Vaccine Non-Responders
A hepatitis B vaccine “non-responder" refers to a person who does not develop protective surface antibodies after completing two full series of the hepatitis B vaccine and for whom an acute or chronic hepatitis B infection has been ruled out.
Although the majority of persons vaccinated against hepatitis B successfully respond to vaccination, an estimated 5-15% of persons may not respond due to older age, obesity, smoking, and other chronic illness.
It is also possible that a person who does not respond to the vaccine may already be infected with hepatitis B. Therefore, testing for the presence of the hepatitis B virus (hepatitis B surface antigen or HBsAg) is recommended before diagnosing a person as a "vaccine non-responder."
CDC Recommendations for Hepatitis B Vaccine Non-Responders
- Persons who do not respond to the primary hepatitis B vaccine series (i.e., anti-HBs <10 mIU/mL) should complete a second vaccine series or be evaluated to determine if they are HBsAg-positive. For the second series, a different brand of vaccine should be administered. For adults in the U.S., the second series can be given using a 3-dose vaccine or the 2-dose vaccine.
- Persons who do not respond to an initial vaccine series have a 30%--50% chance of responding to a second series. Newer vaccines might provide greater seroprotection, which can mean a greater antibody response, especially in adults who may be older, obese or live with type 2 diabetes. If you have not responded to a primary hepatitis B vaccine series, talk to your doctor about whether the Heplislav-B (2-dose) or PreHevbrio (3-dose) vaccine is a better option for you.
- Revaccinated persons should be retested to check antibody response at the completion of the second vaccine series, 1-2 months following the last dose of the series.
- Persons exposed to HBsAg-positive blood or body fluids who are known not to have responded to a primary vaccine series should receive a single dose of hepatitis B immunoglobulin (HBIG) and restart the hepatitis B vaccine series with the first dose of the hepatitis B vaccine as soon as possible after exposure. Alternatively, they should receive two doses of HBIG, one dose as soon as possible after exposure, and the second dose 1 month later.
- The option of administering one dose of HBIG and restarting the vaccine series is preferred for non-responders who did not complete a second 3-dose vaccine series. For persons who previously completed a second vaccine series but failed to respond, two doses of HBIG are preferred.
Hepatitis B vaccine “non-responders” who test negative for hepatitis B infection are at risk for being infected and should be counseled regarding how to prevent a hepatitis B infection and to seek immediate medical care to receive a dose of hepatitis B immunoglobulin (HBIG) if they have been exposed to potentially infected blood.
Hepatitis B vaccine “non-responders" to vaccination who test positive for hepatitis B infection should be counseled regarding how to prevent transmitting the hepatitis B virus to others and the need for regular medical care and monitoring for their chronic infection.
References
Schillie S, Harris A, Link-Gelles R, Romero J, Ward J, Nelson N. Recommendations of the Advisory Committee on Immunization Practices for Use of a Hepatitis B Vaccine with a Novel Adjuvant. MMWR Morb Mortal Wkly Rep. 2018;67(15):455-458.
Immunization Action Coalition. Ask the Experts: Hepatitis B. https://www.immunize.org/askexperts/experts_hepb.asp