Hepatitis: Jilg W

Cornberg M, Protzer U, Dollinger MM, Petersen J, Wedemeyer H, Berg T, Jilg W, Erhardt A, Wirth S, Schirmacher P, Fleig WE, Manns MP, Anonymous00064, Anonymous00065, Anonymous00066, Anonymous00067, Anonymous00068. · Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany. · J Viral Hepat. · Pubmed #18713127 No free full text.

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Cornberg M, Protzer U, Dollinger MM, Petersen J, Wedemeyer H, Berg T, Jilg W, Erhardt A, Wirth S, Schirmacher P, Fleig WE, Manns MP. · Abteilung Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover. · Z Gastroenterol. · Pubmed #18080231 No free full text.

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Cornberg M, Protzer U, Dollinger MM, Petersen J, Wedemeyer H, Berg T, Jilg W, Erhardt A, Wirth S, Schirmacher P, Fleig WE, Manns MP. · Die Institutsangaben sind am Ende des Beitrags gelistet. · Z Gastroenterol. · Pubmed #17554641 No free full text.

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Fitzsimons D, François G, Alpers K, Radun D, Hallauer J, Jilg W, Gerlich W, Rombo L, Blystad H, Nøkleby H, van Damme P. · World Health Organization, Geneva, Switzerland. · Scand J Infect Dis. · Pubmed #16099768 No free full text.

Abstract: The Viral Hepatitis Prevention Board (VHPB) convened a meeting of international experts from the public and private sectors in the Nordic countries and Germany, in order to review the epidemiological situation, the surveillance systems for infectious diseases, the immunization programmes and policy, and the monitoring of adverse events after hepatitis vaccination in those countries, to evaluate prevention and control measures, and to identify the issues that arose and the lessons learnt. Considerable progress has been made in the past decades in the prevention and control of viral hepatitis in the respective countries. Vaccination programmes have been set up, blood products' safety has significantly been improved, and outbreak investigations remain the basis for the implementation of control measures. However, additional work remains to be done. Awareness of viral hepatitis among the public and professionals should further be raised, and more political support is needed regarding the value of prevention efforts and vaccination programmes.

Jilg W, Rink C, Kallinowski B. · Institut für Medizinische Mikrobiologie und Hygiene, Universität Regensburg, Regensburg. · Z Gastroenterol. · Pubmed #15314718 No free full text.

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Manns MP, Wedemeyer H, Meyer S, Roggendorf M, Niederau C, Blum HE, Jilg W, Fleig WE, Anonymous00375, Anonymous00376. · Medizinische Hochschule Hannover, Abt. Gastroenterologie, Hepatologie und Endokrinologie, Hannover. · Z Gastroenterol. · Pubmed #15314713 No free full text.

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Knöll A, Helmig M, Peters O, Jilg W. · Institute of Medical Microbiology and Hygiene, University of Regensburg, Germany. · Lab Invest. · Pubmed #11310819 No free full text.

Abstract: Hospital-related hepatitis C virus (HCV) infections continue to occur even after the introduction of blood donor screening. We report an outbreak of HCV in nine patients of a pediatric oncology ward in 1996/1997. Sequencing of the hypervariable genomic region 1 (HVR1) of the E2/NS1 region showed near identity between HCV isolates from these patients as evidence for infection with the same virus. Despite a detailed and careful investigation, the source of infection and the mode of virus transmission could not be established. Based on a review of the current literature about nosocomial HCV infection and HCV infection in children, hypotheses for possible means of transmission in this outbreak are discussed.

Jilg W. · Institut für Medizinische Mikrobiologie und Hygiene, Universität Regensburg. · Chirurg. · Pubmed #10840604 No free full text.

Abstract: Viral hepatitis is one of the most important infectious diseases worldwide. It is frequent in tropical and subtropical areas, but also plays still a significant role in the industrialized countries of Northern and Western Europe and the USA. In Germany more than 100,000 people are infected by viral hepatitis each year. Whereas hepatitis A and E are transmitted fecal-orally, hepatitis B, C and D are transmitted by the parenteral route. Most hepatitis A infections seen in Germany are acquired abroad. Hepatitis B is still a nosocomial disease; the majority of infections in Germany, however, seems to be transmitted sexually. For the serological diagnosis of viral hepatitis a battery of sensitive tests for specific antibodies and antigens is available; usually testing of one serum sample allows an unambiguous diagnosis. Prophylaxis of hepatitis A and B is possible using safe and efficient vaccines.

