Options for HBV Vaccine Non-Responders



Are you a hepatitis B vaccine non-responder? Approximately 5-15% of people who receive the vaccine are considered non-responders. This is especially important for health care workers, families living in households with people that have HBV, and others who may be at increased risk of exposure to HBV.  A vaccine non-responder is someone that does not build up an adequate immune response after receiving two, 3-shot series of the HBV vaccine.  In other words, they complete one series of the HBV vaccine, and follow it with a surface antibody test (HBsAb or Anti-HBs) 4-6 weeks following the last injection of the series.  If the anti-HBs titre is not greater than 10IU/l, than the series is repeated, preferably with an HBV vaccine from a different manufacturer, and the person is once again tested for immunity by testing for adequate anti-HBs. (See previous blog, “Got Hepatitis B? Keeping loved ones safe though HBV vaccination” for details)

Fortunately there are other options for those concerned with being an HBV vaccine non-responder. There is a higher concentration of the HBV vaccine recommended by the CDC that is used for patients undergoing dialysis, and for those that are immune suppressed.  It is a 40µg/ml concentration. If it has been one year or less since you completed the three-shot series of the regular concentration of the vaccine, you can try one intramuscular dose of 1.0 ml of the 40µg HBV vaccine.  If it has been more than one year since your last three shot series of the vaccine, you can repeat the entire three-shot series with the 40µg concentration of the vaccine.  Follow up with an anti-HBs titre test 4 to 6 weeks following the last injection to ensure it is greater than 10 IU/l, and that you have adequate immunity.

If you continue to remain a non-responder, you can try a series of as many as five intra-dermal injections, given every two weeks, using the 40µg concentration of the HBV vaccine.  Dose one consists of 0.10 ml of the 40µg/ml vaccine, followed by the same dose two 2-weeks later.  At that time an anti-HBs titre test would be drawn to check for immunity.  If there was not adequate immunity, a third-intra-dermal dose of the vaccine would be given two weeks later.  Anti-HBs titres would be checked every two weeks and the patient would be given another intra-dermal injection up to a total of 5 intradermal injections of the 40µg concentration of the HBV vaccine. Don’t forget to ensure that your anti-HBs titre is greater than 10IU/l.

Please note that the schedule for the series might vary depending on the study your doctor chooses to follow.  However, it is recommended that the higher concentration (40µg) of the hepatitis B vaccine be used for best results.

104 Responses to Options for HBV Vaccine Non-Responders

  1. My 20 year old daughter is a Phlebotomist. She was told she was a non- responder when she was tested, vaccinated for her first job at a hospital. Her origional vaccinations as a child were done on scedule with no apparent problems. Her family physician referred her to a Hemotologist, who referred her to a Infectious disease Dr, who referred her to. Gasterologist, who only deals with patience with Hepatitis. Who would we contact about information on how to protect her and get more information for non- responders and the new intermuscular vaccine?

    • This blog was written with direct input from our senior medical adviser on the described protocol for HBV vaccine non-responders. I assume that she has gone through two rounds of the vaccine without success and has been tested to be sure she does not have a current or even an occult HBV infection. Did she try the higher dose of the 40µg/ml concentration vaccine? If she continues to be a non-responder, she can try the 40µg/ml concentration of the vaccine for the intra-dermal vaccine. I would take a copy of this blog to your doctor. If he is unsure, he or you can contact the Hepatitis B Foundation at http://hepb.convio.net/site/PageServer?pagename=contactus, or from the contact button at the top of our website at http://www.hepb.org. . Thank you!

  2. Yes she wen’t through the two rounds without success and is testing cleared, with no signs of HBV. I will bring her Dr a copy, she has not heard of any stronger vaccine. Thank you so much for your rapid and helpful response!

  3. I work in healthcare and was glad to read this. I just finished my second series of Hep B vaccinations 6 weeks ago, and had my blood drawn today to check for titers. If I still come back negative, I know I need further work-up and want to know what options I have. Thank you!

  4. Laura M. Greenfield

    I’m also work in healthcare, and I’m glad I found this site! I originally had the 3 doses back in 2005 (3/05-9/05).

    Today I found out that my HepBsAG was negative.

    I looked back in my records and in 11/05 my antibody test showed me at 1420mIU/mL.

    My question is, why/how am I now considered not immune?

    • I think you mean your anti-HBs or HBsAb is negative and not your HBsAg. It looks like you had an anti-HBs test 1-2 months following the last shot of the series and clearly built up and adequate immune response with a titre of 1420! Over time the immune response may wane and the titre may drop below 10, which is considered an adequate response … when checked 1-3 months following the last shot of the series. If you initially generated an adequate response, which you did, then your immune memory will kick in should you be exposed to HBV, thereby once again generating an immune response and protecting you. Hope that makes sense. It’s all about immune memory.

  5. I am a NR with a negative antigen titer for Hep. B. had three series of the vaccine in a timely fashion with the original live (attenuated) virus. That’s three times full series remain NR. Heavily exposed to variety of viral hepatitis patients and have been since I was a kid, now seventy years old.

    Yes, I could go to a higher 40 units but suspect that won’t change my titer. Suspect a gene preventing my conversion to a responder? Yes, I beleive my ancestry came from Eyam, England.

    Why the exposure, a general surgeon and work in County Hospital Micro/lab. Ten years.
    What do you say.

    • Dr. Thomas London, VP of the HBF board and a member of the board of medical and scientific advisors, says that you may be correct that you are a genetic non-responder, but there is no available information on what the gene or genes might be. Nevertheless, Dr. London recommends that you try the intradermal injection route. Specifically, 1.0 ml of the concentrated vaccine for dialysis patients is given with a tuberculin syringe into the skin. Injections are given every 2 weeks with an antibody test done before the next injection. If you do not respond after 6 injections, then you really are a non-responder. And of course you should take all precautions to avoid exposure -,gown and mask whenever you might be exposed to a patient’s blood.

