Published online Mar 16, 2016. doi: 10.12998/wjcc.v4.i3.71
Peer-review started: August 27, 2015
First decision: October 14, 2015
Revised: November 16, 2015
Accepted: December 13, 2015
Article in press: December 14, 2015
Published online: March 16, 2016
Approximately 240 million people are chronically infected with hepatitis B. The implementation of rigorous vaccination programs has led to an overall decrease in the prevalence of this disease worldwide but this may also have led to emergence of viral mutations that can escape the protection of hepatitis B surface antibody. As this phenomenon is increasingly recognized, concern for transmission to vaccinated individuals has also been raised. Herein, we describe two cases where the suspected presence of a hepatitis B surface antigen escape mutation impacted the decision to initiate early antiviral therapy, as well as provide a brief review of these mutations. Our findings described here suggest that a lower threshold for initiating therapy in these individuals should be considered in order to reduce the risk of transmission, as vaccination does not provide protection.
Core tip: Hepatitis B surface antigen escape mutations are being increasingly recognized, along with concern for the risk of transmission to vaccinated individuals. The management of these patients and the natural history of the disease remain controversial due to insufficient data. However, transmission of this mutated virus to vaccinated individuals has been reported in the literature. Herein, we discuss two different clinical scenarios that led to the initiation of early antiviral therapy in order to decrease the risk of transmission to others due to the suspected presence of this mutation.