Anti-pre-S(2) analysis after hepatitis B vaccination in haemodialysis patients.

We investigated the development of anti-pre-S(2) antibodies by enzyme immunoassay and by Western blot analysis in a vaccination study in haemodialysis patients; both the Pasteur plasma vaccine retaining the pre-S(2) epitopes and the Merck, Sharp and Dohme (MSD) plasma vaccine containing only HBsAg were used. By enzyme immunoassay (EIA), one anti-pre-S(2) response at month 7 was registered in 23 patients after 5 injections with the 5 micrograms dose of Pasteur vaccine (PS group), whereas 6 responses were seen in 20 patients after 4 injections with the 10 micrograms dose (PD group). None of the 22 vaccines injected with MSD vaccine (40 micrograms) (4 injections, MD group) showed an anti-pre-S(2) response at month 7. In the Western blot an anti-pre-S(2) response was seen in 12 PS patients, in 8 PD patients and in none of the MD patients. Anti-pre-S(2) responses were predominantly observed in patients with a high anti-HBs response but exceptions occurred. Prevaccination anti-pre-S(2) positivity, in the absence of anti-HBc and anti-HBs, was detected in dialysis patients with EIA as well as Western blot, in 10.8 and 21.6%, respectively; similar findings were made in health care personnel. The possible nature of this phenomenon is discussed. In this study the Western blot technique has been shown to be a suitable test system for qualitative and semi-quantitative analysis of anti-pre-S(2) antibodies after hepatitis B vaccination with a higher sensitivity, but probably also a different specificity than the EIA.