Tag: titers

The Latest Vaccine Scandal in China

There is a vaccine scandal in China.

What does that mean for you and your kids?

Not much unless they were vaccinated in China. Remember, none of the vaccines used in the United States are made in China.

And our vaccines are tested for safe, pure, and potent before they are released for distribution.

The Latest Vaccine Scandal in China

Changchun Changsheng Life Sciences Ltd. is no longer making vaccines
Changchun Changsheng Life Sciences Ltd. is no longer making vaccines.

Even if your child had been vaccinated in China, there is likely nothing to be concerned about at this point.

The vaccines were not contaminated.

There is a concern that they were “substandard,” or that they might not work as well as they should.

That’s not good either though.

Getting a substandard vaccine might mean that you could get a disease that you thought you were vaccinated and protected against.

Still, since the scandal seems limited to a few companies (well, really just one company) and a few vaccines (just rabies and DTaP), it is very unlikely that many people in other countries have been affected.

“WHO assessed the national regulatory authorities in 2010 and 2014, and found that they met WHO criteria as a functional regulator for vaccines with a clear commitment to continual improvement. WHO welcomes the fact that China’s NDA continues to work with WHO’s Regulatory Systems Strengthening program, as it has been doing for nearly 20 years. While the current incident is clearly regrettable, the detection of this event by an unannounced inspection shows that the regulatory authority’s system of checks and balances to protect population health is working.”

WHO Statement on Rabies Incident in China

It is also important to realize that:

  • affected vaccines include 650,000 doses of DTaP vaccine, which were only sent to Chongqing and the provinces, of Shandong and Hebei. And while they initially passed testing for safety and efficacy before being released for distribution, later, routine testing found low titer testing in vaccines from two companies, Changchun Changsheng Life Sciences Ltd. and Wuhan Institute of Biological Products, who’s vaccines were recalled. Batch numbers have been published, so parents should be able to figure out if they got one of these vaccines.
  • problems with rabies vaccines from Changchun Changsheng Life Sciences Ltd. were discovered on a routine inspection and before the vaccine had been released for distribution. Unfortunately, the problem is that they made up production and inspection records, which is why at least 15 people from the company have been arrested. This is the scandal.

While some folks are concerned of more widespread problems, it is important to keep in mind that vaccines have been working in China. Despite these recent problems, China is polio-free and has “significantly reduced vaccine-preventable diseases such as measles, mumps, rubella, and hepatitis A and B among children.”

If there were a big problem with the effectiveness of their vaccines, they should be seeing more disease. And they aren’t.

And in places that are seeing more disease, like Europe, with their measles outbreaks and deaths, it is clearly unvaccinated folks that are getting sick.

“If you are unsure as to whether or not your child was vaccinated, the doctor can have their blood tested for antibodies to determine their immunity to certain diseases. However, these tests may not always be accurate, so the doctor may not be sure your child is truly protected. In some cases, doctors may prefer to revaccinate your child anyway for best protection. It is safe for your child to be revaccinated, even if your child received that vaccine in their birth country.”

CDC on Adoption and Vaccines

If you are still concerned about vaccines that your child may have gotten in China, either because you were living in China when your child was vaccinated or your child was adopted from China, remember that you can always have those vaccines repeated.

Titer testing is another option for most vaccines.

Until and if we get further guidance on this issue from the WHO, CDC, or AAP, neither seems to be necessary for what seems to be an isolated problem right now.

Vaccine Scandals in China

Tragically, these aren’t the first vaccine scandals in China.

  • there were reports of kids getting sick in 2016 in Shandong providence after getting vaccines that had not been stored properly
  • there were reports of kids getting sick in 2015 after getting expired vaccines in Henan province
  • in 2013, several infant deaths were blamed on hepatitis B vaccines, but they were later determined to be coincidental

And before that, in 2010, at least four children reportedly died in Shanxi province after getting what were said to be improperly stored vaccines.

While improperly stored vaccines could become contaminated, getting kids sick, it is unlikely that they would get sick from expired vaccines, which might just be less effective than newer vaccines.

