Should the Hepatitis B (HBV) vaccination be repeated?

Should Hepatitis B Vaccination Be Repeated?

Persons who have completed a hepatitis B vaccination series should NOT routinely receive additional vaccination, as immunocompetent individuals maintain long-term protection even after antibody levels decline. 1

General Rule for Immunocompetent Individuals

• Revaccination (booster doses) is NOT generally recommended for persons with normal immune status who completed the primary vaccine series at any age. 1
• Immunocompetent persons who achieved anti-HBs ≥10 mIU/mL after the primary series have long-term protection and do not need further periodic testing or booster doses. 1
• There is no evidence that receiving additional vaccine doses is harmful, but it is unnecessary for most people. 1

Specific Populations Requiring Revaccination

1. Initial Non-Responders (Anti-HBs <10 mIU/mL After Primary Series)

If postvaccination testing shows anti-HBs <10 mIU/mL, revaccination is indicated:

• Administer a complete second 3-dose series on an appropriate schedule. 1
• Test anti-HBs 1-2 months after the final dose of the second series. 1
• Among initial non-responders, 60-97% will achieve protective levels (≥10 mIU/mL) after a booster dose. 2
• If anti-HBs remains <10 mIU/mL after 6 total doses, test for HBsAg to rule out chronic infection. 1
• Persons who test negative for HBsAg after complete revaccination should be counseled about precautions and need for HBIG prophylaxis after known exposures. 1

2. Healthcare Personnel (HCP)

HCP with documented complete vaccination but anti-HBs <10 mIU/mL require revaccination:

• Give one additional standard dose of HepB vaccine (10 μg Recombivax HB or 20 μg Engerix-B). 2
• Test anti-HBs 1-2 months after the booster dose. 1
• If anti-HBs remains <10 mIU/mL, complete a second full series (6 doses total), followed by repeat testing 1-2 months after the final dose. 1
• Testing HCP upon hire or matriculation helps ensure protection before potential exposures. 1

3. Hemodialysis Patients

Annual monitoring and booster dosing is required:

• Assess need for booster doses by annual anti-HBs testing. 1
• Administer a booster dose when anti-HBs levels decline to <10 mIU/mL. 1
• Use higher booster doses: 40 μg (either two 20 μg doses of Engerix-B or two 10 μg doses of Recombivax HB given at different sites). 2
• Do NOT test anti-HBs after the booster dose. 1

4. Other Immunocompromised Persons

Consider annual testing and boosters for ongoing risk:

• For HIV-infected persons, hematopoietic stem-cell transplant recipients, and persons receiving chemotherapy, the need for booster doses has not been definitively determined. 1
• Consider annual anti-HBs testing and booster doses for those with ongoing risk for exposure. 1
• Consider high-dose boosters (40 μg/dose for adults) in these populations. 2

5. Infants Born to HBsAg-Positive Mothers

Special revaccination protocol applies:

• If anti-HBs <10 mIU/mL after the primary series, revaccinate with a single dose and retest 1-2 months later. 1
• If anti-HBs remains <10 mIU/mL after single dose, give two additional doses to complete a second series, followed by testing 1-2 months later. 1

6. Sex Partners of HBsAg-Positive Persons

• Postvaccination testing is recommended to determine need for revaccination and other protective methods. 1
• If anti-HBs <10 mIU/mL, follow revaccination protocol for non-responders. 1

Who Should Receive Postvaccination Testing?

Testing 1-2 months after completing the primary series is recommended for: 1

• Infants born to HBsAg-positive or HBsAg-unknown mothers
• Healthcare personnel and public safety workers
• Hemodialysis patients and predialysis patients
• HIV-infected persons
• Other immunocompromised persons (stem-cell transplant recipients, chemotherapy patients)
• Sex partners of HBsAg-positive persons

Common Pitfalls to Avoid

• Do not routinely revaccinate immunocompetent persons who completed the series, even if antibody levels have declined—they retain immune memory. 1
• Only accept dated records as evidence of vaccination—do not rely on patient recall alone. 1
• Research shows that repeated vaccinations in true non-responders (after 6 doses) do not improve immune response, so focus on counseling and post-exposure prophylaxis instead. 3
• Most persons (88%) maintain immune memory even 30 years after vaccination, responding to challenge doses. 2