Widespread immunization with hepatitis B vaccine may be associated with emergence of vaccine escape mutants that can cause occult infection.
Feature: change in HBsAg or other antigens
Significance:
(1) The infection may not be detected if testing is limited to HBsAg.
(2) It can infect a person who has received HBV vaccine.
(3) HBV immune globulin may not be effective.
The diagnosis should be considered:
(1) a patient has evidence of hepatitis but no cause has been identified
(2) the patient has a history of an exposure that would be high risk for HBV
An infection can be detected by:
(1) testing for other viral antigens
(2) viral load or other molecular tests.
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Specialty: Infectious Diseases, Gastroenterology
