Hepatitis B Reverse Seroconversion and Transmission in a Hemodialysis Center: A Public Health Investigation and Case Report

Hepatitis B Virus Mutant Infections in Hemodialysis Patients: A Case Series

“…Rarely, severe immunosuppression can promote reverse seroconversion (reappearance of HBsAg and circulating HBV DNA) and reactivation among persons with previously resolved infection. 4 Patient 1 had HBV genotype H, which is prevalent in some countries outside the United States, including Mexico, and is known to frequently cause occult HBV infection with low-level viremia. 21 Patients 2 and 3 had serologic evidence of previous HBV infection (total anti-HBc positive) before initiation of hemodialysis; therefore, their HBsAg seroconversions could have been the result of reactivation of resolved HBV infection with mutant HBV strains rather than new infection.…”

“…HBsAg testing may also be warranted for patients with past resolved hepatitis B (total anti-HBc positive, HBsAg negative) with immunosuppression. 4 x Persons who develop viral syndromes suggestive of acute hepatitis infection should be re-tested including tests for hepatitis A, B, and C. ǂ The possibility of a false-negative HBsAg test result should be considered when laboratory test results are inconsistent with each other or with the clinical picture. In such circumstances, quantitative HBV DNA testing should be performed to evaluate for possible active HBV infection.…”

“…3 To our knowledge, since the implementation of these guidelines, only a single hemodialysis-related HBV transmission has been reported in the United States. 4 The primary laboratory assessment for active HBV infection is HBsAg testing. 5 HBsAg seroconversion among hemodialysis patients, defined as seroconversion in a patient testing HBsAg negative and subsequently testing HBsAg positive, warrants an assessment to determine the cause of seroconversion and if there have been other seroconversions in the respective dialysis clinic.…”

Infection in Hemodialysis

“…22 Incidence in pediatric hemodialysis population has ranged from 2.5 to 16.6%. 13,23 Recently, HBV outbreaks have been reported in hemodialysis units where the index patients had resolved HBV infection, but developed seroconversion due to new human immunodeficiency virus (HIV) infection 24,25 or due to immunosuppression from solid organ transplant. 26,27 To reduce the risk of transmission, the CDC's recommendations include: (1) regular serologic surveillance for HBV infection with monthly surveillance in those patients and staff who do not have immunity either via infection or immunization, (2) isolation practices for those patients who are infected with care limited to health care professionals who have immunity to HBV, (3) forbidding health care professionals to care for both a HBV-positive patient and HBVsusceptible patients at the same time, (4) isolating equipment that is used to treat HBV-positive patients so that it is not used for HBV-susceptible patients, (5) sterilization of equipment that shared by multiple patients, and (6) focus on the proper use of gloves and washing hands per the World Health Organization (WHO) criteria.…”

Host genes regulate transcription of sperm-introduced hepatitis B virus genes in embryo

“…Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). Transmission of HBV through blood transfusion [1], body fluids [2], intrauterine infection [3], cell, tissue and organ transplantation [4], and others including hemodialysis units or intravenous drug injection or occupational exposure [5,6] have been documented. In recent years some studies reported a true vertical transmission of HBV via germline and found that HBV has a negative effect on sperm motility in vivo and that couples in which the male is infected with HBV have a high risk of a low fertilization rate after in vitro fertilization (IVF) [7].…”