Transient hepatitis B surface antigen circulation after Infanrix-Hexa®: a case report and review of the literature

Mantadakis, Elpis; Thomaidis, Stavros; Efraimidou, Eugnosia-Nektaria; Ramatani, Anna; Chatzimichael, Athanassios

doi:10.1007/s00431-010-1146-2

Eur J Pediatr

2010

DOI: 10.1007/s00431-010-1146-2

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Transient hepatitis B surface antigen circulation after Infanrix-Hexa®: a case report and review of the literature

Elpis Mantadakis

Stavros Thomaidis

Eugnosia-Nektaria Efraimidou

et al.

Abstract: The authors describe the case of a 70-day-old boy who was mistakenly diagnosed as suffering from acute hepatitis B, when he presented with persistent unconjugated hyperbilirubinemia and transaminasemia and was found to be seropositive for the hepatitis B surface antigen. The antigenemia was transient and related to his recent immunization with Infanrix-Hexa. Caution is required during interpretation of a positive HBsAg test that is obtained within 28 days after vaccination against hepatitis B.

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Cited by 3 publications

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“…2,3 In a recent review of mixed populations, transient antigenemia was reported to last between 3 and 21 days. 1 Santana et al 4 suggested that transient postvaccination HBs antigenemia in non-HIV patients may be a marker of no response to HBV vaccination. Thus, in his study only 16.6% of those with transient antigenemia responded to vaccination (i.e., anti-hepatitis B surface antibody titer ‡ 10 mIU/ml) compared to 69% of those who did not have transient antigenemia.…”

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Transient Hepatitis B Surface Antigenemia After Hepatitis B Virus Vaccine in an HIV-Infected Patient

Barbour¹,

Bachmann²,

Núñez³

2013

AIDS Research and Human Retroviruses

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E ditor: Hepatitis B screening and vaccination are part of the standard of care in HIV-infected patients. The reasons for this recommendation are 2-fold. On the one hand, being infected with HIV is a risk factor for hepatitis B virus (HBV) infection as the two viruses share routes of transmission. On the other hand, the presence of HBV coinfection may influence the timing of highly active antiretroviral therapy (HAART) initiation and the HIV regimen chosen, as it must include agents with anti-hepatitis B activity. We present here a case that stimulated discussion regarding the interpretation of HBV serologies and the timing for HBV vaccination in the HIV-infected population. A 39-year-old African-American female was referred to our HIV clinic for initial evaluation after being diagnosed with HIV infection at the local health department. Bipolar disorder was her only significant past medical history. Three days earlier, as part of her initial HIV care at the health department, she received the first dose of Twinrix [a recombinant hepatitis A and hepatitis B vaccine containing inactivated hepatitis A virus (strain HM175) and noninfectious hepatitis B virus surface antigen (HBsAg)]. No hepatitis serologies were obtained prior to vaccination. This is consistent with local health department policy based on costbenefit estimates.At her first visit to our clinic, a hepatitis serology panel was obtained. The hepatitis A IgG, hepatitis B core IgG, hepatitis B surface IgG, and hepatitis C IgG were all nonreactive. Hepatitis B surface antigen was reactive. The serum HIV RNA level was 295 copies/ml, the CD4 count was 690 cells/mm 3 , and the complete blood count and comprehensive metabolic panel were within normal limits. The patient was contacted with the results, and she reported that she was asymptomatic. A serum HBV DNA obtained at that time was undetectable ( < 29 IU/ml). Since the laboratory results were not consistent with acute or chronic HBV infections, HBsAg was repeated upon her return to the clinic 4 weeks later, which was nonreactive. Clarification of the patient's HBV status was important as patients with HIV and HBV coinfection require special consideration regarding antiretroviral therapy and continued follow-up of liver status. For HBsAg testing our laboratory uses the AD-VIA Centaur instrument and follows the manufacturer's recommendations for reporting a positive result. The ADVIA Centaur HBsAg assay is a sandwich immunoassay using direct, chemiluminometric technology and uses index values to determine reactivity. Samples with index values of 1.0 to 50.0 are weakly positive and are retested in duplicate prior to reporting the positive value.A reactive HBsAg in the HIV-infected patient most often represents chronic HBV infection. However, in the reported case the hepatitis B core IGG was negative. Isolated hepatitis B surface antigenemia can occur early in hepatitis B infection or as we will describe as a postvaccination phenomenon. Based on the available information, this patient was most likely not infect...

