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Should I have HvB Vaccine?
Jun 19, 2004

Dear Dr McGovern

I had a Hepatitis B lab this March. here is my result:

HBsAg:Negative anti-HBs : Negative anti-HBc: Positive

I was told by my Doctor that I was previously exposed to Hepatitis B virus, but not a carrier.

But I looked around the web and see four possible interpretations for my case: 1. May be recovering from acute HBV infection. 2. May be distantly immune and test not sensitive enough to to detect very low level of anti-HBs in serum. 3. May be susceptible with a false positive anti-HBc. 4. May be undetectable level of HBsAg present in the serum and the person is actually a carrier.

my question: 1. Is it safe for me to have hepatitis B vaccine? 2. How high is the chance that I am still a carrier? 3. Should I see a liver specialist?

Response from Dr. McGovern

Your laboratory results are consistent with something called "isolated hepatitis B core antibody." The interpretation of which is complicated. About 2-5% of healthy blood donors have isolated anti-HBc.

If you had recent acute hepatitis B, your IgM core would be positive. If you had distant exposure to hepatitis B, your IgG core would be positive. Sometimes hepatitis B surface antibody can wane over time and the individual was distantly infected. False positive anti-HBc antibodies can occur but are very uncommon. Rarely does a person have HBsAg which is undetectable.

This phenomenon also occurs in patients who have underlying hepatitis C.

1. I would recommend that you have testing for hepatitis C and repeat testing for hepatitis B surface antigen. 2. Clarify that the hepatitis B core is IgG fraction. 3. As for hepatitis B vaccine, it is very unclear what to do in this case. Is has been suggested in the literature that it is reasonable to take one dose of vaccine to see if you get a surface antibody response one month later which would suggest that you boosted natural immunity. If there is no respone then receiving all 3 doses is reasonable. However, there is no clear answer unfortunately so I would speak with your physician further about this.

Dr. McGovern



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