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Type B Hepatitis: The Infectivity of Blood Positive for E Antigen and DNA Polymerase after Accidental Needlestick Exposure

List of authors.
  • Harvey J. Alter, M.D.,
  • Leonard B. Seeff, M.D.,
  • Paul M. Kaplan, Ph.D.,
  • Vincent J. McAuliffe, M.D.,
  • Elizabeth C. Wright, M.P.H.,
  • John L. Gerin, Ph.D.,
  • Robert H. Purcell, M.D.,
  • Paul V. Holland, M.D.,
  • and Hyman J. Zimmerman, M.D.

Abstract

To determine the relation between the presence of donor DNA polymerase and e antigen, and recipient hepatitis, we tested, under code, serums from a controlled trial of hepatitis B immune globulin used to treat individuals accidentally inoculated with HBs Ag-positive blood. All recipients lacked antibody to HBs Ag. In 29 of 31 donors, both polymerase and e were in perfect agreement; both demonstrated a highly significant correlation with recipient hepatitis (P<0.001). DNA polymerase/e-negative blood did not cause hepatitis. Blood containing polymerase or e antigen did not cause hepatitis in six of 31 and four of 18 recipients, respectively. Hepatitis did not correlate with transaminase or duration of antigenemia in the donor.

Polymerase and e appear to be indicators of the relative infectivity of HBs Ag-positive serum, particularly after small-volume exposure. They may be important determinants in assessing infectivity of chronic carriers of HBs Ag and in evaluating efficacy of hepatitis B immune globulin and hepatitis B vaccines. (N Engl J Med 295:909–913, 1976)

Funding and Disclosures

Participants in this study were from the VA/NIAID Cooperative Study of Needlestick Hepatitis.

The Molecular Anatomy Program, Rockville, MD, is supported by the NIAID under Union Carbine's contract with the Energy Research and Development Administration.

We are indebted to Bertram F. Felsher, James D. Finkelstein, Pedro Garcia-Pont, Herbert B. Greenlee, Albert A. Dietz, John Hamilton, Raymond S. Koff, Carroll M. Leevy, Thomas Kiernan, Carlo H. Tamburro, Eugene R. Schiff, Charles C. Schwartz, Zeno Vlahcevic, Reuben Zemel, David S. Zimmon, Nrapendra Nath, and all members of the Veterans Administration Cooperative Study of Needlestick Hepatitis, and to Charlotte Langer for technical assistance.

Author Affiliations

From the Blood Bank Department, Clinical Center, and the Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, the departments of Medicine, Veterans Administration Hospital, Georgetown University School of Medicine and George Washington School of Medicine, Washington, DC, and the Molecular Anatomy Program, Oak Ridge National Laboratory, Rockville, MD (address reprint requests to Dr. Alter at the Blood Bank Department, Bldg. 10A, National Institutes of Health, Bethesda, MD 20014).

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