Management of Hepatitis B Vaccine Non-Response in a 76-Year-Old Non-Immunocompromised Individual
For a 76-year-old non-immunocompromised individual who failed the conventional Engerix-B vaccination schedule, a high-dose revaccination series with 40 μg of Engerix-B administered on a 0,1,2, and 6-month schedule is recommended. 1
Understanding Hepatitis B Vaccine Non-Response
- Non-response to hepatitis B vaccination is defined as failure to develop protective antibody levels (anti-HBs ≥10 mIU/mL) after completing a standard vaccination series 2
- Age is a known factor affecting immune response to hepatitis B vaccination, with older adults having lower seroconversion rates 1
- The standard adult dose of Engerix-B is 20 μg (1.0 mL) per dose in a 3-dose schedule at 0,1, and 6 months 2
Recommended Approach for Non-Responders
High-Dose Revaccination Strategy
- For adults who failed the conventional hepatitis B vaccination schedule, a high-dose revaccination series is recommended 1
- For Engerix-B, the high-dose recommendation is 40 μg (2.0 mL) per dose in a 4-dose schedule at 0,1,2, and 6 months 2, 1
- This approach has shown significantly improved response rates in previous non-responders 3
Alternative Options
- Consider using Heplisav-B (if available), which has demonstrated higher seroprotection rates (approximately 90%) compared to Engerix-B (70.5%-90.2%) in clinical trials 2
- Heplisav-B is administered as a 2-dose series (0 and 1 month) with 20 μg (0.5 mL) per dose 1
Monitoring Response to Revaccination
- Test for anti-HBs levels 1-2 months after completing the revaccination series to confirm seroprotection 2
- Seroprotection is defined as anti-HBs levels ≥10 mIU/mL 2
- Individuals who develop protective antibody levels following vaccination are considered protected, even if antibody levels subsequently decline 2
Important Clinical Considerations
- Do not restart the series if the vaccination schedule is interrupted; simply continue where left off 1
- Vaccine doses administered ≤4 days before the minimum interval are considered valid 1
- For older adults, the high-dose regimen is particularly important as age-related immune senescence can reduce vaccine response 1
Evidence for Revaccination Efficacy
- Studies have shown that non-responders to initial hepatitis B vaccination series can achieve seroconversion rates of up to 100% with additional doses of vaccine 3
- Research demonstrates that three doses of recombinant hepatitis B vaccine were effective in eliciting immune response in previous non-responders 3
- These individuals may not be true non-responders but rather "hyporesponders" who require additional or higher doses of vaccine 3