Hepatitis B Laboratory Profile After Vaccination
If you have been successfully vaccinated against hepatitis B, your laboratory profile will show positive anti-HBs (≥10 mIU/mL), with negative HBsAg, negative anti-HBc, and negative HBeAg. 1, 2
Expected Serologic Pattern
Your post-vaccination hepatitis B profile should demonstrate:
Anti-HBs (Hepatitis B surface antibody): Positive (≥10 mIU/mL) - This is the only marker that should be positive after vaccination and indicates vaccine-derived immunity 1, 2
HBsAg (Hepatitis B surface antigen): Negative - Absence of this marker confirms you do not have active hepatitis B infection 1, 2
Anti-HBc (Hepatitis B core antibody): Negative - This marker distinguishes vaccine-derived immunity from natural infection; it remains negative after vaccination but becomes positive only if you have been infected with hepatitis B virus 1, 2
HBeAg (Hepatitis B e-antigen): Negative - This marker is only present during active viral replication in infected individuals, not after vaccination 1
Understanding Your Anti-HBs Level
The protective threshold is anti-HBs ≥10 mIU/mL, which indicates adequate immunity against hepatitis B infection 1, 2. However, different laboratory assays may have varying cutoff values, so refer to your specific test's package insert for interpretation 1.
If you are immunocompetent and achieved anti-HBs ≥10 mIU/mL after completing the vaccine series, you have long-term protection and do not need periodic retesting or booster doses. 1, 2 This protection persists through immunologic memory even if antibody levels decline below 10 mIU/mL over time 3, 4.
Important Clinical Considerations
The pattern of negative HBsAg, negative anti-HBc, and positive anti-HBs definitively confirms vaccine-derived immunity rather than immunity from past infection. 2 This distinction is clinically important because:
- Natural infection produces anti-HBc in addition to anti-HBs 1, 2
- Vaccine-induced immunity relies on both antibodies and cellular immune memory 5, 3
- Approximately 25% of vaccinated adults may lose detectable anti-HBs levels over 10-30 years, but rapid anamnestic response to booster doses demonstrates persistent immune memory 4
Special Populations Requiring Different Management
Healthcare workers with documented complete vaccination should undergo anti-HBs testing upon hire or matriculation; those with anti-HBs <10 mIU/mL should receive additional vaccine doses to ensure protection against occupational exposure 1
Immunocompromised persons (including those on hemodialysis, HIV-positive individuals, or those receiving immunosuppressive therapy) may need annual anti-HBs testing and booster doses when levels decline below 10 mIU/mL 1
Common Pitfalls to Avoid
Do not confuse the absence of anti-HBs with lack of immunity if you were vaccinated years ago - immunologic memory may provide protection even when antibody levels become undetectable 3, 6. Research demonstrates that vaccinated individuals maintain memory B lymphocytes capable of rapidly producing anti-HBs upon re-exposure, even when serum antibody levels fall below the protective threshold 3, 7.
Some vaccinated individuals may show very low but detectable anti-HBs levels that fall below the 10 mIU/mL cutoff in standard assays, yet these levels are significantly higher than in unvaccinated controls and may still contribute to protection 7.