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confidence: 99%

“…1 In neonates it is often the result of passive antibody transfer from the mother, which later disappears. In hemodialysis patients a study suggests that HBV immunization is the most common cause of detectable HbsAg, 2 occurring in 13-31.6% of hemodialysis patients after immunization.…”

mentioning

confidence: 99%

Transient Hepatitis B Surface Antigenemia After Hepatitis B Virus Vaccine in an HIV-Infected Patient

Barbour¹,

Bachmann²,

Núñez³

2013

AIDS Research and Human Retroviruses

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Highly Sensitive Detection of Hepatitis B Virus Surface Antigen by Use of a Semiautomated Immune Complex Transfer Chemiluminescence Enzyme Immunoassay

et al. 2013

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The performance of hepatitis B surface antigen (HBsAg) screening assays is continuously improved to reduce the risk of transfusion-associated hepatitis B. In this study, a semiautomated immune complex transfer chemiluminescence enzyme immunoassay (ICT-CLEIA) for the detection of HBsAg, which is as sensitive as hepatitis B virus (HBV) DNA PCR, was developed; the ICT-CLEIA assay performance was compared with the performance of the Architect HBsAg QT assay and HBV DNA PCR. The specificities in the initial assay and after retesting were 99.50% (1,988/1,998 samples) and 99.95% (1,997/1,998 samples), respectively. The analytical detection limit was determined to be 0.2 mIU/ml using the 2nd International WHO HBsAg standard, and the cutoff value (0.5 mIU/ml) of the ICT-CLEIA assay was 8.0 standard deviations (SD) above the mean of the HBsAg-negative specimens. The ICT-CLEIA assay could detect HBsAg even in the presence of anti-HBs antibodies and demonstrated a 23.6-dayshorter window period using commercially available HBsAg seroconversion panels than the Architect HBsAg QT assay. Furthermore, the monitoring of the viral kinetics by the ICT-CLEIA assay and the HBV DNA PCR produced very similarly shaped curves during both the HBsAg seroconversion and reverse seroconversion periods. Therefore, the ICT-CLEIA assay may be useful not only for an earlier detection of HBV reactivation but also for the monitoring of hepatitis B patients.

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False Positive Hepatitis B Surface Antigen Due to Recent Vaccination

Anjum¹

2014

IJHS

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Abstract:Objective: Hepatitis B is the most common viral hepatitis, potentially life threatening, with long term complications. Currently, vaccine is the most effective tool against hepatitis B infection. It is worthwhile mentioning that due to rampant use of hepatitis B vaccine (HBV), there have been concerns about hepatitis B surface antigen (HBsAg) reactivity. This article aims to report the false positive results of HBsAg due to recent HBV among healthy male adults. Subjects and Methods:The subjects were selected from a Community Health Center, under the umbrella of a tertiary care hospital, Saudi Arabia. The data was retrieved from electronic medical records maintained at the clinic. Results:A total of 130 employees were recruited, only 117 records could be retrieved from the system. The mean age of participants was 31.34 + 12.73 years. The administration of HBV and HBsAg test was performed simultaneously. The lab reported three cases of HBsAg positivity, a false positive result of 2.56%. Repeat testing after one week for HBsAg was negative for the three cases. Conclusion:This study confirmed that HBsAg reactivity might be seen in regular screening programs for healthy adults.

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Transient hepatitis B surface antigen circulation after Infanrix-Hexa®: a case report and review of the literature

Cited by 3 publications

References 15 publications

Transient Hepatitis B Surface Antigenemia After Hepatitis B Virus Vaccine in an HIV-Infected Patient

Transient Hepatitis B Surface Antigenemia After Hepatitis B Virus Vaccine in an HIV-Infected Patient

Highly Sensitive Detection of Hepatitis B Virus Surface Antigen by Use of a Semiautomated Immune Complex Transfer Chemiluminescence Enzyme Immunoassay

False Positive Hepatitis B Surface Antigen Due to Recent Vaccination

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