From the Guidelines
The pattern of hepatitis B core antibody negative, surface antibody positive, and surface antigen negative indicates successful vaccination against hepatitis B virus, and no further action is needed regarding hepatitis B, as you have protective immunity. This serological profile is consistent with the expected outcome after completing the hepatitis B vaccine series, as indicated in the guidelines from 1. The hepatitis B surface antibody (anti-HBs) positivity, in the absence of hepatitis B core antibody, suggests that the immunity was acquired through vaccination rather than from a past infection. According to 1, the presence of anti-HBs is generally indicative of immunity to HBV infection, and this immunity is typically long-lasting.
The interpretation of serologic test results for HBV infection, as outlined in 1, confirms that a negative HBsAg and positive anti-HBs result indicates immunity to HBV, either from vaccination or past infection. However, the absence of hepatitis B core antibody in this case points towards vaccination as the source of immunity. The negative hepatitis B surface antigen (HBsAg) confirms you don't have an active hepatitis B infection, which is a critical aspect of determining the infectious status of an individual.
Key points to consider include:
- The hepatitis B vaccine series is designed to stimulate the production of anti-HBs, which provides protection against future exposure to the virus.
- Routine booster doses are not recommended for immunocompetent individuals who have demonstrated an adequate immune response to the initial vaccine series, as stated in 1 and reinforced by 1.
- The vaccine's efficacy and the duration of immunity have been well-documented, with approximately 30%–55% of individuals acquiring a protective antibody response after the first vaccine dose, 75% after the second, and >90% after the third, according to 1.
- The guidelines from 1 also emphasize that periodic testing to determine antibody levels after routine vaccination in immunocompetent persons is not necessary, further supporting the notion that once immunity is established, it is generally long-lasting.
In conclusion, based on the most recent and highest quality evidence from 1, the individual in question has protective immunity against hepatitis B virus and does not require any further action regarding hepatitis B vaccination or screening.
From the Research
Hepatitis B Serology Interpretation
The given serology results show Hepatitis B core antibody (anti-HBc) negative, Hepatitis B surface antibody (anti-HBs) positive, and Hepatitis B surface antigen (HBsAg) negative. This profile can be interpreted as follows:
- The presence of anti-HBs indicates immunity to Hepatitis B virus (HBV), which can be due to past infection or vaccination 2, 3, 4.
- The absence of anti-HBc suggests that the individual has not been infected with HBV in the past, or the infection was cleared without the development of anti-HBc 5, 6.
- The negative HBsAg result indicates that the individual is not currently infected with HBV 2, 5, 6.
Protection Against HBV Infection
The presence of anti-HBs is considered protective against HBV infection:
- A study published in Transplantation found that the presence of anti-HBs in addition to anti-HBc confers protection against HBV infection in HBsAg-negative patients undergoing kidney transplantation 2.
- Another study published in the Journal of viral hepatitis found that the presence of anti-HBs shows a trend towards delayed reactivation of HBV and may protect against clinical reactivation related to direct-acting antiviral therapy for hepatitis C 3.
- A review article in Human vaccines & immunotherapeutics highlighted the significance of anti-HBs in infection and clearance of HBV, and discussed the potential of neutralizing antibodies and therapeutic vaccines as promising future strategies 4.
Clinical Implications
The given serology results have important clinical implications:
- The individual is considered immune to HBV and is not at risk of infection 2, 3, 4.
- However, it is essential to note that atypical serological profiles can occur, and the detection of HBsAg, anti-HBc, and anti-HBs may not always occur in the bloodstream 5, 6.
- Healthcare professionals should be aware of the complex and varied nature of hepatitis B serological profiles and consider the patient's clinical history and epidemiological antecedents when interpreting serology results 6.