Evaluation of methods of pre-vaccination screening for markers of hepatitis B infection

The prevalence of serologic evidence of hepatitis B virus infection in various populations in Greece was examined to provide data for formulating cost-effective strategies for prevaccination screening. Markers were detected in 17.5% of 320 healthy persons, 73.3% of 273 multiply transfused patients and 61.0% of 146 haemodialysis patients. In multiply transfused patients, antibody to hepatitis B surface antigen (anti-HBs) was significantly more common than antibody to core antigen (anti-HBc) (67.0%, 44.3%), while the opposite was true for haemodialysis patients (43.8%, 57.5%). These data suggest that it may be most cost-effective to screen only for anti-HBs in multiply transfused patients and only anti-HBc in haemodialysis patients. Vaccination without screening may be more cost-effective for healthy persons. Anti-HBs and anti-HBc were detected with similar frequencies (14.7%, 15.9%), thus neither offers an advantage in screening healthy persons, although use of anti-HBc may facilitate detection of chronic carriers. These data indicate that the choice of marker for pre-vaccination screening should depend on the population under consideration.