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Hepatitis B in a vaccinated soldier: a case report
  1. Keri McLean1,2,
  2. T B Elmer3,
  3. D A Freshwater4,
  4. L Lamb5,6,7 and
  5. S D Woolley1,8,9
  1. 1 Tropical and Infectious Diseases Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
  2. 2 Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
  3. 3 Defence Public Health Unit, Defence Medical Services Ringgold standard institution, Lichfield, UK
  4. 4 The Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, Birmingham, UK
  5. 5 Department of Infection, Royal Free London NHS Foundation Trust, London, UK
  6. 6 Division of Infection and Immunity, University College London, London, UK
  7. 7 Academic Department of Military Medicine, Royal Centre of Defence Medicine, Birmingham, UK
  8. 8 Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
  9. 9 Institute of Naval Medicine, Alverstoke, Hampshire, UK
  1. Correspondence to Dr Keri McLean, Tropical and Infectious Diseases Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, L7 8XP, UK; kerimclean{at}


Assessing for an adequate immunological response to a pre-exposure course of hepatitis B vaccine is not routinely recommended in all vaccinated individuals. Current UK guidelines advise checking hepatitis B surface antibody titres only in those considered at high occupational risk such as healthcare and laboratory workers. We present a case of an infantry soldier who developed acute hepatitis B despite having a complete course of hepatitis B vaccinations. This case emphasises that hepatitis B is still an important differential diagnosis for all returning military personnel who present with compatible symptoms despite being vaccinated.

  • hepatitis
  • hep B
  • vaccine
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  • Contributors KM wrote the manuscript with TBE, DAF and LL contributing to the report discussion. SDW conceived the idea for the case report, contributed to its writing and is the guarantor for the publication. All authors approved of the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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