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What Do I Do if I’m a Hepatitis B Vaccine Non-Responder?

Image courtesy of Pixabay

Approximately 5-10% of people do not develop protective antibodies following the completion of the hepatitis B vaccine series.  This is confirmed with a blood test called an anti-HBs titer test which is given 4 weeks following the completion of the series. If the test shows the titer is less then 10 mIU/mL the general recommendation is to complete the series again using a different brand of vaccine (e.g. if you received Engerix B, the first time, switch to Recombivax the 2nd time or vice-versa).  A person is considered to be a “non-responder” if they have completed 2 full vaccination series’ without producing adequate protective antibodies.

Another vaccine option is the new two-dose hepatitis B vaccine, HEPLISAV-BTM. The new vaccine is expected to increase immunization rates for adults in the United States and is administered over a one-month period. The vaccine provides greater seroprotection, which can mean a greater antibody response especially in adults who may be older, obese or live with type 2 diabetes making it an effective vaccine option.

It is also possible that a person who does not respond to the vaccine may already be infected with hepatitis B. Therefore, testing for the presence of the hepatitis B virus (hepatitis B surface antigen or HBsAg) is recommended before diagnosing a person as a “vaccine non-responder.”

CDC Recommendations for Hepatitis B Vaccine Non-Responders

  • Persons who do not respond to the primary hepatitis B vaccine series (i.e., anti-HBs <10 mIU/mL) should complete a second 3-dose vaccine series or be evaluated to determine if they are HBsAg-positive. Persons who do not respond to an initial 3-dose vaccine series have a 30%–50% chance of responding to a second 3-dose series.
  • Revaccinated persons should be retested at the completion of the second vaccine series, 1-2 months following the last shot of the series.
  • Persons exposed to HBsAg-positive blood or body fluids who are known not to have responded to a primary vaccine series should receive a single dose of hepatitis B immunoglobulin (HBIG) and restart the hepatitis B vaccine series with the first dose of the hepatitis B vaccine as soon as possible after exposure. Alternatively, they should receive two doses of HBIG, one dose as soon as possible after exposure, and the second dose 1 month later.
  • The option of administering one dose of HBIG and restarting the vaccine series is preferred for non-responders who did not complete a second 3-dose vaccine series.
  • For persons who previously completed a second vaccine series but failed to respond, two doses of HBIG are preferred.

Hepatitis B vaccine “non-responders” who test negative for hepatitis B infection are at risk for being infected and should be counseled regarding how to prevent a hepatitis B infection and to seek immediate medical care to receive a dose of hepatitis B immunoglobulin (HBIG) if they have been exposed to potentially infected blood.

“Non-responders” who test negative for hepatitis B infection as well as friends and family members should practice ways to prevent the spread of hepatitis B, including washing hands, using condoms during sex, avoid direct contact with blood and bodily fluids, and more.

Hepatitis B vaccine “non-responders” to vaccination who test positive for hepatitis B infection should be counseled regarding how to prevent transmitting the hepatitis B virus to others and the need for regular medical care and monitoring for their chronic infection.

In the case of possible exposures to HBV infected blood or body fluids, it is recommended that non-responders receive 2 doses of hepatitis B immunoglobulin (HBIG) – the first dose should be given within 24 hours of the exposure, and the second dose should be given 1 month later.  The CDC has recommendations online for what to do in case a susceptible person is possibly exposed to the hepatitis B virus.

Check out our previous post on the topic here.

References:

CDC Guidance for Evaluating Health-Care Personnel for Hepatitis B Virus Protection and for Administering Postexposure Management. Retrieved from: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6210a1.htm

HEPLISAV-B. Retrieved from: https://heplisavb.com/

The 3-Shot Hepatitis B Vaccine – Do I Need to Restart the Series if I Am Off the Recommended Schedule?

The Hepatitis B vaccine is a safe and effective 3-shot series that protects against the hepatitis B virus.  If you do not have a current hepatitis B infection, or have not recovered from a past infection, then hepatitis B vaccination is an important way to protect yourself. The recommended schedule for the hepatitis B vaccine is to receive the first shot, followed in one month by the second shot.  Six months following the first shot, you should receive your third and final shot of the series.

If you wish to ensure you have generated adequate immunity, and are protected, you can have your anti-HBs (HBsAb) titres checked 4-8 weeks following the last shot of the hepatitis B vaccine series.  If your titer is greater than 10 mIU/mL, then you have adequate immunity which is thought to confer lifetime immunity, but studies so far show 30 years.  This is because these studies are on-going!

Please note that checking anti-HBs titres is not generally recommended for all vaccine recipients, with the exception of those that are at greater risk of infection.   This includes but is not limited to health care workers, those with sexual partners with hepatitis B, and those living in a household where someone is infected. Talk to your doctor if you think you might be at higher risk and need to have your titres checked.

So what happens if you go for shot one, followed by shot two in a month, but you never get to shot three?  The minimum length of time between the three shots in the series is 0, 1 month, and 6 months.  There is an accelerated schedule, but this is the schedule recommended for the shortest amount of time, with the best immune response for the general population.  However, if you don’t get to shot three of the series for another two years, or if you never got to shot two, you can resume right from where you left off, and continue without the need for repeating the series.

