Hepatitis B Vaccination
Majid Ali, M.D.
Should Individuals At High Risk of Hepatitis Consider Hepatitis B Vaccine?
The Answer: Yes, but with appropriate timing.
What Is the Risk of Breakthrough Infections in Hepatitis B Vaccinated Persons?
Significant In Immunocompromised Individuals With History of Substance Abuse.
Breakthrough Infections in Hepatitis B Vaccinated Persons
Breakthrough infections in immunocompetent vaccinated persons are very uncommon.Moreover, when such breakthrough infections have been documented in apparently immunocompetent persons, they have typically been transient and asymptomatic,
Hepatitis B Vaccination
CFenves AZ, Schaefer PW, Luther J, et al. 21-2016 — A 32-Year-Old Man in an Unresponsive State. N Engl J Med 2016; 375:163-171.
PRESENTATION OF CASE
Dr. Samuel M. Vanderhoek (Anesthesia, Critical Care, and Pain Medicine): A 32-year-old incarcerated man was admitted to this hospital after being found in an unresponsive state in his jail cell.
Two days before this admission, the patient had had nausea and vomiting. Acetaminophen, at a dose of 650 mg up to three times daily as needed, was prescribed, in addition to a preexisting prescription for acetaminophen at a dose of 325 mg twice daily. Earlier during the day of admission, the patient was reported to be acting strangely; later, he was found in an unresponsive state on the floor of his cell. Emergency medical services personnel were called to the jail, where they found the patient in an unresponsive state, in a decerebrate posture, and incontinent of urine. The blood glucose level, obtained by finger-stick testing, was less than 10 mg per deciliter (<0.6 mmol per liter; reference range, 70 to 110 mg per deciliter [3.9 to 6.1 mmol per liter]). The patient was transported by ambulance to the emergency department of this hospital.
The available medical history was limited. The patient had a history of substance-use disorder (including the use of alcohol, opiates, and cocaine), traumatic brain injuries, seizures, anemia, and a psychotic disorder for which the diagnosis of paranoid schizophrenia had been considered. Six years before the current presentation, tests for human immunodeficiency virus (HIV) antibodies, hepatitis C virus (HCV) antibodies, and hepatitis B virus (HBV) surface antigen were negative, and a test for HBV surface antibodies was positive. The patient had been assaulted several times during the 14 months before this admission; the assaults had resulted in a subdural hematoma, orbital and nasal fractures, and jaw fractures. Eight months before the current admission, he had been admitted to this hospital for altered behavior. On evaluation, he had had an unremarkable computed tomographic (CT) scan of the head, hyperammonemia that was thought to be related to alcoholism, and an echogenic liver on ultrasonography that was thought to represent a combination of fatty infiltration and fibrosis; his mental status improved with the administration of lactulose. Six weeks before the current admission, the patient had been evaluated at this hospital because of facial injuries. CT scans of the face, brain, and neck were unremarkable; laboratory test results are shown in Table 1. Medications included lactulose, thiamine, sertraline, oxycodone, ibuprofen, and acetaminophen. Details of the patient’s family history were unavailable. The patient had been homeless. He had smoked one pack of cigarettes daily for the past 15 years, had drunk several pints of vodka daily before incarceration, and had previously reported using intranasal cocaine and heroin.