Kallinowski B, Jilg W, Buchholz L, Stremmel W, Engler S. · Department of Internal Medicine IV, University of Heidelberg, Heidelberg, Germany. · Z Gastroenterol. · Pubmed #14562195 No free full text.

Abstract: OBJECTIVES: Hepatitis A (HAV) and B (HBV) vaccinations are recommended in patients with chronic liver diseases. METHODS: We prospectively investigated immunogenicity and safety of an accelerated vaccination protocol (0-7-21 days) with the combined hepatitis A/B vaccine (Twinrix(R)) versus the standard vaccination scheme (0-1-6 months) in hepatitis C virus-infected patients versus healthy volunteers. RESULTS: Local and general symptoms were mostly mild in all groups. One month after completion of the accelerated vaccination or standard vaccination, with the combined hepatitis A/B vaccine anti-HAV seroconversion rates (>33 IU/l) were 89 % and 88 % in HCV-infected patients. Initial HCV-nonresponders developed protective anti-HAV antibodies in 94 % and 96 % after a booster dose. According to the anti-HBs seroprotection rate, HCV-infected patients developed protective anti-HBs titres (>10 IU/l) in 77 % and 82 % of cases one month after the accelerated and the standard vaccination scheme-at month 2 and 7, respectively. This anti-HBs seroprotection rate could even be increased to 84 % and 85 % when initial HCV-infected nonresponders where given a booster dose with the combined hepatitis A/B vaccine. Protective anti-HAV and anti-HBs titers were achieved as early as month 2 after the accelerated vaccination schedule in the majority of HCV-infected patients. Healthy subjects developed protective anti-HAV titers and anti-HBs titers in 100 % and 98 % after the accelerated and standard vaccination protocol. CONCLUSIONS: This study is the first to have demonstrated that the accelerated combined hepatitis A/B vaccination is both safe and highly immunogenic against HAV and HBV in HCV-infected patients with well compensated liver disease.

Kallinowski B, Knöll A, Lindner E, Sänger R, Stremmel W, Vollmar J, Zieger B, Jilg W. · Department of Internal Medicine IV, University Hospital of Heidelberg, Bergheimer Strasse 58, D-69115, Heidelberg, Germany. · Vaccine. · Pubmed #10924782 No free full text.

Abstract: A combined hepatitis A/B vaccine (Twinrix Adult) has been licensed in Germany since 1997. We investigated possible differences in immunogenicity and safety when changing over from vaccinations with monovalent vaccines made by different manufacturers to vaccinations with the combined hepatitis A/B vaccine in an open, randomized, multicenter trial. We therefore compared four different schemes changing over from concomitant vaccinations with monovalent vaccines against hepatitis A and B (Havrix 1440+Engerix-B or Vaqta+Gen H-B-Vax) to combined vaccination against hepatitis A+B with three injections of the combined hepatitis A/B vaccine (0, 1, and 6 month schedule). Local and general symptoms were mostly mild in all five groups. With complete three-dose course using the combined vaccine or an early changeover from monovalent vaccines to the combined vaccine, higher overall anti-HBs seroprotection rates and geometric mean concentrations (GMCs) against hepatitis B could be achieved as early as after 2 months as compared to those groups switching later to the combined vaccine. This study demonstrated for the first time that switching from monovalent hepatitis A and B vaccinations to the combined hepatitis A and B vaccination has no negative influence on the tolerability and improves the immunogenicity.

Knöll A, Hottenträger B, Kainz J, Bretschneider B, Jilg W. · Institute for Medical Microbiology and Hygiene, University of Regensburg, 93042, Regensburg, Germany. · Vaccine. · Pubmed #10706965 No free full text.