Here is a rule to remember the minimum time in between shots in the series:

Dose 2 should be separated by dose 1 by at least one month (4 weeks or 28 days)

Dose 3 should be separated by dose 2 by at least 2 months (8 weeks) AND from dose 1 by at least 4 months (16 weeks).

Keep in mind that the goal is to get people protected in the shortest amount of time, with the fewest number of doses. If you do not complete the series, you will not have adequate, longterm protection from hepatitis B.

What happens if you don’t have your vaccine records, and you have no idea if you ever got shot 1 or 2, and you just want to repeat the series? There is no concern with repeating the HBV vaccine series, so if you are unsure, please start the series from shot 1.

Be sure you and your loved ones vaccinated are against hepatitis B so you can be hepatitis B free for life!

Who is Ted Slavin? #virusappreciationday

“We will long remember Ted Slavin as a gallant man who loved life and who contributed greatly to our research efforts”

-Baruch S. Blumberg, Irving Millman, W. Thomas London, and other members of the Division of Clinical Research Fox Chase Cancer Center, 19851

Baruch S. Blumberg

“Who is Ted Slavin? Why haven’t I heard about him before?” crept into my mind as I was reading The Immortal Life of Henrietta Lacks. Rebecca Skloot wrote a short snippet about Ted Slavin, detailing the story of a hemophiliac who sold his antibodies and aided Dr. Baruch Blumberg in the discovery of the link between the hepatitis B virus and liver cancer, which eventually led to the first hepatitis B vaccine.2 I was surprised that I had never heard of him, and that his name was not enshrined on the walls of the Hepatitis B Foundation. I see the smiling and jovial face of Dr. Blumberg nearly every time I walk into the office, but never the image of a man who contributed so much to his efforts.

Blood Serum

Ted Slavin developed antibodies against hepatitis B after receiving infected blood transfusions to treat his hemophilia. The blood he received back in the 1950s was not screened for any diseases. His doctor helped him realize that his blood was valuable because of the copious amounts of antibodies for hepatitis B. At the time, those antibodies were a hot commodity as scientists were conducting research to learn more about hepatitis B prevention and treatment. Slavin decided to the sell his antibody-rich blood and even donated his blood to Dr. Blumberg’s research team at Fox Chase Cancer Center. He later formed Essential Biologicals, a company that collected blood from others like him. They were everyday patients who could turn their rare or unique blood into money making products, while at the same time advancing important research into diseases that were not well understood.2

As I read the brief overview of Slavin’s life, I initially perceived him as someone who was both lucky and smart: Slavin was lucky because his doctor gave him information on the value of his antibodies2; and smart because he knew how to make the best of something once considered a burden in his life.3 As I did a little more detective work, I realized Ted Slavin was not just a guy who made money off his cells, but someone who contributed to the fight against the hepatitis B virus, which I am passionate about!

My detective work led me to a deeper understanding of Mr. Slavin and his contribution to important milestones on the road to hepatitis B elimination.3,4,5,6,7 I found discussions and case studies on the ethics associated with his circumstance. Through my research journey, I learned more about him and my perception of Slavin started to change. He was, like many, struggling to make ends meet. He didn’t entirely profit off his antibodies because he donated a majority of the money he made to advance scientific research.4 At the same time, Slavin was “hopeful for a cure,” and he trusted Dr. Blumberg, his favorite researcher among the many studying hepatitis B, with his antibodies.1 To Dr. Blumberg and the researchers working with him, Ted Slavin was a brave, courageous man who helped save millions of lives.1

The story of Ted Slavin, like that of Henrietta Lacks, is not only a reminder of the importance of bioethics and the need for public health and scientific research; his story reminds us there is an invisible face behind every success. Because of Ted Slavin, there are tests to diagnose hepatitis B, ways to detect liver cancer linked to hepatitis B, and the first cancer preventative vaccine!

For more information about the hepatitis B vaccine, please visit our website here.

For helping looking for the hepatitis B vaccine, you can go  here or to the HealthMap Vaccine Finder.

 

References:

  1. Lavin, EFS. (2013). Exploring Life and Death at the Cellular Level: An Examination of How Our Cells Can Live Without Us. Quadrivium: A Journal of Multidisciplinary Scholarship, 5(1),
  2. Skloot, R. (2010). The Immortal Life of Henrietta Lacks. Crown Publishing Group.
  3. Ted Slavin’s Story and more. Retrieved from: http://tissuerights.weebly.com/ted-slavin.html
  4. Skloot, R. (2006, Apr 16). Taking the Least of You. The New York Times Magazine. Retrieved from: http://www.nytimes.com/2006/04/16/magazine/taking-the-least-of-you.html
  5. Angsana T. (2010, Nov 9). Second Story from Ted Slavin. Retrieved from: http://angsanat.blogspot.com/2010/11/second-story-from-ted-slavin.html
  6. C, Anna. (2012, Jul 26). World Hepatitis Day: The History of the Hepatitis B Vaccine. Retrieved from: http://advocatesaz.org/2012/07/26/world-hepatitis-day-the-history-of-the-hepatitis-b-vaccine/