Development and Distribution of Hemagglutinating Antibody against the Hepatitis B Antigen in Institutionalized Populations

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Abstract
Specimens of blood from 1,098 patients and employees at two institutions for the mentally retarded were tested by the passive hemagglutination assay for the presence of antibody (HB Ab) against the antigen of hepatitis B (HB Ag). The test was found to be highly specific and sensitive. Twenty-six of 52 patients newly admitted to one institution developed either HB Ag or HB Ab during an 18- to 30-month period of follow-up. None of these 26 developed overt hepatitis; this indicates a ratio of infection to overt hepatitis of >26: 1 in this population. Forty-three percent to 52% of all patients tested and 20% of employees tested were found to have detectable amounts of HB Ab, which tended to persist for long periods. The prevalence of HB Ab, in contrast to that of HB Ag, was consistently lower among mongols than nonmongols. These findings suggest an immunologic deficiency in patients with mongolism. The prevalence of HB Ab was closely related to the duration of institutionalization. Other variables that have been found to be associated with prevalence or persistence of HB Ag appeared to be unrelated to the development and distribution of HB Ab. These findings indicate that, in hyperendemic conditions, all patients are equally exposed and equally susceptible to type B viral hepatitis but are not equally prone to development of the chronic carrier state.

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