From the Guidelines
A Hepatitis B Surface Antibody (anti-HBs) level of zero indicates that the patient lacks immunity to Hepatitis B virus and should be considered for vaccination. This means the patient is susceptible to Hepatitis B infection. The standard Hepatitis B vaccination series consists of three doses: an initial dose, followed by a second dose 1 month later, and a third dose 6 months after the first dose. For adults, each dose is typically 20 mcg administered intramuscularly in the deltoid muscle. After completing the vaccination series, most individuals develop protective antibody levels (anti-HBs ≥10 mIU/mL) 1.
It's essential to note that this result doesn't indicate current infection but rather lack of immunity. If the patient has risk factors for Hepatitis B (such as healthcare work, multiple sexual partners, injection drug use, or household contact with infected individuals), vaccination becomes even more important. The absence of surface antibodies occurs naturally in those who have never been infected with Hepatitis B or vaccinated against it. The vaccine works by stimulating the immune system to produce these protective antibodies, which prevent the virus from establishing infection if the person is exposed in the future.
Some key points to consider:
- Anti-HBs levels of ≥10 mIU/mL are generally considered seroprotective 1
- Persons who recover from natural HBV infection are typically positive for both anti-HBs and anti-HBc, whereas persons who respond to HepB vaccine are positive only for anti-HBs 1
- Immunocompetent persons who achieve hepatitis B surface antibody (anti-HBs) concentrations of ≥10 mIU/mL after preexposure vaccination have protection against both acute disease and chronic infection 1
- The vaccine series should be followed by anti-HBs testing 1–2 months after the final dose to determine the need for revaccination and the type of follow-up testing 1
In terms of management, the patient should be counseled about precautions to prevent HBV infection and the need to obtain HBIG postexposure prophylaxis for any known or likely exposure to an HBsAg-positive source. Additionally, the patient should be considered for vaccination, and the standard Hepatitis B vaccination series should be administered as described above. It's crucial to follow the recommended vaccination schedule and to perform postvaccination serologic testing to ensure the patient has developed protective antibody levels.
From the Research
Hepatitis B Surface Antibody Level of Zero
A Hepatitis B (HBV) Surface Antibody level of zero indicates that an individual does not have detectable levels of anti-HBs antibodies in their bloodstream. This can occur in several scenarios:
- The individual has not been exposed to HBV or has not been vaccinated against it.
- The individual has been vaccinated, but the anti-HBs antibodies have decreased to undetectable levels over time 2.
- The individual is a "non-responder" to the HBV vaccine, meaning they do not produce detectable anti-HBs antibodies despite vaccination 3.
Implications of a Zero HBV Surface Antibody Level
The absence of detectable anti-HBs antibodies does not necessarily mean that an individual is not immune to HBV. Other immune responses, such as T helper responses and memory cells, may still provide protection against the virus 3. However, the presence of anti-HBs antibodies is generally considered a reliable indicator of immunity to HBV 2.
Key Points to Consider
- A zero HBV Surface Antibody level does not necessarily indicate a lack of immune response to HBV 3.
- Other factors, such as the individual's vaccination history and exposure to HBV, should be considered when interpreting a zero HBV Surface Antibody level 4, 5.
- The use of highly sensitive assays, such as the ELISpot assay, may be necessary to detect low levels of anti-HBs antibodies in some individuals 6.