Response to Letter

We would like to thank Drs Hagmann, Shah, and Purswani for their erudite discussion of antibody to hepatitis B core antigen (anti-HBc) and for clarifying the interpretation and management strategy of the isolated positive anti-HBc. In the context of our study on hepatitis B virus (HBV) screening practices, we did not capture additional data on the management of the opportunities presented from positive results, and we also faced lack of space in our article to provide detailed description of the optimal further evaluations.[1] Testing for anti-HBc in travelers from countries with intermediate to high HBV endemicity clearly augments clinical interpretation of hepatitis B surface antigen and hepatitis B surface antibody results during HBV screening, as we noted. We fully agree with Hagmann and colleagues regarding the need to further assess the positive isolated anti-HBc, and support the management strategy that they highlighted to identify possible situations of viral reactivation.

  • Lin H. Chen,*† Elizabeth D. Barnett,‡§ Mary

  • E. Wilson,|| William MacLeod,¶# Emad A.

  • Yanni,** Winnie Ooi,†† Adolf W. Karchmer,‡‡

  • Laura Kogelman,§§ Nina Marano,** and

  • Davidson H. Hamer¶#||||

  • *Travel Medicine Center, Mount Auburn Hospital,

  • Cambridge, MA, USA; Faculty of Medicine, Harvard

  • Medical School, Boston, MA, USA; Department of

  • Pediatrics, Boston University School of Medicine,

  • Boston, MA, USA; §International Clinic, Department

  • of Pediatrics, Boston Medical Center, Boston, MA,

  • USA; ||Department of Global Health and Population,

  • Harvard School of Public Health, Boston, MA, USA;

  • ¶Center for Global Health and Development, Boston

  • University, Boston, MA, USA; #Department of

  • International Health, Boston University School of

  • Public Health, Boston, MA, USA; **Division of Global

  • Migration and Quarantine, National Center for

  • Emerging and Zoonotic Infectious Diseases, Centers

  • for Disease Control and Prevention, Atlanta, GA,

  • USA; ††Tropical and Travel Medicine, Lahey Clinic

  • Medical Center, Burlington, MA, USA; ‡‡Division of

  • Infectious Disease, Beth Israel Deaconess Medical

  • Center, Boston, MA, USA; §§Division of Geographic

  • Medicine and Infectious Diseases, Tufts Medical

  • Center, Boston, MA, USA; ||||Section of Infectious

  • Diseases, Department of Medicine, Boston University

  • School of Medicine, Boston, MA, USA


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