Hep B Blog

Options for HBV Vaccine Non-Responders

 

Are you a hepatitis B vaccine non-responder? Approximately 5-15% of people who receive the vaccine are considered non-responders. This is especially important for health care workers, families living in households with people that have HBV, and others who may be at increased risk of exposure to HBV.  A vaccine non-responder is someone that does not build up an adequate immune response after receiving two, 3-shot series of the HBV vaccine.  In other words, they complete one series of the HBV vaccine, and follow it with a surface antibody test (HBsAb or Anti-HBs) 4-6 weeks following the last injection of the series.  If the anti-HBs titre is not greater than 10IU/l, than the series is repeated, preferably with an HBV vaccine from a different manufacturer, and the person is once again tested for immunity by testing for adequate anti-HBs. (See previous blog, “Got Hepatitis B? Keeping loved ones safe though HBV vaccination” for details)

Fortunately there are other options for those concerned with being an HBV vaccine non-responder. There is a higher concentration of the HBV vaccine recommended by the CDC that is used for patients undergoing dialysis, and for those that are immune suppressed.  It is a 40µg/ml concentration. If it has been one year or less since you completed the three-shot series of the regular concentration of the vaccine, you can try one intramuscular dose of 1.0 ml of the 40µg HBV vaccine.  If it has been more than one year since your last three shot series of the vaccine, you can repeat the entire three-shot series with the 40µg concentration of the vaccine.  Follow up with an anti-HBs titre test 4 to 6 weeks following the last injection to ensure it is greater than 10 IU/l, and that you have adequate immunity.

If you continue to remain a non-responder, you can try a series of as many as five intra-dermal injections, given every two weeks, using the 40µg concentration of the HBV vaccine.  Dose one consists of 0.10 ml of the 40µg/ml vaccine, followed by the same dose two 2-weeks later.  At that time an anti-HBs titre test would be drawn to check for immunity.  If there was not adequate immunity, a third-intra-dermal dose of the vaccine would be given two weeks later.  Anti-HBs titres would be checked every two weeks and the patient would be given another intra-dermal injection up to a total of 5 intradermal injections of the 40µg concentration of the HBV vaccine. Don’t forget to ensure that your anti-HBs titre is greater than 10IU/l.

Please note that the schedule for the series might vary depending on the study your doctor chooses to follow.  However, it is recommended that the higher concentration (40µg) of the hepatitis B vaccine be used for best results.

Comments on this blog are closed. If you have questions about hepatitis B or this blog post, please email info@hepb.org or call 215-489-4900.

184 thoughts on “Options for HBV Vaccine Non-Responders”

  1. My 20 year old daughter is a Phlebotomist. She was told she was a non- responder when she was tested, vaccinated for her first job at a hospital. Her origional vaccinations as a child were done on scedule with no apparent problems. Her family physician referred her to a Hemotologist, who referred her to a Infectious disease Dr, who referred her to. Gasterologist, who only deals with patience with Hepatitis. Who would we contact about information on how to protect her and get more information for non- responders and the new intermuscular vaccine?

    1. This blog was written with direct input from our senior medical adviser on the described protocol for HBV vaccine non-responders. I assume that she has gone through two rounds of the vaccine without success and has been tested to be sure she does not have a current or even an occult HBV infection. Did she try the higher dose of the 40µg/ml concentration vaccine? If she continues to be a non-responder, she can try the 40µg/ml concentration of the vaccine for the intra-dermal vaccine. I would take a copy of this blog to your doctor. If he is unsure, he or you can contact the Hepatitis B Foundation at http://hepb.convio.net/site/PageServer?pagename=contactus, or from the contact button at the top of our website at http://www.hepb.org. . Thank you!

  2. Yes she wen’t through the two rounds without success and is testing cleared, with no signs of HBV. I will bring her Dr a copy, she has not heard of any stronger vaccine. Thank you so much for your rapid and helpful response!
    Sincerely,
    Kim

  3. I work in healthcare and was glad to read this. I just finished my second series of Hep B vaccinations 6 weeks ago, and had my blood drawn today to check for titers. If I still come back negative, I know I need further work-up and want to know what options I have. Thank you!

  4. I’m also work in healthcare, and I’m glad I found this site! I originally had the 3 doses back in 2005 (3/05-9/05).

    Today I found out that my HepBsAG was negative.

    I looked back in my records and in 11/05 my antibody test showed me at 1420mIU/mL.

    My question is, why/how am I now considered not immune?

    1. I think you mean your anti-HBs or HBsAb is negative and not your HBsAg. It looks like you had an anti-HBs test 1-2 months following the last shot of the series and clearly built up and adequate immune response with a titre of 1420! Over time the immune response may wane and the titre may drop below 10, which is considered an adequate response … when checked 1-3 months following the last shot of the series. If you initially generated an adequate response, which you did, then your immune memory will kick in should you be exposed to HBV, thereby once again generating an immune response and protecting you. Hope that makes sense. It’s all about immune memory.

  5. I am a NR with a negative antigen titer for Hep. B. had three series of the vaccine in a timely fashion with the original live (attenuated) virus. That’s three times full series remain NR. Heavily exposed to variety of viral hepatitis patients and have been since I was a kid, now seventy years old.

    Yes, I could go to a higher 40 units but suspect that won’t change my titer. Suspect a gene preventing my conversion to a responder? Yes, I beleive my ancestry came from Eyam, England.

    Why the exposure, a general surgeon and work in County Hospital Micro/lab. Ten years.
    What do you say.
    Thanks

    1. Dr. Thomas London, VP of the HBF board and a member of the board of medical and scientific advisors, says that you may be correct that you are a genetic non-responder, but there is no available information on what the gene or genes might be. Nevertheless, Dr. London recommends that you try the intradermal injection route. Specifically, 1.0 ml of the concentrated vaccine for dialysis patients is given with a tuberculin syringe into the skin. Injections are given every 2 weeks with an antibody test done before the next injection. If you do not respond after 6 injections, then you really are a non-responder. And of course you should take all precautions to avoid exposure -,gown and mask whenever you might be exposed to a patient’s blood.

    1. Ako ng paumanhin.Ko bang ilagay ang iyong tanong sa google translate, ngunit Hindi ako sigurado kung ano ang ikaw ay humihingi.

  6. Been offered my dream job after 5 years of trying to gain entrance …
    Ambulance technician. I am HepB non responder will this effect my occupational health review?
    Help … I am really panicing . I work in healthcare at the moment as Health care support worker and previously as dental nurse.

    1. Have you been tested to confirm that you do not have HBV? If you have HBV you will not generate an immune response to the vaccine. If you know you are not HBV+, have you gone through the process described in the blog: “Options for vaccine non-responders”? The higher dose vaccine will hopefully permit you to generate immunity. However, there is a low percentage of the population that are vaccine non-responders. I do not know the requirements of the job. Perhaps you can sign a waiver for the vaccine?

  7. I’m one of the non responder after getting 2 sets heb B of vaccination. I am considering to get the double dose concentration but I want to know what is the success rate after getting the 40 mcg vaccine that non responder will become immune?

    1. I’m afraid I don’t have specific study data. If you feel especially at risk or need to show a generated titre for work or school, then I would certainly consider it. Keep in mind you can also avoid transmission of HBV by taking basic precautions, which includes avoiding direct contact with any blood or body fluid by maintaining a barrier. For example, keep any open cuts covered, and practice safe sex with a latex condom. Always avoid sharing personal items such as razors, toothbrushes, clippers, earrings, piercings, or anything that could have trace amounts of blood on it. Be sure to clean all spilled blood or body fluids with a fresh diluted bleach solution. Take care with piercings and tattoos and be sure all items are single use. Never share drug paraphernalia. These are basic precautions that should be taken to prevent the transmission of other blood borne pathogens for which there are no vaccines available.

      1. hello!
        I’ve had 3 sets of HepB shots in 1999, 2005, 2014. And my antiHBs titers all came back negative. Fortunately I’m a palliative care physician and I seldom deal with blood products. However, I still do want to know how I’m not responding to hepB vaccines. Also, I’d like to try the higher dose recommended here when I meet with my IDS.

        1. Hello: Talk to your doctor about the higher-dose version, research continues into developing a more effective vaccine for nonresponders. You could also try an intradermal injection of the vaccine. Good luck.

  8. Hi, I’ve just found discovered I am a non-responder. I am leaving for a 2 month trip of lifetime to Africa in ten days – my doctor has recommended HepB immunisation before I go. I can delay the start of this trip by a couple of weeks as a worst case scenario, but I would prefer to leave as soon as possible. What are my options?

    1. A person is considered a nonresponder if you have gone through 2 complete vaccination series. Here are a couple of options: Note the higher concentration dose of the virus noted in the blog “Options for HBV Vaccine Non-Responders” . There is an accelerated travel vaccine schedule given at day 0, Day 7, Day 21 and month 12. Talk to your doctor about trying the first 3 shots of this series with the higher dose concentration. If you do not generate immunity, then talk to your doctor about getting a shot of HBIG right before you leave for your trip.

  9. Had needle-pricked with hepaB positive patient and i just had my hepaB vaccine after 3weeks.Is it effective?i’m very worried maybe i got infected..