  6. .ano pong gwin k.ngpositve po ako s hepa-b?

    • Ako ng paumanhin.Ko bang ilagay ang iyong tanong sa google translate, ngunit Hindi ako sigurado kung ano ang ikaw ay humihingi.

  7. toothfairy 1968

    Been offered my dream job after 5 years of trying to gain entrance …
    Ambulance technician. I am HepB non responder will this effect my occupational health review?
    Help … I am really panicing . I work in healthcare at the moment as Health care support worker and previously as dental nurse.

    • Have you been tested to confirm that you do not have HBV? If you have HBV you will not generate an immune response to the vaccine. If you know you are not HBV+, have you gone through the process described in the blog: “Options for vaccine non-responders”? The higher dose vaccine will hopefully permit you to generate immunity. However, there is a low percentage of the population that are vaccine non-responders. I do not know the requirements of the job. Perhaps you can sign a waiver for the vaccine?

  8. nice article.. Thanks for sharing

  9. I’m one of the non responder after getting 2 sets heb B of vaccination. I am considering to get the double dose concentration but I want to know what is the success rate after getting the 40 mcg vaccine that non responder will become immune?

    • I’m afraid I don’t have specific study data. If you feel especially at risk or need to show a generated titre for work or school, then I would certainly consider it. Keep in mind you can also avoid transmission of HBV by taking basic precautions, which includes avoiding direct contact with any blood or body fluid by maintaining a barrier. For example, keep any open cuts covered, and practice safe sex with a latex condom. Always avoid sharing personal items such as razors, toothbrushes, clippers, earrings, piercings, or anything that could have trace amounts of blood on it. Be sure to clean all spilled blood or body fluids with a fresh diluted bleach solution. Take care with piercings and tattoos and be sure all items are single use. Never share drug paraphernalia. These are basic precautions that should be taken to prevent the transmission of other blood borne pathogens for which there are no vaccines available.

  10. Hi, I’ve just found discovered I am a non-responder. I am leaving for a 2 month trip of lifetime to Africa in ten days – my doctor has recommended HepB immunisation before I go. I can delay the start of this trip by a couple of weeks as a worst case scenario, but I would prefer to leave as soon as possible. What are my options?

    • A person is considered a nonresponder if you have gone through 2 complete vaccination series. Here are a couple of options: Note the higher concentration dose of the virus noted in the blog “Options for HBV Vaccine Non-Responders” . There is an accelerated travel vaccine schedule given at day 0, Day 7, Day 21 and month 12. Talk to your doctor about trying the first 3 shots of this series with the higher dose concentration. If you do not generate immunity, then talk to your doctor about getting a shot of HBIG right before you leave for your trip.

  11. Had needle-pricked with hepaB positive patient and i just had my hepaB vaccine after 3weeks.Is it effective?i’m very worried maybe i got infected..

    • Did you receive all 3 shots of the series? If you are in health care, they often run an anti-HBs titre 1-2 months following the last shot of the HBV vaccine series to ensure the person has generated an adequate titre and is protected. You can ask and see if you had this test. If you had it and know you are protected, then you are all set. If you are unsure, or did not complete the series, then I would get a booster shot of the vaccine. Regardless, I would still ask your doctor for a hepatitis B panel just to be sure. Be sure to wait 4-6 weeks following your exposure.

  12. Respected Sir,
    I am working as a nurse in theatre they checked titre for all staff all of them having above 10iu but in different ranges,for me 200 some ofthem above1000iu,others with 54,110etc sir most of them didn’t take booster dose can u clear my doubt when we should repeat another dose if range is below…..please reply it early as possible
    thanku verymuch.

    • Since all of your staff have anti-HBs titres above 10 IU/mL, this means they have generated adequate immunity and are protected against getting HBV for at least 25 years, which is the current length of on-going studies. Often titres will wane, but that doesn’t mean someone isn’t protected. If they were exposed, they would mount a fight against an infection. THis is assuming they generated immunity as a result of the vaccine series, since there are non-responders to all vaccines. Typically people do not have their titres checked 1-2 months following the vaccine series. It’s not required, but if you are at-risk, it’s certainly worthwhile. People may worry years later and then have their titres checked. At that point, the titres could wane and you wouldn’t know if they initially generated adequate immunity or if the titres just waned. If the titres waned and they did not show adequate immunity (<10IU/mL) then, they would need a booster and they could have titre's checked 1-2 months following the booster. The variations of titres merely reflects each person's unique immune response to the vaccine series. Hope that clarifies it a bit.

  13. my 7 year old’s titres came back low for hep B and the doctor recommended starting the series again. He was given his first dose yesterday. Are more doses necessary? I am a bit surprised that his titres were tested for hep B in the fist place as he is a healthy child and also we ( his parents) have been vaccinated. Please advise if only the first dose is enough. Thanks!

    • According to the CDC, a booster dose should be sufficient. However, should you choose to confirm immunity, you can have him get his titres checked 1-2 months following the booster shot.

  14. Thanks for the info!

  15. Ive been diagnosed with hepa B but my mother told me id been vaccinated completely with booster and yet my hbsag becomes reactive, anti hbs non reactive, hbe eag 13.33 reactive and hbe ag non reactive… what does this means

    • You currently have a hepatitis B infection. Most likely you were already infected before you were vaccinated. The vaccine is not effective if a person is already infected with HBV. Please talk to your doctor to learn more about your HBV and liver health.