What to Know About Vaccine Scandals in China

While it is horrible that anyone put profits before safety when it comes to keeping kids safe from vaccine-preventable disease, it would also be terrible to further use the China vaccine scandals to scare parents away from vaccinating and protecting their kids.

More on the Vaccine Scandals in China

Vaccines After Cancer and Chemotherapy

Most people know that children being treated for cancer have a suppressed immune system and are at extra risk for vaccine-preventable diseases.

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)

That’s one of the reasons that it is important for everyone to be vaccinated, so that herd immunity levels of protection can protect those who can’t get vaccines.

Vaccines After Cancer and Chemotherapy

But what happens after they complete their cancer treatments?

“The interval until immune reconstitution varies with the intensity and type of immunosuppressive therapy, radiation therapy, underlying disease, and other factors. Therefore, often it is not possible to make a definitive recommendation for an interval after cessation of immunosuppressive therapy when inactivated vaccines can be administered effectively or when live-virus vaccines can be administered safely and effectively.”

Red Book on Immunization in Immunocompromised Children

After they complete therapy for cancer, whether it is chemotherapy or a bone marrow transplant, many children need to get extra vaccines.

In the UK, for example, 6 months after completing “standard antileukemia chemotherapy,” children get a booster dose of DTaP, IPV, Hib, MenC, and MMR.

Why just a single booster dose?

Because most kids can continue to get non-live vaccines on schedule while they are getting standard chemotherapy. They get a booster dose when they finish chemotherapy because those vaccine doses they got while receiving treatment might not be as effective as usual and typically don’t count as valid doses.

Of course, if they were missing any doses, then they might need extra doses to catch up too.

“Three months after cancer chemotherapy, patients should be vaccinated with inactivated vaccines and the live vaccines for varicella; measles, mumps, and rubella; and measles, mumps, and rubella-varicella according to the CDC annual schedule that is routinely indicated for immunocompetent persons.”

2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host

In contrast to those getting standard chemotherapy, if treatment involved a hematopoietic stem cell transplant (HSCT), then these children are essentially revaccinated:

  • beginning at 6 months after the HSCT, they should get 3 doses of DTaP if they are less than 7-years-old vs a dose of Tdap and 2 doses of Td if they are already 7-years-old
  • beginning at 3-6 months after the HSCT, they should get 3 doses of Prevnar
  • beginning at 6-12 months after the HSCT, they should get 3 doses of Hib
  • beginning at 6-12 months after the HSCT, they should get 3 doses of hepatitis B, followed by postvaccination anti-HBs titer testing
  • beginning at 6-12 months after the HSCT, they should get 3 doses of IPV
  • beginning at 6-12 months after the HSCT, they should get 2 doses of a meningocococcal vaccine (if they are already 11 to 18 years old)
  • beginning at 6-12 months after the HSCT, they should get 3 doses of  HPV vaccine (if they are already 11 to 26 years old)
  • beginning at 12 months after the HSCT, one dose of the Pneumovax vaccine
  • beginning at 24 months after the HSCT, two doses of MMR
  • beginning at 24 months after the HSCT, two doses of the chicken pox vaccine
  • a yearly flu shot

Why not just check titers instead of repeating all of those vaccines?

“protective” concentrations or titers in this population may not be as valid as in healthy children, leaving open the question regarding what levels to use as the basis for revaccination. Furthermore, there are some vaccines for which no serological correlate of protection exists (e.g., pertussis) or for which, in routine practice, it is too difficult to have levels measured (e.g., polio).

Soonie R. Patel et al. on Revaccination of Children after Completion of Standard Chemotherapy for Acute Leukemia

In Canada, they used to check titers at 1, 3, and 5 years after the end of chemotherapy and just vaccinate when titers dropped, but they switched to giving all kids a booster dose, as it works better.

What will your child’s immunization look like after completing treatment for cancer?

Although the specific recommendations will come from your child’s treatment team, they will likely look something like the guidelines included here.

