Tag: medical exemptions

What Is Vaccine Choice?

Have you heard about the idea of vaccine choice?

The “right to choose” is being pushed by anti-vaccine groups in many states because they think that laws mandating kids to have vaccines to go to daycare, school, and college violates their parental rights and civil liberties.

“Their claim that vaccines are 100% safe and effective for all people all of the time is not based in science and is not supported by facts or evidence, making it more of a religious belief than an adequate basis for their mandate argument.”

Texans for Vaccine Choice

And of course, they use a lot of anti-vaccine talking points to try and scare parents into believing them. Vaccines are safe and they work, but no one says that they are 100% safe or that they are 100% effective.

What Is Vaccine Choice?

Right away, you should see another big problem with the vaccine choice movement.

No one is forcing anyone to get vaccinated. Everyone has a choice. It’s just that some folks don’t like the consequences that come with that choice of not vaccinating their kids – having to home school their kids instead of going to a public or private school.

So basically, vaccine choice is just the anti-vaccine movement moving the goal posts yet again.

“If you ask a parent of an autistic child if they want the measles or the autism, we will stand in line for the f–king measles.”

Jenny McCarthy

Study after study showed that vaccines are not associated with autism and what did we get, measles outbreaks in unvaccinated kids.

What’s Missing In the Vaccine Choice Argument?

In addition to facts, one big thing that is missing from the vaccine choice argument is that by pushing the idea that unvaccinated kids should be allowed to skip or delay any or all vaccines without consequences, that takes away the choice for the rest of us who want to keep our kids protected from vaccine-preventable diseases.

Can’t we just vaccinate our kids?

Many children with cancer and other medical conditions benefit from herd immunity.
Many children with cancer and other medical conditions benefit from herd immunity. (CC BY 2.0)

We do!

But that doesn’t take away all of the risk if you don’t vaccinate your kids.

“…the increased risk of disease in the pediatric population, in part because of increasing rates of vaccine refusal and in some circumstances more rapid loss of immunity, increases potential exposure of immunodeficient children.”

Medical Advisory Committee of the Immune Deficiency Foundation

There are kids who are too young to be vaccinated or fully vaccinated, kids who can’t be vaccinated because of true medical vaccine exemptions, and folks whose vaccine didn’t work, after all, vaccines aren’t 100% effective.

The “choice” folks don’t talk about those things though.

Make an informed choice about vaccines before you think about leaving your child unvaccinated and unprotected.

What To Know About Vaccine Choice

Listen to anti-vaccine propaganda, skip or delay vaccines and leave your kids unprotected or do your research and understand that vaccines work and are safe and necessary and get them vaccinated and protected – that’s your vaccine choice.

More on Vaccine Choice

Vaccines and Hemophilia

Kids with hemophilia bleed.

The Medical and Scientific Advisory Council of the National Hemophilia Foundation recommends "that patients with bleeding disorders continue to follow the American Academy of Pediatrics’ and CDC’s vaccine recommendation route and schedule for their age."
The Medical and Scientific Advisory Council of the National Hemophilia Foundation recommends “that patients with bleeding disorders continue to follow the American Academy of Pediatrics’ and CDC’s vaccine recommendation route and schedule for their age.”

They bleed into their joints, into their skin (hematoma), and from their mouth and gums. They can bleed after surgery and even after getting their vaccinations.

Vaccines and Hemophilia

Having hemophilia is certainly not a contraindication to getting vaccinated though.

“Your child should get regular immunizations with necessary precautions to prevent bleeding from the injection sites.”

Hemophilia FAQs

There are some precautions that are recommended before giving vaccines to a child with hemophilia, including:

  • using a 23-gauge or smaller caliber fine-gauge needle – consider a 25- or 27-gauge needle
  • when possible, giving the vaccine SQ instead of IM – for example, although the IPV (polio), hepatitis A, and hepatitis B vaccines are usually given IM, studies have shown that they can be given SQ to kids with hemophilia
  • applying firm pressure, without rubbing, after the vaccine is given for at least two minutes and up to 5 to 10 minutes
  • giving acetaminophen for pain relief, if necessary, instead of ibuprofen
  • warning about the risk of a hematoma developing at the injection site

Most importantly, if the child with hemophilia is already getting routine prophylaxis to prevent bleeding, schedule their vaccines around the same time to decrease the risk of bleeding.

Your child’s hematologist will likely give you specific instructions to provide to your pediatrician regarding immunization precautions.

What to Know About Vaccines and Hemophilia

Kids with hemophilia should get all of their vaccines on schedule, but precautions should be taken to decrease the chance of bleeding after getting an immunization.