  16. I had one set of the 3 vaccine shot and came back non-reactive . dose that mean that I have hep-b

    • You mean you did not generate adequate immunity? – anti-HBs less than 10 IU/mL? Some people are non-responders to the HBV vaccine (this is considered after 2 failed attempts to generate immunity after 2 complete HBV vaccine series), but if you believe you may have hepatitis B, then ask your doctor to run a hepatitis B panel to see if you have an HBV infection.

  17. If some one is HBSAg positive, but HBeAg, HBcAg, HBeAb, HBcAb are both negative, please what does that mean?

    • Little confusion here with your question and test results. Usually when someone is HBeAg neg/pos the other HBeAb is the opposite, unless they are in the middle of seroconversion. This is certainly possible, so you would want to retest in a few months to see if you are successful in seroconverting. HBcAg is only positive on biopsy rather than serology, so that would be normal. Most people that test HBsAg positive are nearly always also HBcAb positive. Once again, retest to be sure there is no false positive or to confirm results. ultimately the answer answer here is – rested with a reliable lab and liver specialist

  18. My fiancée was diagnosed to be hep B positive. I did my test and was declared negative. I have taken the first vaccine shot and am expecting to take the second shot 3 days before we start having unprotected sex.while waiting to take the last shot 6 months from now. Will I be protected by these first two shots

    • After the 2nd shot of the HBV vaccine you are UP TO 80% protected against HBV. There are a few factors involved, but everyone is different and I cannot give you any guarantees. If you like you can get a titer test 1 month following this 2nd vaccine or following the last shot of the series to confirm immunity. I would encourage your fiancé to be patient.

  19. I was told that I’m a healthy he b carrier, can I work as a medical assistance in a hospital?

    • That will depend on what country you live. If you live in the U.S. this should not be a problem. HBV is covered under the Americans with Disabilities Act and the CDC revised guidelines for healthcare students and workers. Let us know if you have a problem. If you live in another country, it’s completely dependent on their policies.

  20. I seem to a non-responder to HBV and other vaccines. I’ve had infections as a child that later tested negative anti-body titers with subsequent vaccinations that years later also show negative anti-body titers. Rubella, Varicella, Mumps….I was vaccinated with HBV in 2003 with a postive ab response and negative ag response (can’t get measurement from hospital) but just had titer checks that show non-reactive for ab or ag. I am an ER nurse and am not thrilled about the prospect of going through a series of a potential 6 vaccinations with HBV only to continue to be a non-resonder since I have a poor track record with vaccines. I’ve obviously been exposed through the years to many of these infections several times due to my work and raising 2 children. Can I make a decent supposition that I have “immune memory” and with proper protective equipment and following protocol continue in a safe manner as an ER nurse without more vaccinations? Or could this kind of history indicate “genetic non-responder” Currently hospitals are requiring several vaccines for employment and termination if not completed unless there are medical contraindications. Can someone give me a well versed opinion? Thank You

    • A person is considered a non responder after 2 complete series of the vaccine followed by an inadequate titer drawn 1-2 months following the last shot of the series. I know you seem to be a non-responder to some vaccines, but unless you had a titer to confirm your immunity 1-2 months following the last shot of the vaccine series, then I would get a booster shot and test 1 month following the booster with an anti-HBs titer test. If you generate immunity then you do not need to repeat the vaccine series even if your titers wane over time. If you truly are a non-responder then you could try vaccinating with a higher concentration of the vaccine. Most hospitals are requesting proof of titers. Regardless, I would think following proper infection control practices would still be adequate since there are not vaccines for all blood borne pathogens such as HIV and HCV. With any luck you can generate immunity, but if not strict following of infection control practices should be adequate. I would not think being a non responder should keep you from working.

  21. Hi I would appreciate if you could answer my question. I am from England and I received the full hep b vaccinations which I received the third vaccination in December 2006. As worked at a hospital at this time in late January 2007 I was checked to see if I responded to the vaccinations and the reading from that blood test was more than 100. I recently requested to be checked to see if I still had immunity from the vaccine and I have been told that I have no immunity. I am upset and concerned by this as it has only been 8 years since I had the vaccination. I thought the protection lasted much longer. I am worried tha

    have come in contact with the virus and not have been protected.

    have come into contt with the virus and not been protected

    I am concerned that


    may have come in contact with the virus and not been protected. Would I need to

    immune and still protected from the vaccine. I was informed that I am not immune. I am concerned that after 8 years I am no longer protected by the vaccination. My fear is that I could have been in contact with the virus and not been protected. I was tested for the virus in 2011 during pregnancy which was negative at that time

    rstill protected from the vaccine. I was informed that I am not immune. I am cocerned by this as when I received the vaccine I was responsive to it but now afte

    • You are protected. If you were to be exposed to HBV, you would generate immunity. It is not unusual for the anti-HBs titers to wane over time. The difference is that many do not have their titers checked after they are vaccinated so they don’t know if they ever generated immunity. That is not the case with you since you know you generated immunity since you had a previous titer of 100+. On going studies show that immunity is good for greater than 25 years assuming immunity was generated as a result of the 3 shot vaccine series.

  22. Hi..

    Recently i have taken blood test
    Anti HBS Shows 4.72IU/L … can anyone help me on that value?
    does it mean that i’m affected by Hepatitis B?

    • The anti-hsb is the antibody to hepatitis B. If you want to be tested for hepatitis B, you want to ask that your HBsAg (surface antigen) is tested. A person is considered immune to hepatitis B if there anti-hbs titer is greater than 10 IU/mL. Were you vaccinated or do you believe you were exposed? if you ask the doctor to run a hepatitis B panel, it tests for 3 things: HBsAg, HBcAb, HBsAb. When read together it tells you if you have a current infection, if you resolved a past HBV infection or if you have immunity to HBV whether it is from a past infection or through vaccination.