Abstract: Combining several vaccines in a single formulation can change the potency of the vaccine antigens. Previous studies suggested a higher immunogenicity of a new combined hepatitis A and B vaccine compared with the monovalent hepatitis B vaccine. We investigated the immune response to hepatitis B surface antigen 1 month after the third vaccine dose in 282 healthy adults who had received either a monovalent hepatitis B vaccine (n=148) or the combined hepatitis A/B vaccine (n=134). A slight trend towards higher geometric mean titres of anti HBs was found at this point in time in the group immunised with the combined vaccine, especially in the few vaccinees with preexisting antibodies against hepatitis A virus. However none of these differences was statistically significant, arguing against an advantage of the combined vaccine regarding hepatitis B immunisation.

Kaltenböck A, Dubischar-Kastner K, Eder G, Jilg W, Klade C, Kollaritsch H, Paulke-Korinek M, von Sonnenburg F, Spruth M, Tauber E, Wiedermann U, Schuller E. · Intercell AG, Campus Vienna Biocenter 3, 1030 Vienna, Austria. · Vaccine. · Pubmed #19486955 No free full text.

Abstract: In travellers often several pre-departure immunizations are indicated, thus data are needed about possible interactions between vaccines. This Phase 3 study investigated the immunogenicity and safety of IC51 (JE vaccine) and HAVRIX1440 (hepatitis A vaccine) when administered alone or concomitantly to healthy subjects. The immune response was compared between single and concomitant vaccination in terms of geometric mean titre (GMT) and seroconversion rate (SCR) on Days 28 and 56. Immunogenicity was comparable for the 2 vaccines whether given together or separately which suggests that travellers to such regions could receive the vaccinations concomitantly.

Wichmann O, Schimanski S, Koch J, Kohler M, Rothe C, Plentz A, Jilg W, Stark K. · Department of Infectious Disease Epidemiology, Robert Koch Institute, Germany. · J Infect Dis. · Pubmed #18983248 No free full text.

Abstract: BACKGROUND: Hepatitis E is a classic water-borne disease in developing countries. In Germany, hepatitis E virus (HEV) infections are notifiable. The number of non-travel-associated infections has increased in recent years, but the route of transmission in most is unknown. Our objective was to determine risk factors for autochthonous HEV infections in Germany. METHODS: Cases of HEV met clinical definitions and were confirmed by laboratory analysis (defined as detection of HEV by polymerase chain reaction [PCR] or immunoglobulin M by serologic testing). PCR products from blood or stool samples were genotyped for phylogenetic analysis. A case-control study included case subjects with autochthonous HEV infection and matched control subjects who were randomly recruited from a population-based telephone list. RESULTS: From May 2006 through August 2007, 76 of 96 persons for whom HEV infection had been reported to the routine surveillance system were interviewed. Sixty-six persons had disease that fulfilled the inclusion criteria: 45 (68%) had autochthonous infection, and 21 (32%) had travel-associated disease. Genotypes 3 or 4 were present in 15 of 15 persons with autochthonous infection, and genotype 1 was present in 8 of 9 persons with travel-associated infection. In conditional logistic regression involving 45 case subjects and 135 control subjects, consumption of offal (41% vs. 19%; odds ratio [OR], 2.7; 95% confidence interval [CI], 1.2-6.2) and wild-boar meat (20% vs. 7%; OR, 4.3; 95% CI, 1.2-15.9) were independently associated with autochthonous HEV infection. CONCLUSION: Hepatitis E is endemic in Germany and likely exists as a food-borne zoonosis. Implicated meat products should be investigated to provide recommendations for preventive measures.

Hafner S, Timmer A, Herfarth H, Rogler G, Schölmerich J, Schäffler A, Ehrenstein B, Jilg W, Ott C, Strauch UG, Obermeier F. · Department of Internal Medicine I, University of Regensburg, Regensburg, Germany. · Eur J Gastroenterol Hepatol. · Pubmed #18467916 No free full text.

