Macaulay Amechi Chukwukadibia Onuigbo
1,3*, Catherine Kress
4, Carol Webb
3, Nneoma Agbasi
21 Mayo Clinic College of Medicine, Rochester, MN, USA
2 North East London NHS Foundation Trust, UK
3 Department of Nephrology, Mayo Clinic Health System, Eau Claire, WI, USA
4 Des Moines University, D.O. Class of 2018, USA
Abstract
A 42-year old Caucasian end-stage renal disease (ESRD) male patient with past medical history
including diabetes, hypertension, pulmonary hypertension (RVSP of 53 mm Hg) and tobacco
use tested positive for hepatitis B surface antigen (HBsAg) after a routine blood screening
test using an enzyme immunoassay (EIA) method. He however was otherwise asymptomatic
for any symptoms of hepatitis. On further review, we confirmed that he had received an
intramuscular dose of Recombivax (Merck) vaccine, 1 mL = 40 µg, 5 days previously. Follow
up liver panel test was unremarkable with normal bilirubin and transaminases. Repeat
serology testing at Mayo Clinic, Rochester the next day for a confirmatory neutralizing
antibody assay test was negative for HBsAg. Furthermore, hepatitis B core IgM antibody,
hepatitis B surface antibody, hepatitis B surface antibody qualitative, hepatitis B surface
antibody quantitative test <0.1 (<8.0 mIU/mL), hepatitis B e antibody and hepatitis B core total
antibody tests all subsequently returned negative. This is the second case of transient postvaccination
HbSAgenemia observed in our hemodialysis Unit in Northwestern Wisconsin
in the last 7 years. Once again, as we posited in our 2010 report, we reemphasize previous
recommendations that patients who receive hepatitis B vaccinations should not be screened
for HBsAg less than 4 weeks following a hepatitis B vaccination.
Implication for health policy/practice/research/medical education:
We report the rare phenomenon of transient hepatitis B surface antigenemia (HbsAgenemia) following preventative hepatitis
B vaccination with Recombivax B vaccine. A misdiagnosis of a hepatitis B infection could lead to potentially harmful albeit
unnecessary laboratory work up, unwarranted psychological stressors to the patient and family, and a feeling of, anxiety and
isolation. We reemphasize previous recommendations that patients who receive hepatitis B vaccinations should not be screened
for HBsAg less than 4 weeks following a hepatitis B vaccination.
Please cite this paper as: Onuigbo MAC, Kress C, Webb C, Agbasi N. Transient asymptomatic hepatitis B surface antigenemia
following recombinant Recombivax B hepatitis B vaccine in a 42-year-old ESRD patient on maintenance hemodialysis. J
Nephropharmacol. 2017;7(1):43-45. DOI: 10.15171/npj.2018.10.