  23. Please help me interpret these results:
    HBsAg Screen Positive
    Hep A Ab, Total Negative
    Hep B core Ab, Tot Negative
    Hep B Surface Ab, Qual Reactive

    *by the way I was vaccinated with the Hep B series vaccine as a child.

    • Your results are a bit unusual. Have you also been tested for hepatitis C? Are you being tested as a result of elevated ALT/AST and/or other liver function tests? Please talk to your doctor. Repeat testing and see if the results are the same. Your test indicates that you are positive for hepatitis B, but your core antibody and surface antibody are negative, which is unusual. If you continue to test HBsAg positive, but do not have another infection or problem identified by your doctor and more blood work, then be sure to see a liver specialist to learn more.

      • I was tested for Hep C and it came out negative..I had elevated ALT/AST but when I got retested they were back to normal. I’m very confused and worried. I did have more blood work done and I’m now just waiting for the results.

        • Try not to worry Kay. I think the blood work will reveal more of what is going on. If you continue to have confusion, please be sure you are seen by a hepatologist or GI doctor with experience treating viral hepatitis.

  24. Please help me interpret these results.
    HepBsAg negative
    HepBsAb positive titre 835
    HepBcAb positive

    • You have immunity to hepatitis B and it looks like you got that because you had resolved a previous hepatitis B infection.

  25. Hi my partner is hep b positive, I have had the 3 vaccines and I am none responsive I have had 2 more of the next 3 my last vaccine due in 5 months what are the chances this 2nd treatment will make me immune??

    • Have you been tested to be sure you are not currently HBV positive? Often when a person is a non responder, it is because the have or had an infection. Is the 2nd vaccine series a made by a different manufacturer than the first series? This is recommended. Another option is to ask for a vaccine of a higher concentration, especially since your partner is HBV positive, if you do in fact not respond. I cannot give you any specific statistics, though there is a percentage of the population that does not respond to the vaccine for whatever reason. I would also try the higher concentration if this series does not work. Also consider Hepislav, which will hopefully soon be on the market. Sci-B-Vac is also a good vaccine, but I don’t think it’s available in the U.S.

  26. I have been employed as a medical secretary in a hospital for 15 years. Yesterday when I had my TB test, I was on my way out the door when the secretary handed the nurse a printout of some lab work from 2012, the same year I was diagnosed with breast cancer and went through surgery, chemo, and radiation. He showed me where it said I was nonresponsive to the vaccines I got upon employment. But, he said, since my job & lifestyle doesn’t involve being in contact with blood or blood products, I haven’t traveled out of the country in over 10 years, and I don’t work closely with patients in countries that have a high level of plague and disease, he would consider me low risk and he left it up to me whether I wanted to try a booster. I don’t want a vaccine I don’t need, but I am wondering how safe it is to not have an immunity to Hep B. Your observation and input would be welcome. Thank you.

    • I’m not quite sure what to tell you. it certainly does not sound like you are at risk for HBV with your job as a medical secretary. HBV is not casually transmitted or contagious like TB. Plus the anti-HBs titer test that was likely run in 2012 may not be an accurate reflection of your immunity. I’m not sure when you were vaccinated, but it’s not uncommon for the titer to wane with time. Had you been tested 1-2 months following the last shot of the series, you may have found that you generated adequate immunity. Had you proof of immunity, there would be no question. You would not be to get a booster. However, it sounds like you didn’t. If its a concern for you, you could have a booster shot, followed by an anti-HBs titer test 1-2 months following. If you generate adequate immunity then you are protected despite whether or not your titers wane with time. Let me know if you have other questions.

  27. I am trying to find out the answer to this question. I might be a non responder my surface antibody test is currently less than 10 even though I’ve had the series twice over 10 years ago. I never had the antibody test done right after the series to see if I responded so I’m not sure if I responded or not. Anyway I was dating someone who reveled to me they have hep B. I think my risk of catching it from her is low because we did not do much but what I want to know is if I am a non responder can non responders immune systems fight off the virus on their own or does a non response to the vaccine mean a non responder won’t respond to the real virus either ?

    • A number of variables here. First of course is whether or not you really are a vaccine non-responder. Titers do wane with time, so the timing of the antibody test is very important. Just to be sure, I would get a booster shot of the HBV vaccine and test 1-2 months following the booster shot. Did you have any titer? Also, be sure to look at the definition of a true vaccine non-responder as it is suggested that the person get the second series with a vaccine made by a different manufacturer.

      Don’t know the extent of your contact, but HBV is more likely to be transmitted if there are even trace amounts of blood. Other body fluids do have lower concentrations of the virus. And of course the viral load of the infected person is also to be considered. Take a look at this blog: http://hepbblog.org/2015/02/19/the-50-shades-of-gray-of-hepatitis-b-transmission-part-1/ .

  28. Hello, just got my serology results back and the result was NON-IMMUNE. I have had the infant dose of hepatitis B (3 shots in 1995-6) and follow up of the adult dose of hepatitis B (2 shots in 2007). I was asked to get another dose and then a follow up serology. If i get the dose in a few days time (12th may 2015) when can I get the serology testing done? Im worried as I am going on clinical placement in july-sept and need this sorted asap (serology results must be handed back to my unit coordinator at a deadline – a deadline possibly before this semester ends which is end of june) or I may be missing out on clinical placement experience which will set me back a year behind my university course schedule.

    • Would the 3 doses at infant age and the 2 doses at adult age be considered as 2 complete series? Would that mean I am a non-responder??

      Kind Regards

      • You could try using a different manufacturer of the vaccine. However, 2 complete series would likely be a non-responder. However, keep in mind that titers may wane if you are not checking titers 1-2 months follow a series or booster shot

    • You want to run your anti-HBs titers within 1-2 months following your booster shot. A person is considered a non responder after 2 complete series of the vaccine – preferably using 2 different manufacturers of the vaccine. If you continue to not show immunity, you may wish to be tested for hepatitis B. Sometimes a person may have been infected with HBV prior to the vaccine series or of course a person could be a non responser to the vaccine. I certainly understand your concerns. Follow up as best you can. if not immunity consider noted strategies.

