title: Acute hepatitis B caused by a vaccine-escape HBV strain in vaccinated subject: sequence analysis and therapeutic strategy.
abstract: HBV vaccine contains the 'a' determinant region, the major immune-target of antibodies (anti-HBs). Failure of immunization may be caused by vaccine-induced or spontaneous 'a' determinant surface gene mutants. Here, we evaluate the possible lack of protection by HBV vaccine, describing the case of an acute hepatitis B diagnosed in a 55-year-old Caucasian male unpaid blood donor, vaccinated against HBV. Sequencing data for preS-S region revealed multiple point mutations. Of all the substitutions found, Q129H, located in the "a" determinant region of HBsAg, can alter antigenicity, leading to mutants. This mutant may cause vaccine failure especially when associated with high viremia of infecting source.
authors.affiliation: Gastroenterology Unit, Department of Internal Medicine, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Luongo
authors.affiliation: Gastroenterology Unit, Department of Internal Medicine, Italy.
authors.forename: Rosina
authors.initials: R
authors.lastname: Critelli
authors.affiliation: Microbiology and Virology Service, Department of Diagnostic and Laboratory Services and Legal Medicine, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Grottola
authors.affiliation: Gastroenterology Unit, Department of Internal Medicine, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Gitto
authors.affiliation: Gastroenterology Unit, Department of Internal Medicine, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Bernabucci
authors.affiliation: Blood Transfusion Center, Department of Oncology, Hematology and Respiratory Diseases, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
authors.forename: Mirco
authors.initials: M
authors.lastname: Bevini
authors.affiliation: Blood Transfusion Center, Department of Oncology, Hematology and Respiratory Diseases, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Vecchi
authors.affiliation: Blood Transfusion Center, Department of Oncology, Hematology and Respiratory Diseases, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Montagnani
authors.affiliation: Gastroenterology Unit, Department of Internal Medicine, Italy. Electronic address: erica.villa@unimore.it.
authors.forename: Erica
authors.initials: E
authors.lastname: Villa
mesh_terms: D000595:Amino Acid Sequence; D005838:Genotype; D006509:Hepatitis B / Q000188:drug therapy / Q000276:immunology / Q000517:prevention & control / Q000821:virology*; D006514:Hepatitis B Surface Antigens / Q000737:chemistry / Q000235:genetics / Q000276:immunology; D017325:Hepatitis B Vaccines / Q000009:adverse effects* / Q000235:genetics / Q000276:immunology; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009154:Mutation; D016415:Sequence Alignment; D014611:Vaccination / Q000009:adverse effects
chemical_list: D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines
keywords: Acute hepatitis; Escape mutant; Hepatitis B virus; Telbivudine; Vaccine