    1. Did you receive all 3 shots of the series? If you are in health care, they often run an anti-HBs titre 1-2 months following the last shot of the HBV vaccine series to ensure the person has generated an adequate titre and is protected. You can ask and see if you had this test. If you had it and know you are protected, then you are all set. If you are unsure, or did not complete the series, then I would get a booster shot of the vaccine. Regardless, I would still ask your doctor for a hepatitis B panel just to be sure. Be sure to wait 4-6 weeks following your exposure.

  10. Respected Sir,
    I am working as a nurse in theatre they checked titre for all staff all of them having above 10iu but in different ranges,for me 200 some ofthem above1000iu,others with 54,110etc sir most of them didn’t take booster dose can u clear my doubt when we should repeat another dose if range is below…..please reply it early as possible
    thanku verymuch.

    1. Since all of your staff have anti-HBs titres above 10 IU/mL, this means they have generated adequate immunity and are protected against getting HBV for at least 25 years, which is the current length of on-going studies. Often titres will wane, but that doesn’t mean someone isn’t protected. If they were exposed, they would mount a fight against an infection. THis is assuming they generated immunity as a result of the vaccine series, since there are non-responders to all vaccines. Typically people do not have their titres checked 1-2 months following the vaccine series. It’s not required, but if you are at-risk, it’s certainly worthwhile. People may worry years later and then have their titres checked. At that point, the titres could wane and you wouldn’t know if they initially generated adequate immunity or if the titres just waned. If the titres waned and they did not show adequate immunity (<10IU/mL) then, they would need a booster and they could have titre's checked 1-2 months following the booster. The variations of titres merely reflects each person's unique immune response to the vaccine series. Hope that clarifies it a bit.

  11. my 7 year old’s titres came back low for hep B and the doctor recommended starting the series again. He was given his first dose yesterday. Are more doses necessary? I am a bit surprised that his titres were tested for hep B in the fist place as he is a healthy child and also we ( his parents) have been vaccinated. Please advise if only the first dose is enough. Thanks!

    1. According to the CDC, a booster dose should be sufficient. However, should you choose to confirm immunity, you can have him get his titres checked 1-2 months following the booster shot.

  12. Ive been diagnosed with hepa B but my mother told me id been vaccinated completely with booster and yet my hbsag becomes reactive, anti hbs non reactive, hbe eag 13.33 reactive and hbe ag non reactive… what does this means

    1. You currently have a hepatitis B infection. Most likely you were already infected before you were vaccinated. The vaccine is not effective if a person is already infected with HBV. Please talk to your doctor to learn more about your HBV and liver health.

      1. Let me be cleared of this because I believe I was exposed to hbv 30 days back but non reactive after the HBsAg test. My dr had me injected with hep b vaccine. Will my body be cleared of the infection after the 3 vaccines.

        1. Hello: Your doctor is doing what is recommended after exposure, so hopefully immunization with the three vaccine shots will be effective in protecting you against infection. Good luck.

  13. I had one set of the 3 vaccine shot and came back non-reactive . dose that mean that I have hep-b

    1. You mean you did not generate adequate immunity? – anti-HBs less than 10 IU/mL? Some people are non-responders to the HBV vaccine (this is considered after 2 failed attempts to generate immunity after 2 complete HBV vaccine series), but if you believe you may have hepatitis B, then ask your doctor to run a hepatitis B panel to see if you have an HBV infection.

  14. If some one is HBSAg positive, but HBeAg, HBcAg, HBeAb, HBcAb are both negative, please what does that mean?

    1. Little confusion here with your question and test results. Usually when someone is HBeAg neg/pos the other HBeAb is the opposite, unless they are in the middle of seroconversion. This is certainly possible, so you would want to retest in a few months to see if you are successful in seroconverting. HBcAg is only positive on biopsy rather than serology, so that would be normal. Most people that test HBsAg positive are nearly always also HBcAb positive. Once again, retest to be sure there is no false positive or to confirm results. ultimately the answer answer here is – rested with a reliable lab and liver specialist

  15. My fiancée was diagnosed to be hep B positive. I did my test and was declared negative. I have taken the first vaccine shot and am expecting to take the second shot 3 days before we start having unprotected sex.while waiting to take the last shot 6 months from now. Will I be protected by these first two shots

    1. After the 2nd shot of the HBV vaccine you are UP TO 80% protected against HBV. There are a few factors involved, but everyone is different and I cannot give you any guarantees. If you like you can get a titer test 1 month following this 2nd vaccine or following the last shot of the series to confirm immunity. I would encourage your fiancé to be patient.

    1. That will depend on what country you live. If you live in the U.S. this should not be a problem. HBV is covered under the Americans with Disabilities Act and the CDC revised guidelines for healthcare students and workers. Let us know if you have a problem. If you live in another country, it’s completely dependent on their policies.

  16. I seem to a non-responder to HBV and other vaccines. I’ve had infections as a child that later tested negative anti-body titers with subsequent vaccinations that years later also show negative anti-body titers. Rubella, Varicella, Mumps….I was vaccinated with HBV in 2003 with a postive ab response and negative ag response (can’t get measurement from hospital) but just had titer checks that show non-reactive for ab or ag. I am an ER nurse and am not thrilled about the prospect of going through a series of a potential 6 vaccinations with HBV only to continue to be a non-resonder since I have a poor track record with vaccines. I’ve obviously been exposed through the years to many of these infections several times due to my work and raising 2 children. Can I make a decent supposition that I have “immune memory” and with proper protective equipment and following protocol continue in a safe manner as an ER nurse without more vaccinations? Or could this kind of history indicate “genetic non-responder” Currently hospitals are requiring several vaccines for employment and termination if not completed unless there are medical contraindications. Can someone give me a well versed opinion? Thank You

    1. A person is considered a non responder after 2 complete series of the vaccine followed by an inadequate titer drawn 1-2 months following the last shot of the series. I know you seem to be a non-responder to some vaccines, but unless you had a titer to confirm your immunity 1-2 months following the last shot of the vaccine series, then I would get a booster shot and test 1 month following the booster with an anti-HBs titer test. If you generate immunity then you do not need to repeat the vaccine series even if your titers wane over time. If you truly are a non-responder then you could try vaccinating with a higher concentration of the vaccine. Most hospitals are requesting proof of titers. Regardless, I would think following proper infection control practices would still be adequate since there are not vaccines for all blood borne pathogens such as HIV and HCV. With any luck you can generate immunity, but if not strict following of infection control practices should be adequate. I would not think being a non responder should keep you from working.

  17. Hi I would appreciate if you could answer my question. I am from England and I received the full hep b vaccinations which I received the third vaccination in December 2006. As worked at a hospital at this time in late January 2007 I was checked to see if I responded to the vaccinations and the reading from that blood test was more than 100. I recently requested to be checked to see if I still had immunity from the vaccine and I have been told that I have no immunity. I am upset and concerned by this as it has only been 8 years since I had the vaccination. I thought the protection lasted much longer. I am worried tha

    have come in contact with the virus and not have been protected.

    have come into contt with the virus and not been protected

    I am concerned that

    maz

    may have come in contact with the virus and not been protected. Would I need to

    immune and still protected from the vaccine. I was informed that I am not immune. I am concerned that after 8 years I am no longer protected by the vaccination. My fear is that I could have been in contact with the virus and not been protected. I was tested for the virus in 2011 during pregnancy which was negative at that time

    rstill protected from the vaccine. I was informed that I am not immune. I am cocerned by this as when I received the vaccine I was responsive to it but now afte

    1. You are protected. If you were to be exposed to HBV, you would generate immunity. It is not unusual for the anti-HBs titers to wane over time. The difference is that many do not have their titers checked after they are vaccinated so they don’t know if they ever generated immunity. That is not the case with you since you know you generated immunity since you had a previous titer of 100+. On going studies show that immunity is good for greater than 25 years assuming immunity was generated as a result of the 3 shot vaccine series.

  18. Hi..

    Recently i have taken blood test
    Anti HBS Shows 4.72IU/L … can anyone help me on that value?
    does it mean that i’m affected by Hepatitis B?

    1. The anti-hsb is the antibody to hepatitis B. If you want to be tested for hepatitis B, you want to ask that your HBsAg (surface antigen) is tested. A person is considered immune to hepatitis B if there anti-hbs titer is greater than 10 IU/mL. Were you vaccinated or do you believe you were exposed? if you ask the doctor to run a hepatitis B panel, it tests for 3 things: HBsAg, HBcAb, HBsAb. When read together it tells you if you have a current infection, if you resolved a past HBV infection or if you have immunity to HBV whether it is from a past infection or through vaccination.

  19. Please help me interpret these results:
    HBsAg Screen Positive
    Hep A Ab, Total Negative
    Hep B core Ab, Tot Negative
    Hep B Surface Ab, Qual Reactive

    *by the way I was vaccinated with the Hep B series vaccine as a child.

    1. Your results are a bit unusual. Have you also been tested for hepatitis C? Are you being tested as a result of elevated ALT/AST and/or other liver function tests? Please talk to your doctor. Repeat testing and see if the results are the same. Your test indicates that you are positive for hepatitis B, but your core antibody and surface antibody are negative, which is unusual. If you continue to test HBsAg positive, but do not have another infection or problem identified by your doctor and more blood work, then be sure to see a liver specialist to learn more.

