Isolated Antibody to Hepatitis B Surface Antigen and Response to Hepatitis B Vaccination

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Abstract
To determine the need for immunization of health workers with antibody to hepatitis B surface antigen (anti-HBs) as their only serologic marker of previous hepatitis B exposure, the level, persistence, and immunologic specificity of isolated anti-HBs was studied in 46 persons identified during screening for hepatitis B vaccine. These persons were rescreened 1 yr later and were administered a single dose of hepatitis B vaccine. The anti-HBs level was determined at 1, 2 and 8 wk after vaccination. Isolated anti-HBs levels were low and antibody did not persist; 22 subjects tested had lost detectable anti-HBs within 19 mo. even though immunologic specificity was shown in vitro in 34. Anamnestic responses suggesting previous exposure and immunity were seen in only 10 subjects; 5 of these subjects had moderate-level, persistent anti-HBs. Although some persons with naturally acquired, isolated anti-HBs may be protected from hepatitis B, the immunologic specificity and protective value of anti-HBs, especially when levels are low, remain questionable.