What to Know About Vaccines After Cancer and Chemotherapy

Kids often have to get revaccinated, or at least get booster doses of their vaccines, after completing treatment for cancer.

More on Vaccines After Cancer and Chemotherapy

When a Vaccine Doesn’t Count and Needs to Be Repeated

Of course, anti-vaccine folks are wrong when they say that vaccines don’t work.

Vaccines work and they work well to protect us from many different vaccine preventable diseases.

At least they do when you get the right vaccine at the right time and it is given properly. If an error is made, sometimes a vaccine dose needs to be repeated.

When a Vaccine Doesn’t Count and Needs to Be Repeated

While it would be unfortunate to have to repeat a vaccine dose, in most cases, if you didn’t, it would leave the child without full protection.

Why might a vaccine dose not count?

The Menomune vaccine has been discontinued, but this label is a good example of things to check before giving a vaccine.
The Menomune vaccine has been discontinued, but this label is a good example of things to check before giving a vaccine.

Although it doesn’t happen often, it is possible that:

  • the wrong vaccine was given
  • the vaccine was given too early, either before the next dose was due or when the child was too young. Although there is some leeway for when most vaccines can be given, there are still some specific rules to follow, especially the minimum time between doses, the earliest age you can get a dose, and the age requirement for booster doses. (sticking to the standard immunization schedule can help avoid these types of errors)
  • the vaccine was mixed improperly (many vaccines are now premixed, making this error less likely to occur)
  • part of the vaccine leaked out when it was being injected, which can happen when kids move, if they aren’t being held well as the shot is being given (rotavirus doses aren’t repeated if a child spits up though)
  • the vaccine had expired or had not been stored properly
  • two live vaccines (except for the typhoid vaccine) were given on separate days, but less than 28 days apart (again, sticking to the standard immunization schedule can help avoid this types of error)
  • the vaccine was given by the wrong route, although depending on the vaccine, this dose might still be valid (most vaccines, except hepatitis B and rabies)

Still, instead of a vaccine dose not counting, the much more common reason for a vaccine dose to be repeated is for folks to lose their vaccine records.

Do You Really Have to Repeat That Vaccine Dose?

Are you worried now that your kids might get a vaccine dose that has to be repeated?

Don’t be. It doesn’t happen very often.

It helps that we don’t actually have a one-size-fits-all immunization schedule and

  • there is a range of recommended ages for most vaccines
  • there is a range of recommended ages for catch-up immunization, which is basically an accelerated immunization schedule, which is why infants can typically start getting their vaccines as early as age 6 weeks and get the first few sets as early as 4 weeks apart

Also, you typically have a grace period, during which early vaccine doses will still count.

“…administering a dose a few days earlier than the minimum interval or age is unlikely to have a substantially negative effect on the immune response to that dose. Known as the “grace period”, vaccine doses administered ≤4 days before the minimum interval or age are considered valid…”

AICP on Timing and Spacing of Immunobiologics

The grace period doesn’t count for the rabies vaccine and while it is an ACIP guideline, it might be superseded by local or state mandates. The grace period also can’t be used to shorten the interval between two live vaccines, which must be at least 28 days.

One last way to get away without repeating an invalid dose would be checking your child’s titers.

When Do You Repeat the Invalid Vaccine Dose?

The next question that comes up after you realize that you have to repeat a dose of a vaccine is when should you repeat it?

It depends.

  • give the correct vaccine as soon as possible if the problem was that the wrong vaccine was given
  • repeat the dose as soon as possible if the problem was an expired, improperly stored, or a dose that had leaked out
  • if the dose was given too early, then you need to wait for the appropriate interval or when your child is old enough to get the dose. Keep in mind that when you repeat the dose, you would generally restart counting your interval from the invalid dose, not from the previous dose. That’s because the invalid dose might interfere with mounting a good immune response.

And in all cases, report the error to the ISMP National Vaccine Errors Reporting Program (VERP) or VAERS.

