Booster immunity – diagnosis of chronic hepatitis B viral infection

  • Radka T Komitova Department of Infectious diseases, Parasitology and Tropical medicine, Faculty of Medicine, Medical University, Plovdiv, Bulgaria
  • Ani K Kevorkyan Department of Epidemiology and Disaster Medicine, Faculty of Public Health, Medical University, Plovdiv, Bulgaria
  • Maria V Atanasova Department of Microbiology and Immunology, Faculty of Pharmacy, Medical University, Plovdiv, Bulgaria
  • Aneta V Ivanova Laboratory of Porphyrias and Molecular Diagnostics of Liver Diseases. Clinic of Gastroenterology, Saint Ivan Rilski University Hospital, Sofia, Bulgaria
  • Elica Golkocheva-Markova National Reference Laboratory “Hepatitis viruses”, National Center for Infectious and Parasitic Diseases, Sofia, Bulgaria
Keywords: hepatitis B virus, occult HBV infection, anti-HBc alone, hepatitis B vaccine


Introduction: Diagnosis of chronic hepatitis B virus (HBV) infection particularly its occult form requires monitoring and repeat serological and molecular studies. The aim of the study was to investigate the possible relation between the case of a family outbreak of hepatitis A and the finding that a member of this family was diagnosed with chronic hepatitis B.

Methodology: A mother and her two sons, one previously diagnosed with chronic HBV infection, were hospitalized due to suspected acute hepatitis. Serological markers for hepatitis A, hepatitis B and hepatitis C were assessed. Additionally, HBV DNA was tested with a sensitive PCR. Hepatitis B vaccine was administered to the mother to differentiate resolved from occult HBV infection.

Results: A family outbreak of hepatitis A was confirmed, alongside a focus of chronic HBV infection. The serological profile for two brothers was HBsAg(+), anti-HBcIgM(-), anti-HBc(+), HBcAg(-)/anti-HBe(+). The mother was negative for all HBV markers except anti-HBc. HBV DNA was detected at a level of 461 IU/mL in the elder brother, 3647 IU/mL in the younger brother and was negative in the mother on two occasions. Her anti-HBc alone, having two sons with chronic HBV infection, and her lack of antibody response to hepatitis B vaccine despite being negative for HBV DNA, led to the diagnosis of probable occult HBV infection.

Conclusion: Our results confirmed that a vaccination approach could facilitate diagnosis of chronic HBV infection in the presence of isolated anti-HBc. If it were not for a family outbreak of hepatitis A, this unexpected family HBV focus would not have been revealed.


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How to Cite
Komitova RT, Kevorkyan AK, Atanasova MV, Ivanova AV, Golkocheva-MarkovaE (2019) Booster immunity – diagnosis of chronic hepatitis B viral infection. J Infect Dev Ctries 13:255-260. doi: 10.3855/jidc.9929
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