Hepatitis B Vaccination is Required
This patient lacks immunity to Hepatitis B virus and requires immediate vaccination with the complete 3-dose hepatitis B vaccine series (administered at 0,1, and 6 months), followed by post-vaccination serologic testing 1-2 months after the final dose to confirm protective immunity (anti-HBs ≥10 mIU/mL). 1
Interpretation of Current Serologic Results
Your patient's results indicate no immunity to Hepatitis B:
- Non-reactive HBV core antibody total (anti-HBc): Rules out past or current HBV infection 2
- Non-reactive HBV surface antibody (anti-HBs): Confirms absence of immunity from either vaccination or natural infection 3, 1
This serologic pattern (HBsAg negative, anti-HBc negative, anti-HBs negative) definitively indicates no infection and no immunity 2, 4. The patient is susceptible to HBV infection and requires vaccination 2, 3.
Vaccination Protocol
Standard Vaccination Schedule
- Administer the 3-dose hepatitis B vaccine series at 0,1, and 6 months 1
- This regimen induces protective antibody response (anti-HBs ≥10 mIU/mL) in >90% of healthy immunocompetent recipients 1
Post-Vaccination Testing is Mandatory
Test anti-HBs levels 1-2 months after completing the final vaccine dose to document immunity 1, 5. This is critical because:
- 5-32% of vaccinated individuals fail to develop protective immunity 6
- Without post-vaccination testing, you cannot confirm the patient achieved protection 6, 5
- The protective threshold is anti-HBs ≥10 mIU/mL 1
Management of Non-Responders
If post-vaccination anti-HBs is <10 mIU/mL:
- Administer a complete second 3-dose vaccine series 1
- Retest anti-HBs 1-2 months after the final dose of the repeat series 1
- 44-100% of initial non-responders achieve protective levels after revaccination 1
Long-Term Protection Considerations
Once the patient achieves anti-HBs ≥10 mIU/mL:
- Immunocompetent individuals maintain lifelong protection through immune memory, even when antibody levels subsequently decline below 10 mIU/mL 1
- No routine booster doses or periodic anti-HBs monitoring are needed for immunocompetent persons 1
- Protection persists for at least 30 years and likely for life 1
Critical Pitfalls to Avoid
Do not assume immunity without documented serologic testing. A study of healthcare workers found that 29% who were previously vaccinated showed no serologic evidence of immunity when tested years later 6. Without post-vaccination testing, you cannot distinguish true responders from non-responders.
Do not delay vaccination while awaiting additional testing. The patient's current results are sufficient to proceed with vaccination immediately 2, 3.