title: Acute hepatitis B virus infection by genotype F despite successful vaccination in an immune-competent German patient.
abstract: BACKGROUND
  Hepatitis B Virus (HBV) infection is a leading cause of chronic hepatitis and liver cirrhosis worldwide, and efficient protection can usually be achieved by vaccination that is based on recombinant HBsAg protein from HBV genotype A and D.
  
  
  RESULTS
  Here we report the case of a fully immune-competent German patient that acquired a symptomatic acute HBV infection during adulthood despite a complete and formally successful vaccination, which had resulted in anti-HBs titers considered protective. Further phylogentic analysis identified an infection with the rare genotype F of HBV, possibly acquired in Spain, without apparent aberrations in the immunodominant 'a' determinant domain of the envelope gene. However, sequence comparisons revealed that all reported genotype F isolates display marked differences from the other genotypes in this domain which serves as an epitope for humoral immune responses.
  
  
  CONCLUSIONS
  The rare HBV genotype F, as detected in this immune-competent, previously vaccinated patient, has marked sequences differences in the envelope/polymerase gene. Therefore, current HBV vaccines based on genotype A and D may not result in full protective immunity towards viral strains from genotype F.
authors.affiliation: Medical Clinic III, RWTH-University Hospital Aachen, Aachen, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Tacke
authors.forename: Samad
authors.initials: S
authors.lastname: Amini-Bavil-Olyaee
authors.forename: Albert
authors.initials: A
authors.lastname: Heim
authors.forename: Tom
authors.initials: T
authors.lastname: Luedde
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
authors.forename: Christian
authors.initials: C
authors.lastname: Trautwein
mesh_terms: D000208:Acute Disease; D000328:Adult; D000595:Amino Acid Sequence; D004279:DNA, Viral / Q000235:genetics; D005838:Genotype; D005858:Germany; D006509:Hepatitis B / Q000276:immunology* / Q000821:virology*; D006510:Hepatitis B Antibodies / Q000097:blood; D017325:Hepatitis B Vaccines / Q000276:immunology*; D006515:Hepatitis B virus / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008969:Molecular Sequence Data; D010802:Phylogeny; D017422:Sequence Analysis, DNA; D017386:Sequence Homology, Amino Acid
chemical_list: D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D017325:Hepatitis B Vaccines