Screening of Health Care Workers Before Hepatitis B Vaccination: More Questions than Answers
Authors: ROBERT P. PERRILLO
Journal: Annals of Internal Medicine (1985)

Editorials1 November 1985Screening of Health Care Workers Before Hepatitis B Vaccination: More Questions than AnswersROBERT P. PERRILLO, M.D.ROBERT P. PERRILLO, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-103-5-793 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptImmunoassays for hepatitis B viral markers are extremely sensitive diagnostic tools. However, in the past few years several studies have raised concerns about the reliability of an isolated finding of antibody to hepatitis B surface antigen (anti-HBs) or core antigen (anti-HBc) as an indicator of past infection with hepatitis B virus (1-8). Particular emphasis has been placed on the questionable biologic significance of isolated anti-HBs. In brief, these studies have shown the following: first, isolated, low-level anti-HBs occurs in several nonprimate animal species that lack susceptibility to hepatitis B virus infection (1, 2); second, health care workers and chimpanzees with...References1. MILLMANMCMICHAEL IJ. Glycoproteins of natural origin with an affinity for hepatitis B surface antigen. Infect Immun. 1978;21:879-85. CrossrefMedlineGoogle Scholar2. HOOFNAGLESCHAFERFERENCI JDP Antibody to hepatitis B surface antigen in nonprimate animal species. Gastroenterology. 1983;84:1478-82. CrossrefMedlineGoogle Scholar3. SHERERTZSPINDELHOOFNAGLE REJ. Antibody to hepatitis B surface antigen may not always indicate immunity to hepatitis B virus infection [Letter]. N Engl J Med. 1983;309:1519. CrossrefMedlineGoogle Scholar4. LINNEMANNASKEY CP. Susceptibility to hepatitis B despite high titre anti-HBs antibody [Letter]. Lancet. 1984;1:346-7. CrossrefMedlineGoogle Scholar5. BROTMANPRINCE BA. 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Response to hepatitis B virus vaccine in subjects with low levels of antibody to hepatitis B surface antigen [Letter]. N Engl J Med. 1984;310:1463. CrossrefMedlineGoogle Scholar11. KESSLERHARRISPAYNEHUDSONPOTKINLEVIN HAJEBS. Antibodies to hepatitis B surface antigen as the sole hepatitis B marker in hospital personnel. Ann Intern Med. 1985;103:21-6. LinkGoogle Scholar12. KANEHADLERMAYNARD MSJ. Antibody to hepatitis B surface antigen and screening before hepatitis B vaccination [Editorial]. Ann Intern Med. 1985;103:791-3. LinkGoogle Scholar13. HOOFNAGLESEEFFBALESGERETYTABOR JLRRE. Serologic responses in HB. In: VYAS GN, COHEN SN, SCHMID R, eds. Viral Hepatitis. Philadelphia: Franklin Institute Press; 1978:219-42. Google Scholar14. KRUGMANOVERBYMUSHAHWARLINGFROSNERDEINHARDT SLICGF. Viral hepatitis, type B: studies on natural history and prevention re-examined. N Engl J Med. 1979;300:101-6. CrossrefMedlineGoogle Scholar15. PERRILLOPARKERCAMPBELLSANDERSSTRANGREGENSTEIN RMCGSF. Prevaccination screening of medical and dental students: should low levels of antibody to hepatitis B surface antigen preclude vaccination? JAMA. 1983;250:2481-4. CrossrefMedlineGoogle Scholar16. SZMUNESSHARLEYIKRAMSTEVENS WEHC. Sociodemographic aspects of the epidemiology of hepatitis B. In: VYAS GN, COHEN SN, SCHMID R, eds. Viral Hepatitis. Philadelphia: Franklin Institute Press; 1978:297-320. Google Scholar17. Employment, Hours, and Earnings, United States, 1909-84. Vol. II. Washington, D.C.: U. S. Department of Labor, Bureau of Labor Statistics; 1985: Bulletin 1312-12:780-6. Google Scholar18. . Recommendations for protection against viral hepatitis: recommendation of the Immunization Practices Advisory Committee (ACIP). MMWR. 1985;34:313-24, 329-35. Reprinted in Ann Intern Med. 1985;103:391-402. MedlineGoogle Scholar19. DIENSTAGSTEVENSBHANSZMUNESS JCAW. Hepatitis B vaccine administered to chronic carriers of hepatitis B surface antigen. Ann Intern Med. 1982;96:575-9. 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