Læknablaðið - 01.02.1977, Page 41

LÆKNABLAÐIÐ
17
ósvarað varðandi viðhorfin til langtíma
HBAg-bera. Sums staðar hafa verið stofn-
settar sérstakar deildir („Liver Clinics“),8'1
til rannsókna og eftirlits HBAg-bera. Nauð-
synlegt er að þeir skilji, að blóð þeirra
er ekki aðeins hættulegt til blóðgjafa, held-
ur ber þeim að vara þá við, sem þurfa
að meðhöndla eða komist gætu í snertingu
við blóð þeirra, svo sem lækna, tannlækna,
meinatækna og hjúkrunarfólk. Læknar eða
annað starfsfólk heilbrigðisþjónustu, sem
finnast HBAg jákvæðir, eru yfirleitt úti-
lokaðir frá störfum á deildum, sem annast
haemodialysis eða líffæraflutninga vegna
hinnar sérstöku hættu þar.81 Lítið er vit-
að um tíðni slíkrar starfstengdrar smitun-
ar, t. d. frá lækni til sjúklings. Smithættan
virðist almennt ekki mikil, en ráðlögð er
sérstök varúð, ekki sízt fyrir tannlækna.
Oll þessi vandamál undirstrika hversu
brýn er meiri þekking á raunverulegum
smitleiðum hepatitis-B.
Lítið er vitað um tíðni og útbreiðslu á
bráðum virus hepatitis hérlendis. Með svo
fáa HBAg-bera, sem hér virðast vera, og
með vísbendingu frá framangreindum já-
kvæðum tilfellum, verður að teljast frem-
ur líklegt, að hjá talsverðum hluta þeirra
HBAg jákvæðu, sem hér finnast, hafi
smitun átt sér stað erlendis.
ÞAKKARORÐ
Höfundur þakkar starfsliði Rannsóknadeildar
Landakotsspitala veitta aðstoð við framkvæmd
þessara rannsókna. Sérstaklega ber að þakka
Malcolm Coote. Ragnhiidi Kolka og Samir
Awad þeirra framlag.
ENGLISH SUMMARY
Hevatitis B antipen (HBAg) is reviewed
under the main headings of: Historical review,
Terminolopy, Nature and structure, Methods
of detection, Rpread and transmission, and
Antigenaemia in health and disease.
To gain some information on the prevalence
of Hepatitis B antigen in Iceland, three se-
lected grouns of peonle were investigated and
their sera tested for HBAg hv counterimmuno-
electrophoresis: Blood donors. Great variations
have been found in the nrevalence of HBAg
in blood donors from different parts of the
world.
From Novemher 1971 until October 197.1.
11754 donations were tested for the Blood Bank
in Revk.iavík. Only 1 was HBAg positive
(0.007%). an annarentlv heatthv 23 years old
male carrier. living in Revkiavik.
Hospital patients. Contrary to hlood donors
there is little published information regarding
the prevalence of HBAg in Hospital patients.
From November 1971 until the end of 1972,
3000 patients, 15 years and older, admitted to
St. Jósefsspítalinn in Reykjavík, were tested
for HBAg. 5 patients were HBAg-positive
(0,167%), 2 of these were admitted because
of jaundice and had acute hepatitis. The other
3 patients were asymptomatic HBAg-carriers
(0,1%), not regarded as “high risk” in relation
to transmission of hepatitis when admitted.
Some relevant details are given in tables 5-9.
Patients with Down’s syndrome. Many re-
ports from different countries have eonfirmed
the high frequency of persistent HBAg in
institutionalized patients with Down’s syn-
drome.
In August 1974 HBAg testing was carried
out on 53 patients with Down’s syndrome who
are resident in 2 institutions for the mentally
retarded near Reykjavík. None of them had
a positive result.
These results are discussed. and compared
with reported results from varlous countries.
Our findings suggest that the prevalence of
HBAg is very low in the Icelandic population.
They also remind us that hospitals must fre-
quently be treating unknown earriers and
emphasize the importance of handling all
specimens with great care. It is suggested that
in addition to the established practice of blood
donor screening, hospital patients should be
screened for HBAg if possible. Finally some
of the problems and questions that have come
up in relation to the management of asymp-
tomatic HBAg-carriers are briefly discussed.
HEIMILDIR
1. Akdamar, K. A., Mammus, L., Cherrie Epps,
A., Leaeh, R., Warren, S. S. H. Antigen in
bile. Lancet 1:909. 1971.
2. Almeida, J. D., Waterson, A. P. Immune
complexes in hepatitis. Lancet 1:983. 1969.
3. Almeida, J. D., Rubenstein, D., Stott, E. J.
New antigen-antibody system in Australia
— antigen-positive hepatitis. Lancet 2:1225.
1971.
4. Alter, H. J., Blumberg, B. S. Further
studies on a “new” human isoprecipitin
system (Australia antigen). Blood 27:297.
1966.
5. Anthony, P. P., Vogel, C. L., Barker, L. F.
Liver cell dysplasia: a premalignant con-
dition. J. Clin. Path. 26:217. 1973.
6. Banke, O. et al. Australia antigen and anti-
bodv in 10.000 Danish blood-donors. Lancet
1:860. 1971.
7. Bayer. M. E., Blumberg, B. S„ Werner, B.
Particles associated with Australia antigen
in the sera of patients with leukaemia,
Down’s syndrome and hepatitis. Nature
218:1057. 1968.
8. Blainey, J. D.. Earle. A., Flewett, T. H„
Williams. L. K. L. Is the urine infective in
serum hepatitis? Lancet 1:797. 1971,