From the Guidelines
For a 65-year-old woman with a low Hepatitis B surface antibody (anti-HBs) level, a booster dose of the Hepatitis B vaccine is generally recommended to ensure protection against Hepatitis B infection. The standard approach would be to administer a single booster dose of the Hepatitis B vaccine (such as Engerix-B 20 mcg or Recombivax HB 10 mcg) intramuscularly in the deltoid muscle, as recommended by the Advisory Committee on Immunization Practices 1. After receiving the booster, antibody levels should be checked 1-2 months later to confirm an adequate immune response, with a protective threshold of 10 mIU/mL or higher considered seroprotective 1. If the antibody level remains below the protective threshold after the booster, a complete three-dose series may be necessary (doses at 0,1, and 6 months), especially for individuals with ongoing risk factors for Hepatitis B exposure or those with conditions that might compromise their immune system, as outlined in guidelines for immunocompromised hosts 1. Key considerations include:
- The natural decline of antibody levels over time
- Potential reduced immune responses at age 65
- Importance of maintaining protective antibody levels to prevent Hepatitis B infection and its serious liver complications, particularly in older adults who may have more difficulty clearing the virus. Given the potential risks and benefits, the recommendation for a booster dose is based on the most recent and highest quality evidence available, prioritizing the prevention of morbidity, mortality, and improvement of quality of life for the patient 1.
From the FDA Drug Label
Clinical studies of ENGERIX-B did not include sufficient numbers of subjects 65 years of age and older to determine whether they respond differently from younger subjects. Other reports from the clinical literature indicate that hepatitis B vaccines are less immunogenic in adults 65 years of age and older than in younger individuals
The FDA drug label does not answer the question.
From the Research
Hepatitis B Booster Recommendation
- The decision to recommend a hepatitis B booster in a 65-year-old woman with low hepatitis B surface antibody (HBsAb) levels depends on various factors, including her immune status and vaccination history.
- According to a study published in 2016 2, there is no need for regular anti-HBs titer testing or booster vaccination in immunocompetent individuals with anti-HBs ≤ 10 IU/L.
- Another study from 2019 3 suggests that sustained immune memory and long-term protection are present 20-30 years after a complete primary HBsAg vaccination course during adulthood, and a booster is not needed in fully vaccinated immunocompetent adults.
- A 2009 study 4 found that protection afforded by primary immunization with plasma-derived hepatitis B vaccine during childhood and adulthood lasts at least 22 years, and booster doses are not needed.
- However, it is essential to note that these studies may not directly address the specific situation of a 65-year-old woman with low HBsAb levels, and individual factors should be considered.
- Other studies, such as those from 2013 5 and 2018 6, provide additional information on hepatitis B vaccination and immune responses, but do not directly address the question of booster recommendations for this specific population.