      1. I was tested for Hep C and it came out negative..I had elevated ALT/AST but when I got retested they were back to normal. I’m very confused and worried. I did have more blood work done and I’m now just waiting for the results.

        1. Try not to worry Kay. I think the blood work will reveal more of what is going on. If you continue to have confusion, please be sure you are seen by a hepatologist or GI doctor with experience treating viral hepatitis.

    1. You have immunity to hepatitis B and it looks like you got that because you had resolved a previous hepatitis B infection.

  20. Hi my partner is hep b positive, I have had the 3 vaccines and I am none responsive I have had 2 more of the next 3 my last vaccine due in 5 months what are the chances this 2nd treatment will make me immune??

    1. Have you been tested to be sure you are not currently HBV positive? Often when a person is a non responder, it is because the have or had an infection. Is the 2nd vaccine series a made by a different manufacturer than the first series? This is recommended. Another option is to ask for a vaccine of a higher concentration, especially since your partner is HBV positive, if you do in fact not respond. I cannot give you any specific statistics, though there is a percentage of the population that does not respond to the vaccine for whatever reason. I would also try the higher concentration if this series does not work. Also consider Hepislav, which will hopefully soon be on the market. Sci-B-Vac is also a good vaccine, but I don’t think it’s available in the U.S.

  21. I have been employed as a medical secretary in a hospital for 15 years. Yesterday when I had my TB test, I was on my way out the door when the secretary handed the nurse a printout of some lab work from 2012, the same year I was diagnosed with breast cancer and went through surgery, chemo, and radiation. He showed me where it said I was nonresponsive to the vaccines I got upon employment. But, he said, since my job & lifestyle doesn’t involve being in contact with blood or blood products, I haven’t traveled out of the country in over 10 years, and I don’t work closely with patients in countries that have a high level of plague and disease, he would consider me low risk and he left it up to me whether I wanted to try a booster. I don’t want a vaccine I don’t need, but I am wondering how safe it is to not have an immunity to Hep B. Your observation and input would be welcome. Thank you.

    1. I’m not quite sure what to tell you. it certainly does not sound like you are at risk for HBV with your job as a medical secretary. HBV is not casually transmitted or contagious like TB. Plus the anti-HBs titer test that was likely run in 2012 may not be an accurate reflection of your immunity. I’m not sure when you were vaccinated, but it’s not uncommon for the titer to wane with time. Had you been tested 1-2 months following the last shot of the series, you may have found that you generated adequate immunity. Had you proof of immunity, there would be no question. You would not be to get a booster. However, it sounds like you didn’t. If its a concern for you, you could have a booster shot, followed by an anti-HBs titer test 1-2 months following. If you generate adequate immunity then you are protected despite whether or not your titers wane with time. Let me know if you have other questions.

  22. I am trying to find out the answer to this question. I might be a non responder my surface antibody test is currently less than 10 even though I’ve had the series twice over 10 years ago. I never had the antibody test done right after the series to see if I responded so I’m not sure if I responded or not. Anyway I was dating someone who reveled to me they have hep B. I think my risk of catching it from her is low because we did not do much but what I want to know is if I am a non responder can non responders immune systems fight off the virus on their own or does a non response to the vaccine mean a non responder won’t respond to the real virus either ?

    1. A number of variables here. First of course is whether or not you really are a vaccine non-responder. Titers do wane with time, so the timing of the antibody test is very important. Just to be sure, I would get a booster shot of the HBV vaccine and test 1-2 months following the booster shot. Did you have any titer? Also, be sure to look at the definition of a true vaccine non-responder as it is suggested that the person get the second series with a vaccine made by a different manufacturer.

      Don’t know the extent of your contact, but HBV is more likely to be transmitted if there are even trace amounts of blood. Other body fluids do have lower concentrations of the virus. And of course the viral load of the infected person is also to be considered. Take a look at this blog: http://hepbblog.org/2015/02/19/the-50-shades-of-gray-of-hepatitis-b-transmission-part-1/ .

  23. Hello, just got my serology results back and the result was NON-IMMUNE. I have had the infant dose of hepatitis B (3 shots in 1995-6) and follow up of the adult dose of hepatitis B (2 shots in 2007). I was asked to get another dose and then a follow up serology. If i get the dose in a few days time (12th may 2015) when can I get the serology testing done? Im worried as I am going on clinical placement in july-sept and need this sorted asap (serology results must be handed back to my unit coordinator at a deadline – a deadline possibly before this semester ends which is end of june) or I may be missing out on clinical placement experience which will set me back a year behind my university course schedule.

    1. Would the 3 doses at infant age and the 2 doses at adult age be considered as 2 complete series? Would that mean I am a non-responder??

      Kind Regards

      1. You could try using a different manufacturer of the vaccine. However, 2 complete series would likely be a non-responder. However, keep in mind that titers may wane if you are not checking titers 1-2 months follow a series or booster shot

    2. You want to run your anti-HBs titers within 1-2 months following your booster shot. A person is considered a non responder after 2 complete series of the vaccine – preferably using 2 different manufacturers of the vaccine. If you continue to not show immunity, you may wish to be tested for hepatitis B. Sometimes a person may have been infected with HBV prior to the vaccine series or of course a person could be a non responser to the vaccine. I certainly understand your concerns. Follow up as best you can. if not immunity consider noted strategies.

  24. Hi. My daughter 7 years old had first complete course of vaccination when she was born (2008) and it was found last year that she was not immunized. so she had another complete course and finished the last dose on January ( mean she had 6 does all total) and is still not immunized.
    So her Dr prescribed the Twinrix JR to try another manufacture. My husband is Hep B carrier, so I want my daughter to have immunity. But she already tried two complete course. Do you think it has worth to try?

    1. I believe you are saying that your daughter is immunized (completed all 3 shots of the series), but does not show immunity at this time? Did you run the anti-HBs titer test 1-2 months following the last shot of the 2nd series? Did you also try the vaccine from both of the FDA approved vaccine manufacturers?

      Has your daughter been tested for hepatitis B? Please consider asking the doctor to run a hepatitis B panel test which is one blood draw, but returns three results: HBsAg, HBcAb and HBsAb. Just want to confirm that she does not have a current hepatitis B infection. I don’t have an issue with trying the TwinRix vaccine, but you may want to first test for HBV. The other option is the vaccine at a higher concentration that is used for patients undergoing hemodialysis. Please discuss with your doctor.

  25. I work at a hospital and I recently have been bitten by a patient that broke my skin. I went for lap drawls and today was my second lab draw I was told that I am a nonresponder to the hep B shot and that I needed a booster which I took today. My concern is I did not know that we should have been tested to find out if we are nonresponders after the shots. Is it possible that I was a responder and no longer am? I took today. My concern is I did not know that we should have been tested to find out if we are nonresponders after the shots. Is it possible that I was a responder and no longer am ? Should I be going through another series of hepatitis B shots? And what should I do after this booster if I’m still in nonresponder? ? Should I be going through another series of hepatitis B shots? And what should I do after this booster if I’m still in nonresponder? Should I be requesting hepatitis B panel? I’m not for sure what steps to take next please guide me I go back in October 2015 to see if the booster worked and if I’m a responder now.

    1. Ouch! Hard to say if you are truly a non-responder at this time. Good that you had a booster. Please ask your doctor to check your anti-HBs titer test in 1-2 months. If you completed the hepatitis B series, it is possible that the titers waned over time. Since you likely did not confirm immunity following the vaccine series, it’s impossible to know. Let’s see how the titer looks in a month. If you do not generate an adequate titer then you will want to complete this 2nd series .- preferably with a vaccine from a different manufacturer and then retest the titer 1-2 months following the last shot of the series. you can also try a booster with a higher concentration of the vaccine as noted in this article. Should you decide to get test for HBV (via the hepatitis B panel) then be sure you wait a month until after the vaccine. A test for hepatitis B within a month of vaccination can cause a false positive test result.

  26. I m 26 years old, medical interne, i didnt know i was a NR,i completed my three serie vaccination in 2007, i recently have been working in the surgery department, and i found out I was HBsAg positive, usually we dont treat acute hepatitis B, but since i m a NR i m afraid my body wont respond and build up the immunity, what should i do?

    1. Hello: I am sorry to hear of your hepatitis B surface antigen (HBsAg). Before your immunization, were you ever screened for hepatitis B? Is it possible you were infected during childhood, or are you certain you were recently exposed to hepatitis B blood/body fluids? If you were just exposed, usually you are given the first shot of the vaccine and one dose of HBIG (hepatitis B antibodies), if it is available. More information on this is available at:
      http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm
      If you were already infected with hepatitis B before your immunization, then the vaccine would have had no effect.
      As you may know, there are two types of hepatitis B infection, chronic or long-term and short-term or acute. If you test positive for HBsAg for longer than six months, you are considered chronically infected and probably became infected at birth or during childhood. If you were just recently exposed, over several weeks your body should clear the infection (and clear the HBsAg) and develop surface antibodies (HBsAb).
      If it turns out that a second test in six months shows you are still infected, then it will be important for you to see a doctor who is familiar with hepatitis B and get monitored regularly to monitor your infection and health of your liver.
      Also, you should refrain from smoking and drinking and eat healthy food. You should practice universal precautions, as your blood or body fluids can contain the virus, and bandage any cuts or bruises and use safe sex (condoms.) What is vital, is if and when you have children, they must be immunized with the first hepatitis B shot and given one dose of HBIG within 12 hours of birth.
      Good luck and take care.

