From the Guidelines
The Hepatitis B vaccine series should be repeated for a patient with no immunity to Hepatitis B, as approximately 50-60% of individuals who do not respond to the initial series will develop protective antibody levels after a second complete series. According to the recommendations of the Advisory Committee on Immunization Practices 1, postvaccination serologic testing should be performed 1–2 months after administration of the final dose of the vaccine series to determine the need for revaccination. The standard approach is to administer a complete second series of three doses following the 0,1, and 6 month schedule using the adult formulation. After completing the second series, antibody testing should be performed 1-2 months later to confirm immunity 1. Some key points to consider when repeating the vaccine series include:
- Testing for anti-HBs and HBsAg to determine the need for revaccination and the type of follow-up testing 1
- Using a method that allows determination of a protective concentration of anti-HBs (≥10 mIU/mL) 1
- Counseling patients about precautions to prevent HBV infection and the need for Hepatitis B immune globulin (HBIG) prophylaxis if exposed 1
- Considering genetic factors, immunosuppression, obesity, advanced age, or chronic diseases that may reduce vaccine effectiveness 1.
From the Research
Hepatitis B Vaccine Series Repeat
For a patient with no immunity to Hepatitis B, the decision to repeat the vaccine series is based on several factors, including the patient's health status and previous response to the vaccine.
- The Hepatitis B vaccine series can be repeated for patients who do not respond to the initial vaccination, with studies showing that repeat vaccination can increase immunologic seroconversion in a significant percentage of patients 2.
- Patients with certain medical conditions, such as end-stage renal disease, HIV infection, and hepatitis C virus infection, may require a higher dose of the vaccine or a different vaccination schedule to achieve adequate immunity 2, 3.
- The use of a single-dose vaccine booster or repeating the vaccine series can be beneficial for patients who do not respond to the initial vaccination and are not actively infected with HBV 2.
- However, for immunocompetent individuals with anti-HBs ≤ 10 IU/L, there is no need for regular anti-HBs titer testing or booster vaccination, as cellular immune memory has been shown to play an important role in protection against infection 4.
- In certain cases, such as for hemodialysis staff members exposed to needlestick contaminated with blood containing hepatitis B surface antigen, combined hepatitis B immune globulin and vaccine can be effective for postexposure prophylaxis 5.
- For patients with end-stage renal disease, vaccination against hepatitis B infection can be effective, but primary seroconversion may be relatively poor, and protective anti-HBs titres may decline rapidly, requiring yearly antibody checks and selective booster doses 6.