Dialysis-associated hepatitis: prevention and control.
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Acute Kidney Injury↗
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Blood safety in developing countries.
This study, based on responses to a questionnaire, was undertaken to define problems in and formulate solutions for improving blood safety in developing countries as part of an effort to monitor the status of blood transfusion services globally. Despite improvements between 1988 and 1992, only 66% of developing countries (DGCs) and 46% of least developed countries (LDCs) screen all blood donations for antibodies to human immunodeficiency viruses; 72% DGCs and 35% LDCs test all donations for hepatitis B surface antigen and 71 and 48%, respectively, for syphilis. The antihuman globulin test is performed routinely in 62% DGCs and 23% LDCs, and inadequate quality assurance in all aspects of preparatory testing is a major weakness in many countries. The blood supply is usually insufficient: none of the LDCs and 9% of the DGCs collect 30 units or more per 1,000 of the population annually. Blood donor systems are totally voluntary and non-remunerated in 15% DGCs and 7% LDCs; 80% DGCs and 93% LDCs rely totally or partially on replacement donors and 25% of both groups on paid donations. The proportion of repeat donors is low (medians: 47% in DGCs, 20% in LDCs), and discard rates for collected blood are often high (up to 33%). Most of the blood collected is transfused as whole blood, and most DGCs and LDCs have inadequate supplies of plasma substitutes for management of acute haemorrhage. The reasons for these problems and suggested solutions are discussed.
AIDS Serodiagnosis↗
[The general conclusions of the II Congress of Nursing Assistants. Nursing assistants demand more information on AIDS and hepatitis].
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Acquired Immunodeficiency Syndrome↗
Efficacy of thermoplastic elastomer and latex condoms as viral barriers.
The barrier efficacy of a thermoplastic elastomer (TPE) and three brands of latex condoms was compared in a passive-leak test and in a dynamic model of simulated intercourse. Fifteen replicates of each of the condoms were challenged with bacteriophage T7 (100 nm) and the polio virus Type 1 (PV-1, 27 nm). In the passive test, no condom leaked either virus. In the dynamic model, no TPE condoms leaked either virus and no latex condoms leaked T7. Two samples of one commercially available latex condom leaked T7 but not PV-1. These data support that intact latex condoms are effective in vivo viral barriers and extend the finding to TPE condoms as well. Given its substantial equivalence to latex as a viral barrier, TPE condoms are an alternative choice for individuals with latex allergies. The TPE material is also more resistant to common environmental conditions that affect latex adversely and should therefore be a superior choice if condoms must be stored for extended periods in suboptimal conditions.
Bacteriophage T7↗
Long-term efficacy of continuing hepatitis B vaccination in infancy in two Gambian villages.
In 1984, all non-immune children under the age of 5 years in the Gambian villages of Keneba and Manduar were vaccinated against hepatitis B virus (HBV). All children born in these villages since 1984 have been vaccinated in infancy. Despite a rapid fall in antibody concentrations, vaccine efficacy against HBV infection and chronic carriage of HBsAg has increased with time. Overall, vaccine efficacies in 1993 against HBV infection and chronic HBsAg carriage were 94.7% (95% Cl 93.0-96.0) and 95.3% (91.0-97.5), respectively. Breakthrough infections in vaccinated children largely originate from chronic HBsAg carriers. Thus, we tested 261 chronic carriers for HBV DNA and e antigen. The prevalence of these markers of infectivity, and the amount of HBV DNA, decreased greatly with age. Detailed studies of breakthrough infections over two 4-year periods revealed that in the second period there were fewer than half the expected numbers of infections. Our findings suggest that in Keneba and Manduar long-term vaccination is progressively decreasing HBV transmission by chronic carriers, since their infectivity diminishes with time.
Adolescent↗
A nonpenetrating fetal scalp electrode.
OBJECTIVE: To develop a nonpenetrating scalp electrode for intrapartum fetal monitoring. DESIGN: Preliminary observational evaluation of the device. SETTING: An urban academic hospital in Johannesburg, South Africa. SUBJECTS: Fifteen women in labour. INTERVENTION: Application of the electrode for intrapartum monitoring. OUTCOME MEASURES: Quality of tracings, duration of application, disconnection of the electrode, marking of the scalp. RESULTS: Application was successful in 13 of 15 women, and high quality tracings obtained in 12. CONCLUSIONS: The design of scalp electrode tested is effective and produces high quality tracings in most cases.
Adult↗
Reduced doses of hepatitis B vaccines: is it a good idea?
Hepatitis B vaccines are not generic products and it cannot be assumed that all such vaccines can be used in reduced doses in order to save costs. Any use of vaccines in an unlicensed manner should only be performed in the context of a study that is approved by the national control authority and appropriate ethical review committees.
Dose-Response Relationship, Immunologic↗
Safety, effectiveness and ease of use of a non-reusable syringe in a developing country immunization programme.
