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LETTER |
Catherine Diamond is with the Department of Medicine, University of California, Irvine.
Correspondence: Requests for reprints should be sent to Catherine Diamond, MD, MPH, University of California Irvine Medical Center, 101 City Dr S, Bldg 11, Route 81, Orange CA 92868 (e-mail: diamondc{at}uci.edu).
In their article "Hepatitis B Virus Immunization Among Young Injection Drug Users in San Francisco, Calif: The UFO Study,"1 Lum et al. describe a lack of hepatitis B virus (HBV) surface antibody seroconversion at 4 weeks after completion of the 3-dose HBV vaccination series in injection drug users (IDUs). Only 78% of the subjects underwent anti-HBV surface antibody seroconversion. All UFO subjects were IDUs aged younger than 30 years. Among subjects who completed the vaccine series, 80% were White; 71% were male and 34% were gay or bisexual. While 41% were hepatitis C virus (HCV)–seropositive, only 1% were HIVinfected. Lum et al. propose that injection drug use likely blunts the immune response to HBV vaccination, but they also suggest that HCV infection may be partially responsible for the inadequate serological response.
The lack of seroconversion in the UFO Study was similar to results previously reported in the Seattle Young Men’s Survey (YMS), where 69% of men who have sex with men who reported a full HBV vaccination series had HBV surface antibodies.2 YMS subjects who reported receiving the 3-injection HBV immunization series were similar to UFO subjects in that they were aged younger than 30 years and were predominantly White men (68%). However, only 9% reported any injection drug use; 1% were HCV-seropositive. Four percent were HIVinfected. Since the YMS relied on selfreport of vaccination status and the time since HBV vaccination was longer than in the UFO Study, inaccurate recall regarding vaccination and waning antibodies may have played a role in the lack of HBV seropositivity among YMS participants who reported completing the HBV immunization series.
The results of the UFO and YMS studies demonstrate that HBV seroconversion, whether after documented completion of a vaccination series or self-reported receipt of 3 vaccines, does not equal the close to 100% serological response in young adults reported by vaccine manufacturers.3,4 Thus, screening for presence of HBV antibodies before vaccination may be useful in patients who report prior HBV vaccination and injection drug use or having sex with other men as HBV risk factors.
References
1. Lum PJ, Ochoa KC, Hahn JA, Page Shafer K, Evans JL, Moss AR. Hepatitis B virus immunization among young injection drug users in San Francisco, Calif: the UFO Study. Am J Public Health. 2003;93:919–923.
2. Diamond C, Thiede H, Perdue T, et al. Viral hepatitis among young men who have sex with men: prevalence of infection, risk behaviors, and vaccination. Sex Transm Dis. 2003;30:425–432.[Medline]
3. Recombivax HB Hepatitis B Vaccine (Recombinant). Whitehouse Station, NJ: Merck; 2002. Product monograph.
4. West DJ. Clinical experience with hepatitis B vaccines. Am J Infect Control. 1989;17:172–180.[ISI][Medline]
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