Didn't get HepB titer done in time, what do I do?

[Lannister]

My immunization documentation to start med school was due today. I had my doctor fill out the AAMC immunization form and attach a copy of my immunization records. I submitted this several days ago. But today I found out that it was rejected because I didn't include my HepB titer results. I stupidly assumed that this was just some routine test they did on children and that it would be included in the form my doctor filled out. I take full responsibility for my mistake, but I'm not sure what to do about it. I asked my primary care doctor if they could fax an order to the hospital that I live near, but they said no because I haven't had a physical in two years. I can't have a physical done by my primary care physician until early July, because I'm living out of state (going home is not an option). I called the university hospital near me and they said they aren't taking new patients at any of their hospitals, so I can't get a physical done here, and I don't think anyone will write me an order without having done a physical.

I've emailed the admissions office about this (I can't find their phone number anywhere, and when I tried to call the main administrative number I got hung up on, and then was given the number for the hospital immunology department) and basically told them it looks like I'm not going to have it done by July. I haven't gotten a response yet. Does anyone have any suggestions for what I can do to get it done sooner? I feel really stupid for not getting this done. They told us a week or so ago that not having all this done on time is grounds for having our acceptance rescinded, so I'm really scared right now.

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[thecook]

Maybe check with a local health dept.? Some do titers, though they may not do HepB. My local health dept. couldn't, but they did the rest I needed.

 

[parachichi]

Is there a public health clinic (or travel clinic) near you? Kaiser doesn't do quantitative titers, only qualitative, so I had to look elsewhere to get it done. Cost me about $80 out-of-pocket, which probably isn't the cheapest out there, but the results were ready the next day. You can also try something like Quest Diagnostics. Beware though - your titer may come back negative (as mine did), requiring you to get a booster and re-titer a month later.

 

[LizzyM]

I just googled Hep B titers and a bunch of ads are on page 1. One looked promising... for $49 they'll get you a doctor's order and direct you to a lab that will draw the blood and send it to a Quest labs.

 

[ZedsDed]

Man that really sucks. Have you tried to go out of pocket for a private lab? It'll cost you, but they can usually turn around and get the results back to you in like 48 hours. Get off SDN, find a lab nearby, and get your test done before the work day is out. Go go go!

 

[Lannister]

@ZedsDed For these private labs (would that include Quest?) do you still need a doctor's order?
Another issue is that I don't have a car or know of anyone who can drive me to get this done, and I think the nearest Quest lab is going to be about a $100 Uber drive away.

 

[Lannister]

@LizzyM I did see that website but I wasn't sure if it was trustworthy, that sounds sketchy to me...

 

[ZedsDed]

@ZedsDed For these private labs (would that include Quest?) do you still need a doctor's order?
Another issue is that I don't have a car or know of anyone who can drive me to get this done, and I think the nearest Quest lab is going to be about a $100 Uber drive away.

I don't know, call the lab and ask. Quest is fine, I had them do a test a while back.

100$<Med school acceptance possibly rescinded

Why are you still here girl?!

 

[Lannister]

The day is saved. My pediatrician decided that she's going to write me the order so hopefully I can go get it done today before I have to go in for work tonight. Thank goodness I was a sickly child so she knows me well and is willing to do this for me 😛

Edit: Okay, can't get it done till Monday, but I guess that's a lot better than July. Hoping I won't be penalized for this =/

 

[piii]

The day is saved. My pediatrician decided that she's going to write me the order so hopefully I can go get it done today before I have to go in for work tonight. Thank goodness I was a sickly child so she knows me well and is willing to do this for me 😛

Edit: Okay, can't get it done till Monday, but I guess that's a lot better than July. Hoping I won't be penalized for this =/

You'll be fine. They aren't going to rescind your acceptance because you are a little late for a titer. Med schools aren't some evil monster trying to eff everyone over. Just be upfront and get it done.

 

[Lannister]

You'll be fine. They aren't going to rescind your acceptance because you are a little late for a titer. Med schools aren't some evil monster trying to eff everyone over. Just be upfront and get it done.

Thank you, this makes me feel a lot better.

 

[Isotopes]

Mine came out negative the first time. You might need a booster and will have to re-titer so keep that in mind.

 

[itsogre]

it's not a big deal, just get it done ASAP. Definitely your acceptance is safe over this. The admissions office doesn't even have access to this sort of information (or care about this information), it's probably under the purview of clinical education office and student health.

 

[danib2k15]

For those joining this thread looking for help with titers - I used to Quest Labs for all of mine. Specifically, look at Accessa labs (quest is a part of them). You don't need a doctors note and you can go in any time. I got MMR, Varicella, HepB titers done in one sitting (simple blood test - about $150.) I know my school does fine if you don't get your health forms in but the most important thing is to get them done before matriculation so that you don't miss out.

