Hepatitis

Hepatitis B virus (HBV) produces an illness characterized by jaundice, poor appetite, malaise, and nausea. Chronic liver disease may follow the infection. Hepatitis B vaccine is recommended for persons who are at a greater risk of contracting the disease because of their life-styles or jobs. These include health-care personnel who are exposed to blood products, hemodialysis patients, institutionalized patients and their staffs, patients receiving multiple transfusions, prostitutes and the sexual partners of individuals with the disease, users of illicit intravenous drugs, homosexual males, and newborn infants of mothers with hepatitis B infection.

Hepatitis B vaccine, which is quite expensive, consists of inactivated viral surface antigen particles. Its immediate side effects are minimal and no long-term reactions have been reported.

 

Vaccine

Passive immunity is the administration of antibodies to an unimmunized person from an immune subject to provide temporary protection against a microbial agent, poison, or cell. The process is also used in the treatment of certain disorders associated with toxins (diphtheria, tetanus), in certain bites (snake and spider), and as a specific (Rho-GAM) or nonspecific (antilymphocyte serum) immunosuppressant. Other antibody preparations are available under specific conditions for specific disorders. Passive immunization is not always effective; the duration of immunity provided is brief and variable, and undesirable reactions may occur, especially if the antiserum is of nonhuman origin. Several preparations are available for use as passive immunizing agents.

Human immune serum globulin (HISG) is prepared from human serum. Special treatment of the serum removes various undesirable proteins and infectious viruses, thus providing a safe product for intramuscular injection. HISG is used for the treatment of antibody deficiency conditions and for the prevention of hepatitis A and hepatitis B viral infections, measles, chicken pox, German measles, and poliomyelitis.

The most widespread use of HISG is in the prevention of hepatitis A infection, a disease for which there is no active immunization available, in individuals known to have had intimate exposure to the disease. Hepatitis B immunoglobulin should be given immediately to persons who are exposed to contaminated blood or who have had intimate physical contact with a person who has hepatitis B infection. Because of the scarcity of the product and the lack of its proven efficacy, hepatitis B immune globulin is not recommended routinely for those who are continuously at high risk of exposure to hepatitis B. It should be given, however, to infants born to mothers who have serological evidence of hepatitis B viral infection.

Passive immunity can be conferred on persons who are exposed to measles, mumps, whooping cough, poliomyelitis, rabies, German measles, tetanus, chicken pox, and shingles (herpes zoster). Several investigators have claimed a beneficial effect of HISG in persons suffering asthma and other allergic disorders; evidence confirming its efficacy in these conditions is lacking, however. Monthly HISG is not beneficial in the prevention of upper respiratory infections, otitis, skin infections, gastrointestinal disorders, or fever of undetermined cause. HISG has been used inconclusively in the treatment of infants with significantly low levels of immunoglobulins and patients with severe burns who are at an increased risk of infection. Antivenoms derived from horses are used effectively to treat snake or spider bites, but not without significant risk of reaction to the equine antibody preparation.

Rho-GAM is a human anti-Rhesus immune serum globulin used in the prevention of Rh hemolytic disease of the newborn. Rh positive is given to an Rh-negative mother after the delivery of an Rh-positive infant or after miscarriage or abortion.

Botulism, a severe paralytic poisoning, results from the ingestion or absorption of the toxin of the bacteria Clostridium botulinum. As a preventive measure, antitoxin can be given to individuals known to have ingested contaminated food and to patients with symptoms as soon as possible after exposure.

Most of the damaging effect of diphtheria results from the toxin produced by the bacteria Corynebacterium diphtheriae. This toxin not only has local effects but also is distributed through the blood to the heart, nervous system, kidneys, and other organs. Diphtheria antitoxin of animal origin remains the principal treatment, along with antibiotics.