Hepatitis B represents a global health threat because its chronic course and sequelae contribute to a high morbidity and mortality. Hepatitis B virus (HBV)
infection can be controlled by
vaccines,
antiviral treatment, and by interrupting transmission. Rare
vaccine escape mutants are serious because they eliminate
vaccine protection. Here, we present a 74-year-old vaccinated patient with HBV reactivation 11 years after
kidney transplantation. The patient was HBV-positive but
HBsAg-negative prior to vaccination 6 years before
transplantation. The reactivated virus was HBV genotype F3 with
vaccine escape mutations G145R, P120Q, and Q129P. The patient was successfully treated with
entecavir. The epidemiological reasons for this subgenotype, which is extremely rare in Western Europe, were unclear. This case illustrates that second-generation
vaccines are not always effective in a specific group of patients.