  29. Hi. My daughter 7 years old had first complete course of vaccination when she was born (2008) and it was found last year that she was not immunized. so she had another complete course and finished the last dose on January ( mean she had 6 does all total) and is still not immunized.
    So her Dr prescribed the Twinrix JR to try another manufacture. My husband is Hep B carrier, so I want my daughter to have immunity. But she already tried two complete course. Do you think it has worth to try?

    • I believe you are saying that your daughter is immunized (completed all 3 shots of the series), but does not show immunity at this time? Did you run the anti-HBs titer test 1-2 months following the last shot of the 2nd series? Did you also try the vaccine from both of the FDA approved vaccine manufacturers?

      Has your daughter been tested for hepatitis B? Please consider asking the doctor to run a hepatitis B panel test which is one blood draw, but returns three results: HBsAg, HBcAb and HBsAb. Just want to confirm that she does not have a current hepatitis B infection. I don’t have an issue with trying the TwinRix vaccine, but you may want to first test for HBV. The other option is the vaccine at a higher concentration that is used for patients undergoing hemodialysis. Please discuss with your doctor.

  30. I work at a hospital and I recently have been bitten by a patient that broke my skin. I went for lap drawls and today was my second lab draw I was told that I am a nonresponder to the hep B shot and that I needed a booster which I took today. My concern is I did not know that we should have been tested to find out if we are nonresponders after the shots. Is it possible that I was a responder and no longer am? I took today. My concern is I did not know that we should have been tested to find out if we are nonresponders after the shots. Is it possible that I was a responder and no longer am ? Should I be going through another series of hepatitis B shots? And what should I do after this booster if I’m still in nonresponder? ? Should I be going through another series of hepatitis B shots? And what should I do after this booster if I’m still in nonresponder? Should I be requesting hepatitis B panel? I’m not for sure what steps to take next please guide me I go back in October 2015 to see if the booster worked and if I’m a responder now.

    • Ouch! Hard to say if you are truly a non-responder at this time. Good that you had a booster. Please ask your doctor to check your anti-HBs titer test in 1-2 months. If you completed the hepatitis B series, it is possible that the titers waned over time. Since you likely did not confirm immunity following the vaccine series, it’s impossible to know. Let’s see how the titer looks in a month. If you do not generate an adequate titer then you will want to complete this 2nd series .- preferably with a vaccine from a different manufacturer and then retest the titer 1-2 months following the last shot of the series. you can also try a booster with a higher concentration of the vaccine as noted in this article. Should you decide to get test for HBV (via the hepatitis B panel) then be sure you wait a month until after the vaccine. A test for hepatitis B within a month of vaccination can cause a false positive test result.

  31. I m 26 years old, medical interne, i didnt know i was a NR,i completed my three serie vaccination in 2007, i recently have been working in the surgery department, and i found out I was HBsAg positive, usually we dont treat acute hepatitis B, but since i m a NR i m afraid my body wont respond and build up the immunity, what should i do?

    • Hello: I am sorry to hear of your hepatitis B surface antigen (HBsAg). Before your immunization, were you ever screened for hepatitis B? Is it possible you were infected during childhood, or are you certain you were recently exposed to hepatitis B blood/body fluids? If you were just exposed, usually you are given the first shot of the vaccine and one dose of HBIG (hepatitis B antibodies), if it is available. More information on this is available at:
      If you were already infected with hepatitis B before your immunization, then the vaccine would have had no effect.
      As you may know, there are two types of hepatitis B infection, chronic or long-term and short-term or acute. If you test positive for HBsAg for longer than six months, you are considered chronically infected and probably became infected at birth or during childhood. If you were just recently exposed, over several weeks your body should clear the infection (and clear the HBsAg) and develop surface antibodies (HBsAb).
      If it turns out that a second test in six months shows you are still infected, then it will be important for you to see a doctor who is familiar with hepatitis B and get monitored regularly to monitor your infection and health of your liver.
      Also, you should refrain from smoking and drinking and eat healthy food. You should practice universal precautions, as your blood or body fluids can contain the virus, and bandage any cuts or bruises and use safe sex (condoms.) What is vital, is if and when you have children, they must be immunized with the first hepatitis B shot and given one dose of HBIG within 12 hours of birth.
      Good luck and take care.

  32. I had a serology which was negative in 2007, also i did my antibody antiHbs and antiHBe which are 0,00 and 0,03 respectively (acute hepatitis),
    I m dreading tht since my body doesnt respond to the vaccination it aswell wont respond to the infection,,is there no need for me to treat in this case??
    As for kids i dont think there is a possibility since i surely will infect my spouse
    thank you

    • Hello: Without seeing all the lab results, it’s difficult for us to say. I encourage you to see your doctor and ask these questions. The doctor will keep monitoring you to see if this is an acute infection and to see if you develop surface antibodies. It may take several weeks or months to determine that. If you are infectious at this time (and test positive for the hepatitis B surface antigen), it is important to practice universal precautions, including using safer sex practices. Good luck.

