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BMJ Case Rep. 2014 Jun 10;2014. pii: bcr2013202191. doi: 10.1136/bcr-2013-202191.

Persistence of hepatitis B surface antigen in blood in a chronic haemodialysis patient following vaccination booster.

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Department of Virology, Royal Free London NHS Foundation Trust, London, UK.
Department of Renal Medicine, Royal Free London NHS Foundation Trust, London, UK.


Patients receiving haemodialysis are at an increased risk of hepatitis B infection; regular screening for incident infection and vaccination of susceptible individuals is recommended. Haemodialysis patients often require repeated high-dose hepatitis B vaccination boosters because of impaired response. Since the hepatitis B surface antigen is used as an immunogenic agent for vaccination and as a marker of hepatitis B infection, it has occasionally been detected in the blood shortly after vaccine administration and can be mistaken for a new infection. These transient results, however, are unlikely to persist for longer than 14 days after vaccination. We report the case of a haemodialysis patient who tested weakly positive for hepatitis B surface antigen 52 days after a vaccine booster. This is the longest vaccine-induced antigenaemia described in the literature and indicates that vaccination can cause weakly positive hepatitis B surface antigen results for longer than previously reported.

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