Non-A, Non-B Hepatitis: A Prospective Study of a Hemodialysis Outbreak with Evaluation of a Serologic Marker in Patients and Staff

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Abstract
An outbreak of non-A, non-B hepatitis (NANBH) in a hemodialysis unit was prospectively studied and the clinical, biochemical, and serologic events were correlated with an experimental immunodiffusion assay for serum antigen and antibody. One hundred sixteen subjects (76 dialysis patients and 40 staff members) were studied over an 8-month period. Hepatitis was defined as two consecutive SGPT levels greater than two times the upper limit of normal occurring in two separate samples drawn greater than 7 days apart in the absence of other likely causes of liver disease. Weekly serum specimens were obtained and tested for SGPT, SGOT, alkaline phosphatase, bilirubin HBsAg, anti-HBc, anti-HBs, total anti-HAV, and anti-HAV IgM by commercial reagents, and for antigen and antibody by agar gel diffusion using reference reagents previously obtained from well-documented posttransfusion NANBH patients. Clinical evaluations were performed three times per week. Thirty patients and none of the staff developed NANBH. The NANBH patients were asymptomatic, except for two patients with jaundice. Fifteen of the 30 patients were positive for antigen which was detectable in at least one serum collected during the acute phase. Six patients and 10 staff without clinical NANBH or abnormal serology had antigen. Antigenemia was also observed in three patients with acute hepatitis B, with chronic hepatitis B in one patient and with alcoholic hepatitis in one patient. Thus, an antigen was detected in a high proportion of patients during the acute phase of NANBH, and it was also found in exposed patients who had other liver diseases. NANBH antigen was found in 19 of 72 (26.4%), transfused cancer patients without evidence of liver disease, and in 20% of 168 other control patients without liver diseases. Fifty per cent of patients with NANBH developed antigenemia compared to 13% of exposed patients (6 of 46) without NANBH (p < 0.05). Of eight patients who developed chronic hepatitis, six were NANB antigen positive. Transient antigenemia was found in some asymptomatic staff members whose liver tests remained normal. Immune serum globulin did not prevent transmission of NANBH under the circumstances of this study.