  33. I married in January 2015.In the last may I understood that wife had hepatitis B 12 years back,when she was 15 years old.The following are the results of her blood test, conducted recently.HbsAg(ECLIA)-0.367(Non-Reactive) ,ANTI Hbc-0.01(Positive) ,ANTI HBs-<5mI U/ml ,HBeAg(ELISA)-0.01(Negative) ,HBV Quantitative PCR – Not detected – sensitivity 2.1 iu/mL ,Scanning- No abnormality found,Liver function test – all are perfect figures. I like to know the following things
    1.Is there any harmful effect if she receives Hepatitis B preventive vaccine?
    2.Is she totally free from the disease?
    3.Is there any possibility to infect the child while pregnancy?
    4.Is there any need to receive Preventive vaccine to all family members?
    I took two dose of vaccine and my ANTI HBs level is 10. Expecting your response eagerly

    • Hello: That is great news that your wife has an undetectable viral load and is negative for HBsAg (hepatitis B surface antigen.) What is missing is whether she has tested positive (reactive) for hepatitis B surface antibodies (HBsab). Developing surface antibodies means you have cleared the infection completely. If she does not test positive for HBsab, then you need to assume there are still low levels of the virus around. So find out her HBsab status.
      It is doubtful that getting a vaccine at this stage will help her.
      However, all household members should certainly be screened for hepatitis B and vaccinated if they have not been infected.
      Your wife can certainly have children. As long as the newborn is immunized with the first hepatitis B vaccine shot within 12 hours of birth and given a dose of HBIG (if it’s available to you), your child should be free of infection, especially given your wife’s undetectable viral load.
      Congratulations on getting immunized and making sure you protected against infection. Good luck.

  34. Hello! I have a problem about my Anti-Hbs. I’m a medtech student and it is required for us to have an Anti-HBs before our internship, the problem is i’m still non-reactive after the 3 doses of vaccine. Here’s my result:
    Patient’s value: 0.090
    Cut off Value: 0.105
    Remarks: Non Reactive
    My doctor advises me to have a Hepa B booster then a titer after 2-6 months.
    Can this booster make me reactive (only 1 dose) before October 18? Help please.

    • Hello: You can safely get a fourth hepatitis B (booster) shot to see if it will increase your antibodies/titers. Usually you wait a month or two after the booster shot to see if your immune system has generated sufficient titers (at least 10 mIU/mL). Be aware that you can safely repeat the entire three-dose regimen if needed. Ideally you should have the 10 titer count, however you still should be able to practice if you do not achieve it. Thank you.

      • Thank you! Is it safe to have 2 doses of booster in one day? Or is there any intervals to take it?

        • Hello: You should not have two vaccine doses in one day. Medical experts recommend you space them out so your immune system has time ton respond to each dose and produce the antibodies needed to protect you against infection. There should be at least 30 days between the first and second dose, and at least two months before you get the third dose. The actual recommended timing for the third is six months after the first dose is administered. For more information see: http://www.cdc.gov/vaccines/adults/vaccination-records.html

  35. Hi,

    I got diagnosed for HBV positive two months back. I am inactive carrier and never took medicine. I got married 3 years back. Two months back only I tested my wife’s HBsAg and it’s 0.02 iu/mL to her which is negative.

    But today when I tested anti-HBs, she tested negative for this too. It indicates that she never vaccinated. My question is how HBV didnt transmitted to her with 3 years of unprotected sex? Please recommend which vaccination she needs to go for it?

    Do I need to have unprotected sex with her till she gets antibodies after vaccination? Please suggest.

    • Hello: That is surprising. There are some possibilities, first, a small percentage of people do not respond to the vaccine, so if she was vaccinated perhaps she never generated enough antibodies (titers). Another option is your viral load is low enough that you did not infect her sexually (also surprising.) There are some people who retain an “immune memory” of a virus following immunization, even though years later they don’t test positive for titers/antibodies. What that means is her immune system may still remember the virus and protect her, even though there are not lots of antibodies in her system. I don’t know if any of those possibilities apply to her.
      What important is that she gets vaccinated immediately, but please talk to your doctor about that. You could use safe sex for the next six months during the time it takes for her to get the three shots, and then retested again. You appear not to have infected her yet, but if you suddenly develop an unrelated illness that weakens your immune system and your viral load rises, you risk infecting her. You are not the only couple I have heard about where infection did not occur! Good luck.

  36. Hi,

    Can I go for accelerated Vaccination to my wife? How effective is it? What is the chance that my wife gets the HBsAb after vaccination as already we are in unprotected relation since more than three years and her HBsAg is only 0.02 iu/mL and HBsAb is 0.00 iu/mL?

    • Hello: Accelerated immunization schedules have been found to be successful. The CDC recommends 30 days between the first and second dose, and it recommends at least two months between the second and third dose. This shortens the immunization period from six months down to three months. Thank you.

  37. Hello,

    I am not a ‘non-responder’, but I am wondering about waning immunity levels that has been mentioned here. I desire to maintain a iu of >200 for plasma donation; however, unfortunately my iu spikes to >500 and quickly wanes to around 10. Although I am immune, my plasma isn’t considered so for the plasma receivers. Would the stronger HB concentration dose help or am I doomed to a very thoughtful immune system?

    • Hello: Your immune system may be “thoughtful,” but it’s also very normal. Ideally, to be able to fight off infection, you want a hepatitis B antibody (titer) count of 10 mIU/mL, which you have. It is not realistic to continue to get vaccines in order to qualify for plasma donation, however noble your intention. Good luck.

  38. Hi , i just need to ask a small question , i am a hep b carrier and i had unprotected sex with my boyfriend for almost a week and some of them i was at the end of my period ! Is it possible that he got infected already ? How fast does the body catches the virus ? He got vaccine shots 10 days after that ! Could that be effective ? Can he still avoid being infected ?

    • Hello: There is no way to answer your questions with any certainty. It is harder for a male partner to catch hepatitis B from an infected female because they don’t have the exposure to blood and body fluids, such as semen, that women do during unprotected sex with men. It also depends on your viral load — the amount of HBV DNA in your bloodstream. The higher your viral load, the more infectious your body fluids are. Your boyfriend will get his second vaccine shot 30 days after the first one, and then his third shot six months after the first shot. It’s important he get all three shots.
      About one or two months after his third vaccine, he should return to his doctor and ask to be tested for hepatitis B surface antigen and antibodies. He will find out if he was infected, and he’ll find out if the vaccine worked and whether he has enough hepatitis B antibodies to protect him from infection. Good luck.