What to Know About Vaccine Errors

Although they aren’t common, vaccine errors sometimes lead to the need to repeat your child’s vaccines.

More on Vaccine Errors

Can I Give My Kids Tylenol When They Have Their Vaccines?

Many parents ask about acetaminophen (Tylenol) when kids get their vaccines.

Is it okay to give kids Tylenol when they get their shots?

The Tylenol and Vaccines Controversy

As you can probably guess, there is no real controversy about Tylenol and vaccines.

Instead, what we are talking about are the myths surrounding Tylenol and vaccines that anti-vaccine folks have created, including that:

  • giving Tylenol right before a child gets their shots somehow increases the risk that they will have side effects
  • giving Tylenol right after a child gets their shots somehow masks the symptoms of serious vaccine damage
  • giving Tylenol after the MMR vaccine is associated with developing autism

Fortunately, most parents understand that like other anti-vaccine misinformation, none of these statements are true.

Why do some folks believe it?

Well, there have been studies warning people about giving Tylenol before vaccines. It had nothing to do with side effects though. They suggested that a vaccine might be less effective if the child got Tylenol before his vaccines. It is important to note that they never really found that the vaccines didn’t work as well, as all of the kids in the study still had protective levels of antibodies, they were just a little lower than kids who didn’t get Tylenol.

Other studies have found the same effect if Tylenol was given after a child got his vaccines. Although interestingly, other studies have found that giving Tylenol after vaccines does not affect antibody titers.

“Antibody titres to diphtheria and tetanus toxoids and pertussis bacteria of the placebo (n = 25) and acetaminophen (n = 34) groups did not differ significantly from each other. It is concluded that acetaminophen in a single dose schedule is ineffective in decreasing post-vaccination fever and other symptoms.”

Uhari et al on Effect of prophylactic acetaminophen administration on reaction to DTP vaccination

Giving Tylenol after the MMR vaccine is not associated with autism.
Giving Tylenol after the MMR vaccine is not associated with autism.

The only thing that this had to do with side effects though, is that the kids who got Tylenol had a little less fever.

Could giving Tylenol mask something like encephalitis, which some anti-vaccine folks think can be vaccine induced?

Nope. It typically can’t even keep someone from getting a febrile seizure.

What about the association of MMR, Tylenol and autism? Although one study did suggest that to be true, the study, a parental survey, was found to be “fatally flawed.”

Can I Give My Kids Tylenol When They Have Their Vaccines?

So, can you give your kids Tylenol when they get their vaccines?

The better question is, should you give your kids Tylenol either before or after they get their vaccines?

Have some Tylenol or Motrin on hand after your kids get their vaccinations, just in case they need a dose.
Have some Tylenol or Motrin on hand after your kids get their vaccinations, just in case they need a dose. Photo by Vincent Iannelli, MD

Notwithstanding the very small chance that giving Tylenol might cause decreased immunogenicity (lower antibody production) if you give it before your kids get their vaccines, since there is a good chance that they won’t have any pain or fever and won’t even need any Tylenol, then why give it?

Skip the “just in case” dose and wait and see if they even need it.

What about afterwards?

If your kids have pain or fever and are uncomfortable, then you should likely give them something for pain or fever control, such as an age appropriate dose of either acetaminophen or ibuprofen. Will that cause lower antibody production? Maybe. Will that mean that their vaccines won’t work. That’s doubtful. It certainly won’t lead to increased side effects though, unless they a reaction to the dose of Tylenol itself.

Should you give a pain or fever reducer after a vaccine “just in case?” Again, there is a good chance that your kids might not need it, so it is likely better to wait and see if they do, instead of giving a dose automatically after their shots.

There is even some evidence that giving acetaminophen or ibuprofen before vaccines, or as a routine dose right after, especially with booster shots, doesn’t really prevent side effects that well anyway. They work better if given on an as needed basis instead, and these kinds of doses are less likely to be associated with decreased antibody production.

