The efficacy of a heat inactivated hepatitis B virus vaccine, containing 3 vg hepatitis B surface antigen (HBsAg), was studied in a high risk group of 800 susceptible homosexual men by a randomised placebo controlled double blind trial. At the trial end point (215 months), 17 hepatitis B virus infections had occurred in vaccinated subjects (attack rate 4 8%) and 56 in subjects receiving a placebo (attack rate 23-8%). This reduction in the incidence of hepatitis B virus infections in vaccinated subjects was highly significant (p <0 0001). Two months after the first injection 72-3% of the vaccinated subjects had formed antibodies against hepatitis B surface antigen, and this percentage increased to 89% at four months. Maximum anti-HBs titres were reached five months after the first vaccination, the geometric mean titre being 107 6 mIUJ. Even vaccinated subjects with a low antibody response ( > 1 and <10 mIU) were found to be protected from HBsAgpositive infections. The vaccine had no serious side effects.
In a study of 689 male homosexuals 290 (42%) were found to have antibodies to hepatitis A virus. The 399 men who did not have antibodies were followed up for up to 690 days, and 35 cases of hepatitis A were detected. The attack rate at the end of the study was 14%. The incidence climbed steadily, indicating that the cases of hepatitis A did not occur in clusters. Statistical analysis showed that the prevalence of antibodies to hepatitis A virus was significantly correlated with the duration of homosexual activity (p <0 006), and this was independent of age. The incidence of hepatitis A was found to be correlated with the number of different sexual partners in the preceding six months.It is concluded that hepatitis A is a sexually transmitted disease among homosexual men in countries with a low rate of exposure to hepatitis A during childhood.
SUMMARY The prevalence and incidence of cytomegalovirus (CMV) infections were studied in a group of homosexual men. Of the 710 participants, 501 (70-6%7o) had complement fixing antibodies to CMV on entry to the study. During the follow up (maximum 23 months) 69 CMV infections were found: 50 primary infections among the 209 seronegative men (attack rate 27 -3 0o), and 19 recurrent infections among the 501 seropositive men (attack rate 6-2%7o).The prevalence of antibody to CMV was correlated with four characteristics of the participants' lifestyles: duration of homosexual activity, number of different sexual partners, history of syphilis, and anal sexual contact. Among the seronegative men, the incidence of primary infection with CMV correlated with a history of syphilis and anal sexual contact.We conclude that infections with CMV are highly prevalent among homosexual men, and that anal sexual contact plays an important part in the transmission of this virus.
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