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September 4, 1987, Vol 258, No. 9 >
ARTICLE | September 4, 1987

Significance of Isolated Antibody to Hepatitis B Core Antigen Determined by Immune Response to Hepatitis B Vaccination FREE

Michael Draelos, MD; Tim Morgan, MD; Ron B. Schifman, MD; Richard E. Sampliner, MD
[+] Author Affiliations

Reprint requests to Department of Pathology (113), Tucson Veterans Administration Medical Center, Tucson, AZ 85723 (Dr Schifman).


JAMA. 1987;258(9):1193-1195. doi:10.1001/jama.1987.03400090077037
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References

The immune response to hepatitis B vaccine was studied in 14 individuals with isolated, high-titer antibody to hepatitis B core antigen (anti-HBc) and examined as an indicator of this serologic pattern's significance. Four subjects demonstrated a low-titer antibody to hepatitis B surface antigen (anti-HBs) on repeated testing, and three in this subgroup had anamnestic responses (anti-HBs, 82 to 140 ratio units) after vaccination. Compared with 22 seronegative controls, the remaining ten had significantly higher anti-HBs response rates (78% vs 22%, P=.003) and median anti-HBs titers (4 vs 0 ratio units, P =.008) two weeks after vaccination. One of ten subjects had an anamnestic response, while another exhibited no response. The general pattern of anti-HBs responsiveness observed in those subjects with isolated, high-titer anti-HBc was intermediate between seronegative and anti-HBs—positive groups and may indicate a state of waning immunity after natural infection. Hepatitis B vaccination with follow-up anti-HBs testing should be done for those patients with isolated, high-titer anti HBc to help exclude chronic infection and boost protective immunity.

(JAMA 1987;258:1193-1195)

REFERENCES

1 +
Hoofnagle J:  Serologic markers of hepatitis B virus infection . Annu Rev Med 1981;;32:1-11.
2 +
Kessler HA, Harris AA, Payne JA, et al:  Antibodies to hepatitis B surface antigen as the sole hepatitis B marker in hospital personnel . Ann Intern Med 1985;;103:21-26.
3 +
Kane MA, Hadler SC, Maynard JE:  Antibody to hepatitis B surface antigen and screening before hepatitis B vaccination . Ann Intern Med 1985;;103: 791-793.
4 +
Perrillo RP, Bodicky C, Campbell C, et al:  Response to hepatitis B virus vaccine in subjects with low levels of antibody to hepatitis B surface antigen . N Engl J Med 1984;;310:1463.
5 +
Werner BG, Dienstag JL, Kuter BJ, et al:  Isolated antibody to hepatitis B surface antigen and response to hepatitis B vaccination . Ann Intern Med 1985;;103:201-205.
6 +
Szumness W, Stevens CE, Harley EJ, et al:  The immune response of healthy adults to a reduced dose of hepatitis B vaccine . J Med Virol 1981;;8: 123-129.
7 +
Dienstag JL, Stevens CE, Bhan AK, et al:  Hepatitis B vaccine administered to chronic carriers of hepatitis B surface antigen . Ann Intern Med 1982;;96:575-579.
8 +
Hanson M, Polesky HF:  Prevalence of anti-HBc in anti-HBs positive individuals: Implications for selecting vaccine candidates . Am J Clin Pathol 1984;;82:716-719.
9 +
Hadler SC, Murphy BL, Schable CA, et al:  Epidemiological analysis of the significance of lowpositive test results for antibody to hepatitis B surface and core antigens . J Clin Microbiol 1984;; 19:521-525.
10 +
Tedder RS, Cameron CH, Wilson-Croome R, et al:  Contrasting patterns and frequency of antibodies to the surface, core and e antigens of hepatitis B virus in blood donors and in homosexual patients . J Med Virol 1980;;6:323-332
11 +
Hoffnagle JH, Gerety RJ, Barker LF:  Antibody to hepatitis B virus core in man . Lancet 1973;;2: 869-873.
12 +
Chau KH, Hargie MP, Decker RH, et al:  Serodiagnosis of recent hepatitis B infection by IgM class anti-HBc . Hepatology 1983;;3:142-149.
13 +
Bonino F, Rosina F, Rizzetto M, et al:  Chronic hepatitis in HBsAg carriers with serum HBV-DNA and anti-HBe . Gastroenterology 1986;;90: 1268-1273.
14 +
Brechot C, Degos F, Lugassy C, et al:  Hepatitis B virus DNA in patients with chronic liver disease and negative tests for hepatitis B surface antigen . N Engl J Med 1985;;312:270-276.
15 +
Bonino F, Poli G, Ponzetto A, et al:  Immune response to hepatitis B vaccine of individuals with serum anti-HBc . Hepatology 1984;;4:1041.
16 +
Tong MJ, Howard AM, Schatz GC, et al:  A hepatitis B vaccination program in a community teaching hospital . Infect Control 1987;;8:102-107.
17 +
Hadler SC, Francis DP, Maynard JE, et al:  Long-term immunogenicity and efficacy of hepatitis B vaccine in homosexual men . N Engl J Med 1986;;315:209-214.

