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Els Reijn and Marcel Verweij
As a public health professional, you are notified that a 2-year-old boy in your town has been found to be a hepatitis B virus (HBV) carrier. The boy had been immunised (actively and passively) after birth because his mother was also a HBV-carrier. Such early immunisation prevents transmission from mother to child in most cases, but apparently this time it had not worked. Further investigation revealed that the child carried a specific genetic mutant of the virus (G145R-HBV-mutant) which could explain why passive and active immunisation had failed. The boy has a high viral load. As a consequence, it is reasonable to recommend vaccination for all close contacts.
However, several questions arise. First, the child will probably go to a day nursery within a couple of months. Is that acceptable, given the risks of transmission (e.g. saliva on toys)? Should professionals at the nursery be informed that the boy is a HBV-carrier …