Borzooy Zohreh, Jazayeri Seyed Mohammad, Mirshafiey Abbass, Khamseh Azam, Mahmoudie Masoud Karkhaneh, Azimzadeh Pedram, Geravand Babak, Boroumand Mohammad Ali, Afshar Mina, Poortahmasebi Vahdat, Hosseini Mostafa, Streinu-Cercel Adrian
PhD student, Ms, Department of Infectious Diseases, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Immunology and Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
MD, PhD, Clinical virologist, Hepatitis B Molecular Laboratory, Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Germs. 2015 Dec 2;5(4):134-40. doi: 10.11599/germs.2015.1081. eCollection 2015 Dec.
Worldwide, healthcare workers (HCWs) show different levels of response to hepatitis B virus (HBV) vaccine. One of the factors associated with vaccine unresponsiveness may be the existence of current or past HBV infection. Regardless of the presence of HBsAg (overt infection), occult HBV infection (OBI, defined as presence of HBV DNA in the absence of HBsAg) might also account for some non- or hypo-response cases.
Sera from 120 HBsAg-negative HCWs with low and moderate levels of anti-HBs, <10 IU/mL (group I) and <100 IU/mL (group II) respectively, were selected and were examined for OBI by sensitive real-time PCR regardless of HBV serological profiles. Direct sequencing on surface genes was carried out in OBI-positive cases.
Four (3.3%) were positive for OBI. All were negative for anti-HBc. Two of the positive cases had moderate levels of anti-HBs (>10 to <100 IU/mL). No significant differences were found between the two groups in terms of risk factors or serological data. No mutations were found in surface proteins of OBI cases.
OBI in these subjects might be due to other factors rather than presence of "a" determinant mutations. Healthcare workers with inadequate to moderate levels of anti-HBs (<100 IU/mL) following vaccination, regardless of their serological profile for HBV, should be tested for the presence of HBV DNA by sensitive molecular tests. Anti-HBc is not a reliable marker for suspicion of OBI, especially in high-risk group individuals.
在全球范围内，医护人员（HCWs）对乙型肝炎病毒（HBV）疫苗的反应程度各不相同。与疫苗无反应相关的因素之一可能是当前或既往HBV感染的存在。无论HBsAg（显性感染）是否存在，隐匿性HBV感染（OBI，定义为在无HBsAg的情况下存在HBV DNA）也可能是一些无反应或低反应病例的原因。
选取120名抗-HBs水平低和中等、分别<10 IU/mL（第一组）和<100 IU/mL（第二组）的HBsAg阴性医护人员的血清，无论HBV血清学特征如何，通过灵敏的实时PCR检测OBI。对OBI阳性病例进行表面基因直接测序。
4例（3.3%）OBI呈阳性。所有病例抗-HBc均为阴性。其中2例阳性病例抗-HBs水平中等（>10至<100 IU/mL）。两组在危险因素或血清学数据方面未发现显著差异。OBI病例的表面蛋白未发现突变。
这些受试者中的OBI可能是由其他因素而非“a”决定簇突变的存在所致。接种疫苗后抗-HBs水平不足至中等（<100 IU/mL）的医护人员，无论其HBV血清学特征如何，均应通过灵敏的分子检测来检测HBV DNA的存在。抗-HBc不是怀疑OBI的可靠标志物，尤其是在高危人群个体中。