  27. I had a serology which was negative in 2007, also i did my antibody antiHbs and antiHBe which are 0,00 and 0,03 respectively (acute hepatitis),
    I m dreading tht since my body doesnt respond to the vaccination it aswell wont respond to the infection,,is there no need for me to treat in this case??
    As for kids i dont think there is a possibility since i surely will infect my spouse
    thank you

    1. Hello: Without seeing all the lab results, it’s difficult for us to say. I encourage you to see your doctor and ask these questions. The doctor will keep monitoring you to see if this is an acute infection and to see if you develop surface antibodies. It may take several weeks or months to determine that. If you are infectious at this time (and test positive for the hepatitis B surface antigen), it is important to practice universal precautions, including using safer sex practices. Good luck.

  28. I married in January 2015.In the last may I understood that wife had hepatitis B 12 years back,when she was 15 years old.The following are the results of her blood test, conducted recently.HbsAg(ECLIA)-0.367(Non-Reactive) ,ANTI Hbc-0.01(Positive) ,ANTI HBs-<5mI U/ml ,HBeAg(ELISA)-0.01(Negative) ,HBV Quantitative PCR – Not detected – sensitivity 2.1 iu/mL ,Scanning- No abnormality found,Liver function test – all are perfect figures. I like to know the following things
    1.Is there any harmful effect if she receives Hepatitis B preventive vaccine?
    2.Is she totally free from the disease?
    3.Is there any possibility to infect the child while pregnancy?
    4.Is there any need to receive Preventive vaccine to all family members?
    I took two dose of vaccine and my ANTI HBs level is 10. Expecting your response eagerly
    anu.

    1. Hello: That is great news that your wife has an undetectable viral load and is negative for HBsAg (hepatitis B surface antigen.) What is missing is whether she has tested positive (reactive) for hepatitis B surface antibodies (HBsab). Developing surface antibodies means you have cleared the infection completely. If she does not test positive for HBsab, then you need to assume there are still low levels of the virus around. So find out her HBsab status.
      It is doubtful that getting a vaccine at this stage will help her.
      However, all household members should certainly be screened for hepatitis B and vaccinated if they have not been infected.
      Your wife can certainly have children. As long as the newborn is immunized with the first hepatitis B vaccine shot within 12 hours of birth and given a dose of HBIG (if it’s available to you), your child should be free of infection, especially given your wife’s undetectable viral load.
      Congratulations on getting immunized and making sure you protected against infection. Good luck.

  29. Hello! I have a problem about my Anti-Hbs. I’m a medtech student and it is required for us to have an Anti-HBs before our internship, the problem is i’m still non-reactive after the 3 doses of vaccine. Here’s my result:
    Patient’s value: 0.090
    Cut off Value: 0.105
    Remarks: Non Reactive
    My doctor advises me to have a Hepa B booster then a titer after 2-6 months.
    Can this booster make me reactive (only 1 dose) before October 18? Help please.

    1. Hello: You can safely get a fourth hepatitis B (booster) shot to see if it will increase your antibodies/titers. Usually you wait a month or two after the booster shot to see if your immune system has generated sufficient titers (at least 10 mIU/mL). Be aware that you can safely repeat the entire three-dose regimen if needed. Ideally you should have the 10 titer count, however you still should be able to practice if you do not achieve it. Thank you.

      1. Thank you! Is it safe to have 2 doses of booster in one day? Or is there any intervals to take it?

        1. Hello: You should not have two vaccine doses in one day. Medical experts recommend you space them out so your immune system has time ton respond to each dose and produce the antibodies needed to protect you against infection. There should be at least 30 days between the first and second dose, and at least two months before you get the third dose. The actual recommended timing for the third is six months after the first dose is administered. For more information see: http://www.cdc.gov/vaccines/adults/vaccination-records.html
          Thanks

  30. Hi,

    I got diagnosed for HBV positive two months back. I am inactive carrier and never took medicine. I got married 3 years back. Two months back only I tested my wife’s HBsAg and it’s 0.02 iu/mL to her which is negative.

    But today when I tested anti-HBs, she tested negative for this too. It indicates that she never vaccinated. My question is how HBV didnt transmitted to her with 3 years of unprotected sex? Please recommend which vaccination she needs to go for it?

    Do I need to have unprotected sex with her till she gets antibodies after vaccination? Please suggest.

    1. Hello: That is surprising. There are some possibilities, first, a small percentage of people do not respond to the vaccine, so if she was vaccinated perhaps she never generated enough antibodies (titers). Another option is your viral load is low enough that you did not infect her sexually (also surprising.) There are some people who retain an “immune memory” of a virus following immunization, even though years later they don’t test positive for titers/antibodies. What that means is her immune system may still remember the virus and protect her, even though there are not lots of antibodies in her system. I don’t know if any of those possibilities apply to her.
      What important is that she gets vaccinated immediately, but please talk to your doctor about that. You could use safe sex for the next six months during the time it takes for her to get the three shots, and then retested again. You appear not to have infected her yet, but if you suddenly develop an unrelated illness that weakens your immune system and your viral load rises, you risk infecting her. You are not the only couple I have heard about where infection did not occur! Good luck.

  31. Hi,

    Can I go for accelerated Vaccination to my wife? How effective is it? What is the chance that my wife gets the HBsAb after vaccination as already we are in unprotected relation since more than three years and her HBsAg is only 0.02 iu/mL and HBsAb is 0.00 iu/mL?

    1. Hello: Accelerated immunization schedules have been found to be successful. The CDC recommends 30 days between the first and second dose, and it recommends at least two months between the second and third dose. This shortens the immunization period from six months down to three months. Thank you.

  32. Hello,

    I am not a ‘non-responder’, but I am wondering about waning immunity levels that has been mentioned here. I desire to maintain a iu of >200 for plasma donation; however, unfortunately my iu spikes to >500 and quickly wanes to around 10. Although I am immune, my plasma isn’t considered so for the plasma receivers. Would the stronger HB concentration dose help or am I doomed to a very thoughtful immune system?

    1. Hello: Your immune system may be “thoughtful,” but it’s also very normal. Ideally, to be able to fight off infection, you want a hepatitis B antibody (titer) count of 10 mIU/mL, which you have. It is not realistic to continue to get vaccines in order to qualify for plasma donation, however noble your intention. Good luck.

  33. Hi , i just need to ask a small question , i am a hep b carrier and i had unprotected sex with my boyfriend for almost a week and some of them i was at the end of my period ! Is it possible that he got infected already ? How fast does the body catches the virus ? He got vaccine shots 10 days after that ! Could that be effective ? Can he still avoid being infected ?

    1. Hello: There is no way to answer your questions with any certainty. It is harder for a male partner to catch hepatitis B from an infected female because they don’t have the exposure to blood and body fluids, such as semen, that women do during unprotected sex with men. It also depends on your viral load — the amount of HBV DNA in your bloodstream. The higher your viral load, the more infectious your body fluids are. Your boyfriend will get his second vaccine shot 30 days after the first one, and then his third shot six months after the first shot. It’s important he get all three shots.
      About one or two months after his third vaccine, he should return to his doctor and ask to be tested for hepatitis B surface antigen and antibodies. He will find out if he was infected, and he’ll find out if the vaccine worked and whether he has enough hepatitis B antibodies to protect him from infection. Good luck.

  34. My husband have hepb and I am hepb carrier. My son was vaccinated at birth. Just recently we found out that he is Hep B core Ab, tot positive and Hep B surface Ab, qual-None reactive. He is now 21yrs old. His Dr thinks that he did not have immune to acquire the antigen as an infant. I am now reading through this blog and realized that are many people have NR to the vaccine. Can you tell me what are the reasons for NR and I know it’s not standard on care to get tested after your vaccine but is there a guild line? Thanks you

    1. Hello: I’m confused about your son’s test results. If he tests positive for the core antibody (Hep B core Ab) it means he was infected in the past. Is he reactive or positive for the hepatitis B surface antibody (HBsAb)? If he is, it means he cleared the infection. If he tests positive for the hepatitis B surface antigen (HBsAg) it means he is infected with hepatitis B. Sometimes, the vaccine dose that is administered within 12 hours of birth is not effective if the mother has a very high viral load, which means there are lots of virus in her blood and body fluids during delivery. It may be that your son was infected at birth, despite the vaccine, because your viral load was high. Recently, doctors have begun recommending treating pregnant women with high viral loads with antivirals during the last trimester of their pregnancy to lower their viral load and the risk of infecting their baby, in addition to treating the newborn with HBIG (hepatitis B antibodies) and the first dose of the vaccine. I hope this helps, please ask more questions if this doesn’t answer your question. Thank you.