More About Vaccines and Hemophilia

How to Claim a Vaccine Exemption

Don’t want to get your kids vaccinated?

You might be surprised to know that no one is out there trying to force you into vaccinating them.

Want to enroll your kids in daycare, preschool, school, or college?

Then they will need to be vaccinated.

How to Claim a Vaccine Exemption

Of course, depending on where you live, you could get a vaccine exemption and leave your kids unvaccinated and unprotected.

Does your child qualify for a medical exemption? All states allow kids to claim medical exemptions to getting vaccinated. True medical exemptions are rare though, as you can see from the rates in states that actually require screening and approval of medical vaccine exemptions.

Are you a Christian Scientist? In 47 states, laws allow religious exemptions to vaccinations. Ironically, these exemptions are often abused, as you don’t actually need to belong to a religion that is against vaccines to claim a religious exemption to vaccinations.

“When you are challenged by the viewpoint of a denomination, pastor, publication, or atheist authority: You do not worship any pastor, church, religious publication, or denomination. Your pastor’s personal view on vaccines is irrelevant to your stance because pastors do not learn about the biblical implications of vaccinating during seminary and your pastor isn’t God. (Though if you have a pastor willing to go to bat for you, use him.)”

Megan on How To Get a Vaccine Religious Exemption Like a Boss

It is not even a secret that parents abuse the religious vaccine exemption, claiming them even when they don’t have a sincere religious belief against getting vaccinated.

And in 20 states, it is even easier to claim a vaccine exemption. These are the states that allow philosophical or personal belief vaccine exemptions, in which you can typically just say that you are against vaccinating and protecting your kids “for reasons of conscience.”

Vaccine exemptions are too easy to get in some states, but even with an exemption, your child will still be excluded if there is an outbreak.
Vaccine exemptions are too easy to get in some states, but even with an exemption, your child will still be excluded if there is an outbreak.

What reasons? You don’t usually have to go into much detail…

Why Parents Abuse Vaccine Exemptions

It is not hard to understand why some parents abuse vaccine exemptions.

They abuse vaccine exemptions because they can.

In many states, it is easy to abuse vaccine exemptions because medical exemptions aren’t verified and approved and it is often easier and more convenient to get an exemption than to get vaccinated. Believe it or not, some doctors will even sell you a medical exemption for your child. Also, parents are made to feel so scared by anti-vaccine propaganda that they think that they need to get an exemption.

“Permitting personal belief exemptions and easily granting exemptions are associated with higher and increasing nonmedical US exemption rates. State policies granting personal belief exemptions and states that easily grant exemptions are associated with increased pertussis incidence.”

Omer et al on Nonmedical exemptions to school immunization requirements: secular trends and association of state policies with pertussis incidence.

But just because you can claim an easy exemption in a state without strong vaccine exemption laws doesn’t mean that you should.

While there are no benefits to delaying or skipping vaccines, there are plenty of risks. And the risks aren’t just to your unvaccinated child. We continue to see and hear about kids who are too young to be vaccinated or who couldn’t be vaccinated getting caught up in outbreaks caused by others who simply chose to not get vaccinated.

“I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.”

Dr. Bob Sears in The Vaccine Book

Not surprisingly, websites and organizations that give advice on getting kids easy vaccine exemptions never mention these risks. They also overstate the risks of vaccines and don’t mention the benefits of getting vaccinated.

Vaccines are safe and necessary. Unless your child has a true medical contraindication to getting one or more vaccines, do a little more research before getting a non-medical exemption.

What to Know About Claiming a Vaccine Exemption

While it is typically not hard to claim a vaccine exemption for your child, since vaccines are safe and necessary, be sure you understand the risks of delaying or skipping any vaccines if your child doesn’t need a true medical exemption.

More on Claiming a Vaccine Exemption

 

Immunization Requirements to Start School and Daycare

If you are following the latest immunization schedule and your kids are up-to-date on all of their vaccines, then they will likely be ready to start daycare, kindergarten, high-school, or college.

There aren’t usually any extra vaccines that they will need to start school.

Of course, if you have skipped or delayed any vaccines, then they might have to catch up on some immunizations before starting school.

Another situation where you might need to do some catching up is if you move, and instead of following the CDC schedule, you were just getting the minimum number of vaccines that were required to attend school where you used to live. For example, your kids could have been all set to start kindergarten in Arkansas, but if you suddenly moved to Texas, they might need a second MMR, a booster dose of Varivax, and two doses of hepatitis A vaccine, as none of those are required in Arkansas.

