Fleshing out vulnerability.

In the literature on medical ethics, it is generally admitted that vulnerable persons or groups deserve special attention, care or protection. One can define vulnerable persons as those having a greater likelihood of being wronged - that is, of being denied adequate satisfaction of certain legitimate claims. The conjunction of these two points entails what we call the Special Protection Thesis. It asserts that persons with a greater likelihood of being denied adequate satisfaction of their legitimate claims deserve special attention, care or protection. Such a thesis remains vague, however, as long as we do not know what legitimate claims are. This article aims at dispelling this vagueness by exploring what claims we have in relation to health care - thus fleshing out a claim-based conception of vulnerability. We argue that the Special Protection Thesis must be enriched as follows: If individual or group X has a greater likelihood of being denied adequate satisfaction of some of their legitimate claims to (i) physical integrity, (ii) autonomy, (iii) freedom, (iv) social provision, (v) impartial quality of government, (vi) social bases of self-respect or (vii) communal belonging, then X deserves special attention, care or protection. With this improved understanding of vulnerability, vulnerability talk in healthcare ethics can escape vagueness and serve as an adequate basis for practice.

High immunogenicity of delayed third dose of hepatitis B vaccine in travellers.

Travellers often present late for the third dose of hepatitis B vaccination and measuring anti-HBs serology is common practice to ensure that these individuals are protected. We assessed the adequacy of immune response in 86 healthy travellers who had their third dose of hepatitis B (HB) vaccine performed more than 1 year (median: 3.4 years; range: 1.1-10.5 years) after the second dose. Eighty-two travellers (95.3%) had evidence of sero-protection (anti-HBs titre >10 UI/L) including 16/17 (94.1%) travellers who had an interval of more than 5 years between second and third vaccine dose. We did not find any risk factor associated with insufficient response.