Vaccine-induced hepatitis B surface antigen positivity in adult hemodialysis patients: incidental and surveillance data.
This report describes hepatitis B vaccinations that resulted in transient hepatitis B surface antigen positivity in six adult hemodialysis patients. Initially, three patients were incidentally discovered to be hepatitis B surface antigen-positive temporally related to hepatitis B vaccination. Two other patients who displayed transient positivity were among 15 hemodialysis patients under prospective surveillance after receiving a dose of hepatitis B vaccine. The sixth patient was negative for hepatitis B surface antigen when monitored in the prospective surveillance group but was incidentally found to be positive after a nonsurveillance dose of the vaccine. All positive cases cleared hepatitis B surface antigen within 20 days of vaccination. In our search of the literature, this is the first report of hepatitis B vaccine inducing hepatitis B surface antigen positivity in adult hemodialysis patients. Because this study proposes that this transient surface antigen positivity is vaccine-induced and not a true hepatitis B infection, we recommend that renal dialysis patients not be screened for hepatitis B surface antigen for at least 21 to 28 days after hepatitis B vaccination. As well, blood donors should not donate blood in this early postvaccination period. These guidelines would incorporate a measure of safety to prevent individuals in the early postinoculation period from being erroneously labeled as having hepatitis B viral infections.
Janzen
L
L
Department of Medicine, Health Sciences Centre, Winnipeg, Monitoba, Canada.
Minuk
G Y
GY
Fast
M
M
Bernstein
K N
KN
D000328:Adult; D000368:Aged; D004279:DNA, Viral / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis / Q000635:transmission; D006510:Hepatitis B Antibodies / Q000097:blood; D006512:Hepatitis B Core Antigens / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D017325:Hepatitis B Vaccines / Q000276:immunology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D012680:Sensitivity and Specificity; D065227:Transfusion Reaction; D014611:Vaccination; D014614:Vaccines, Synthetic / Q000276:immunology*
D004279:DNA, Viral; C075654:Engerix-B; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D014614:Vaccines, Synthetic