title: Acute hepatitis B in a healthcare worker: a case report of genuine vaccination failure.
abstract: BACKGROUND
  Individuals who reach the antibody threshold level of 10IU/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.
  
  
  METHODS
  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 14years 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.
  
  
  CONCLUSIONS
  Healthcare workers whose response to the initial hepatitis B vaccination is moderate might be vulnerable to hepatitis B virus infection.
authors.affiliation: Centre for Infectious Disease Control, National institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands. Hein.Boot@RIVM.NL
authors.forename: Hein J
authors.initials: HJ
authors.lastname: Boot
authors.forename: Laurens A
authors.initials: LA
authors.lastname: van der Waaij
authors.forename: Jurjen
authors.initials: J
authors.lastname: Schirm
authors.forename: Cees G M
authors.initials: CG
authors.lastname: Kallenberg
authors.forename: Jim
authors.initials: J
authors.lastname: van Steenbergen
authors.forename: Bert
authors.initials: B
authors.lastname: Wolters
mesh_terms: D000208:Acute Disease; D006282:Health Personnel; D006509:Hepatitis B / Q000276:immunology*; D017325:Hepatitis B Vaccines / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014611:Vaccination
chemical_list: D017325:Hepatitis B Vaccines