Acute hepatitis B in a healthcare worker: A case report of genuine vaccination failure

Background Individuals who reach the antibody threshold level of 10 IU/l against the surface protein of the hepatitis B virus (HBV) after completion of a series of hepatitis B vaccination are considered to be long-term protected against a clinically manifest HBV infection. Case report Here we descri...

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Bibliographic Details
Published in:Journal of hepatology 2009-02, Vol.50 (2), p.426-431
Main Authors: Boot, Hein J, van der Waaij, Laurens A, Schirm, Jurjen, Kallenberg, Cees G.M, van Steenbergen, Jim, Wolters, Bert
Format: Article
Language:English
Subjects:
Acute Disease
Biological and medical sciences
Gastroenterology and Hepatology
Gastroenterology. Liver. Pancreas. Abdomen
HBV Genotype A
Health Personnel
Healthcare worker
Hepatitis B - immunology
Hepatitis B surface antigen (HBsAg)
Hepatitis B Vaccines - immunology
Hepatitis B Virus
Human viral diseases
Humans
Infectious diseases
Male
Medical sciences
Middle Aged
Vaccination
Vaccination failure
Viral diseases
Viral hepatitis
Waning immunity
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Summary:Background Individuals who reach the antibody threshold level of 10 IU/l against the surface protein of the hepatitis B virus (HBV) after completion of a series of hepatitis B vaccination are considered to be long-term protected against a clinically manifest HBV infection. Case report Here we describe an acute hepatitis B infection in a patient who received five hepatitis B vaccinations. Although his initial response to vaccination was moderate, he finally reached an excellent hepatitis B surface antibody level (anti-HBs) titres of more than 1000 IU/l in response to a booster vaccination with a recombinant DNA vaccine. Nevertheless, he developed full-blown acute hepatitis due to an HBV infection 14 years after this booster vaccination. A DNA analysis of the surface protein encoding region followed by phylogenetic analysis showed that our patient was infected with a normal HBV strain that is circulating among men who have sex with men. To our knowledge, this is the first report of a genuine hepatitis B vaccination failure in someone who acquired a high anti-HBs level in response to a recombinant DNA hepatitis B vaccine. Conclusion Healthcare workers whose response to the initial hepatitis B vaccination is moderate might be vulnerable to hepatitis B virus infection.
ISSN:0168-8278
1600-0641
DOI:10.1016/j.jhep.2008.07.040