Hepatitis B Virus Mutant Infections in Hemodialysis Patients: A Case Series
Rationale & Objective: Hepatitis B virus (HBV) transmission in hemodialysis units has become a rare event since implementation of hemodialysis-specific infection control guidelines: performing hemodialysis for hepatitis B surface antigen (HBsAg)-positive patients in an HBV isolation room, vaccin...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-11-01
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| Series: | Kidney Medicine |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590059519301037 |
| _version_ | 1828970781213720576 |
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| author | Ibironke W. Apata Duc B. Nguyen Yury Khudyakov Tonya Mixson-Hayden Jon Rosenberg Matt Zahn Jane Greenko Ernest Clement Allison E. Portney Prathit A. Kulkarni Maura Comer Eleanor Adams Saleem Kamili Priti R. Patel Anne C. Moorman |
| author_facet | Ibironke W. Apata Duc B. Nguyen Yury Khudyakov Tonya Mixson-Hayden Jon Rosenberg Matt Zahn Jane Greenko Ernest Clement Allison E. Portney Prathit A. Kulkarni Maura Comer Eleanor Adams Saleem Kamili Priti R. Patel Anne C. Moorman |
| author_sort | Ibironke W. Apata |
| collection | DOAJ |
| description | Rationale & Objective: Hepatitis B virus (HBV) transmission in hemodialysis units has become a rare event since implementation of hemodialysis-specific infection control guidelines: performing hemodialysis for hepatitis B surface antigen (HBsAg)-positive patients in an HBV isolation room, vaccinating HBV-susceptible (HBV surface antibody and HBsAg negative) patients, and monthly HBsAg testing in HBV-susceptible patients. Mutations in HBsAg can result in false-negative HBsAg results, leading to failure to identify HBsAg seroconversion from negative to positive. We describe 4 unique cases of HBsAg seroconversion caused by mutant HBV infection or reactivation in hemodialysis patients. Study Design: Following identification of a possible HBsAg seroconversion and mutant HBV infection, public health investigations were launched to conduct further HBV testing of case patients and potentially exposed patients. A case patient was defined as a hemodialysis patient with suspected mutant HBV infection because of false-negative HBsAg testing results. Confirmed case patients had HBV DNA sequences demonstrating S-gene mutations. Setting & Participants: Case patients and patients potentially exposed to the case patient in the respective hemodialysis units in multiple US states. Results: 4 cases of mutant HBV infection in hemodialysis patients were identified; 3 cases were confirmed using molecular sequencing. Failure of some HBsAg testing platforms to detect HBV mutations led to delays in applying HBV isolation procedures. Testing of potentially exposed patients did not identify secondary transmissions. Limitations: Lack of access to information on past HBsAg testing platforms and results led to challenges in ascertaining when HBsAg seroconversion occurred and identifying and testing all potentially exposed patients. Conclusions: Mutant HBV infections should be suspected in patients who test HBsAg negative and concurrently test positive for HBV DNA at high levels. Dialysis providers should consider using HBsAg assays that can also detect mutant HBV strains for routine HBV testing. Index Words: hemodialysis, hepatitis B virus infection, hepatitis B virus mutation, hepatitis B surface antigen mutation, hepatitis B surface antigen seroconversion |
| first_indexed | 2024-12-14T12:57:18Z |
| format | Article |
| id | doaj.art-53a34cf3cb124589a82a83888eb28f1a |
| institution | Directory Open Access Journal |
| issn | 2590-0595 |
| language | English |
| last_indexed | 2024-12-14T12:57:18Z |
| publishDate | 2019-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney Medicine |
