Table 2.

Teaching points

1.All nephrologists and staff working in hemodialysis units should be aware that hepatitis B antigenemia may occur after vaccination. This should not be assumed or treated as iatrogenic transmission of hepatitis B without confirmatory testing. The patient should not be dialyzed using a designated hepatitis B machine pending confirmatory testing.

2.Hepatitis B surface antigen should not be tested for at least 14 to 28 days after vaccination to prevent interpretation issues.

3.Patient and dialysis staff education on the appropriate timing of hepatitis B surface antigen testing would help to reduce misinterpretation, particularly in health care settings where vaccination and dialysis are administered by different providers. Hepatitis B vaccine passports may help in this regard.

4.Should a patient on dialysis develop a positive hepatitis B surface antigen, vaccination history should be sought, and investigations including a repeat hepatitis B surface antigen and viral load should be performed expeditiously to rule out hepatitis B infection while the patient’s dialysis machine is isolated.