Abstract: BACKGROUND: Environmental factors are likely to be involved in the pathogenesis of inflammatory bowel disease (IBD), as the incidence of both Crohn's disease (CD) and ulcerative colitis (UC) increased with improved living standards in Europe after World War II. On the basis of earlier reports suggesting that hygienic standards may also play a role in the pathogenesis of IBD, we investigated the influence of hepatitis A seroprevalence as an indicator for poorer hygienic conditions and worm infestations in IBD. METHODS: Hepatitis A seroprevalence was examined in patients with UC and CD. Patients with minor endocrinological disorders served as controls. All patients were questioned about immunizations, parasitic infections (worms), contact with animals, living on a farm, and ever traveling abroad. Patients were excluded for active hepatitis A immunization or recent passive immunization. Results are presented as Mantel-Haenszel odds ratios with 95% confidence interval, adjusted for age group. RESULTS: The sample included 307 patients (73 CD, 48 UC, and 186 controls). Hepatitis A seroprevalence was strongly associated with age older than 50 years. Age adjusted Mantel-Haenszel odds ratios were 0.25 (0.09-0.71) for UC and 0.75 (0.38-1.46) for CD versus controls. For parasitic infections, the odds ratios were 1.15 (0.52-2.53) for UC and 0.34 (0.13-0.89) for CD. CONCLUSION: We were able to demonstrate a negative association of hepatitis A infection with UC only. In contrast, a novel finding was a strong protective effect of worm infestations for the occurrence of CD, but not UC.

Ross RS, Steinbrückner B, Böhm S, Viazov S, Jilg W, Roggendorf M. · Institute of Virology, National Reference Centre for Hepatitis C, Essen University Hospital, University of Duisburg-Essen, Essen, Germany. · J Clin Virol. · Pubmed #18304865 No free full text.

Abstract: BACKGROUND: Health-care workers infected with the hepatitis C virus (HCV) and performing exposure-prone procedures may expose their patients to the risk of nosocomial HCV infection. OBJECTIVE: To assess the number of provider-to-patient transmissions of HCV among former patients of an HCV-infected general surgeon. RESULTS: The notification exercise covered 1461 individuals, on whom the surgeon performed 1683 operations. Eighty-two percent of these patients were tested for markers of HCV infection, and all but six subjects turned out to be not infected with the virus. Two of the anti-HCV positive patients were already infected before their operations, one individual was not available for further molecular analyses, and three subjects harboured HCV isolates that belonged to a different subtype (i.e. 1b) than the variant detected in the surgeon's serum. CONCLUSION: In this retrospective survey, no provider-to-patient transmission of HCV was detected among 1192 former patients of an infected general surgeon. This finding, one more time, suggests that such nosocomial transmission events are probably very rare. Consequently, recommendations for the management and guidance of HCV-infected health-care workers should carefully balance the workers' rights against justified patients' interests.

Huzly D, Schenk T, Jilg W, Neumann-Haefelin D. · Institute for Medical Microbiology and Hygiene, Freiburg University Medical Center, Hermann-Herder-Str.11, 79104 Freiburg, Germany. · J Clin Microbiol. · Pubmed #18256221 links to  free full text

Abstract: Quantitative measurement of anti-HBs is used to evaluate the response to hepatitis B vaccination in health care workers and to optimize postexposure management. The different guidelines for hepatitis B vaccination and booster policy imply that the measurement of anti-HBs levels by different assays is accurate and consistent, yielding comparable quantitative results. We measured anti-HBs levels in 200 serum samples from patients and health care professionals by nine different anti-HBs assays and compared the quantitative results and the performance characteristics of the different test systems. The assay specificity ranged between 96.8 and 100% when sera from individuals without a vaccination history and with negative anti-HBc status were defined as true negatives. Sensitivity ranged between 93.5 and 100%. A high number of sera showed discrepancies between measurements by the different systems. The mean coefficient of variation between the different measurements was 47.1% (range, 15.0 to 201.0%), and the factors of multiplication ranged from 2.8 to 105. Hemolysis or lipemia did not seem to influence the measurement, and there was no difference between anti-HBc-positive and -negative individuals. The classical enzyme immunoassays tend to find lower anti-HBs levels than the automated systems, with higher values by the Abbott AXSYM assay. The serial dilution of the international standard preparation was measured accurately by most of the assays. In conclusion, the quantitative measurement of anti-HBs levels is not reliable, even though an international standard is used for the calibration of the systems. Some systems showed specific problems that should be addressed by the manufacturers.

Knöll A, Boehm S, Hahn J, Holler E, Jilg W. · Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany. · J Viral Hepat. · Pubmed #17576389 No free full text.