  39. My husband have hepb and I am hepb carrier. My son was vaccinated at birth. Just recently we found out that he is Hep B core Ab, tot positive and Hep B surface Ab, qual-None reactive. He is now 21yrs old. His Dr thinks that he did not have immune to acquire the antigen as an infant. I am now reading through this blog and realized that are many people have NR to the vaccine. Can you tell me what are the reasons for NR and I know it’s not standard on care to get tested after your vaccine but is there a guild line? Thanks you

    • Hello: I’m confused about your son’s test results. If he tests positive for the core antibody (Hep B core Ab) it means he was infected in the past. Is he reactive or positive for the hepatitis B surface antibody (HBsAb)? If he is, it means he cleared the infection. If he tests positive for the hepatitis B surface antigen (HBsAg) it means he is infected with hepatitis B. Sometimes, the vaccine dose that is administered within 12 hours of birth is not effective if the mother has a very high viral load, which means there are lots of virus in her blood and body fluids during delivery. It may be that your son was infected at birth, despite the vaccine, because your viral load was high. Recently, doctors have begun recommending treating pregnant women with high viral loads with antivirals during the last trimester of their pregnancy to lower their viral load and the risk of infecting their baby, in addition to treating the newborn with HBIG (hepatitis B antibodies) and the first dose of the vaccine. I hope this helps, please ask more questions if this doesn’t answer your question. Thank you.

  40. Hi i was diagnose reactive hbsag titer is 3.66 what does that mean pls help

    • Hello: A positive hepatitis B surface antigen (HBsAg) test means you are infected with the hepatitis B virus. Was this your first positive test for hepatitis B? If so, you should be retested in six months to see if you are still infected, or whether your immune system was able to clear the infection. Good luck.

  41. Hi, I am currently in school for dental hygiene and are required to be vaccinated for Hep B. I did not have my previous shot records from when I was a child so my doctor did the whole titer test and it showed that my immunity was very low so he gave me a booster shot in September and was told to come back in December to re-check. Well on Friday i gave blood again and it still showed no immunity. He gave me my 2nd shot today but thinks that I am not going to build antibodies for hep B. He thinks that I am probably one of the many people out there that do not build antibodies for hep B. My question. Should i still continue pursuing my career as a a dental hygienist and if I do not build immunity against the virus am I at a high risk for contracting hep B?

    • Hello: There are a small percentage of people whose immune systems do not generate enough hepatitis B surface antibodies following immunization to reach the desired titer (antibody) count of 10 mIU/mL, which is considered to protect you against hepatitis B infection. The CDC recommends that a “non-responder” repeat the entire three-dose series, which your doctor is having you do, then you can be rechecked to see if you have developed sufficient “titers.” Also, have you been tested for hepatitis B (which includes the hepatitis B surface antigen and antibody) just to see if you were exposed in the past?
      If you do not have immunity, yes you are at risk of hepatitis B, but if you practice universal precautions in your work your risk should be low. Also, many people are immunized against hepatitis B, so it is not as widespread as it was 20 years ago. Talk to your doctor and your school advisors so you are comfortable in your choices. Good luck.

  42. Hello everyone maybe someone can help me out. . In May my blood work came back hep b surface antibody negative. . . They told me to go thru the vaccine . . I went thru the vaccine and my last shot was in November. . . I just got blood work and waiting to see what happens . . I’m so confused on what hep b surface antibody really is and if there is side affects from this ? There’s not much info on that really . . And if the vaccine works , where does this leave me ?

    • Hello: The hepatitis B vaccine contains only one protein or antigen from the hepatitis B virus — the hepatitis B surface antigen (HBsAg). The vaccine spurs your immune system to create hepatitis B surface antibodies (HBsAb) that will protect you against infection with the “real” virus. To be protected, you must have at least 10 mIU/mL of surface antibodies. If after the three shots you haven’t generated sufficient HBsAg levels, your doctor may recommend a fourth, booster dose or they may have you repeat the entire series, especially if you are at high risk of hepatitis B. Good luck.

  43. Hi, I am a medical student and unfortunately due to delay, my Hep B vaccinations have run late. If my blood test comes back and shows that I am not immune, I will have to repeat the course. However this would need to be completed before I start my clinical years in August. I am wondering whether a second course for potential non-responders can be done on an accelerated basis, i.e. at 0, 1, 2 months or 0, 7,21 with a booster at 12 months? Or does it have to be at the typical 0, 1, 6 month intervals? Many Thanks.

    • Hello: Yes, there are accelerated vaccine schedules recommended by CDC for emergency situations (primarily travel.) Often, some people achieved immunity after two doses, which I hope happens in your case. Please talk to your doctor. A fourth vaccine dose is also permitted by CDC. This is from CDC: “The accelerated vaccination schedule calls for vaccine doses administered at days 0, 7, and 21–30; a booster should be administered at 12 months to promote long-term immunity. A combined hepatitis A and hepatitis B vaccine can also be used on the same 3-dose schedule (0, 7, and 21–30 days), with a booster at 12 months.” Source: http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/hepatitis-b
      Good luck.

