Hi,
My family members don’t have Hep B and I am hoping to keep it this way. Per my hepatologist and my kids’ pediatrician, I had titers checked on my daughter at 1, 10, and 14 years old. Her HBs Ab went from 28.7 to 11.2 from 10 to 14 years old. Both kids received HBig and the vaccines from birth. One hepatologist recommends revaccinating if titer falls below 10 mIU/ml.
My pediatrician found this article on revaccination vs Hep B in late teenagers who received vaccinations during infancy in Human Vaccine immunotherapy which supports no booster needed for at least 30 years but there is uncertainty on duration of protection.
I was hoping to see if anyone has a more definitive answer. I tried to include a picture of part of the article. Also, how often should titers be rechecked in both those who received the vaccine as adults like my husband and those who received it at birth?
Great questions! The good news is that your daughter will be out of the danger zone and is not at high risk of having a chronic infection if she were exposed, regardless of antibody levels.
The true risk if these levels do sink below 10 mIU/mL is not really known, but is probably very low. This is because even if the circulating levels of antibody are low, the cells that make the antibodies are still there in a waiting state (these are called memory B cells). As soon as the body sees the virus, these memory B cells will activate, and antibody production will be quickly ramped up. For peace of mind, your daughter can be vaccinated again with a booster to raise levels up above 10 mIU/mL.
How often you should check for your antibody titres will probably depend on your risk of exposure. @simone.strasser, @PLampertico, or @MarkDouglas might have a more informed or definite timeline.
Hi @hope4us, it’s wonderful that Thomas is able to provide the scientific knowledge for his answers! So I agree your children are most likely protected for life against a hep b exposure. With that said, here in the U.S. the CDC only recommends boosters if titer levels fall < 10 when a person works or lives in a “high risk” situation. This applied primarily to health care workers dealing with blood and invasive procedures. I would NOT consider living with you or visiting you is a high risk situation. It would only apply to someone in a sexual relationship with a person who has high viral loads. If the sexual partner is on treatment with undetectable viral loads, then the risk of sexual transmission is very, very low. There is currently no recommended testing timeline for people who get the hep b vaccine except for health care providers who are advised to get antibody titers checked about every 10 years. Not sure this is really done, though, here in the U.S. Hope this helps and reassures you. Always, Joan
@ThomasTu, Thank you for all your responses. I am so grateful for this HepB community. It’s such a wonderful resource and lifeline. Thanks for making it possible and sharing your incites and time. I think you and @Joan_Block help me to shift my focus. I am not on any treatments yet and delayed getting my labs with this crazy year. So when my DNA went from 500 (10/19) to 9710 recently, I worried about what risk I am to my family even tho I don’t need to as they are all vaccinated. I do not know how I got it as my mom is neg and I came to the US from Vietnam when I was 18 months old. Even if my daughter contracts hep B from me or someone else, it sounds like acute hep is not very problematic. Although I am so relieved to learn that acute hep B is not so worrisome and am so so grateful there is a vaccine, I kinda feel like we are a lost generation because governments may not care about chronic hep B when only a select population who were unlucky to get this when they were young, have to deal with this. But I am grateful to know there is still research being done. Thanks for raising awareness of the need for funding research on finding a cure because our lives matter.
Dear Hope4us,
I red your story. Can you please let me know if you have started treatment. I red your viral load is raised. I have a similar story and my doctor is till considering. my ALAT/ASAT are normal. Fibroscan score F0-1.
Thank you for sharing.
I will see my hepatologist this Wed to find out if I start. I had been seeing him 1x year which is when he would do the fibroscan. I was to do labs q6 months and ultrasound 6 months after my fibroscan. My last fibroscan had median 4.3 kPa and the one prior to it was 4.8.
I’m a senior HBV virologist. Thomas is likely right for the very large proportion of people, but the safe course is what is recommended by the US CDC, ie, getting a booster shot. There is substantial uncertainty regarding durability of the HBV vaccination after ~20-25 years. I remember seeing some studies of nursing students in Taiwan who were vaccinated at birth and then screened for HBV and HBV antibodies when they entered nursing school. There were a few low-level breakthrough infections, and HBV antibody titers in many students had fallen to pretty low levels. The data were not strong enough to recommend universal boosting, but did raise questions about who may benefit from boosting.
I had both my kids boosted just before they went to college at age 18 as a safety precaution. The vaccine is really safe, so I felt there was no downside to boosting and potentially big upsides.
@john.tavis, Thank you so much. My daughter’s level was 11.2 when she was only 14. I appreciate your input. I think I will do the same as I don’t see the negative implications of revaccinating.
There is substantial uncertainty regarding durability of the HBV vaccination after ~20-25 years.
Hi John - this is really interesting! Almost every doctor I’ve talked to (and in many publications) has said confidently that durability of immunity is “probably lifelong”, but I haven’t seen any data to back this up since I don’t think there is even vaccinated cohort that has actually been tracked for a full lifetime yet. Is that why there is substantial uncertainty?
On the other hand, my primary care many years ago told me that vaccination is not guaranteed protection and it is “just like the flu” in that vaccination lowers the probability of infection, but repeated exposure will eventually infect you even if the chance of each individual exposure infecting you is small. This really concerned me since my partner is a carrier so I would be repeatedly exposed.
The truth is between the 2 extremes you mentioned.
I don’t know what your doctor was referring by comparing the HBV vaccine to the flu vaccine. The flu vaccine is very good, but the virus mutates so fast that vaccination with a new vaccine is needed every year. That is very different from the case with HBV.