Abstract: Reactivation of resolved hepatitis B virus (HBV) infection is increasingly recognized in patients with severe immunosuppression. We monitored seven patients with pretransplant antibodies to hepatitis B surface antigen (anti-HBs) and hepatitis B core antigen (anti-HBc) for HBV reactivation after allogeneic haematopoietic stem cell transplantation (allo-HSCT). Reverse seroconversion (from anti-HBs to HBsAg) was observed in six recipients occurring 12, 14, 16, 22, 31 and 39 months after allo-HSCT, respectively. The only patient without HBV reactivation had the highest pretransplant anti-HBs titre and died after the shortest follow-up period (25 months). A novel HBV surface mutant (D144G/G145E) was isolated from one recipient of stem cells from a donor vaccinated against HBV. Another surface mutant (P142L/G145R) was detected in a recipient from a non-immune donor. Serum ALT elevation was measured in only two of the six patients with viral reactivation, followed by spontaneous clearance of HBsAg in one of them. Antiviral treatment reduced viral load in five patients, but the emergence of YMDD motif polymerase mutations resulted in lamivudine resistance in two patients. In conclusion, the risk of reactivation of a resolved HBV infection is close to 100% in allogeneic stem cell recipients and vaccination of the donor does not always warrant reliable protection.

Bauer T, Günther M, Bienzle U, Neuhaus R, Jilg W. · Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany. · Liver Transpl. · Pubmed #17318860 links to  free full text

Abstract: After liver transplantation for hepatitis-B-related diseases, patients currently receive lifelong treatment with hepatitis B immunoglobulin to prevent endogenous reinfection with hepatitis B virus (HBV). Active immunization with hepatitis B vaccine would be a preferable alternative; however, most attempts to immunize these patients with standard vaccine have failed. A recent study with a new adjuvanted hepatitis B vaccine was exceptionally successful, leading to a high-titered long-lasting antibody response in 80% of all vaccinees. To identify the immunological mechanisms behind these unexpected results, the successfully vaccinated participants were tested for hepatitis B surface antigen (HBsAg)-specific T and B cells, and their cellular responses to revaccination with conventional vaccine were studied. HBsAg-specific CD4(+) T lymphocytes could be detected in 13 of 16 patients after immunization with the new vaccine. Unexpectedly, these T cells produced almost exclusively interleukin (IL)-10 and had a CD4(+)/CD25(+) phenotype. They were functionally active, suppressing cytokine secretion in HBsAg-specific (Th1) cells, thus representing antigen-specific regulatory T cells (T(Reg)). Following a booster dose with conventional vaccine 22-31 months after completion of the initial vaccination series, the T-cell pattern in the revaccinated individuals changed substantially: 7 days after revaccination 9 of 11 individuals showed a switch to a Th1-type immune response with HBsAg-specific T cells secreting IL-2, interferon gamma and tumor necrosis factor alpha as observed in healthy controls. Four weeks after the booster, 4 patients still showed a Th1-type cytokine pattern, whereas in 5 patients only IL-10-secreting cells were detectable. After 1 year, in 3 of 4 revaccinated individuals only IL-10-secreting cells could be found, whereas the specific T cells of the fourth patient still showed a Th1-type of response. HBsAg-specific T(Reg) cells could be demonstrated in HBV-positive liver transplant recipients successfully immunized with a new adjuvanted vaccine. Revaccination led to immediate disappearance of the these cells and the appearance of HBsAg-specific T cells with a Th1-type cytokine profile, which in most cases were replaced by the IL-10-secreting regulatory cells during the following months. The specific induction of T(Reg) cells could contribute to the poor response of liver transplant recipients to conventional vaccine. In conclusion,, for successful vaccination of these patients, a vaccine with a strong inhibitory effect on T(Reg) cells would be desirable.

Lock G, Dirscherl M, Obermeier F, Gelbmann CM, Hellerbrand C, Knöll A, Schölmerich J, Jilg W. · Albertinenkrankenhaus Hamburg, 2nd Medical Department, University of Regensburg, Regensburg, Germany. · J Viral Hepat. · Pubmed #16907842 No free full text.