    1. Hello: A positive hepatitis B surface antigen (HBsAg) test means you are infected with the hepatitis B virus. Was this your first positive test for hepatitis B? If so, you should be retested in six months to see if you are still infected, or whether your immune system was able to clear the infection. Good luck.

  35. Hi, I am currently in school for dental hygiene and are required to be vaccinated for Hep B. I did not have my previous shot records from when I was a child so my doctor did the whole titer test and it showed that my immunity was very low so he gave me a booster shot in September and was told to come back in December to re-check. Well on Friday i gave blood again and it still showed no immunity. He gave me my 2nd shot today but thinks that I am not going to build antibodies for hep B. He thinks that I am probably one of the many people out there that do not build antibodies for hep B. My question. Should i still continue pursuing my career as a a dental hygienist and if I do not build immunity against the virus am I at a high risk for contracting hep B?

    1. Hello: There are a small percentage of people whose immune systems do not generate enough hepatitis B surface antibodies following immunization to reach the desired titer (antibody) count of 10 mIU/mL, which is considered to protect you against hepatitis B infection. The CDC recommends that a “non-responder” repeat the entire three-dose series, which your doctor is having you do, then you can be rechecked to see if you have developed sufficient “titers.” Also, have you been tested for hepatitis B (which includes the hepatitis B surface antigen and antibody) just to see if you were exposed in the past?
      If you do not have immunity, yes you are at risk of hepatitis B, but if you practice universal precautions in your work your risk should be low. Also, many people are immunized against hepatitis B, so it is not as widespread as it was 20 years ago. Talk to your doctor and your school advisors so you are comfortable in your choices. Good luck.

  36. Hello everyone maybe someone can help me out. . In May my blood work came back hep b surface antibody negative. . . They told me to go thru the vaccine . . I went thru the vaccine and my last shot was in November. . . I just got blood work and waiting to see what happens . . I’m so confused on what hep b surface antibody really is and if there is side affects from this ? There’s not much info on that really . . And if the vaccine works , where does this leave me ?

    1. Hello: The hepatitis B vaccine contains only one protein or antigen from the hepatitis B virus — the hepatitis B surface antigen (HBsAg). The vaccine spurs your immune system to create hepatitis B surface antibodies (HBsAb) that will protect you against infection with the “real” virus. To be protected, you must have at least 10 mIU/mL of surface antibodies. If after the three shots you haven’t generated sufficient HBsAg levels, your doctor may recommend a fourth, booster dose or they may have you repeat the entire series, especially if you are at high risk of hepatitis B. Good luck.

  37. Hi, I am a medical student and unfortunately due to delay, my Hep B vaccinations have run late. If my blood test comes back and shows that I am not immune, I will have to repeat the course. However this would need to be completed before I start my clinical years in August. I am wondering whether a second course for potential non-responders can be done on an accelerated basis, i.e. at 0, 1, 2 months or 0, 7,21 with a booster at 12 months? Or does it have to be at the typical 0, 1, 6 month intervals? Many Thanks.

    1. Hello: Yes, there are accelerated vaccine schedules recommended by CDC for emergency situations (primarily travel.) Often, some people achieved immunity after two doses, which I hope happens in your case. Please talk to your doctor. A fourth vaccine dose is also permitted by CDC. This is from CDC: “The accelerated vaccination schedule calls for vaccine doses administered at days 0, 7, and 21–30; a booster should be administered at 12 months to promote long-term immunity. A combined hepatitis A and hepatitis B vaccine can also be used on the same 3-dose schedule (0, 7, and 21–30 days), with a booster at 12 months.” Source: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b
      Good luck.

  38. I have read many of the post here, some similar to my situation. I had my first series during miltary service, approximately 1993. My second came after testing show no titers, in late 04-05, with both of those following the 0-1-6 protocol. After a potential exposure, a third series was done following the same protocol in 07. After a second potential exposure in 2010, I received the double dose of HBIG, as well as another full series of the vaccine. Testing in early 2013 showed continued negative, so I had to go through a fifth round. 6mos testing should good results, 3 year I am back to negative. I am looking to apply for another Healthcare career, and the program is stating I would need to go through again regardless of past history because of the current negative results. As a side note, this is not the only vaccine I have had this kind of response to, as it took three of the pneumo vacs to get a response to 8/13, and a few other childhood ones had to be redone for my last career change in 2013. I also had to do a chicken pox vaccine even though I had documented chicken pox as a child long before the vaccine was created (I am 44). Most of the info I keep finding tells me to find a specialist, but my Healthcare doesn’t like to unless you fight for it. After five go rounds, I honestly doubt whether another series will help considering past. Any recommendations for a possible specialist?

    1. Hello: As mentioned in my other response, I recommend you talk to your doctor and try different vaccine formulations (at higher doses) or an intra-dermal injection. Given the lengths you have gone to, I recommend you see a specialist. Good luck.

  39. So I know I am a probable non-responder, but not sure what path to take at this point. I have had the series a total of five times now, over a 20+ year time frame as follows:
    1-1993
    2- 2004-5
    3- 2007 booster involved, 4 total doses.
    4-2010 two doses HBIG with normal series of vaccine
    5-2013
    3rd and 4th were done for possible exposures.
    On the 3rd series, a check was done one month after the second dose, and results were low, so the booster was given before the sixth month dose.
    On the forth series, the HBIG was given in two very large doses, as well as the full series over the six months. Testing at three months, with two vaccines and both doses of HBIG showed normal, six month post series normal, one year showed negative.
    Fifth series showed good at six month follow up, negative at one year, and again at three years.
    I am applying for another Healthcare field, and will be required to show evidence of vaccination with positive results, which does not seem to work for me. Are there any other options, short of an evaluation by a specialist? As a side note, this is not the only vaccine that I have this problem with, pneumovacs took three to get 8/13, and I have verified chicken pox as a child but was negative for tiers as an adult, among others.

    1. Hello: I recommend you talk to your doctor and try different vaccine formulations (at higher doses) or an intra-dermal injection. Given the lengths you have gone to, I recommend you see a specialist. Good luck.

  40. When i go to doctor and the doctor advice me to do Hbv and it was positive. so doctor give me medecine and took the medicine for six month and after the course is over i did test the Hbv and now it is negative. So my question is ,is it possible to get vaccine after negative???

    1. Hello: If you have been exposed to hepatitis B and successfully cleared the infection, then you are now immune to it and do not need to be immunized.
      However, please be sure you no longer test positive for the hepatitis B surface antigen (HBsAg) and now test positive for the hepatitis B surface antibody (HBsAb). To completely clear the infection, you must get rid of HBsAg, and test positive for HBsAb. Good luck.

  41. So I need to test the HBsAb positive in order to completely clear infection??
    And the test should be positive?

    1. Yes, the holy grail of clearing hepatitis B is the appearance of the hepatitis B surface antibody (HBsAb), it’s the antibody we all hope for! Good luck.

  42. I have been in health care for about. In 1998 I received the series of 3 shots when I changed jobs to a different hospital. Titers came back negative. I was offered the series again in late 1998 the results again came back negative. I received the series again in 1999 and the result came back positive. I recently did a physical for a new job and my physician did serology for Hep B. Now again it is saying I do not have immunity. Can ones immune status return to negative after it was positive. In 1998 it was 156 now it is less than 5.

    1. Hello: Yes, the number of hepatitis B antibodies (titers) can decline over time. However, experts say that even though titers decline below the 10 mIU/mL level required to confirm protection against infection, we retain an “immune memory” and remain protected against infection. If your potential employer requires proof, you could show them results from your old test or get one booster shot to see if that’s enough to spur production of titers to prove your immunity. Good luck.

  43. Hi, I am in dentistry. I had a course of 3 injections for Hep B but did not gain sufficient immunity. I repeated the course a couple of years later but abreacted to the first 2 injections with muscle spasms that lasted weeks. The health dept decided not to proceed with the 3rd injection and a blood test showed my titres were just within immune range. 5 years later I am now due a booster so had a blood test and my titres are too low again. I am hesitant to proceed with any further vaccines due to the abreactions I experienced previously. My doctor has no advice for me – can you give me any indication of what I should do? Many thanks for your time.

    1. Hello: If you at some point had titers at or exceeding 10 mIU/mL, you probably do not require a booster. U.S. health officials do not recommend a booster for anyone who has achieved immunity. Research shows that even as titers decline over time, we retain an “immune memory” of the hepatitis B surface antigen and our immune systems are able to protect us should we be exposed to the virus. Good luck.

  44. hi ,i recently just finished the 3 hep b vaccine series and i forgot to test 4-8 weeks after the last vaccine ,i tested at 11 weeks post vaccine and it came back <5 l ,saying it was low ,could the titer drop that fast ?

    1. Hello: It should not be that low after the three doses. Call your doctor back and get a fourth booster shot. Hopefully that will boost your antibody level to the 10 mIU/mL that is considered protective. Good luck.

    1. Hello: If you are “reactive” and have tested positive for the hepatitis B surface antigen (HBsAg), then you do not need to get vaccinated because you have already been exposed to the virus.
      However, if you mean you have tested “reactive” or positive following immunization for the hepatitis B surface antibody (anti-HBsAg), and you get vaccinated again, then it should cause no problem. I hope this answers your question. Good luck.

