Immunity to hepatitis B among health care workers performing exposure prone procedures

Health care workers who are in direct contact with blood are at increased risk of acquiring hepatitis B infection.The Department of Health recommends vaccination against hepatitis B for people at special risk.'We report a case of Reiter's syndrome after the second dose of Engerix B vaccine and a case of reactive arthritis after the first, both occurring in health care workers. Case reports CASE 1A 29 year old health care worker developed polyarthritis four weeks after the second injection in a course of hepatitis B immunisation.Initially, he had developed pain, stiffness, and swelling in his left wrist and his knees and had been unable to walk.He had also developed bilateral conjuctivitis and dysuria.There had been no prodromal illness.On examination he was not feverish, and he had bilaterial conjunctivitis with scanty purulent dis- charge.His right knee was hot, swollen, and tender but no effusion was detectable.He had a normal full blood count with a raised plasma viscosity (1 -90, normal range 1 5-1 72).Liver enzyme activities were normal, and screening for rheumatoid factor and autoanti- bodies gave negative results.Urine cultures were sterile; a urethral swab was not taken.He improved with bed rest and splinting and was discharged from hospital taking indomethacin.Over the next six months he had intermittent dysuria but urine cultures remained sterile.He subsequently developed persistent swelling in his wrists and knees.Enteric coated prednisolone 5 mg daily was added, and his symptoms improved gradually over the next four months, when all drugs were withdrawn.He was observed for a further four months with no recurrence in his symptoms and remained well during the following year.