Kidney Week

Abstract: SA-PO1069

Recurring Engerix-B Postvaccination Hepatitis B Surface Antigenemia by Atellica IM HBsAgII Protocol

Session Information

• Kidney Replacement Therapy and Care Delivery Innovations
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Onuigbo, Macaulay A., University of Vermont The Robert Larner MD College of Medicine, Burlington, Vermont, United States

Macaulay A. Onuigbo, MD, MS, MBA, FASN

• Miller, Mary, University of Vermont The Robert Larner MD College of Medicine, Burlington, Vermont, United States

Mary Miller

• Andrus, Andrea, University of Vermont The Robert Larner MD College of Medicine, Burlington, Vermont, United States

Andrea Andrus

• Noyes, Cindy, University of Vermont The Robert Larner MD College of Medicine, Burlington, Vermont, United States

Cindy Noyes, MD

• Bullis, Sean, University of Vermont The Robert Larner MD College of Medicine, Burlington, Vermont, United States

Sean Bullis, MD

• Biediger, Jessica, University of Vermont The Robert Larner MD College of Medicine, Burlington, Vermont, United States

Jessica Biediger, RN

Introduction

ENGERIX-B [Hepatitis B Vaccine] is a Recombinant sterile suspension of noninfectious Hepatitis B Surface Antigen (HBsAg). Hepatitis B screening tests utilize assays for HBsAg in blood. Post-vaccination and often transient HBsAgenemia has been rarely reported. We report recurrent post-vaccination HBsAgenemia.

Case Description

A 78-yo ESRD male on hemodialysis exhibited positive HBsAg tests despite being asymptomatic with unremarkable liver function tests. The positive HBsAg tests - Atellica IM HBsAgII sandwich immunoassay using direct, chemiluminometric technology - followed ENGERIX-B vaccinations (Table 1). The recurring positive HBsAg tests were as early as 2 days post-vaccination (March 2026) and as late as 87 days post-vaccination (October 2025). There were few instances, between November 2025 through early February 2026, when HBsAg tests were negative after ENGERIX-B vaccination (Table 1). On further analysis, the falsely positive HBsAg tests were consistently negative when retested on the same day using the different Atellica IM HBsII Conf assay that is based on the principle of specific antibody neutralization (Table 2).

Discussion

Post-ENGERIX-B vaccination HBsAgenemia is likely underrecognized. We posit that only the Atellica IM HBsII Conf assay be used to avoid the pursuit of falsely positive post-vaccination HBsAgenemia. This will minimize further expensive Infectious Disease lab testing, as well as limit the costs and stigma of unnecessary isolation of patients in the hemodialysis unit. Is this phenomenon due to genetic susceptibility? This calls for further study.

Acknowledgment

This abstract is deidated to all the hardworking Hemodialysis Staff around the world! It is such a difficult job to continuously perform. It is also dedicated to all our ESRD patients on maintenance hemodialysis.

Hepatitis B Serologies

HBsAg Serologies Compared