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1 +
Hoofnagle J:  Serologic markers of hepatitis B virus infection . Annu Rev Med 1981;;32:1-11.
2 +
Kessler HA, Harris AA, Payne JA, et al:  Antibodies to hepatitis B surface antigen as the sole hepatitis B marker in hospital personnel . Ann Intern Med 1985;;103:21-26.
3 +
Kane MA, Hadler SC, Maynard JE:  Antibody to hepatitis B surface antigen and screening before hepatitis B vaccination . Ann Intern Med 1985;;103: 791-793.
4 +
Perrillo RP, Bodicky C, Campbell C, et al:  Response to hepatitis B virus vaccine in subjects with low levels of antibody to hepatitis B surface antigen . N Engl J Med 1984;;310:1463.
5 +
Werner BG, Dienstag JL, Kuter BJ, et al:  Isolated antibody to hepatitis B surface antigen and response to hepatitis B vaccination . Ann Intern Med 1985;;103:201-205.
6 +
Szumness W, Stevens CE, Harley EJ, et al:  The immune response of healthy adults to a reduced dose of hepatitis B vaccine . J Med Virol 1981;;8: 123-129.
7 +
Dienstag JL, Stevens CE, Bhan AK, et al:  Hepatitis B vaccine administered to chronic carriers of hepatitis B surface antigen . Ann Intern Med 1982;;96:575-579.
8 +
Hanson M, Polesky HF:  Prevalence of anti-HBc in anti-HBs positive individuals: Implications for selecting vaccine candidates . Am J Clin Pathol 1984;;82:716-719.
9 +
Hadler SC, Murphy BL, Schable CA, et al:  Epidemiological analysis of the significance of lowpositive test results for antibody to hepatitis B surface and core antigens . J Clin Microbiol 1984;; 19:521-525.
10 +
Tedder RS, Cameron CH, Wilson-Croome R, et al:  Contrasting patterns and frequency of antibodies to the surface, core and e antigens of hepatitis B virus in blood donors and in homosexual patients . J Med Virol 1980;;6:323-332
11 +
Hoffnagle JH, Gerety RJ, Barker LF:  Antibody to hepatitis B virus core in man . Lancet 1973;;2: 869-873.
12 +
Chau KH, Hargie MP, Decker RH, et al:  Serodiagnosis of recent hepatitis B infection by IgM class anti-HBc . Hepatology 1983;;3:142-149.
13 +
Bonino F, Rosina F, Rizzetto M, et al:  Chronic hepatitis in HBsAg carriers with serum HBV-DNA and anti-HBe . Gastroenterology 1986;;90: 1268-1273.
14 +
Brechot C, Degos F, Lugassy C, et al:  Hepatitis B virus DNA in patients with chronic liver disease and negative tests for hepatitis B surface antigen . N Engl J Med 1985;;312:270-276.
15 +
Bonino F, Poli G, Ponzetto A, et al:  Immune response to hepatitis B vaccine of individuals with serum anti-HBc . Hepatology 1984;;4:1041.
16 +
Tong MJ, Howard AM, Schatz GC, et al:  A hepatitis B vaccination program in a community teaching hospital . Infect Control 1987;;8:102-107.
17 +
Hadler SC, Francis DP, Maynard JE, et al:  Long-term immunogenicity and efficacy of hepatitis B vaccine in homosexual men . N Engl J Med 1986;;315:209-214.

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