From the Guidelines
If a person shows hepatitis B surface antibody (HepB s Ab) positivity after receiving only one dose of the three-dose hepatitis B vaccination series, they generally do not need to complete the remaining doses. A positive HepB s Ab result (typically ≥10 mIU/mL) indicates that the person has developed protective immunity against hepatitis B virus infection, as stated in the recommendations of the Advisory Committee on Immunization Practices 1. This immunity could have developed from either the single vaccine dose or from a previous undiagnosed hepatitis B infection that resolved. The presence of these antibodies means the person is protected against future hepatitis B infection, making additional vaccine doses unnecessary. However, in certain high-risk individuals such as healthcare workers, immunocompromised patients, or those on dialysis, completing the series might still be recommended to ensure robust and long-lasting immunity, as suggested by the guidelines for postvaccination serologic testing 1. Key points to consider include:
- The level of anti-HBs considered protective is ≥10 mIU/mL 1.
- Immunocompetent individuals with anti-HBs ≥10 mIU/mL after vaccination are considered immune and do not require further periodic testing 1.
- Certain groups, like healthcare workers or those with immunocompromised status, may require additional doses or testing to confirm immunity 1. If there's any uncertainty about the antibody level or the person's risk factors, consulting with a healthcare provider for personalized advice is important, as the management might vary based on specific circumstances, such as the need for revaccination or periodic antibody testing 1. The protective antibodies typically provide lifelong immunity for most healthy individuals, though some may need periodic antibody testing to confirm continued protection, especially in high-risk groups or those with certain medical conditions 1.
From the Research
Hepatitis B Surface Antibody Positivity After 1/3 Hep B Series
- Individuals who develop hepatitis B surface antibody (HBsAb) positivity after receiving one or two doses of the hepatitis B vaccine series may not need to finish the vaccination series, as they have already developed immunity 2, 3.
- However, the level of HBsAb titers is important, and higher titers are associated with longer-term maintenance of immunity 2, 4.
- Studies have shown that individuals who receive additional doses of the hepatitis B vaccine after initial vaccination failure are more likely to achieve seroprotective levels of HBsAb 5.
- The presence of HBsAb is protective against hepatitis B virus (HBV) reactivation, and higher titers (>30 IU/L) may provide the most pronounced prevention 4.
- Hepatitis B vaccination can increase the HBsAb seroconversion rate and reduce recurrence in patients with functional cure of hepatitis B 6.
Factors Influencing HBsAb Positivity
- The level of HBsAb titers is influenced by factors such as the number of vaccine doses received, the time between vaccine doses, and the individual's immune status 2, 5, 3.
- Higher HBsAb titers are associated with longer-term maintenance of immunity, and individuals with higher titers are less likely to experience HBV reactivation 2, 4.
- The presence of HBsAb is protective against HBV reactivation, and individuals with higher titers (>30 IU/L) may be at lower risk of reactivation 4.
Clinical Implications
- Individuals who develop HBsAb positivity after receiving one or two doses of the hepatitis B vaccine series should be monitored for HBsAb titers to determine if additional doses are necessary 2, 3.
- Healthcare providers should consider a more aggressive revaccination strategy with an additional 3-dose series for individuals who fail primary HBV vaccination 5.
- Hepatitis B vaccination can be an effective strategy for increasing HBsAb seroconversion rates and reducing recurrence in patients with functional cure of hepatitis B 6.