Epidemiology and Infection
- Epidemiology and Infection / Volume 137 / Issue 04 / April 2009, pp 495-503
- Copyright © 2008 Cambridge University Press
- DOI: http://dx.doi.org/10.1017/S095026880800085X (About DOI), Published online: 23 July 2008
Original Papers
Hepatitis
Significance of isolated antibody to hepatitis B core antigen in Dutch national vaccination campaign of behavioural high-risk groups
R. P. M. KOENEa1 c1, H. M. GOTZa2, J. A. R. VAN DEN HOEKa3, M. L. A. HEIJNENa4, J. A. VAN STEENBERGENa5 and A. C. M. KROESa6
a1 Community Health Service Region Nijmegen, The Netherlands & Academic Collaborative Center Public Health AMPHI, The Netherlands
a2 Municipal Public Health Service Rotterdam Rijnmond, The Netherlands
a3 Municipal Health Service Amsterdam, The Netherlands & Academic Medical Center, Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, The Netherlands
a4 Netherlands Association for Community Health Services (GGD Nederland), The Netherlands
a5 Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), The Netherlands
a6 Leiden University Medical Center, Clinical Microbiology Laboratory, Leiden, The Netherlands
SUMMARY
In the Dutch national vaccination campaign for behavioural risk groups, anti-HBcore is used as the primary HBV screening test. Samples with positive results undergo testing for active infection (HBsAg) but are otherwise accepted as indicating past infection, thereby assuming immunity. This study evaluated evidence for immunity in the target population screened on the basis of this algorithm, by re-analysing 1000 anti-HBcore-positive blood samples equally divided among risk groups: 14·7% of confirmed anti-HBcore lacked anti-HBs (‘isolated’ anti-HBcore). Independent risk factors for isolated anti-HBcore were risk group, HCV infection in hard-drug users (DU) and origin from Sub-Saharan Africa. After extrapolation, the proportion of participants who were said to be immune but lacked any additional evidence of immunity amounted to 9·6% (ranging from 12·5% in DU to 6·5% in men who have sex with men). It is recommended that as a minimum anti-HBs screening is included in testing algorithms used to determine vaccination programmes for risk groups, in particular in DU.
(Accepted May 14 2008)
(Online publication July 23 2008)
Correspondence:
c1 Author for correspondence: Dr R. P. M. Koene, Community Health Service Region Nijmegen, PO Box 1120, 6501 BC Nijmegen Netherlands. (Email: rkoene@ggd-nijmegen.nl)
