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Acute hepatitis B in the era of immunisation: pitfalls in the identification of high risk patients
  1. G Rosner,
  2. Y Lurie,
  3. L Blendis,
  4. Z Halpern,
  5. R Oren
  1. Liver Unit, Department of Gastroenterology and Hepatology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
  1. Correspondence to:
 Dr Y Lurie
 Department of Gastroenterology and Hepatology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 64239, Israel; dr_lurie{at}


Background: Since the adoption of a universal hepatitis B immunisation strategy, the reported incidence of acute hepatitis B has declined dramatically worldwide including in Israel. However, new cases of acute hepatitis B still occur. The aim of this study was to describe the incidence of acute hepatitis B in a referral area, routes of transmission, and outcome.

Methods: The charts of all new hepatitis B patients, who visited the clinic in the years 2002 and 2003 (January 2002 to December 2003), were reviewed. The main criteria for a diagnosis of acute hepatitis B were transient increase of alanine transaminase activity, and hepatitis B surface antigen seroconversion.

Results: Twenty nine men and seven women were diagnosed with acute hepatitis B infection during the study period. Two patients were previously vaccinated with hepatitis B vaccine. One case of hepatitis D coinfection was reported. The incidence of acute hepatitis B in the referral area was estimated as 2.25 per 100 000 adult population. Mean age was 36 years (17–75). Twenty one patients (18 men and 3 women) acquired the virus through unprotected sexual contact, and seven patients through iatrogenic exposure. Thirty three patients underwent spontaneous seroconversion while three patients became chronic carriers.

Conclusions: Despite a universal immunisation policy, frequent cases of acute hepatitis B in Israel are still seen. High risk heterosexual activity and iatrogenic exposure seem to be the commonest routes of transmission. Further recommendations regarding vaccination policy are discussed.

  • HBV, hepatitis B virus
  • ALT, alanine transaminase
  • AST, aspartate transaminase
  • HBsAg, hepatitis B surface antigen
  • anti-HBs Ab, antihepatitis B surface antibody
  • acute hepatitis B
  • transmission
  • high risk heterosexual contact
  • Israel

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  • Funding: none.

  • Conflicts of interest: none declared.

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