HBV vaccination is remarkably durable in most patients, and birth-dose vaccination lasts for at least 20 years. However, antibody levels wane with time, and there are some interesting data from Taiwan where they studied nursing students who had been vaccinated as infants. A fraction of them had essentially lost anti-HBs and showed evidence of a low-level HBV infection similar to what is referred to as “occult HBV” by their early 20s. Despite waning HBV antibodies, the net HBV+ rate was still quite low among these students, indicating the vaccine was still working in most of them. My interpretation is that the vaccine lasts at least 20 years but that protection can become spotty after that, at least in some people. Those data led me to have both my sons boosted with an HBV vaccine just before they entered college. Note that HBV boosters were not recommended by the US CDC or FDA the last time I checked. I was just erring on the side of caution.
I just wanted to add a follow-up now that my 18 yo daughter had her titer rechecked this week. It was 4.6 as opposed to 11.2 when she was 14 yo and 28.7 when she was 10 yo. My hepatologist recommended she get the booster.
Does anyone know how often titers are rechecked after a booster is given? Does it get rechecked to make sure the booster worked? Should she continue to recheck every 10 years or is 1 booster sufficient? I am not as worried since she would not have chronic hep B but between getting acute hep B vs vaccine side effects, I figure it doesn’t hurt to get the vaccine. Now I am wondering when my husband should recheck his titer. He did not get the initial Hep B vaccine until he was in his 20s (in order to start school). His last titer, 18 years after starting initial series was 50.8.
I wanted to correct an error in the comments you have from your doctor in the post above for the community. Vaccination protection against HBV is not the same as for influenza (flu).
In the case of influenza, there are new seasonal variants every year all with the same potential for infection and causing disease. This is why flu vaccines each year consist of the 4 most prevalent influenza strains from the previous year. This is why the effectiveness of influenza vaccines (despite this “race”) still varies from 30-50% in healthy adults and typically < 10% in those over 70 years of age (this is from data that the US CDC maintains).
In the case of HBV, genetic alteration of the virus and the development of numerous genetic variants does occur but this is within patients who have chronic disease over several decades. Despite the evolution of these genetic variants, it appears that the efficient transmission of HBV is still limited to a small subset of these variants.
Current HBV vaccines are very effective against the prevention of disease in those who have not been infected (> 99% protection from transmission via cuts, unprotected sex or needle use). HBV vaccination is not quite as effective in preventing infection during birth with the mother is infected but there are reasons for this beyond the scope of this post.
In the case of protective titers of anti-HBs, values of 10 mIU/mL are the officially considered “protective” but protection is still occurring at levels below this (i.e. 4.6 mIU/mL as in the case of your daughter). Erosion of anti-HBs titers is normal after vaccination in normal as there is no virus present so your body slowly adjusts over time, not reinforcing the maintenance of anti-HBs. As John has said, this erosion is very slow and typically provides protection for several decades in most people. There are exceptions depending on the specific type of vaccine used and the initial anti-HBs response elicited by vaccination.
The good news is that all HBV vaccines are very safe and use very well known technologies which have been around for many decades. You can discuss with your doctor the newest (and best performing) vaccine for HBV called Prehevbrio which is already approved for use in the US and Canada.
Doctor Sonic
I’ve received my first booster shot on 1 March and as I was born in 1999 in Egypt I should have been vaccinated (it was compulsory) but I have never checked that so I missed my second and third dose now on 2 September and I took the second dose yesterday on 4 September I measured my anti hbs ab and it was less than 3.1 mIU/L does this mean I didn’t respond to the first shot?
Welcome to the forum! This doesn’t necessarily mean you didn’t respond to the first shot, but you need to undergo the full vaccination course to have a high chance of long-lasting protective immunity (>10mIU/mL).
Thanks Thomas so even booster doses require full vaccination?
I mean I think I already vaccinated since birth and the one on march was only a booster but in egypt booster doses is the same as real vaccination (3 doses)
Hi everyone
first of all I apologize if the topic is somehow repetitive but I have inquiry regarding antihbs titer and vaccination from scientific prespective
as I have posted before in booster topic I am a 24 medical graduate and in Egypt mandatory vaccination has been established since 1992 so although I don’t have a record of my childhood vaccination it’s highly likely I have been vaccinated
in 2022 I have my virology lab after donation (hbsag and hcv ab and hiv) all were negative
in March 2023 I have received a booster dose as I will be working in hospital but in Egypt there’s no discrimination between those vaccinated and those who are not vaccinated all should receive 3 doses 0,1,6 months apart I received only one and on 2 September (after six months) out of cautious I got the second shot on 4th September I tried to measure my antihbs and lab showed it’s negative (below 3.1 which according to my lab they don’t know how much as they only count above 3.1) so I wonder why this is the case I tried to understand why chronic hbv usually don’t have anti hbs and found out that they have a lot of hbsAgs that bind to the antibody so can the hbsag on vaccine a cause for a temporarily negative result since I measured it only todays after the second shot
Thanks for the great question. Had you tested for your anti-HBs antibody level after your initial birth dose but before your booster? There is a proportion of people who do not react strongly to the vaccine and may require several boosters to get to a protective level. I knew someone who required 9 (!) boosters to get it up to a protective level.
I don’t know if there is any evidence for the vaccine causing a temporary negative result…
No I haven’t since it’s not required and It’s not very common to test for it in Egypt
I will try finish my third dose after 2 months form last shot so that I will get a new full vaccination and I will test it again to see the results