Unsterile needles and syringes may transmit blood-borne infectious agents such as HIV and hepatitis B virus. The emergence of these diseases as major public health concerns and the risk of nosocomial transmission has heightened interest in the development of single-use injection devices. WHO and UNICEF embarked on a programme to develop and introduce these devices in 1987. We report on a field trial in Karachi, Pakistan, of the SoloShot (SS) plastic disposable syringe, which has a metal clip in the syringe barrel to prevent second-time withdrawal of the plunger. A conventional disposable syringe (CS) was used as a comparison. We observed 48 vaccinators giving 2400 injections with the SS and 1440 with the CS; 98.7% of SS performed as designed. The average volume required per delivered dose was comparable for the two syringes and was delivered more quickly with SS. Training and experience had a small but statistically significant effect on several aspects of SS use. Vaccinators who indicated a syringe preference preferred SS on 7 out of 9 indicators. SS is safe and effective in preventing reuse and is easier and quicker to use than the CS. Vaccinators require little, if any, special training. It could directly replace disposable syringes in expanded programmes on immunization (EPI) in countries where use of unsterile disposable devices occurs or when sterilization is not practical.
Allied Health Personnel↗
Integration of hepatitis B immunization in the Expanded Program on Immunization of the Child Survival Project.
The Expanded Program on Immunization (EPI) is a component of the Child Survival Project (CSP) whose objectives are to reduce the incidence rates of six childhood diseases (Measles, Diphtheria, Pertussis, Tetanus, Tuberculosis, Poliomyelitis) and to reduce the number of infant deaths from those diseases by increasing effective vaccination coverage. In 1991, the CSP/EPI developed a national plan to introduce national immunization of infants against hepatitis B in an attempt to control the magnitude and seriousness of the damage which viral hepatitis causes in terms of morbidity, mortality and serious sequelae as hepatitis B is an endemic disease in Egypt causing an important public health problem which requires urgent control. This presentation will discuss the integrated effort undertaken to plan and implement the program, the different challenges it faces, control studies being performed as well as the proposed objectives of the hepatitis B vaccination program.
Child↗
[Increased transaminase activity in the patients and personnel of dialysis centers and problem of its assessment].
Within the general hepatitis prevention on dialysis wards regular controls of the liver values and the HBsAG/AK are necessary for the patients and the personnel. The general symptom which is frequently found in these cases -- increased transaminase -- demands a diagnostic clarification and the exclusion of an acute virus hepatitis. Using all examination methods which are at present at our disposal and taking into consideration epidemiologic criteria and the total clinical picture a decision must be done which is right for the patient and the entire dialysis personnel. Own clinical observations refer to the fact that isolated increases of the liver enzyme in dialysis patients must not be traced back a priori to a virus hepatitis, but that these may also be caused by other endogenic and exogenic noxae. In the observation period of 10 years was evident that in an existing infectious hepatitis the increase of the liver enzyme was accompanied by clinical complaints.
Alanine Transaminase↗
VHPB: summary of strategies and recommendations. Viral Hepatitis Prevention Board.
The Viral Hepatitis Prevention Board (VHPB) believes that stronger action is needed to control hepatitis B. Vaccinating those identified as at 'high risk' has failed to make a significant impact on the epidemiology of the disease. Many people with hepatitis B do not fall into any of the 'classic' high-risk groups and efforts to reach these groups have been unsuccessful. The VHPB supports the recommendation of the World Health Organization (WHO) that hepatitis B vaccine should be incorporated into national universal vaccination programmes by 1997. The recommendation came initially from the Global Advisory Group of the Expanded Programme on Immunization and was endorsed in 1992 by the World Health Assembly, the governing body of WHO which consists of representatives of all WHO member states. The WHO Working Group on the control of viral hepatitis in Europe, which met in Munich in 1991, concluded that the routine immunization of infants and adolescents should receive the highest priority. Universal infant and adolescent strategies have their own benefits and drawbacks; the VHPB has looked carefully into the rationale for and against these strategies. The prerequisites for implementing these strategies are discussed. A combined infant and adolescent strategy emerges as having many of the advantages of the individual approach and fewer disadvantages. Universal vaccination is clearly the most effective strategy for preventing hepatitis B. Its timely and successful implementation, even in countries with medium and low prevalence, is a priority. There is no reason why hepatitis B should not follow the success of smallpox, polio, diphtheria and measles vaccination.
Adolescent↗
The Viral Hepatitis Prevention Board and earlier efforts at hepatitis B control.
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Developing Countries↗
Congress objectives.
In 1993, the Viral Hepatitis Prevention Board (VHPB) recognized that selective vaccination of individuals at high risk from hepatitis B had failed to control the spread of hepatitis B. The Action towards Control of Hepatitis B as a Community Health Risk was therefore established to provide information and make recommendations on actions to take to combat hepatitis B in the community. The VHPB supports the World Health Organization (WHO) recommendation that universal hepatitis B vaccination for all infants and/or adolescents should be integrated into the national immunization programme in all countries by 1997. The VHPB met regularly throughout 1993 to consider the issues involved in implementing universal strategies and to develop practical solutions that can help all countries meet the WHO goal. During this congress the feasibility of implementing universal infant and/or adolescent vaccination strategies were explored by reviewing the seroprevalence data in Europe, development of cost-benefit models and progress in countries that have already implemented universal vaccination. With the delegates' input, resolutions were reached that will guide future action towards meeting the WHO goal and combating hepatitis B in the community.
