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Appendix D-5: The Prospects for Immunizing Against Hepatitis B Virus
Pages 208-222

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From page 208...
... DISEASE DESCRIPT ION The diseases associated with HBV occur at two intervals after infection: acute hepatitis appears within several weeks; the manifestations of chronic hepatitis B infection may not appear until many years later. Symptoms of acute hepatitis B virus infection include nausea, vomiting, abdominal pain, generalized myalgia with occasional joint pain, urticarial rash, and jaundice.
From page 209...
... Individuals who recover from HBV infection usually develop substantial anti-HBs levels, which probably persist for life. The major humoral immune response following infection is to the common a antigenic component (anti-HBs/_)
From page 210...
... Acute HBV manifestations are relatively less common in endemic countries than in other areas because much of the disease burden occurs during childhood, when symptoms are less frequent.- However, the total burden of acute disease is large in these countries because the disease is so widespread. The total disease burden resulting from HBV in endemic areas is large because of the high infection rates at early ages, with the late sequelae that result from persistent infection.
From page 211...
... Table D-5.2 shows the disease burden resulting from acute hepatitis B Primary Hepatocellular Carcinoma PHC may occur in chronic hepatitis B carriers 20 years or more after an acute infection.
From page 212...
... 212 so co s4 co PA Go ~o to ~4 0 a, P~ a~ l u)
From page 213...
... Table D-5.6 shows the total disease burden estimates for hepatitis B PROBABLE VACCINE TARGET POPULATION In highly endemic areas, the goal of HBV vaccination is to prevent both infection and the chronic carrier state.
From page 215...
... · To o in 1 A ·rl ·ri lo: ·e Q]
From page 216...
... 216 o ID so sat 0 Q
From page 217...
... Alternative Control Measures and Treatment No effective treatment for acute or chronic hepatitis B exists. Although some researchers have shown that the combination of alphafetoprotein screening and surgery can effectively treat primary hepatocellular carcinoma, the logistics and expense of this combination make widespread application impractical for the developing world.
From page 218...
... Large boosts in titer followed the third dose. Phase 1 clinical trials with the Genentech mammalian cell derived vaccine suggest that it is at least as immunogenic as the presently licensed vaccine (National Institute of Allergy and Infectious Diseases, 1985~.
From page 219...
... 1983 . Ef f icacy of a heat inactivated hepatitis B vaccine in male homosexuals: Outcome of a placebo controlled double blind trial.
From page 220...
... 1983a. Chemically synthesized peptides of hepatitis B surface antigen duplicate the d/y specificities and induce subtypespecific antibodies in chimpanzees.
From page 221...
... 1981. Chemically synthesized peptides predicted from the nucleotide sequence of the hepatitis B virus genome elicit antibodies reactive with the native envelope protein in Dane particles.
From page 222...
... 1983. Infectious vaccinia virus recombinants that express hepatitis B virus surface antigen.


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