Immunization Requirements to Start Daycare and Preschool

Daycare rules in Idaho give parents a month to stay on schedule with all of the CDC immunization requirements.
Daycare rules in Idaho give parents a month to stay on schedule with all of the CDC immunization requirements.

Since many new parents have to go back to work when their baby is only about two to six weeks old, they won’t have time to get their first set of vaccines at two months.

That won’t keep them out of daycare, but delaying too much longer, usually more than a month, probably will.

To start daycare or preschool, infants and toddlers need to get most of the vaccines on the CDC immunization schedule. This includes DTaP, hepatitis B, Hib, Prevnar, and IPV (polio), and then once they are 12 months old, booster doses of the primary series of vaccines and the MMR, Varivax (chickenpox), and hepatitis A vaccines.

The only vaccine that is missing from many state mandates is the rotavirus vaccine. And that simply has to do with the strict timing requirements of when you need to start (before 15 weeks of age) and finish this vaccine (by 8 months).

Some states do require rotavirus though, and simply state that kids must follow “age appropriate dosing.” That way, if they are too old, they just don’t need to get it.

Immunization Requirements to Start Kindergarten

In addition to most of the vaccines they needed to start daycare or preschool, to start kindergarten, kids need their 4 to 6 year old boosters:

  • the fifth dose of DTaP to protect them against diphtheria, tetanus, and pertussis
  • the fourth dose of IPV to protect them against polio
  • the second dose of MMR to protect them against measles, mumps, and rubella
  • the second dose of Varivax to protect them against chicken pox

If using combination vaccines, these four immunizations can be combined into just two shots – Proquad (MMR + Varivax) and either Kinrix or Quadracel (DTaP + IPV), which your preschooler will appreciate to help reduce the pain from getting these shots.

If your kids were missing any vaccines, they will also need to get caught up on those before starting school.

Immunization Requirements to Start Middle School

Preteens and teens get a few vaccines when they start middle school when they are around 11 to 12 years old, including:

  • a dose of Tdap to protect them against diphtheria, tetanus, and pertussis
  • a dose of Menactra or Menveo to protect them against meningoccocal disease

Although not required by most schools, the HPV vaccine is also usually given around this time.

Immunization Requirements to Start College

And then, before going off to college, at around age 16 years, kids will usually need:

They can also get the MenB vaccine, although it isn’t yet required for all students. This vaccine (Bexsero or Trumenba) has a “permissive” recommendation, in that parents are told they can get it if they want their kids to avoid meningococcal B disease, but it is not required yet.

What about a third dose of MMR?

While an extra dose of the MMR vaccine is now being given in some situations, it is mainly if your child is at high risk because of a current mumps outbreak. A mumps booster shot is not currently recommended just because your child is going off to college.

What to Know About Immunization Requirements for Incoming Students

If you have been following the latest immunization schedule and your kids are up-to-date on all of their vaccines, then they will likely be ready to start daycare, kindergarten, high-school, and college without needing any extra vaccines.

More on Immunization Requirements for Incoming Students

 

Abuse of Vaccine Exemptions

Every state has laws mandating vaccines to attend school and daycare.

Every state also allows exemptions to those mandates, including:

The way that  these laws and exemptions are set up leaves a lot of room for abuse though.

Abuse of Religious Exemptions

How many religions are actually against kids getting vaccinated?

That’s right, almost none.

So why are there so many religious vaccine exemptions in most states, especially in states that don’t have a personal belief exemption?

Right again.

Folks who don’t want to vaccinate their kids, and can’t use a personal belief exemption, just say that vaccinating them would be against their religion.

Abuse of Medical Exemptions

There are some children who shouldn’t be vaccinated.

These children can get a true medical exemption to one or more vaccines because they have a real contraindication or precaution to getting vaccinated.

“If a child has a medical exemption to immunization, a physician licensed to practice medicine in New York State must certify that the immunization is detrimental to the child’s health. The medical exemption should specify which immunization is detrimental to the child’s health, provide information as to why the immunization is contraindicated based on current accepted medical practice, and specify the length of time the immunization is medically contraindicated, if known.”

Dear Colleague letter regarding guidelines for use of immunization exemptions

Fortunately, these medical reasons to skip or delay vaccines are not very common and are often temporary. They can include the contraindications and precautions listed in the package insert for each vaccine and by the Advisory Committee on Immunization Practices, with the most common medical exemptions being:

  • a severe allergic reaction to a previous dose
  • a severe allergic reaction to a vaccine component
  • a known severe immunodeficiency and live vaccines
  • a moderate or severe acute illness with or without fever (precaution)
  • a progressive neurologic disorder (precaution)
A family history of these conditions would not be a reason to skip or delay any vaccines.
Although it will get you a medical exemption for just $120 in California, a family history of these conditions would not be a reason to skip or delay any vaccines.