What to Know About Tylenol and Vaccines

Giving a pain or fever reducer either before or after your child’s vaccinations likely won’t affect how it works, but since it often isn’t necessary, it is likely best to only given one, like Tylenol or Motrin, if it is really needed.

More on Tylenol and Vaccines

How to Avoid a Quarantine During an Outbreak at Your School

Believe it or not, hundreds of kids get caught up in quarantines for vaccine-preventable diseases in the United States each year.

Quarantines were routine in the pre-vaccine era.
Quarantines were routine during pre-vaccine era epidemics.

Wait, what?

Caught up in quarantines for vaccine-preventable diseases?

Then why do we have vaccines?

How to Avoid a Quarantine During an Outbreak at Your School

Is it fair that unvaccinated students need to stay home when there is an outbreak of a vaccine-preventable disease?
Is it fair that unvaccinated students need to stay home when there is an outbreak of a vaccine-preventable disease?

As you have probably already guessed, these aren’t usually vaccinated kids that are getting sick or quarantined in these outbreaks of measles, meningococcemia, and chicken pox, etc.

That’s right, they are unvaccinated.

Typically intentionally unvaccinated, although they are sometimes too young to be vaccinated or may have a medical exemption.

And that brings up to a few very easy ways to avoid getting quarantined during an outbreak:

  1. make sure you are always up-to-date on all of your vaccines
  2. if you think that you have natural immunity (already had the disease) or were vaccinated, but don’t have your immunization records, then getting a titer test might keep you out of quarantine if you can prove that you are immune
  3. get vaccinated, if possible, at the first sign of the outbreak, which might help you avoid quarantine in the case of measles and chicken pox

“Persons who continue to be exempted from or who refuse measles vaccination should be excluded from the school, child care, or other institutions until 21 days after rash onset in the last case of measles.”

Manual for the Surveillance of Vaccine-Preventable Diseases

That’s right, especially in the case of measles, you can often avoid being quarantined if you simply get vaccinated.

Unvaccinated children exposed to measles are quarantined for at least 21 days.
Unvaccinated children exposed to measles are typically quarantined for at least 21 days.

Why are quarantines important?

Can’t you just isolate yourself if you get sick?

The problem with that strategy is that you are often contagious before you develop symptoms. That’s especially true of measles, when you likely won’t even realize that you have measles until you get the measles rash, after having a high fever for three to five days. That’s why people with measles are often seen at clinics and emergency rooms multiple times, exposing many people, before they are finally diagnosed. It is the classic signs of a rash with continued fever that helps to make the diagnosis.

Without quarantines of unvaccinated people, especially those who are known exposures to other cases, today’s outbreaks would be even bigger and harder to control.

If you don’t want to take the risk of being quarantined and missing weeks or months of school or work, then don’t take the risk of being unvaccinated. Tragically, that’s not the only risk you take when you skip or delay your vaccines. In addition to getting sick, you also risk getting others sick, including those who didn’t have a choice about getting vaccinated yet.

What to Know About Avoiding Quarantines During an Outbreak

The easiest way to avoid getting caught up in a quarantine for a vaccine-preventable disease is to simply make sure your kids are up-to-date on all of their vaccines.

More on Avoiding Quarantines During an Outbreak

 

What to Do If Your Child Is Exposed to Hepatitis B

Hepatitis B is a vaccine-preventable disease.

“In the United States, based on national health surveys, there are approximately 850,000 persons living with chronic HBV infection. However, estimates based on other methods and data yield estimates as high as 1.29 to 2.2 million persons with chronic HBV infection.”

Manual for the Surveillance of Vaccine-Preventable Diseases

That doesn’t mean that your child can’t be exposed at some point though.

What to Do If Your Child Is Exposed to Hepatitis B

Hepatitis B is mainly spread through blood and body fluids, which is why some folks consider the hepatitis B vaccine an STD vaccine.

“If you are concerned that you might have been exposed to the Hepatitis B virus, call your health professional or your health department. If a person who has been exposed to Hepatitis B virus gets the Hepatitis B vaccine and/or a shot called “HBIG” (Hepatitis B immune globulin) within 24 hours, Hepatitis B infection may be prevented.”