  45. hi i have question i recieved my 3 shots and not following the 0-1-6 intervals then when i got checked my immunity the result was 0.0
    what do you think is the problem?

    1. Hello: Some people require a fourth, “booster” hepatitis B vaccine shot. You can also safely get all three shots again. If you were immunized many years ago, it is natural for hepatitis B antibodies to decline over time, even though you remain protected against hepatitis B. Get a fourth shot, then get tested for surface antibodies (titers) again. If you still do not have at least 10 IU/mL of surface antibodies, then get the full three vaccine doses again. Good luck.

  46. I’m HBV reactive. my body doesn’t show any sign of the presence of the HBV. Even with that i have given birth to two who are not reactive. my wife who hasn’t been vaccinated is still not a carrier. could it be that I’m not a carrier?

    1. Hello: Your immune system may be able to keep the infection mostly in-check and you may have a low viral load (HBV DNA), which is why your wife has not been infected. However, having said that, it is imperative that your wife and children get vaccinated as soon as possible. Just because they have not become infected to date does not mean that they are safe from infection. Please get them vaccinated, and continue to get monitored for hepatitis B to protect your own health. Good luck.

  47. any help from you for me since drugs are expensive here in Ghana. i also need advice on diet to keep me strong. what are also the drugs that can exacerbate the situation?

    1. Hello: Keep in mind not everyone living with hepatitis B requires treatment. Eating a well-balanced diet, getting exercise, and avoiding alcohol and cigarettes can go far to preserve your health and strengthen your immune system. For more information, I encourage you to contact the following organization that works on hepatitis B issues in Ghana:
      Hepatitis Foundation of Ghana
      Theobald Owusu-Ansah
      Phone: 00233 247093893
      Email: theobald2003@yahoo.com Ghana
      http://theobaldhepb.org
      Good luck.

  48. I was vacinated in 2003 with the 3 shots, also got a vacination in 2014. I was going through a routine check this year and i was given this result
    HBsAG -Reactive
    Anti HBS – Non- reactive
    HbeAG : Non Reactive
    Anti HBE : Reactive
    Anti HBC Total : Reactive
    Anti HBC igm : Non Reactive
    AST : 23 u/l
    Alt : 32 u/l
    HBV dna: 3129 iu/ml

    What should i do next pls

    1. Hello: Is this the first time you have been tested for hepatitis B? You may have been infected during early childhood, before you were immunized. If you are infected and are vaccinated, the vaccine will be ineffective. Your results show that you are currently infected with hepatitis B. The good news is the ALT test indicates the infection is not harming your liver. However, it is important that you are monitored regularly for liver damage, and that you contact a liver specialist who is familiar with hepatitis B. Good luck.

    1. Hello: Good question, over time the hepatitis B surface antibodies that our immune system produces start to decline, but scientists don’t think this means your immunity is weakening. They have performed tests and found that our immune systems retain an “immune memory” of the hepatitis B virus and are ready to quickly produce antibodies to eradicate the virus, even if the level of surface antibodies has declined. Good luck.

  49. Hi,Di I need to be concerned? I have started training as a nurse and have taken a blood test to check for hep b immunity. 14 months I recieved the first injection but didn’t complete the course (2 nore). I have received a letter regarding my blood test that states I have not responded adequately to the vaccine. They are requesting permission to test for markers or natural immunity.

    1. Hello: If you had only one of the three-dose vaccine, you have not yet developed the antibodies you need to protect you from infection and therefore do not have immunity. Especially considering you work in healthcare, you should immediately get your second hepatitis B vaccine dose, wait five months, and get the third. About one or two months after your third dose, get retested and that should show if you have developed immunity. Good luck.

  50. Hello so I’ve received a Hep B vaccine in 2010. Just recently I went to get blood drawn to see if I had immunity I showed as nonreactive. Would I need the three step to show if I was immune?

    1. Hello: If you received all three vaccine doses and still do not have enough hepatitis B surface antibodies (HBsAb) to protect you against infection, you can get one more vaccine dose (called a booster) and get retested one or two months later to see if you have at least 10 mIU/mL of HBsAb. If you do not, you can safely repeat the series a second time. Talk to your doctor about your options. Good luck.

  51. Hi
    After 30 years of having hep C, I have stage 4 cirrhosis. My liver was shutting down. When I was cured with the new line of medication. My wife is a hep b carrier. I had the twinrix treatment 3 times over three different times in my life just to make sure I was protected. Only to find out now I am a non responder. 5-15 percent non-responders! WHY is this information not made clear in all the advertisements. I didn’t know there was such a thing. My wife’s viral load has gone high for the first time. I’m having liver problems again.

    1. Hello: The hepatitis B vaccine is not as effective in people with medical conditions that suppress their immune system. The vaccine depends on an immune system that can generate antibodies in response to the viral antigen contained in a vaccine. Many people with hepatitis C are coinfected with hepatitis B, but because the hepatitis C virus “dominates” over the hepatitis B virus, they often appear to test negative for hepatitis B. It is only after they have cleared their hepatitis C infection, as a result of the new treatment, that their hepatitis B reactivates because it’s no longer “suppressed” or dominated by the hepatitis C infection. I don’t know if that is what is happening with you, but medical guidelines now encourage doctors to monitor their hepatitis C patients carefully during treatment in case hepatitis B suddenly reactivates and causes dangerous liver damage. For more information, please read: http://www.hepb.org/what-is-hepatitis-b/hepatitis-c-co-infection/
      Please consult with your doctor, good luck.

      1. Thank you for your reply.
        When I found out I was a non res ponder I believe it was a gastric response to my fear.
        My lab results report no hep b virus in my blood all though no immunity response either. What would the best sort of vaccine for me now.
        Will

        1. Hello: Talk to your doctor and get another series of hepatitis B immunizations. Also, make sure you have been tested for both hepatitis B surface antigen and antibody, so your doctor knows for sure that you were not infected in the past. Good luck.

  52. I completed 2 full courses of Hep B vaccine (3 shots each) in the past plus booster shot. My Ab titre never reached more than 65 IU/ml after a month of the booster shot. Over the years it has gone below 10 IU/ml. I am 15 weeks pregnant and my workplace require that I have a recent vaccination. Is it fine to undergo again the vaccination during pregnancy and considering that I’m somewhat a non responder?

    1. Hello: Getting a hepatitis B immunization during pregnancy is safe, however you do not need one. As long as you have generated AT LEAST 10 mIU/mL after your third shot, you are protected for life. It is natural for your antibodies to decrease over time, however your immune system retains “immune memory” of the virus and is always ready to swing into action and attack any infection. Good luck.

  53. I would just like to ask if once your Heb B titer is ok, does it mean that you will not acquire Heb b virus? I only have Heb b titer tested but i didnt have any HbSaG test.

    1. Hello: As long as you have at least 10 mIU/mL of the hepatitis B surface antibody (also called titer) you are protected against hepatitis B. If you have the surface antibody, it is very unlikely that you will also have the hepatitis B surface antigen. Good luck.

  54. My son 21 year old, he had 3 dose of hepatitis B vaccine after born ( Immunoglobulin at birth, one at one month and third one at 7 month old , mum was hepatitis B carrier, HBsAg Positive only ), then he had another 2 dose when he was 13 years old. Never checked the related titer of hepatitis B. last week, he had the blood test done ( required by University for entry the medical school ), the results were all negative or not detected included the hepatitis B surface antibody. The minimum standard for entry medical school is 10 mIU/ml. Dose he is a HBV vaccine non-responder? What is the best option for him?

    1. Hello: Has he been tested for the hepatitis B surface antigen (HBsAg)? Or just the surface antibody? I hate to bring this up, but in some cases if the birthmother had a very high viral load, sometimes immunization at birth and HBIG are not enough to prevent mother-to-child infection. Please have him retested for both surface antigen and antibody. If he tests negative for both the antigen and antibody, have him undergo the full three-shot vaccine series again. According to CDC, he can safely undergo another round of immunization. Good luck, please write again if you have more questions.

      1. Hi,
        He is both HBsAg and HBsAb negative and has now started the full-three shot course.
        What is the longest period of waiting time possible, between the first and the second shot when starting the full three-shot vaccine series? What would happen if the second shot is injected seven weeks after the first shot? He can’t do his second shot within 4 weeks because he’s travelling overseas.
        Thanks

  55. Sir, my wife is infected with Hepatitis B. i also tested myself. but the result was non reactive. the doctor suggested me that i should be vaccinated myself with anti HBV dose . i took two dose and waiting for 6 mnth for third dose. i want to take third dose of anti HBV vaccination at 4th month . if i take this what will hapend ? answer me sir

    1. Hello: I’m glad your doctor recommended immunization. If you take the third dose four months after the second dose, instead of five months, there should be no problem. An accelerated vaccination schedule can be used for people traveling on short notice or for other reasons. The accelerated vaccination schedule calls for vaccine doses administered at days 0, 7, and 21–30; a booster should be administered at 12 months to promote long-term immunity. A combined hepatitis A and hepatitis B vaccine can also be used on the same 3-dose schedule (0, 7, and 21–30 days), with a booster at 12 months.
      Whatever you choose, about one or two months after your third vaccine dose, please return and get tested again to make sure you have enough hepatitis B surface antibodies to protect your from infection. You should have at least 10 mIU/mL of surface antibodies to be protected. Good luck.