| spelling | doaj.art-53a34cf3cb124589a82a83888eb28f1a2022-12-21T23:00:31ZengElsevierKidney Medicine2590-05952019-11-0116347353Hepatitis B Virus Mutant Infections in Hemodialysis Patients: A Case SeriesIbironke W. Apata0Duc B. Nguyen1Yury Khudyakov2Tonya Mixson-Hayden3Jon Rosenberg4Matt Zahn5Jane Greenko6Ernest Clement7Allison E. Portney8Prathit A. Kulkarni9Maura Comer10Eleanor Adams11Saleem Kamili12Priti R. Patel13Anne C. Moorman14Centers for Diseases Control and Prevention, Atlanta, GA; Emory University School of Medicine, Division of Renal Medicine, Atlanta, GA; Address for Correspondence: Ibironke W. Apata, MD, US Centers for Disease Control and Prevention; 1600 Clifton Rd, Mailstop A-31, Atlanta, GA 30322.Centers for Diseases Control and Prevention, Atlanta, GACenters for Diseases Control and Prevention, Atlanta, GACenters for Diseases Control and Prevention, Atlanta, GAHealthcare-Associated Infections Program, California Department of Public Health, Santa Ana, CAOrange County Public Health, Santa Ana, CANew York State Department of Health, Central Islip, Albany, NYNew York State Department of Health, Albany, NYCommunicable Disease Service, New Jersey Department of Health, Trenton, NJ; School of Public Health, Rutgers University, Newark, NJCenters for Diseases Control and Prevention, Atlanta, GA; Communicable Disease Service, New Jersey Department of Health, Trenton, NJFlorida Department of Health, Tallahassee, FLNew York State Department of Health, New Rochelle, NYCenters for Diseases Control and Prevention, Atlanta, GACenters for Diseases Control and Prevention, Atlanta, GACenters for Diseases Control and Prevention, Atlanta, GARationale & Objective: Hepatitis B virus (HBV) transmission in hemodialysis units has become a rare event since implementation of hemodialysis-specific infection control guidelines: performing hemodialysis for hepatitis B surface antigen (HBsAg)-positive patients in an HBV isolation room, vaccinating HBV-susceptible (HBV surface antibody and HBsAg negative) patients, and monthly HBsAg testing in HBV-susceptible patients. Mutations in HBsAg can result in false-negative HBsAg results, leading to failure to identify HBsAg seroconversion from negative to positive. We describe 4 unique cases of HBsAg seroconversion caused by mutant HBV infection or reactivation in hemodialysis patients. Study Design: Following identification of a possible HBsAg seroconversion and mutant HBV infection, public health investigations were launched to conduct further HBV testing of case patients and potentially exposed patients. A case patient was defined as a hemodialysis patient with suspected mutant HBV infection because of false-negative HBsAg testing results. Confirmed case patients had HBV DNA sequences demonstrating S-gene mutations. Setting & Participants: Case patients and patients potentially exposed to the case patient in the respective hemodialysis units in multiple US states. Results: 4 cases of mutant HBV infection in hemodialysis patients were identified; 3 cases were confirmed using molecular sequencing. Failure of some HBsAg testing platforms to detect HBV mutations led to delays in applying HBV isolation procedures. Testing of potentially exposed patients did not identify secondary transmissions. Limitations: Lack of access to information on past HBsAg testing platforms and results led to challenges in ascertaining when HBsAg seroconversion occurred and identifying and testing all potentially exposed patients. Conclusions: Mutant HBV infections should be suspected in patients who test HBsAg negative and concurrently test positive for HBV DNA at high levels. Dialysis providers should consider using HBsAg assays that can also detect mutant HBV strains for routine HBV testing. Index Words: hemodialysis, hepatitis B virus infection, hepatitis B virus mutation, hepatitis B surface antigen mutation, hepatitis B surface antigen seroconversionhttp://www.sciencedirect.com/science/article/pii/S2590059519301037 |
| spellingShingle | Ibironke W. Apata Duc B. Nguyen Yury Khudyakov Tonya Mixson-Hayden Jon Rosenberg Matt Zahn Jane Greenko Ernest Clement Allison E. Portney Prathit A. Kulkarni Maura Comer Eleanor Adams Saleem Kamili Priti R. Patel Anne C. Moorman Hepatitis B Virus Mutant Infections in Hemodialysis Patients: A Case Series Kidney Medicine |
| title | Hepatitis B Virus Mutant Infections in Hemodialysis Patients: A Case Series |
| title_full | Hepatitis B Virus Mutant Infections in Hemodialysis Patients: A Case Series |
| title_fullStr | Hepatitis B Virus Mutant Infections in Hemodialysis Patients: A Case Series |
| title_full_unstemmed | Hepatitis B Virus Mutant Infections in Hemodialysis Patients: A Case Series |
| title_short | Hepatitis B Virus Mutant Infections in Hemodialysis Patients: A Case Series |
| title_sort | hepatitis b virus mutant infections in hemodialysis patients a case series |
| url | http://www.sciencedirect.com/science/article/pii/S2590059519301037 |
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