (2/2), acute rheumatic fever (2/3), pre-eclamptic toxaemia (0/14), lung cancer (3/7), glomerulonephritis (26/98) and renal transplant patients (0/5). The best correlation with disease activity was seen in systemic lupus erythematosus and infective endocarditis where serial immune complex determinations were clearly of value in monitoring therapy. The findings in primary glomerulonephritis indicate only a limited usefulness of the assay in that serum immune complexes were detected in a minority (22/73) of patients with glomerular immune deposits. In particular the data do not support a role for Clq fixing immune complexes in the pathogenesis of membranous glomerulonephritis or in pre-eclamptic toxaemia.

Antigen-Antibody Complex↗

Antibody responses in rats infected with Angiostrongylus cantonensis and the passive transfer of protective immunity with immune serum.

Little haemagglutinating antibody was detected in the serum of rats with primary Angiostrongylus cantonensis infections until the juvenile worms left the brain and lodged in the lungs about 35 days after infection. Antibody titres reached a peak 50 days after infection and were maintained for at least a further 95 days. Increasing the infective dose of A. cantonensis larvae increased the peak antibody titres attained by the infected rats. Re-infection temporarily reduced the serum antibody titre, but later it increased and showed an anamnestic response. Reaginic antibody production was transient during primary infections; re-infection failed to stimulate further reaginic antibody production. Antiserum from immune donor rats protected recipients against A. cantonensis. The transferred immune serum suppressed anti-A. cantonensis antibody production in recipient rats.

Angiostrongylus↗

Pre-exposure prophylaxis of viral hepatitis with immune serum globulin in an endemic area. A trial in field units of the Israel Defence Forces.

Field units in the Israel Defence Forces represent a high risk group for type A infectious hepatitis. Very large scale post-exposure prophylaxis with immune serum globulin (ISG) has been successfully employed for the past decade with a reduction in incidence and an elimination of overt epidemic cycles. The use of pre-exposure prophylaxis in an indigenous population in whom approximately 70% have antibody to HAV at age 18 was compared in a field trial with the routine post-exposure method. Units were randomized into an intervention group (A) in which all subjects were to receive ISG (79% were in fact immunized), a second group (B) in which 50% of subjects were to be immunized (36% were actually immunized) and a non-immunized control group (C). During the trial incidence rates in the non-immunized study population dropped well below predicted levels. The incidence rates were zero in group A, 1.31/1000 in group B (0.61/1000 among the immunized and 1.72/1000 among the non-immunized) and 2.49/1000 in group C over the 6-month follow-up. Pre-exposure ISG afforded excellent protection and even at the low rate of incidence was cost-effective. The possibility of herd immunity is discussed.

Antibodies, Viral↗