Most other things are “incorrectly perceived as contraindications to vaccination” and should not be a medical exemptions, including having :

  • a mild acute illness with or without fever
  • a mild to moderate local reaction
  • relatives with allergies
  • a family history of seizures
  • a stable neurologic condition
  • an autoimmune disease
  • a family history of an adverse event after DTP or DTaP administration

A medical exemption can also exist if your child already had the disease and so has natural immunity. In most cases, except for chicken pox disease, titers will likely need to be done to prove that your child already has immunity.

Stopping the Abuse of Vaccine Exemptions

We know that vaccine exemptions are being abused.

How do you stop it?

“Permitting personal belief exemptions and easily granting exemptions are associated with higher and increasing nonmedical US exemption rates. State policies granting personal belief exemptions and states that easily grant exemptions are associated with increased pertussis incidence.”

Omer et al on Nonmedical exemptions to school immunization requirements: secular trends and association of state policies with pertussis incidence.

You likely have to make it harder to get a vaccine exemption.

Strong exemption laws, which are needed in many states, make it clear that:

  • many exemptions are temporary
  • medical exemptions are based on ACIP guidelines, current accepted medical practice, and evidence based medicine – not anecdotes
  • religious exemptions specifically exclude philosophical exemptions and must reflect a sincere religious belief
  • exempted students will be excluded from school during outbreaks
  • exemptions should include a signed affidavit that is notarized
  • exemptions should be recertified each year
  • a separate exemption application will be needed for each vaccine

Getting an exemption shouldn’t be easier than getting vaccinated! And it should include some degree of education against the myths and misinformation that scares parents away from vaccinating their kids.

“Because rare medically recognized contraindications for specific individuals to receive specific vaccines exist, legitimate medical exemptions to immunization requirements are important to observe. However, nonmedical exemptions to immunization requirements are problematic because of medical, public health, and ethical reasons and create unnecessary risk to both individual people and communities.”

AAP on Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance

You could also get rid of nonmedical vaccine exemptions.

Of course, for that to work, you can’t allow just anything to count as a medical exemption.

“Review of all medical exemption requests will be conducted at the Mississippi State Department of Health by the State Epidemiologist or Deputy State Epidemiologist.”

Mississippi Medical Exemption Policy

In Mississippi, for example, where medical exemptions are reviewed and approved by the State Epidemiologist or Deputy State Epidemiologist, there were just 208 medical exemptions in the whole state during the 2016-17 school year.

In some states, rates of medical exemptions might be six or seven times higher. This is mostly seen in states that don’t allow personal belief exemptions and make it difficult to get a religious exemption.

That seems to be the case in Nebraska, where there are no personal belief exemptions and you have to submit a notarized statement to get a religious exemptions. Their high rates of medical exemptions likely reflect some abuse and the fact that medical exemptions aren’t reviewed or approved by anyone, they just reflect “that, in the health care provider’s opinion, the specified immunization(s) required would be injurious to the health and well – being of the student or any member of the student’s family or household.”

As we are seeing, that simply invites vaccine exemption abuse.

Very few states currently require that exemption applications go to the health department for review. Those that do include Alabama, Arkansas, Michigan, Minnesota, Mississippi, and West Virginia.

California is notably absent. I guess they didn’t see the potential for abuse when they passed their latest vaccine law. I mean, who could have guessed that doctors would actually be selling medical exemptions to parents based on unrelated conditions, like a family history of diabetes, celiac disease, or autism?

The non-medical vaccine exemption form in Colorado includes information on the risks of each vaccine-preventable disease.
The non-medical vaccine exemption form in Colorado includes information on the risks of each vaccine-preventable disease.

At the very least, until we have stronger exemption laws, parents who want to get a nonmedical exemption should acknowledge that they understand the risks they are taking when they skip or delay their child’s vaccines.

What to Know About Abuse of Vaccine Exemptions

While medical exemptions are necessary for kids who have true contraindications to getting vaccinated, stronger laws can help decrease the abuse we see in medical, religious, and personal belief vaccine exemptions.

More Information on Abuse of Vaccine Exemptions

 

The Unvaccinated Child

We know that your unvaccinated child is not healthier than vaccinated children.

And we know that among pediatric flu deaths, most are unvaccinated.

What else do we know about unvaccinated children?