Abstract: Chronic hepatitis C patients are advised not to share toothbrushes, razors, nail-scissors or other personal articles that potentially may have been in contact with blood, with others. This study examines the contamination of toothbrushes in patients with chronic hepatitis C as a model for a possible unconventional way of transmission. In 30 patients with chronic hepatitis C, 2 mL of saliva (before and after toothbrushing) and the toothbrush rinsing water after toothbrushing were tested for HCV-RNA. Saliva before and after toothbrushing was positive for HCV-RNA in nine (30%) and 11 patients (36.7%), respectively. Twelve of the toothbrush rinsing water specimens (40%) tested HCV-RNA-positive. In six of these 12 patients, the 'native' saliva had been negative for HCV-RNA. Patients with HCV-RNA-positive toothbrush rinsing water showed no significant differences from those with negative rinsing water with respect to certain clinical, biochemical and virological parameters. In conclusion, our study demonstrates a contamination with HCV-RNA of a considerable portion of toothbrushes used by hepatitis C patients, suggesting at least a theoretical risk of infection by sharing these objects and strengthening the recommendations to take care of a clear separation of these personal care objects between patients and their household members.

Preiss JC, Plentz A, Engelmann E, Schneider T, Jilg W, Zeitz M, Duchmann R. · Medizinische Klinik I (Gastroenterologie, Infektiologie, Rheumatologie), Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. · Infection. · Pubmed #16804663 No free full text.

Abstract: Hepatitis E virus (HEV) is a common cause of acute hepatitis in endemic areas. Yet reports on autochthonous cases in other areas such as middle Europe are increasing. Here we report on a patient, who obviously acquired his HEV infection in Germany. Sequence analysis of the virus gained from his serum revealed homologies to other European isolates and swine isolates.

Knöll A, Hartmann A, Hamoshi H, Weislmaier K, Jilg W. · Institute of Medical Microbiology and Hygiene, University of Regensburg, D-93042 Regensburg, Germany. · World J Gastroenterol. · Pubmed #16534880 links to  free full text

Abstract: AIM: To investigate the prevalence and clinical significance of "anti-HBc alone" in an unselected population of patients and employees of a university hospital in southern Germany. METHODS: All individuals with the pattern "anti-HBc alone" were registered over a time span of 82 mo. HBV-DNA was measured in serum and liver samples, and clinical charts were reviewed. RESULTS: Five hundred and fifty two individuals were "anti-HBc alone" (of 3004 anti-HBc positive individuals; 18.4%), and this pattern affected males (20.5%) more often than females (15.3%; P<0.001). HBV-DNA was detected in serum of 44 of 545 "anti-HBc alone" individuals (8.1%), and in paraffin embedded liver tissue in 16 of 39 patients tested (41.0%). There was no association between the detection of HBV genomes and the presence of biochemical, ultrasonic or histological signs of liver damage. Thirty-eight "anti-HBc alone" patients with cirrhosis or primary liver carcinoma had at least one additional risk factor. HCV-coinfection was present in 20.4% of all individuals with "anti-HBc alone" and was the only factor associated with a worse clinical outcome. CONCLUSION: In an HBV low prevalence area, no evidence is found that HBV alone causes severe liver damage in individuals with "anti-HBc alone". Recommendations for the management of these individuals are given.

Günther M, Neuhaus R, Bauer T, Jilg W, Holtz JA, Bienzle U. · Institute of Tropical Medicine, Humboldt University, Berlin, Germany. · Liver Transpl. · Pubmed #16447191 links to  free full text

Abstract: Patients after orthotopic liver transplantation (OLT) due to hepatitis B virus (HBV)-related disease are at risk of endogenous hepatitis B reinfection and may receive life long prophylaxis with hepatitis B hyperimmunoglobulin (HBIG). In a previous study 16 of 20 OLT patients were immunized successfully with an adjuvant hepatitis B vaccine. To maintain protective antibody levels under immunosuppressive therapy, 11 of these patients were revaccinated with a double dosed conventional hepatitis B vaccine. Median interval between last vaccination and booster was 24 months (range 22-31 months). Antibody titres against hepatitis B surface antigen (anti-HBs) were monitored at the day of booster vaccination (day 0), at day 7 and day 28. At day 0, all vaccinees but one had anti-HBs titres greater than 500 IU/L (median 1,925 IU/L, range 196-7,612 IU/L). Maximum antibody titres after previous vaccination declined by a median of 82% (range 47-96%). After booster vaccination the anti-HBs titre increased significantly by a median factor of 2.42 (P<0.05). In conclusion, the majority of liver transplant recipients who previously had responded to adjuvant hepatitis B vaccine exhibited sufficient immunocompetence to produce a substantial antibody response after booster immunization with a conventional vaccine.

