Should a booster of the hep b vaccine be given if titer falls below 10?

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?

Thank you in advance for any responses.
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Dear @hope4us,

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.

Hope this helps,
Thomas

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.

BR

Dear @Lili,

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.

Hi all,

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.

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@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.

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