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Serum samples from 226 patients covering a wide spectrum of liver disease were tested for antibodies to hepatitis C virus (HCV) using both first and second generation enzyme linked immunosorbent assays. Selected sera were also tested by peptide immunoassays, by the four-antigen recombinant immunoblot assay (RIBA II), and for viral genome by the polymerase chain reaction. Antibody to c100-3 was detected in 61% of patients with chronic non-A, non-B (NANB) hepatitis and/or 46.5% with presumed NANB-related cirrhosis by the first generation test. These figures increased to 77% and 58% when antibodies to recombinant structural and non-structural HCV antigens were sought by the second generation assay. Supplemental testing against peptide Sp75 and Sp65/sp67 confirmed that reactivity of sera by second generation assays was due to antibodies to the additional structural and non-structural antigens. Samples negative by the first generation assay were not confirmed by the supplemental assay using peptides Sp75 and Sp65/Sp67. HCV RNA was detected in 60% of the anti-HCV positive sera tested, most of which were also RIBA II positive. Our findings confirm that the introduction of the structural and non-structural antigens, especially the putative nucleocapsid protein, improves sensitivity of detection of antibodies to HCV, and facilitates diagnosis in patients with "cryptogenic" chronic hepatitis.

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Two hundred and fifty-three cases of acute viral hepatitis admitted to Ibn Al-Khateeb Infectious Disease Hospital, Baghdad, were studied prospectively regarding the viral aetiological agent. The most common cause was infection with one of the non-A, non-B viruses (51%). The second most common cause was infection with the hepatitis B virus (32%); two of these patients had hepatitis delta-co-infection. Hepatitis A virus was responsible for 15% of the cases, and hepatitis delta-virus superinfection in 2% of the cases.

Acute viral hepatitis occupies an important place among infectious diseases in the Baghdad area and was responsible for 11.2% of the total admissions to Hummayat Infectious Diseases Hospital, Baghdad, over the five-year period 1979 to 1983. There was no change in the admission rate during this five-year period, while there was a regular and significant increase during the last six months of each year. The total number of males admitted was higher than females (P <0.01), while the fatality rate was higher in females and mainly related to the 15+ years age group (P <0.001). The total fatality rate was 6%, while the fatality rate among the fulminant cases was 84%. Of the 500 patients tested for HBsAg, 24% were positive.