Isolated Antibody to Hepatitis B Surface Antigen and Response to Hepatitis B Vaccination

  1. BARBARA G. WERNER, Ph.D.;
  2. JULES L. DIENSTAG, M.D.;
  3. BARBARA J. KUTER, M.P.H.;
  4. B. FRANK POLK, M.D.;
  5. DAVID R. SNYDMAN, M.D.;
  6. DONALD E. CRAVEN, M.D.;
  7. CLYDE S. CRUMPACKER, M.D.;
  8. RICHARD PLATT, M.D.; and
  9. GEORGE F. GRADY, M.D.
  1. Boston, Massachusetts; and West Point, Pennsylvania

    Abstract

    To determine the need for immunization of health workers with antibody to hepatitis B surface antigen (anti-HBs) as their only serologic marker of previous hepatitis B exposure, we studied the level, persistence, and immunologic specificity of isolated anti-HBs in 46 persons identified during screening for hepatitis B vaccine. We rescreened these persons 1 year later, administered a single dose of hepatitis B vaccine, and determined the anti-HBs level at 1, 2, and 8 weeks after vaccination. Isolated anti-HBs levels were low and antibody did not persist; 22 subjects tested had lost detectable anti-HBs within 19 months even though immunologic specificity was shown in vitro in 34. Anamnestic responses suggesting previous exposure and immunity were seen in only 10 subjects; 5 of these subjects had moderate-level, persistent anti-HBs. Although some persons with naturally acquired, isolated anti-HBs may be protected from hepatitis B, the immunologic specificity and protective value of anti-HBs, especially when levels are low, remain questionable.

    Article and Author Information

    • ▸From the Boston Inter-Hospital Hepatitis B Vaccine Study Group (State Laboratory Institute, Department of Public Health, Commonwealth of Massachusetts; Massachusetts General Hospital; Brigham and Women's Hospital; Channing Laboratory; Tufts-New England Medical Center; Boston University Hospital; Boston City Hospital; Beth Israel Hospital; and New England Deaconess Hospital), the Departments of Medicine, Tufts University School of Medicine, Harvard Medical School, and Boston University School of Medicine, Boston, Massachusetts; and Merck Sharp & Dohme Research Laboratories, West Point, Pennsylvania.

    • Grant support: In part by a grant from the Department of Virus and Cell Biology Research, Merck Sharp & Dohme, West Point, Pennsylvania.

    • &Requests for reprints should be addressed to Barbara G. Werner, Ph.D.; State Laboratory Institute, 305 South Street; Jamaica Plain, MA 02130.

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    1. Ann Intern Med August 1, 1985 vol. 103 no. 2 201-205
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