  44. I have read many of the post here, some similar to my situation. I had my first series during miltary service, approximately 1993. My second came after testing show no titers, in late 04-05, with both of those following the 0-1-6 protocol. After a potential exposure, a third series was done following the same protocol in 07. After a second potential exposure in 2010, I received the double dose of HBIG, as well as another full series of the vaccine. Testing in early 2013 showed continued negative, so I had to go through a fifth round. 6mos testing should good results, 3 year I am back to negative. I am looking to apply for another Healthcare career, and the program is stating I would need to go through again regardless of past history because of the current negative results. As a side note, this is not the only vaccine I have had this kind of response to, as it took three of the pneumo vacs to get a response to 8/13, and a few other childhood ones had to be redone for my last career change in 2013. I also had to do a chicken pox vaccine even though I had documented chicken pox as a child long before the vaccine was created (I am 44). Most of the info I keep finding tells me to find a specialist, but my Healthcare doesn’t like to unless you fight for it. After five go rounds, I honestly doubt whether another series will help considering past. Any recommendations for a possible specialist?

    • Hello: As mentioned in my other response, I recommend you talk to your doctor and try different vaccine formulations (at higher doses) or an intra-dermal injection. Given the lengths you have gone to, I recommend you see a specialist. Good luck.

  45. So I know I am a probable non-responder, but not sure what path to take at this point. I have had the series a total of five times now, over a 20+ year time frame as follows:
    2- 2004-5
    3- 2007 booster involved, 4 total doses.
    4-2010 two doses HBIG with normal series of vaccine
    3rd and 4th were done for possible exposures.
    On the 3rd series, a check was done one month after the second dose, and results were low, so the booster was given before the sixth month dose.
    On the forth series, the HBIG was given in two very large doses, as well as the full series over the six months. Testing at three months, with two vaccines and both doses of HBIG showed normal, six month post series normal, one year showed negative.
    Fifth series showed good at six month follow up, negative at one year, and again at three years.
    I am applying for another Healthcare field, and will be required to show evidence of vaccination with positive results, which does not seem to work for me. Are there any other options, short of an evaluation by a specialist? As a side note, this is not the only vaccine that I have this problem with, pneumovacs took three to get 8/13, and I have verified chicken pox as a child but was negative for tiers as an adult, among others.

    • Hello: I recommend you talk to your doctor and try different vaccine formulations (at higher doses) or an intra-dermal injection. Given the lengths you have gone to, I recommend you see a specialist. Good luck.

  46. When i go to doctor and the doctor advice me to do Hbv and it was positive. so doctor give me medecine and took the medicine for six month and after the course is over i did test the Hbv and now it is negative. So my question is ,is it possible to get vaccine after negative???

    • Hello: If you have been exposed to hepatitis B and successfully cleared the infection, then you are now immune to it and do not need to be immunized.
      However, please be sure you no longer test positive for the hepatitis B surface antigen (HBsAg) and now test positive for the hepatitis B surface antibody (HBsAb). To completely clear the infection, you must get rid of HBsAg, and test positive for HBsAb. Good luck.

  47. So I need to test the HBsAb positive in order to completely clear infection??
    And the test should be positive?

    • Yes, the holy grail of clearing hepatitis B is the appearance of the hepatitis B surface antibody (HBsAb), it’s the antibody we all hope for! Good luck.

  48. Paulette Francis

    I have been in health care for about. In 1998 I received the series of 3 shots when I changed jobs to a different hospital. Titers came back negative. I was offered the series again in late 1998 the results again came back negative. I received the series again in 1999 and the result came back positive. I recently did a physical for a new job and my physician did serology for Hep B. Now again it is saying I do not have immunity. Can ones immune status return to negative after it was positive. In 1998 it was 156 now it is less than 5.

    • Hello: Yes, the number of hepatitis B antibodies (titers) can decline over time. However, experts say that even though titers decline below the 10 mIU/mL level required to confirm protection against infection, we retain an “immune memory” and remain protected against infection. If your potential employer requires proof, you could show them results from your old test or get one booster shot to see if that’s enough to spur production of titers to prove your immunity. Good luck.

  49. Hi, I am in dentistry. I had a course of 3 injections for Hep B but did not gain sufficient immunity. I repeated the course a couple of years later but abreacted to the first 2 injections with muscle spasms that lasted weeks. The health dept decided not to proceed with the 3rd injection and a blood test showed my titres were just within immune range. 5 years later I am now due a booster so had a blood test and my titres are too low again. I am hesitant to proceed with any further vaccines due to the abreactions I experienced previously. My doctor has no advice for me – can you give me any indication of what I should do? Many thanks for your time.

    • Hello: If you at some point had titers at or exceeding 10 mIU/mL, you probably do not require a booster. U.S. health officials do not recommend a booster for anyone who has achieved immunity. Research shows that even as titers decline over time, we retain an “immune memory” of the hepatitis B surface antigen and our immune systems are able to protect us should we be exposed to the virus. Good luck.

  50. hi ,i recently just finished the 3 hep b vaccine series and i forgot to test 4-8 weeks after the last vaccine ,i tested at 11 weeks post vaccine and it came back <5 l ,saying it was low ,could the titer drop that fast ?

    • Hello: It should not be that low after the three doses. Call your doctor back and get a fourth booster shot. Hopefully that will boost your antibody level to the 10 mIU/mL that is considered protective. Good luck.

  51. Hello, hopefully there is somebody that can help. I have had two HBV vaccines, and I am showing a reactive for the HBV SURFACE antibody but NOT the HBV CORE. For the CORE it says NON-REACTIVE. Why whould this be? Would i be considered a “NON-responder?”

    • Hello: Good question! The hepatitis B vaccine contains only the hepatitis B surface antigen, which is the protein that covers the virus. In response, our immune system creates hepatitis B surface antibodies that will be ready to attack the real virus if you are ever infected. The surface antibody is the only antibody to hepatitis B that your immune system creates. Now, if you had been infected for real and your immune system cleared the virus, you would test positive for both the hepatitis B surface antibody and the hepatitis B core antibody. That is why the test looks for both antibodies, so a doctor can tell if you have been vaccinated or if you were actually infected in the past. Thanks.

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