Acute hepatitis B infection escaping vaccination: A case report

Area of Science:

• Hepatology
• Virology
• Immunology

Background:

• Hepatitis B virus (HBV) infection is a global health concern, with vaccines offering significant protection.
• Vaccine failure occurs in 5-10% of individuals, but viral escape mutations are rare.

Purpose of the Study:

• To report a case of acute HBV infection in a fully vaccinated individual with high antibody titers.
• To investigate the role of a rare HBV S-gene mutation in vaccine escape.

Main Methods:

• Case presentation of a 72-year-old man with symptoms of acute HBV infection.
• Detection of HBV DNA and identification of a specific S-gene mutation (D144A).
• Analysis of patient's vaccination status and antibody titers.

Main Results:

• The patient, fully vaccinated against HBV with high post-vaccination titers, presented with acute HBV infection.
• A rare D144A mutation in the HBV S-gene was identified, previously linked to vaccine escape.
• The patient recovered spontaneously without antiviral treatment.

Conclusions:

• This case demonstrates acute HBV infection despite vaccination and high antibody titers, attributed to a rare S-gene mutation.
• The findings underscore the potential for HBV vaccine escape and its public health implications.
• Further surveillance of HBV mutations is crucial for understanding and managing vaccine effectiveness.