Hepatitis B

Hep B Vaccinations for Healthcare workers and students

(PicMed offers both the Hepatitis B vaccines as well as Titers to provide proof of immunity)

Which workers in the healthcare setting need hepatitis B vaccine?

 The Occupational Safety and Health Administration (OSHA) requires that hepatitis B vaccine be offered to healthcare workers (HCWs) who have a reasonable expectation of being exposed to blood on the job. This requirement does not include HCWs who would not be expected to have occupational risk, such as receptionists, billing staff, and general office workers.

 If a HCW had one dose only of hepatitis B vaccine 4 months ago, should the series be restarted?

 No. The hepatitis B vaccine series should not be restarted when doses are delayed; rather, the series should be continued from where it stopped. The HCW should receive the second dose of vaccine now and the third dose at least 8 weeks later. There needs to be at least 16 weeks between the first and the third doses and at least 8 weeks between the second and third doses of vaccine.

 Is it safe for HCWs to be vaccinated during pregnancy?

 Yes. Limited data indicate no apparent risk for adverse events to developing fetuses. Current hepatitis B vaccines contain noninfectious hepatitis B surface antigen (HBsAg) and should pose no risk to the fetus. If the mother is being vaccinated because she is at risk for hepatitis B virus (HBV) infection (e.g., a HCW, a person with a sexually transmitted disease, an injection drug user, multiple sex partners), vaccination should be initiated as soon as her risk factor is identified during the pregnancy. If not vaccinated, a pregnant woman may contract an HBV infection, which might result in severe disease for the mother and chronic infection for the newborn. In addition, giving hepatitis B vaccine to the mother is not a contraindication to breastfeeding.

 Which HCWs need serologic testing after receiving 3 doses of hepatitis B vaccine?

 All HCWs who have a reasonable risk of exposure to blood or body fluids containing blood (e.g., HCWs with direct patient contact, HCWs who have the risk of needlestick or sharps injury, laboratory workers who draw or test blood) should have postvaccination testing for antibody to hepatitis B surface antigen (anti-HBs). Postvaccination testing should be done 1-2 months after the last dose of vaccine.

 What should be done if a HCW’s postvaccination anti-HBs test is negative 1-2 months after the last dose of vaccine?

 Repeat the 3-dose series and test for anti-HBs 1-2 months after the last dose of vaccine. If the HCW is still negative after a second vaccine series, the HCW is considered a non-responder to hepatitis B vaccination. HCWs who do not respond to vaccination should be tested for HBsAg to determine if they have chronic HBV infection. If the HBsAg test is positive, the person should receive appropriate counseling and medical management. Persons who test negative for HBsAg should be considered susceptible to HBV infection and should be counseled about precautions to prevent HBV infection and the need to obtain hepatitis B immune globulin (HBIG) prophylaxis for any known or likely exposure to HBsAg-positive blood.

How often should I test HCWs after they’ve received the hepatitis B vaccine series to make sure they’re protected?

For immune competent HCWs, periodic testing or periodic boosting is not needed. Postvaccination testing (anti-HBs) should be done 1-2 months after the last dose of hepatitis B vaccine. If adequate anti-HBs (at least 10 mIU/mL) is present, nothing more needs to be done. If postvaccination testing is less than 10 mIU/mL, the vaccine series should be repeated and anti-HBs testing done, 1-2 months after the last dose of the second series. This information should be recorded in the HCW’s employee health record.

 Should a HCW who performs invasive procedures and who once had a positive anti-HBs result be revaccinated if the anti-HBs titer is rechecked and is less than 10 mIU/mL?

No. Immune competent persons known to have responded to hepatitis B vaccination do not require additional passive or active immunization. Postvaccination testing should be done 1-2 months after the original vaccine series is completed. In this scenario, the initial postvaccination testing showed that the HCW was protected. Substantial evidence suggests that adults who respond to hepatitis B vaccination (anti-HBs of at least 10 mIU/mL) are protected from chronic HBV infection for as long as 23 years, even if there is no detectable anti-HBs currently. Only immunocompromised persons (e.g., hemodialysis patients, some HIV-positive persons) need to have anti-HBs testing and booster doses of vaccine to maintain their protective anti-HBs concentrations of at least 10 mIU/mL.

 Before reading the recommendations of CDC’s Advisory Committee on Immunization Practices (ACIP) that say not to do this, we tested our employees for anti-HBs several years after they were vaccinated and some people had inadequate results, even though they had all completed a 3-dose series. What should we do now?

 ACIP does not recommend periodic testing of immunized HCWs because anti-HBs concentrations decline over time, and HCWs remain protected even if their anti-HBs concentration declines to below 10 mIU/mL. For HCWs who have been vaccinated in the past and who do not have a documented response to vaccination of at least 10 mIU/mL, ACIP recommends testing for anti-HBs at the time of an exposure and providing appropriate management based on the results of testing. (See postexposure guidelines in Table 3.) If cost is not a great concern or if an employee or employer wants documented assurance of immunity, a revaccination series can be undertaken followed by testing 1-2 months after the 3rd dose of hepatitis B vaccine.

Hepatitis B 

 Vaccine issues

For how long is hepatitis B vaccine protective?

Studies indicate that immunologic memory remains intact for at least 23 years and confers protection against clinical illness and chronic HBV infection, even though anti-HBs levels might become low or decline below detectable levels. 

Is hepatitis B vaccine safe? 

Yes. Hepatitis B vaccines have been demonstrated to be safe when administered to infants, children, adolescents, and adults. Since 1982, an estimated 70 million adolescents and adults and 50 million infants and children in the United States have received at least one dose of hepatitis B vaccine; a billion doses of hepatitis B vaccine have been given worldwide. Vaccination causes a sore arm occasionally, but serious reactions are very rare.