example, approximately 60% of inhabitants of

American Samoa and 40% of the population of
Ponapeare reported to have serologic evidence

of past infection with this virus (Wong,Purcell,
and Rosen 1979). The clinical significance of the
cellular immune response in hepatitis B infection is unclear (Hansonetal. 1984; Rustgi et
al. 1984). In contrast to hepatitis A, serious late
manifestations of disease (chronic active hepatitis, cirrhosis, and hepatocellular carcinoma)
are not rare with hepatitis B. It has been
suggested that Japanese atomic bombing
survivors in the United States do not have a
deficit in natural cell-mediated cytotoxicity
(Bloom et al. 1983), but studies of the Radiation
Effects Research Foundation have revealed an
impaired response of lymphocytes to phytohemagglutinin in Japanese receiving >100 rads
(Akiyamaet al. 1983). If the radiation-exposed
Marshallese have an impaired immune mechanism, it is possible that they will be atincreased risk for serious hepatic sequelae if
they acquire the infection. For this reason, a
serological evaluation of radiation-exposed and
unexposed Marshallese was performed in conjunction with the Hepatitis Branch, Division of
Viral Diseases, Centers for Disease Control,
Atlanta, GA (Dr. Howard Fields and Dr. Stephen
Hadler).
Analysis of the results of serologic testing of
314 Marshallese tested revealed that 91.8% gave
serologic evidence of past hepatitis B infection.
The surveyed population included 98% of the
Rongelap group, 82%of the Utirik group, 70% of
the comparison population, and 46 younger
persons. Thelast group, ranging in age from 10
to 28 years, was included to evaluate the age-

specific prevalence of infection. A tabulation of
the hepatitis experience of the different subgroups is presented in Table 2.
There was no difference in the prevalence of
serologic evidence of hepatitis B infection
among the three exposure groups. However, a
significant group difference in the prevalence of
hepatitis B surface antigen was detected, with
the high-exposure Rongelap group having the
lowest prevalence (X?=8.17,df=2, p< 0.02). This
finding contrasts with that of the Radiation
Effects Research Foundation, which indicated
that the Japanese atomic bombing survivors
who received > 100 rads had significantly

higher prevalenceof hepatitis B surface antigen

than the low-dose groups (3.4% vs 2.0%) (Kato et
al. 1983). The reason for the relative infrequency
of hepatitis B surface antigenemia among the
exposed Rongelap group(2 of 61 persons tested)
is not known. However, it is more likely related
to local factors rather than to radiation dose
because the prevalence of this hepatitis B marker among the unexposed comparison population was not significantly different from that of
the Rongelap exposed (X?=1.93,df=1, p>0.10).
Serological evidence of delta agent was not
found in any of the persons tested. Delta agent
is a co-infecting virus which canaffect the host
responseto hepatitis B. Since the frequency of
serious chronic liver disease can be muchgreater
in delta antigen-positive individuals, its absence

in the Marshallese is reassuring from the public
health perspective.

Tuberculin and Candida

Sensitivity

Impaired cellularimmunity increases the risk
of many types of infection. A survey of skin test
responsiveness to mycobacteria and Candida
was therefore undertaken to determine whether
the exposed Marshallese reacted appropriately
to these antigens. Another reason for the choice
of M. tuberculosis testing is the increasing
prevalence of tuberculosis in many partsof the
world, including Micronesia.
Most persons were evaluated in March 1983.
Screening was performed with the Mantoux
tuberculin test, where 0.1 ml of PPD containing
5 TU was injected intracutaneously into the
forearm in a manner recommended by the
American Thoracic Society. A dosage of 0.1 ml
of Candida antigen was injected into the
opposite arm to test for anergy. After 48 to 72
hours, the amount of induration was measured,

with 10 mm or more of induration being considered a positive test. Most individuals with a
positive test had a chest x ray taken. Exceptions
included those persons who were known, either
by personal history or from the medical program records, to have had a positive PPD in
earlier years.
A total of 323 PPD tests were applied and read
in adults (those = 15 years of age). Of those

tested, 147 had a positive test, for a prevalence
of 45.5%. One hundred and ten persons received
a chest x ray; none revealed evidence of tuber-

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