Dear
Editors:
Two
questions: is B vaccination effective in chronic carriers? How infective are this group of patients in
terms of working with children or in a hospital setting {medical and legal
implications}
E R
G
Dear
ERG:
Hepatitis
B vaccination has no beneficial effect in chronic carriers. It also has no
adverse effects, but should not be given. There is an ongoing research effort
to identify a "therapeutic" hepatitis B vaccine, in some cases using
more potent adjuvants and/or modifications of standard vaccine products, that
might have antiviral efficacy, but these studies so far have been
disappointing. Chronic HBsAg carriers are potentially infective to their
patients, but as long as standard barrier precautions are taken, the risk of
transmission is very low. There is no directive from the CDC that health care
providers should not continue their employment, but should carefully follow
standard barrier protection practices. The potentially most infective
individuals are those with detectable HBeAg and high titers of HBV DNA.