Hepatitis B↗
Post-transfusion hepatitis: impact of non-A, non-B hepatitis surrogate tests. Canadian Post-Transfusion Hepatitis Prevention Study Group.
Canada has not introduced the non-A, non-B (NANB) surrogate marker tests (antibodies to hepatitis B core antigen and alanine aminotransferase) to screen donated blood. We evaluated the effect of NANB surrogate markers in reducing post-transfusion hepatitis in a prospective randomised intervention study. From 1988 to 1992, 4588 subjects were enrolled into two study groups that received allogeneic blood from which units positive for NANB surrogate markers were either withheld (n = 2311) or not withheld (n = 2277). We also assessed a simultaneous non-randomised cohort (n = 650) of subjects who received only syngeneic blood. All subjects were followed up for 6 months and assessed for the presence of post-transfusion hepatitis due to hepatitis A, B, C, non ABC, Epstein-Barr virus (EBV) and cytomegalovirus (CMV). Withholding of blood containing NANB surrogate positive units reduced the overall post-transfusion hepatitis rate by 40% (p = 0.065) and the hepatitis C rate by 70% (p = 0.05). Most of the benefit of NANB surrogate testing was due to reduced frequency of hepatitis C virus after transfusion before all donor blood was screened for anti-HCV. During this time the overall post-transfusion hepatitis rate per 1000 transfusion recipients was 20.2 in the no-withhold group compared with 5.0 in the withhold group (p = 0.05), and the HCV hepatitis rate was 12.6 and 0 respectively (p = 0.06). After the introduction of HCV screening, the overall post-transfusion hepatitis rates were 8.6 and 6.8 per 1000 (p = 0.55) respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Alanine Transaminase↗
Hepatitis B "immune" globulin: effectiveness in prevention of dialysis-associated hepatitis.
A randomized, double-blind, multicenter study of hepatitis prevention by immune serum globulin with high anti-HBs titer ("hepatitis B immune globulin") was carried out among 318 new patients and 296 staff members of renal dialysis units. Three milliliters of high titer globulin, repeated at four months, was compared with equal doses of intermediate or normal titer globulin. Among staff members, the cumulative percentages developing hepatitis or HBs Ag, or both, within eight months were 6.9, 11.7, and 11.1 in the high, intermediate, and normal titer groups respectively. The lower incidence associated with high titer globulin was not significant (P greater than 0.05). However, among the patients the respective percentages were 7.9, 21.3, and 23.1 and the lower incidence in the high titer globulin group was significant.
Antibodies↗
Costs and benefits of the passive prophylaxis of hepatitis B in an Italian hospital.
The authors report the clinical results and the cost/benefit analysis of a protocol of passive prophylaxis of hepatitis B based on the administration of two doses of three ml each of HBIG and on the control of anti-HBs levels by RIA for six months after accidental exposure in health-care personnel. Only two out of 351 susceptible subjects developed viral hepatitis instead of the expected 70 if passive prophylaxis had not been performed. The cost/benefit analysis showed a saving of 356 509 US$ in the past 36 months. Furthermore, the cost of each case of hepatitis prevented was 2194 US$, whereas the cost of one case of acute, benign hepatitis was 6180 US$. Since a saving of 3.39 US$ for each dollar spent is achieved, this protocol of passive prophylaxis appears more than adequate both clinically and economically. It is believed that the adoption of some general prophylactic measures will further stress the advantages of this procedure.
Adult↗
Integration of hepatitis B vaccination into national immunisation programmes. Viral Hepatitis Prevention Board.
Hepatitis B is a major public health problem even though safe and effective vaccines have been available for over 10 years. Because hepatitis B infection is largely asymptomatic with long term complications occurring after many years it has not received the attention it deserves. Strategies to immunise those at high risk have failed to control the disease. Delegates to the World Health Assembly of the World Health Organisation recommended in May 1992 that all countries should integrate hepatitis B vaccination into their national immunisation programmes by 1997. Some western European countries remain unconvinced that the burden of disease warrants the expense of universal vaccination. However, epidemiological data and economic evaluation show that universal hepatitis B vaccination is cost effective in countries with low endemicity and that it will control hepatitis B, reinforcing the necessity for action.
Cost-Benefit Analysis↗
Evaluation of a region-wide hepatitis B vaccination program in dialysis patients: experience in an Italian region. The Latium Hepatitis Prevention Group.
In 1985-1986, 634 adult dialysis patients were tested prior to hepatitis B vaccination, representing 40% of the total patients in Latium, an Italian region. HBsAg and anti-HBs prevalences were 7.1 and 36.0%, respectively. Merck, Sharp & Dohme (MSD) and Pasteur plasma-derived vaccines were randomly allocated to the 44 dialysis units. An anti-HBs response greater than or equal to 10 IU/l was elicited in 58.5% of 236 subjects tested at 6 months, 63.4% MSD and 52.4% Pasteur (p n.s.). The relatively low response to the vaccine in this high-risk group stresses the need to improve the efficacy of the vaccination and to maintain policies of environmental control.
Adult↗