Three doses of the hepatitis B vaccines have been shown to provide long lasting protection in most people.
Do you need to get your titers checked to make sure you are immune?
Usually not. Simply being fully vaccinated with the vaccine is good enough evidence that you are immune in most, but not all circumstances.
A few circumstances in which you might need to be tested can include:
- a baby who was born to a HBsAg (hepatitis B surface antigen) mother
- being a healthcare worker who has a job and who is in a work setting that puts them at higher risk for exposure to blood or body fluids from patients who are positive for HBsAg
- being immunocompromised, so you are not sure if the vaccine is going to work, or patients requiring chronic dialysis
- someone who has sex or shares needles with a person who has a chronic hepatitis B infection
The screening test for vaccine immunity that is done checks the persons level of anti-HBs (antibody to the hepatitis B surface antigen). It should be done one to two months after your last dose of hepatitis B vaccine, but not later.
“Persons determined to have anti-HBs concentrations of ≥10 mIU/mL after receipt of the primary vaccine series are considered immune, and the result should be documented. Immunocompetent persons have long-term protection and do not need further periodic testing to assess anti-HBs levels.”
CDC on Immunization of Health-Care Personnel
The alternative to screening healthcare workers after they complete their vaccination series is to do postexposure management. In this method, in the case of a needlestick or other blood or body fluid exposure, both the source patient and the health care worker are tested and postexposure prophylaxis is given as necessary.
Don’t pregnant women get tested for hepatitis B? They do, but not to see if they are immune from immunization. They routinely have a HBsAg test to see if they have a chronic hepatitis B infection, which can be passed on to their baby.
Other screening tests that can be done include anti-HBc (antibody to hepatitis B core antigen) and IgM anti-HBc (IgM subclass to hepatitis B core antigen). These two tests can help you figure out if a person has an acute infection or is immune from a past infection.
Non-Immune Hepatitis B Titer Levels
Why check the anti-HBs level?
Because of the devastating effects of chronic hepatitis B infections, it is good to have all of the information you can get to help prevent a possible infection if you are exposed to blood or body fluids while working.
Having a positive anti-HBs level, typically defined as a level of ≥10 IU/mL, means that you are immune and protected.
But what if your level is negative? What if your level is <10 IU/mL after you have already gotten three doses of hepatitis B vaccine?
Then you get another dose of hepatitis B vaccine and the level is checked again in one to two months. If it is still <10 IU/mL, then you get two more doses of hepatitis B vaccine and the level is checked again in one to two months.
If you are still negative after six or more doses of hepatitis B vaccine, then you are considered a non-responder. You would then require postexposure testing and possible prophylaxis if you are exposed to a patient’s blood or body fluids.
What If You Lost Your Hepatitis B Immunity?
There is a reason that they don’t recommend testing more than one to two months after your last dose of hepatitis B vaccine.
“Studies indicate that immunologic memory remains intact for at least 20 years and confers protection against clinical illness and chronic HBV infection, even though anti-HBs levels that once measured adequate might become low or decline below detectable levels. If one is challenged with HBV, people whose immune systems are competent will mount an anamnestic response and develop protective anti-HBs.”
Immunization Action Coalition on Hepatitis B Questions
It is known that anti-HBs levels can decrease over time.
Fortunately, this does not lead to waning immunity in typical circumstances. Because of an anamnestic response, the hepatitis B vaccine provides long lasting protection, even if your antibody levels appear to have dropped.
Avoiding Hepatitis B
Since health care workers should practice universal precautions whether or not they are immune to hepatitis B, being a non-responder isn’t going to change how you do things too much.
Plus, there are other diseases that are not yet vaccine preventable that you could get if you are stuck with a needle, so you are hopefully still very careful, no matter how immune you are to hepatitis B.
Still, it is very nice to have one less thing to worry about in this situation.
“Unvaccinated or incompletely vaccinated persons who experience a workplace exposure from persons known to be HBsAg-positive should receive 1 dose of hepatitis B immune globulin HBIG (i.e., passive vaccination) as soon as possible after exposure (preferably within 24 hours).”
CDC on Immunization of Health-Care Personnel
If you are a non-responder and and are exposed to hepatitis B, then one thing that is different is that you will likely require two doses of HBIG (hepatitis B immune globulin) for protection. Others can get one dose of HBIG and can repeat the hepatitis B vaccine. Those who are fully vaccinated and known to be immune likely won’t have to do anything to protect themselves from hepatitis B, although each incident should be investigated to make sure.
But it is not just healthcare workers who are at risk for accidental needlesticks. What if a healthcare worker sticks themselves and then you or your child? Or what if your child gets stuck with a discarded needle at the park?
What to Know About Hepatitis B Titers
Get vaccinated and follow the latest guidelines if you are exposed to hepatitis B, especially if you are a non-responder to the vaccine with low titer levels.
More on Hepatitis B Titers and Immunity
- CDC – Hepatitis B FAQs for Health Professionals
- CDC – Preventing Needlesticks and Sharps Injuries
- CDC – What to Do Following a Sharps Injury
- ACOG – Routine Tests During Pregnancy
- MMWR – CDC Guidance for Evaluating Health-Care Personnel for Hepatitis B Virus Protection and for Administering Postexposure Management
- MMWR – Immunization of Health-Care Personnel (ACIP)
- Ask the Experts About Hepatitis B
- Pre-exposure Management for Healthcare Personnel with a Documented Hepatitis B Vaccine Series Who Have Not Had Post-vaccination Serologic Testing
- Hepatitis B Facts: Testing and Vaccination
- Hepatitis B and Healthcare Personal
- WHO – Hepatitis B and the Healthcare Worker
- Study – Antibody Levels and Protection after Hepatitis B Vaccine: Results of a 22-Year Follow-Up Study and Response to a Booster Dose
- Study – Durability of antibody response against hepatitis B virus in healthcare workers vaccinated as adults.
- Study – How to determine protective immunity in the post-vaccine era.
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