Passive-Active Immunity from Hepatitis B Immune Globulin

doi:10.1059/0003-4819-91-6-813

Passive-Active Immunity from Hepatitis B Immune Globulin

Reanalysis of a Veterans Administration Cooperative Study of Needle-Stick Hepatitis

JAY H. HOOFNAGLE, M.D.;
LEONARD B. SEEFF, M.D.;
Z. BUSKELL BALES, B.S.;
ELIZABETH C. WRIGHT, M.P.H.;
HYMAN J. ZIMMERMAN, M.D.; and
THE VETERANS ADMINISTRATION COOPERATIVE STUDY GROUP

Bethesda, Maryland; and Washington, D.C.

Abstract

The mechanism of action of hepatitis B immune globulin (HBIG) and immune serum globulin was sought in a reanalysis of a Veterans Administration cooperative study on needle-stick exposure to hepatitis B surface antigen (HBsAg)-positive blood. Sera from 296 exposed persons were tested for HBsAg, antibody to HBsAg (anti-HBs), and antibody to hepatitis B core antigen (anti-HBc) by radioimmunoassay. Type B hepatitis developed in three HBIG (2%) and in 12 ISG (8%) recipients. In contrast, subclinical infection (development of HBsAg or anti-HBs and anti-HBc without symptoms or jaundice) developed in 16 HBIG (10%) but only six immune serum globulin (4%) recipients. Thus, infection occurred equally in both groups but was more likely to be subclinical in HBIG recipients, indicating that HBIG permitted development of passive-active immunity to type B hepatitis. An additional 53 immune serum globulin recipients (36%) but only one HBIG recipient developed anti-HBs alone, without hepatitis, HBsAg, or anti-HBc. This response was more compatible with immunization by HBsAg than with infection. Ultracentrifugation analysis revealed occult HBsAg in the immune serum globulin but not the HBIG, indicating that some immune serum globulin preparations contain HBsAg and can induce active immunity to type B hepatitis.

Article and Author Information

▸From the Section on Diseases of the Liver, Digestive Diseases Branch, National Institute of Arthritis, Metabolism, and Digestive Diseases, National Institutes of Health; Bethesda, Maryland; the Medical Service, The Veterans Administration Medical Center, Washington, D.C.; and the Departments of Medicine, Georgetown and George Washington Universities; Washington, D.C.
▸Requests for reprints should be addressed to Jay H. Hoofnagle, M.D.; Section on Diseases of the Liver, National Institute of Arthritis, Metabolism, and Digestive Diseases, Building 10, Room 4D-52, National Institutes of Health; Bethesda, MD 20205.
- Received May 30, 1979.
- Accepted August 27, 1979.