  56. i had a needle stick injury in 2013. the patient had an inactive hbv. meaning his alt levels are fine. i already have the one shot from a series of 3 when i had the needle stick injury, i remember they gave me a boost shot from my buttocks which to no avail, didnt became immune so i continued 2 more shots up to one year and got tested and im positive with 20ml of titers. recently i had another needle stick, my hiv and hepatitis c were both non reactive. however my HPSAb is just 1.38ml so its low. the nurse told me to get another series but i already did 2 years ago. i was kinda surprised. does thaty mean i have hepatitis b? im a little bit worried.

    1. Hello: To test for hepatitis B, get a hepatitis B surface antigen (HBsAg) test if you are worried. Hepatitis B surface antibody (titer) levels can vary over time. If you have achieved at least a 10 mIU/mL level of surface antibodies, doctors believe you are protected and that your immune system retains “immune memory” of the virus and is ready to spring into action and produce antibodies if you are ever exposed, even if your titer levels decline below 10.
      To be safe, get tested and get one more booster, then get tested again one or two months later. If your antibodies increase again, then you know you are immune.
      Good luck.

  57. My daughter (born in 1999) received the 3-shot Hep B series at birth (and I tested negative for Hep B during pregnancy). In 2010 her Hep B surface AB was below 10, so she received a booster shot in June of 2012 before an extended trip to South America. Two months later her Hep B surface AB were tested at 82, but they fell back below 5 by 2014. She will be spending two months in Central or South America this summer, so I want to clarify the best course of action. Is it logical to assume that she has adequate immune memory based on the titer taken after the 2012 booster? Should I consider either having her complete the 3-shot series again or get another booster before departure to provide more certainty about her immune status or more robust immunity? Two notes of interest: her younger brother (born 2004) also completed the 3-shot series as an infant (starting shortly after birth) and his 2014 Hep B surface AB results were also below 5. Both kids demonstrate Hep immunity: non-reactive Hep A IgM and reactive HAV AB total.

    1. Hello: You are correct, over time hepatitis B surface antibodies can decline in the years after immunization. As long as she has achieved an antibody level above 10 mIU/mL, her immune system will retain an “immune memory” of the virus and be able to protect her from infection. Thank you.

    1. Hello: Unfortunately, the vaccine will do nothing to help them get rid of hepatitis B. The vaccine contains only the hepatitis B surface antigen piece of the virus, in order to spur the immune system to create surface antibodies that will guard them against infection. If you are infected, you already have the hepatitis B surface antigen in you, and unfortunately your immune system has not been able to fight the infection completely and create surface antibodies. Good luck.

  58. In the 3 years I have also not infected my husband as he still tests negative. Though my 2 kids were immunized at birth and after.Doctor maintains I had it but it’s cleared off and nothing to worry about but I still test positive. How is this possible???

    1. Hello: Could you please send us your lab reports? If you still test positive for the hepatitis B surface antigen (HBsAg) then you are still infected, even though your viral load is low and your liver tests show no damage. It is important to continue to get monitored even if your hepatitis B is “inactive.” If your husband has not developed the hepatitis B surface antibody, he should be vaccinated so he will be protected. Good luck.

  59. Hi. Great blog. I just got confusing hep B results from a test. I’m non reactive to the HBV surface antigen, but reactive to the HBV core total (IgG + IgM) antibody, which means I had evidence of past infection. I had a series of hep b vaccinations when I was 10, but my tests further say the HBV surface antibody is non-reaxtive at 1.66 mIU/mL, an no evidence of immunity.

    I also got STI tests done a few months ago and I did not get this result.

    I am going for follow up tests to see if my HBV core reactivity is a false positive. But if it isn’t, does it mean my vaccine didn’t work and I had once got infected without knowing?

    1. Hello: Sometimes hepatitis B tests can be confusing, and it’s always good to get retested to clarify any contradictory results.
      Here’s a possibility: You may have been infected at birth or during early childhood, before you were vaccinated at age 10. (You may recommend that your mother/family members get tested.) Over time, your healthy immune system has suppressed the infection to the degree that you test negative for the hepatitis B surface antigen (HBsAg). However, your immune system hasn’t been able to generate enough hepatitis B surface antibodies to indicate you’ve cleared the infection. You need at least 10 mIU/mL to be considered cleared of hepatitis B.
      Getting tested again for the surface antigen and antibody, core antibody and also for viral load (HBV DNA) should clarify your results. It won’t tell you when you were infected, but it will clarify what stage of infection you are at. You may also want to get a liver enzyme test for ALT (also called SGPT) to evaluate your liver health.
      Good luck.

  60. Hi ..I got vaccinated at 2013 but later I found out that the 3rd shot was a children dose and not for an adult ..in this case please tell me ,should I repeat the whole series again ?

    1. Hello: Good question. Some adolescent hepatitis B vaccine doses are the same as adult doses, but because you can’t be sure, I would get the third dose repeated, this time of course with the adult dose. Getting another dose will not harm you at all. Good luck.

  61. hello . If HBsag and Anti HBs are non reactive . We can say that person are not affected by HBV?

    1. Hello: Correct, it means you have not been infected. However, it also means you need to be vaccinated in order to protect yourself against hepatitis B. Good luck.

  62. my Hepatitis B profile test is

    normal range

    HBsag (ARCH) reactive > or = 2.000. S/N
    HBeag. reactive > or = 2.100 S/CO
    Anti-Hbe. reactive > or = 1.000 S/CO
    Anti-hbe(IGG) reactive > or = 1.000 S/CO
    Anti hbe(IGM) 0.51. reactive > or = 1.2000 Index
    Anti-HBS. reactive > or = the cut off rate
    CUT OFF RATE. 10.0 mlU/mL

    what is the meaning of this sir ?
    wait for the respond sir thanksss

    1. Hello: I am a bit confused myself, but whenever you test positive for the hepatitis B surface antigen (HBsAg), it means you are infected with hepatitis B. You appear to test positive or reactive for both the hepatitis B “e” antigen (HBeAg) and antibody (anti-HBe), which can happen, though it’s unusual. I am confused by the reactive (positive) result for the hepatitis B surface antibody (anti-HBs). Please talk to your doctor, and ask him or her to explain it. Your doctor may also order a viral load (HBV DNA) test, which measures how much hepatitis B virus you have in your body.
      Is this the first time you have been tested for hepatitis B? If it is, you also need to be tested again in six months to find out if this is a new, acute infection that will go away in six months, or whether you were infected at birth or during early childhood and have a long-term chronic infection. Good luck, please don’t hesitate to ask more questions when you have more test results.

      1. thanks sir for information .
        Recently i was infected by HBsag then after six months i go to my doctor to examine whether if im still infected with the said virus and to monitor my liver. After that when i see my result its appeal that my HBsag result and Anti – HBs are non reactive . What does it mean sir ? Im still infected with the said virus according in the result ? What best thing i do if i am still a carrier of HBV or not ?

        Thanks. Wait for your respond sir. god blesss

        1. Hello: I want to make sure I understand, do you currently test negative or nonreactive for both the hepatitis B surface antigen (HBsAg) and the hepatitis B surface antibody (anti-HBs)?
          Although you still do not test positive for surface antibodies, it is a very good sign that you are now testing negative for HBsAg.
          Please get tested again in a few months to see if the surface antibodies have appears. Sometimes it can take longer than six months. Good luck.

    1. Hello: Yes, your liver enzyme test (called ALT or SGPT) is normal. Healthy ALT/SGPT levels range up to around 19 in women and around 30 in men. However, every lab has its own “healthy” range. So your level of 35 is probably in your lab’s healthy range. Keep leading a healthy lifestyle and avoid alcohol and cigarettes. Good luck.

  63. I have not responded to my 1st course of hep b vaccine. I was wondering whether it would bw a good idea to start straightaway using the 40mcg vaccine for the next course, rather than just paying to repeat the same course again that probably wont work. Are there any increased risks with using the higher dose vaccine? Is there any reason why I shouldnt just ask for that for the 2nd course? Thanks

    1. Hello: Most guidelines recommend that you get a second series of the regular vaccine. Also, make sure you have been tested for the hepatitis B surface antigen (HBsAg) to make sure you are not infected. Good luck.

  64. I am a student nurse nearing qualification. I’ve had 3 vaccinations, a blood test which I was low immunity and a booster and I’m still low! What do I do? Can I have another booster or is that dangerous?

    1. Hello: Go ahead and get two more shots, one 30 days (or longer) after your recent booster, and then the third five months later. Basically, you’ll repeat the series. One or two months after the third dose, get tested again to see what your hepatitis B surface antibody level is. At the very least, you will have documentation that you had the series, depending on what your program requires. Good luck.