Who’s Who Among Unvaccinated Children

Many children with cancer and other medical conditions benefit from herd immunity.
Many children with cancer and other medical conditions have medical exemptions to getting vaccinated and benefit from herd immunity. (CC BY 2.0)

Although it seems like unvaccinated kids all get grouped together, it is important to remember that not all unvaccinated kids are intentionally unvaccinated.

Some are too young to be vaccinated or fully vaccinated, some have medical exemptions, usually to just one or a few vaccines, and sometimes just temporary, and some have skipped or delayed one or more vaccines because of a lack of access to health care.

Whatever the reason, they are all at risk because they are unvaccinated.

The intentionally unvaccinated child poses the bigger risk though, because they tend to cluster together and are more likely to be either completely unvaccinated or to have skipped multiple vaccines. A child with a medical exemption because she is getting chemotherapy, on the other hand, very likely lives with a family who is completely vaccinated and protected. Similarly, a child with an allergy to a vaccine likely isn’t missing multiple vaccines.

Risks to the Unvaccinated Child

Of course, the main risk to the unvaccinated child is that they will get a potentially life-threatening vaccine-preventable disease.

While many vaccine-preventable diseases are no longer endemic in the United States and other developed countries, they have not been eradicated.

People do still get vaccine-preventable diseases in the United States.

And tragically, people do still die of vaccine-preventable diseases in the United States.

Can’t you just hide in the herd, depending on everyone else to be vaccinated and protected to keep these diseases away from your unvaccinated child? While that ends up being what happens most of the time, as there are no real alternatives to getting vaccinated, that strategy doesn’t always work. And it is a gamble that’s not worth taking and won’t keep working if more parents skip or delay getting their kids vaccinated.

Risks of the Unvaccinated Child to Everyone Else

Unvaccinated kids are also a risk to those around them, as they are more likely to get sick with a vaccine-preventable disease, since they have no immunity. No, they are not an instant danger if they don’t actually have a vaccine-preventable disease, but since you can be contagious a few days before you have symptoms, you are not always going to know when your child is sick and a risk to others.

Why does that matter if everyone else is vaccinated and immune?

Well, obviously, everyone else is not vaccinated and immune, including those with medical exemptions and those who are too young to be vaccinated. And since vaccines aren’t perfect, some people who are vaccinated can still get sick.

That’s why it is critical that if your unvaccinated child is sick or was exposed to someone who is sick, you are sure to:

  • notify health professionals about your child’s immunization status before seeking medical attention, as they will likely want to take precautions to keep you from exposing others to very contagious diseases like measles, mumps, and pertussis
  • follow all appropriate quarantine procedures that may have been recommended, which often extends up to 21 days after the last time you were exposed to someone with a vaccine-preventable disease
  • seek medical attention, as these are not mild diseases and they can indeed be life-threatening, even in this age of modern medicine

Hopefully you will think about all of these risks before your unvaccinated child has a chance to sick.

Getting Your Unvaccinated Child Caught Up

Fortunately, many unvaccinated kids do eventually get caught up on their vaccines.

It may be that they had a medical exemption that was just temporary and they are now cleared to get fully vaccinated.

Or they might have had parents who were following a non-standard, parent-selected, delayed protection vaccine schedule, but they have now decided to get caught up to attend daycare or school.

Others get over their fears as they get further educated about vaccines and vaccine myths and decide to get caught up and protected.

Is it ever too late to get vaccinated?

Actually it is.

In addition to the fact that your child might have already gotten sick with a particular vaccine preventable diseases, some vaccines are only given to younger kids.

For example, you have to be less than 15 weeks old to start the rotavirus vaccine. And you should get your final dose before 8 months. That means that if you decide to start catching up your fully unvaccinated infant at 9 months, then you won’t be able to get him vaccinated and protected against rotavirus disease. Similarly, Hib vaccine isn’t usually given to kids who are aged 5 years or older and Prevnar to kids who are aged 6 years or older, unless they are in a  high risk group.

Still, you will be able to get most vaccines. And using combination vaccines, you should be able to decrease the number of individual shots your child needs to get caught up. An accelerated schedule using minimum age intervals is also available if you need to get caught up quickly.

You should especially think about getting quickly caught up if there is an outbreak in your area or if you are thinking about traveling out of the country, as many vaccine-preventable diseases are still endemic in other parts of the world.

What to Know About The Unvaccinated Child

The main things to understand about the unvaccinated child is that they aren’t healthier than other kids, are just at more risk for getting a vaccine preventable disease, and should get caught up on their vaccines as soon as possible.

More on The Unvaccinated Child

Did Your Hepatitis B Antibody Test Come Back Negative?

Hepatitis B can be prevented.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