Bauer T, Jilg W. · Institute for Medical Microbiology and Hygiene, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany. · Vaccine. · Pubmed #16171909 No free full text.

Abstract: Long-term protection after hepatitis B vaccination is dependent on the persistence of a strong immunologic memory. In search of reliable markers for a hepatitis B surface antigen (HBsAg)-specific immunological memory we studied the cellular and humoral immune responses of 15 healthy individuals who were successfully vaccinated but had lost anti-HBs titers. To determine the reactivity of vaccine-induced HBsAg-specific T cells of both effector and memory phenotype CD4+/CD45RA+ and CD4+/CD45R0+ T cells, respectively, were isolated, stimulated with HBsAg and tested for IFN-gamma and IL-5-secretion by enzyme-linked immunospot assays (Elispot). To detect even small numbers of specific T cells, we enriched the appropriate subpopulation from the entire PBMC population. B cell memory was analysed by cocultivation of isolated B cells with CD4+ T cells and identification of anti-HBs-secreting cells by Elispot. All individuals were revaccinated and humoral and cellular responses were determined. The results showed significant numbers of HBsAg-specific memory T and B cells present in all vaccinees despite the absence of specific antibodies. Our data suggest that individuals who had lost their anti-HBs seropositivity still show immunologic T cell memory and that these T cells are able to trigger anti-HBs production of B cells activated by revaccination.

Fitzsimons D, François G, Hall A, McMahon B, Meheus A, Zanetti A, Duval B, Jilg W, Böcher WO, Lu SN, Akarca U, Lavanchy D, Goldstein S, Banatvala J, Damme PV. · World Health Organization, Via Appia 20, CH-1211 Geneva, Switzerland. · Vaccine. · Pubmed #15964484 No free full text.

Abstract: The long-term efficacy of hepatitis B vaccine, long-term effectiveness of hepatitis B immunisation programmes, immune memory induced by hepatitis B vaccine, current booster policies, and impact of hepatitis B virus mutants on immunisation programmes were reviewed at the Viral Hepatitis Prevention Board (VHPB) meeting in Sevilla, Spain, March 2004. The main focus was on universal vaccination programmes with data being presented from Italy, Saudi Arabia, Singapore, Spain, Taiwan, Thailand, The Gambia, and USA (Alaska).

Knöll A, Pietrzyk M, Loss M, Goetz WA, Jilg W. · Institute of Medical Microbiology and Hygiene, University of Regensburg, D-93042 Regensburg, Germany. · Transplantation. · Pubmed #15940056 No free full text.

Abstract: Hepatitis B virus (HBV) reactivation is a well-described event in HBV surface antigen (HbsAg)-positive patients undergoing immunosuppression. There are only few data about the risk of HBV reactivation in HBsAg-negative solid-organ transplant recipients with resolved HBV infection. We conducted a systematic screening of serum and liver samples from 38 HBsAg-negative and anti-HBV core antigen (anti-HBc)-positive patients for the presence of HBV-DNA and for serologic HBV markers before and after solid-organ transplantation (kidney, n=23; liver, n=9; heart, n=6). Pretransplant prevalence of HBV-DNA was 24% (6/25) in serum and 33% (3/9) in liver samples. Forty-four percent (15/34) of the recipients were viremic after transplantation; this finding was more common in patients coinfected with hepatitis C (P=0.011) and in patients negative for anti-HBs (P=0.001). Two recipients became antigenemic (HBsAg-positive), but none developed clinical signs of hepatitis. In conclusion, subclinical reactivation of HBV infection was detected in a significant proportion of HBsAg-negative solid-organ-transplant recipients.