  65. Hi. My staff was tested for hep s ag and hepb ab 2 months after completing his course for hep b vaccine. Results came back as

    Hep B s Ag negative
    Hep B Ab negative
    Heb B Ab titre 4

    Does he need a booster dose or a repeat course of the 3 shots? Tq very much

    1. Hello: Yes, have him repeat the three-shot series again and then test for hepatitis B surface antibodies. Good luck.

  66. You mentioned several times a booster shot. Is that different than the 3 in series.

    I ask because my daughter had all 3 years ago and now comes back as not immune and also not infected.

    She is the medical field, so should get a booster and then be tested or the series of 3 and then be tested.

    Is the booster different than the 1st shot in the series?

    1. Hello: A booster is simply an extra hepatitis B vaccine shot. When children are immunized, over the years the level of hepatitis B surface antibodies often decline and are no longer detectable. Despite this, the immune system retains an “immune memory” of the hepatitis B virus and remains ready to fight an infection.
      Have her get one hepatitis B vaccine shot (the booster) and then she should be retested about one to two months to determine if she has adequate antibodies. (She needs at least 10 mIU/mL to be considered immune.)
      If by some chance she still lacks antibodies, she should get the full series a second time, so a second vaccine after her test, and a third vaccine five months later.
      Good luck.

  67. I am a Hepatitis B Vaccine Non-Responder. Have had boosters and full rounds of hep b vaccine and was told I could not take anymore Hep B Vaccine shots. Over the years working in healthcare have had boosters and 4 series of the 3 rounds of hep B vaccines still no antibodies. Was told that that working in healthcare was a risk (worked in ER and ran rescue during my time in healthcare). a few years later quit working in healthcare in 2002. Now I’m in my 60’s never contacted Hep B thank goodness. So after all those shots and boosters is it true I can not take anymore vaccines as stated by the hospital I was working for? Thank you

    1. Hello: If you have had several series of vaccines, it is unlikely another round will work. Also, as we get older, our immune system becomes weaker and doesn’t generate as many antibodies following immunization as when we were young.
      I assume from what you’ve written that you have been tested for hepatitis B? There is a type of hepatitis B, called “occult” hepatitis B, that infects without creating hepatitis B surface antigen (HBsAg) because of a mutation in the virus. Just to be sure, you may want to be tested for both HBsAg as well as HBV DNA.
      Good luck.

      1. I had 1shot of the hep b vaccine possibly 2. Florida DEPARTMENT of HEALTH Departments took my blood5-10yrs after only shot and stated I was vaccinated. Cam I trust that now it been 15yrs since getting the single shot, I swear I didn’t get down for a 2nd though either way claim I was safe in 2011

        1. Hello: If a public health agency told you that you were protected or immune from hepatitis B, then you probably had enough antibodies to prove you were protected. It’s unusual but can happen. A vaccination protects you indefinitely, so you don’t have to worry about getting a booster or another shot. Good luck.

  68. Hi, I had my first round of Hep B in 2009 and tested as seroconverted. In 2011, I experienced a needle poke at hospital and went through all testing protocols which found I no longer had HepB protection. I was re-immunized and titer test showed no conversion on 2nd set of shots. 1st question : should I be tested for HepB? (I no longer work in health care) and second, when you “lose” your immunity to HepB, does that mean that other vaccines may not be “working?” Is there anything else in normal vaccination booster schedule which should change? Thanks very much.

    1. Hello: Yes, as a precaution get tested for HBsAg (the hepatitis B surface antigen) to ensure you are not infected. It is not unusual for your hepatitis B surface antibodies (also called titers) to decline over time. And, as we get older and our immune system weakens, we no longer generate the antibodies we used to in our youth. However, despite age, your immunity to diseases that you have been vaccinated against should not wane. Good luck.

  69. Hello, I received the three series vaccination when I was an infant in 1995. I had a titre test in the summer of 2014, and I was not immune so I received a booster vaccination. In May 2017, I had another titre test and my results were “borderline immunity”, so my physician wants to give me another booster. Is receiving another booster the correct protocol? Or should I have the three series again? I work in healthcare, so it is important that I am immune. Thank you!

    1. Hello: If you are close to having the required number of antibodies (titer), one more vaccine shot will hopefully do the trick. Basically, instead of repeating the three-shot series, you’ve had two shots.
      Researchers find that even if our antibody levels decline, our immune system retains an “immune memory” of the virus and is ready to fight the infection should it occur. Good luck.

  70. I contracted HBV from my mother when I was born and I recently decided to go to dental school. All schoos require HBV vaccinations and a titer. I will always test negative because I have the virus, but I take medication and my viral load is undetectable. Now, I am worried that I will not be accepted into dental school even though my viral load is undetectable. I’ve read on the CDC website that deny someone a job/position because of them having HBV is considered “prejudice” but I am still worried. Any advice?

    1. Hello: In the U.S., the CDC and other agencies determined that doctors/nurses/dentists etc. do not pose a risk to coworkers or patients if they have hepatitis B. Their findings can be found at: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6103a1.htm?s_cid=rr6103a1_w in the event you ever need to use this as ammunition to fight for your right to practice.
      A board that regulates surgeons etc. in the U.S. did recommend that surgeons and dentists who perform surgeries that carry high risk of needle or surgical tool cuts use antivirals to lower their viral load if they had high viral loads, but that’s the only restriction we know of. If you live in the U.S., there are clear legal protections for you.
      Good luck.

  71. Hello, my 2 year old had her hep b shots and the dr said she is non responsive to them. She then did anither round of it, and also found it to be non responsive. She is recommending another round and if it’s not responding then she says my child cannot get the hep b shots again. Can you please help me understand if this is right and how to go about it? Thank you for your help!

    1. Hello: It is unusual for children not to respond to the hepatitis B immunization, unless their immune system is weak. I assume she has been tested for hepatitis B?
      Usually, doctors try up to three rounds of immunization. If the person remains a nonresponder, then it is not worthwhile to try again. Good luck.

  72. I’m a 43 year old male and I thought that I received a complete round of three vaccinations in Fall 2013 and Spring 2014. As it turns out, I might have only received two vaccinations for Hepatitis B and and one for Hepatitis A after finding my vaccination records today. I live overseas now and the doctor who initially performed the vaccinations retired so I have no way of accessing them easily. I want to believe that he made a mistake and didn’t include the final Hepatitis B shot on the form, but I can’t say it with certainty.

    In Summer 2015 I checked for antibodies and antigens because my girlfriend turned out positive for Hepatitis B when we checked for STDs. All testing was clear except her HBsAg which was 4696.64 but I was negative for surface antigens. My antibodies came back positive at 15 IU/L so the overseas doctor assured me I was immunized and was above the threshold of 10. At that time I received the remaining Hepatitis A shot (second) because I do know that I only received one of them previously. In Summer 2016 I again tested negative for antigens and positive for antibodies, but this time at 12 IU/L. The doctor explained immunological memory and told me not to worry about the decreasing titer levels. However, since I just found my records today, I’m now distraught because I may not have received the third dose of the Hepatitis B vaccine.

    I have been having regular unprotected sex with my Hepatitis B positive girlfriend. On one occasion recently, I came in contact with menstrual blood, but we stopped having sex immediately once we realized her period was beginning. Needless to say, I’m now freaking out. Am I protected based on the known antibody results from 1 and 2 years after vaccination? What should I do at this point? I’ll be grateful for any information you can provide.

    1. Hello: The hepatitis B vaccine is very effective and confers life-long immunity against hepatitis B, your continued high level of titers (surface antibodies) shows your immune system is protecting you.
      You do not require a booster shot if your titers are above 10 mIU/mL. Good luck.

      1. Thank you for your response. To be clear, does this mean that it is possible to obtain lasting immunity after only two vaccinations instead of the regularly administered three shots? Also, when in a relationship with someone positive for the virus, how often should titer levels be checked? Thank you.

        1. Hello: Some people who have strong or responsive immune systems develop immunity to the the infection after just two vaccine doses, but most people require three doses.
          Once you have achieved the minimum 10 mIU/mL of hepatitis B surface antibodies, you never have to be vaccinated again, even if you are in a sexual relationship with someone with hepatitis B.
          Good luck.

  73. I have been through a total of 19 vaccines for HepB over a 15 year period, including Hep B by itself (numerous series) and combined with A (series) and still test non-immune. Every year, they would test immunity level, and have me undergo another series. A travel specialist in London Royal Free Hospital did one more series and then said I should stop getting vaccines as no one knew the cumulative impact of so many, and to consider myself non-immune. My work can involve travel to remote areas/developing countries, but am in a work transition stage–should I look for work that doesn’t involve travel. Any advice?

    1. Hello: Addressing only hepatitis A and B, as long as you practice universal precautions during your travels, as anyone should, you should be fine. Hepatitis B is not spread casually, you need to have direct contact with infectious blood or body fluids (including semen). Are you a healthcare worker? If your job places you at high risk of infection (for example if you give injections and handle sharps), then you may want to scale back.
      In terms of hepatitis A, it is spread through food or contact with feces that contains the virus. As long as your food is cooked and your drinking water is from bottled or reliable sources, you should be fine.
      Good luck.

      1. Thanks, no, I am not at all high risk for B, except in the event of an accident requiring medical treatment/transfusions in remote areas. (HepA is not the concern–I only mentioned it because they just tried to combine A/B when I did not respond to B vaccine on its own.) Thanks again.

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