CDC on Hepatitis B FAQs for the Public

It is also possible to get hepatitis B from exposure from an infected family member or caretaker, or much more rarely, in a daycare or school setting.

So what do you do if your child is exposed to hepatitis B?

It depends.

Kids should complete the three dose hepatitis B vaccine series by the time they are 18 months old.
Kids should complete the three dose hepatitis B vaccine series by the time they are 18 months old.

Not surprisingly, one of the biggest factors that will determine what needs to be done is whether or not your child has completed a three dose hepatitis B vaccine series.

First things first though.

Before going any further, you will want to confirm that the person that exposed your child actually has hepatitis B (has a positive HBsAg level).

Next, confirm that it was a real exposure, which the AAP Red Book defines as “a discrete, identifiable percutaneous (eg, needlestick, laceration, bite or nonintact skin), mucosal (eg, ocular or mucous membrane), or sexual exposure to blood or body fluids.”

Keep in mind that the hepatitis B virus is not spread by casual contact, like hugging, kissing, holding hands, or even sharing silverware. It can be spread by having unprotected sex or sharing needles with someone who is infected, but also by coming into contact with open sores, getting bitten, sharing personal-care items, sharing chewing gum, or an unintentional needle stick at a doctor or dentist office or from a needle picked up in the community (park, playground, or street, etc.).

And of course, a newborn baby can be exposed if their mother has hepatitis B.

Biting and Hepatitis B

Young kids, especially toddlers, often go through a biting phase.

Do you have to worry about hepatitis B every time your child gets bit or bites someone?

Fortunately, no.

If any of the kids involved include one that is known to have hepatitis B, then talk to your pediatrician and follow the exposure guidelines.

Keep in mind that one of the reasons we don’t have to worry about these very low risk situations is because most kids are now vaccinated. There were more reports of kids and adults getting hepatitis B in unusual ways in the pre-vaccine era.

What to Do If Your Unvaccinated Child Is Exposed to Hepatitis B

If your unvaccinated child, or incompletely vaccinated child, is exposed to hepatitis B, you should talk to your pediatrician or local health department about starting post-exposure prophylaxis as soon as possible and preferably within 24 hours of the exposure (and not longer than 7), including:

  • a dose of HBIG
  • the first dose of hepatitis B vaccine, with plans to complete the three dose series as quickly as possible over the next 6 months

If you aren’t sure if the person had hepatitis B, then your unvaccinated child should likely just complete the three dose hepatitis B series without getting HBIG.

What to Do If Your Vaccinated Child Is Exposed to Hepatitis B

Unfortunately, if your vaccinated child is exposed to hepatitis B, you can’t simply assume that your child is protected and ignore the exposure. That is, unless your child has already had testing to confirm that he was a responder to the hepatitis B vaccine series – a HBsAb level of 10 or greater.

Since this titer test isn’t routinely done, your child will likely need a booster dose of the hepatitis B vaccine. A dose of HBIG isn’t needed.

If you aren’t sure if the person that exposed your child had hepatitis B, then your fully vaccinated child doesn’t need any additional treatment.

Getting Exposed to Hepatitis B in a Healthcare Setting

It should be noted that the guidelines are a little different and more aggressive if you are exposed in a healthcare setting vs your child having a nonoccupational exposure to hepatitis B.

Why?

There is probably more risk of getting infected from an occupational exposure where patients might be sick with hepatitis B. That’s why post-exposure testing on the exposed person is routinely done.

And since they are at risk for continued exposures, post-treatment testing, if required, to confirm a good response to the hepatitis B vaccine is also usually done.

What to Know About Getting Exposed to Hepatitis B

Hepatitis B exposures can come from more than just having sex or getting stuck with a needle. Learn what to do if your child is exposed to hepatitis B, especially if they aren’t already fully vaccinated and protected.

More on Getting Exposed to Hepatitis B

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