Does This Patient Have Hepatitis B Immunity?
No, this patient does not have immunity to hepatitis B. A non-reactive hepatitis B surface antibody (anti-HBs) means there is no protective immunity, regardless of the negative surface antigen and absence of infection evidence.
Understanding the Serologic Pattern
This patient's results indicate:
- HBsAg non-reactive = No current infection 1
- Anti-HBs non-reactive = No protective immunity 2
- No evidence of HBV infection = Never infected 3
This serologic pattern (HBsAg negative, anti-HBs negative, presumed anti-HBc negative) definitively indicates a person who is susceptible to HBV infection and has never been vaccinated or never responded to vaccination 1, 2, 3.
What Defines Protective Immunity
Protective immunity requires anti-HBs ≥10 mIU/mL measured by quantitative assay 2. This threshold provides >90% protection against both acute hepatitis B disease and chronic HBV infection in immunocompetent individuals 2. Without detectable anti-HBs, there is no serologic evidence of immunity from either vaccination or prior resolved infection 1, 2.
Clinical Implications and Recommendations
This patient should be vaccinated against hepatitis B immediately 1. The recommended approach is:
- Administer a complete 3-dose vaccine series at 0,1, and 6 months (standard adult dose: 20 μg Engerix-B or 10 μg Recombivax HB) 2
- Test anti-HBs levels 1-2 months after completing the series to document protective immunity 2
- If anti-HBs remains <10 mIU/mL after the first series, administer a complete second 3-dose series 2
- Retest 1-2 months after the second series to confirm response 2
Critical Distinction: Susceptible vs. Immune Patients
According to dialysis unit screening guidelines, patients are categorized as 1:
- Susceptible to HBV infection: Negative HBsAg AND negative anti-HBs (this patient's status) 1
- Immune from prior vaccination: Anti-HBs >10 IU/mL 1
- Immune from prior infection: Anti-HBs >10 IU/mL AND anti-HBc positive 1
Susceptible patients require monthly HBsAg screening in high-risk settings and should receive hepatitis B vaccination 1.
Important Caveats
Do not confuse "no evidence of infection" with immunity 3. These are distinct concepts—absence of infection simply means the person has never been exposed to HBV, while immunity requires documented anti-HBs ≥10 mIU/mL indicating protection against future infection 2, 3.
Isolated anti-HBs positivity (without anti-HBc) indicates vaccine-derived immunity, not natural immunity from resolved infection 3. Since this patient has non-reactive anti-HBs, they have neither vaccine-derived nor natural immunity 2, 3.
After successful vaccination, immunocompetent individuals maintain lifelong protection through immune memory even when antibody levels subsequently decline below 10 mIU/mL 2. However, this protection only applies to those who initially achieved anti-HBs ≥10 mIU/mL after vaccination—not to those who never developed antibodies 2.