Infection with hepatitis B virus carrying novel pre-S/S gene mutations in female siblings vaccinated at birth: two case reports

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Infection with hepatitis B virus carrying novel pre-S/S gene mutations in female

siblings vaccinated at birth: two case reports

IntroductionAfter the initiation of a mass hepatitis B vaccination program in

Taiwan, the prevalence of hepatitis B virus infection has declined

progressively. However, about 1 percent of the young generation, who received

hepatitis B vaccination at birth, remain carriers.

Infection with vaccine-escape hepatitis B virus mutants always occurs shortly

after birth. Here, we report two female siblings in whom the infection occurred

in their adolescence.

This report raises the question of whether a booster for hepatitis B vaccination

is needed.Case presentationTwo 19 and 14-year-old Taiwanese female siblings were

born to a mother infected with hepatitis B virus and received a complete course

of hepatitis B vaccination at birth. They remained negative for serum hepatitis

B surface antigen and positive for serum anti-hepatitis B surface antibody

throughout their childhood.

However, both were infected with the hepatitis B virus in their adolescence.

Hepatitis B virus DNA was extracted from serum samples from the mother and two

siblings.

Hepatitis B virus pre-S/S sequence was amplified by polymerase chain reaction

followed by nucleotide sequencing. When compared with the sequence obtained from

the mother, multiple amino acid substitutions located near or in the major

hydrophilic region of the surface antigen were identified in the elder sister.

Four of these mutations (sL97S, sL98S, sG102R, and sA159P) were novel. A novel

in-frame deletion (14 amino acids deleted, pre-S 127-140) was found in the

hepatitis B virus pre-S2 region in the younger sister.

Conclusions: Despite having received hepatitis B vaccination at birth, hepatitis

B virus infection can still occur in adolescence with the emergence of novel

mutations in the pre-S/S gene.

This is a rare event and, to the best of our knowledge, has not been previously

reported.

Author: Ming-Wei Lai YehChau-Ting Yeh

Credits/Source: Journal of Medical Case Reports 2010, 4:190

Published on: 2010-06-23

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