Hepatitis B Immunity Interpretation
Yes, this patient has immunity to hepatitis B from prior vaccination. The serologic pattern of non-reactive hepatitis B core antibody total with reactive hepatitis B surface antibody definitively indicates vaccine-derived immunity, not natural infection, and this patient is protected against HBV infection. 1
Understanding the Serologic Pattern
A reactive (positive) hepatitis B surface antibody (anti-HBs) with a non-reactive (negative) hepatitis B core antibody (anti-HBc) is the hallmark of successful vaccination, distinguishing vaccine-derived immunity from immunity acquired through natural infection. 1
The CDC defines protective immunity as anti-HBs ≥10 mIU/mL, which provides >90% protection against both acute hepatitis B disease and chronic HBV infection in immunocompetent individuals. 2
This specific combination (HBsAg negative, anti-HBc negative, anti-HBs positive) confirms the patient has never been infected with HBV and acquired immunity solely through vaccination. 1
Clinical Implications for This Patient
The patient is fully protected against HBV infection and does not require vaccination or booster doses (assuming they are immunocompetent). 1
The patient is not infectious and cannot transmit HBV to others. 1
No further routine testing or monitoring is needed for immunocompetent individuals with documented vaccine-derived immunity, as protection persists for 30 years or more and likely for life, even when antibody levels eventually decline. 2
Contrast with Natural Infection
If the patient had immunity from past natural infection (rather than vaccination), the serologic pattern would show both anti-HBs positive AND anti-HBc positive, indicating resolved infection with natural immunity. 3, 1
The absence of anti-HBc in this patient definitively rules out any past or current HBV infection. 1
Long-Term Protection Considerations
Immunocompetent persons who achieve protective anti-HBs levels after vaccination maintain lifelong protection through immune memory (B and T lymphocyte memory cells), even when antibody levels subsequently decline below 10 mIU/mL. 2
Among vaccinated individuals, 15-50% will have anti-HBs levels decline to <10 mIU/mL within 5-15 years, yet they remain protected against clinically significant infection through immune memory. 2
88% of vaccinated individuals mount an anamnestic response when given a challenge dose 30 years after initial vaccination, demonstrating persistent immune memory. 2
Special Populations Requiring Different Management
If this patient were to require significant immunosuppressive therapy in the future (such as chemotherapy, anti-CD20 monoclonal antibodies, or transplantation), they would remain protected against HBV reactivation due to the absence of anti-HBc, as there is no latent virus to reactivate. 1
For immunocompromised patients (hemodialysis patients, HIV-infected persons, hematopoietic stem-cell transplant recipients), annual anti-HBs testing with booster doses when levels fall <10 mIU/mL is recommended, but this does not apply to immunocompetent individuals. 2
Dialysis patients with vaccine-derived immunity require annual screening with anti-HBs to monitor for potential loss of immunity. 3
Common Pitfalls to Avoid
Do not confuse this pattern with "isolated anti-HBc positive" (anti-HBc positive with anti-HBs negative), which carries significant HBV reactivation risk (3% to 45%) with immunosuppressive therapy, particularly with rituximab-based regimens. 4
Do not order unnecessary booster vaccinations in immunocompetent individuals with documented vaccine-derived immunity, as routine booster doses are not recommended. 1
Recognize that passively acquired anti-HBs (such as after hepatitis B immune globulin administration or intravenous immunoglobulin) can produce false interpretation of immune status and can be detected for 4-6 months, though this is unlikely in the absence of recent exposure to these products. 2