Also to make you feel better - I failed my hep B titer aka I didn't show immunity. I am still going to medical school. I am now being re-vaccinated but no matter what its fine. I should also add that there is a small percentage of the population that never even shows immunity to hep B. They can also still be doctors. It's all about the clinical site rules. Try not to stress about this. Just make sure to be on top of it if anything does pop up!

 

[Tenk]

Just get it done and don't worry about it. It's not a big deal.

 

[Lost in Translation]

You'll be fine. They aren't going to rescind your acceptance because you are a little late for a titer. Med schools aren't some evil monster trying to eff everyone over. Just be upfront and get it done.

Since I'm going to the same school as @Lannister, I'll say that I had the same issue but with my TB PPD. Just email the med admissions office asking for an extension and they'll (most likely) grant you one.

 

[Tabiyou]

The day is saved. My pediatrician decided that she's going to write me the order so hopefully I can go get it done today before I have to go in for work tonight. Thank goodness I was a sickly child so she knows me well and is willing to do this for me 😛

Edit: Okay, can't get it done till Monday, but I guess that's a lot better than July. Hoping I won't be penalized for this =/

That Pediatrician sounds like an an awesome person. Remember to live up to your family's slogan.

 

[Lannister]

Since I'm going to the same school as @Lannister, I'll say that I had the same issue but with my TB PPD. Just email the med admissions office asking for an extension and they'll (most likely) grant you one.

I haven't done the TB one either but it says to get it between April and July so I'm just gonna update it once I get it done.

 

[Crayola227]

the med school can technically kick you out for anything, and because of that unopposed power they frequently threaten more harm then they ever carry out

that said, remember the first half of the sentence

you'll get a sense when they're bluffing and when they mean business

 

[claduva94]

So many people in my class were late with their documentation. Don't worry.

 

[Lannister]

Wow. I got my titer done and it came back negative. So now I have to get the whole vaccine series again and then get the titer performed again. This stinks. There's no way I have hepatitis.

 

[hopefulERdoc251]

Wow. I got my titer done and it came back negative. So now I have to get the whole vaccine series again and then get the titer performed again. This stinks. There's no way I have hepatitis.

Happens more often than not with the negative titer. My doc explained it as having to do with vaccine metabolism due to genetics. We all metabolize vaccines and other drugs at different rates, some faster than others, making the titer negative!

 

[LizzyM]

Wow. I got my titer done and it came back negative. So now I have to get the whole vaccine series again and then get the titer performed again. This stinks. There's no way I have hepatitis.

It is not that you have hepatitis but that you have not proven that you are immune to hepatitis. Given that it is a leading cause of liver failure and a major reason for liver transplant and given that it is blood borne and an occupational hazard for physicians, the school wants to be sure you have immunity before you are exposed and placed at risk for a very devastating but preventable disease.

 

[minor.groove]

Happens more often than not with the negative titer. My doc explained it as having to do with vaccine metabolism due to genetics. We all metabolize vaccines and other drugs at different rates, some faster than others, making the titer negative!

Not quite how immunity works...

 

[heybubbaa]

I am also going to the same school as Lannister. The requirement will be completed if you upload the negative titer results, and a new requirement to get a booster and a titer 4 weeks after the booster will appear (apparently this is the case- my requirement hasn't shown up yet, even though I have already gotten the booster and positive titer - but that is just what the portal company told me).

 

[nwts]

Wow. I got my titer done and it came back negative. So now I have to get the whole vaccine series again and then get the titer performed again. This stinks. There's no way I have hepatitis.

I just had the same thing happen, and I just got another dose of the vaccine. Here's hoping my next titer comes back positive. Best of luck to you!

 

[dougy]

My Hep B titer was negative too. Med school (or their hospital) require full new 3 vaccine series, then re-titer. First must be administered before 1st day of school, other than that they were quite casual about it. I think the rest can be administered at student heath clinic and I can stop badgering my pediatrician 1000 miles away🙂 My HMO is highly un cooperative too, we are constantly fighting about out of area routine care. The whole "stay on your parents insurance till you're 27" is driving my HMO nuts with 1000s of beneficiaries living out of the coverage area. Thinking as a medical student 4 years from being a doctor, I might need an "adult" doctor soon!

 

[Lannister]

I just had the same thing happen, and I just got another dose of the vaccine. Here's hoping my next titer comes back positive. Best of luck to you!

Good luck to you too!

My Hep B titer was negative too. Med school (or their hospital) require full new 3 vaccine series, then re-titer. First must be administered before 1st day of school, other than that they were quite casual about it. I think the rest can be administered at student heath clinic and I can stop badgering my pediatrician 1000 miles away🙂 My HMO is highly un cooperative too, we are constantly fighting about out of area routine care. The whole "stay on your parents insurance till you're 27" is driving my HMO nuts with 1000s of beneficiaries living out of the coverage area.

Luckily for me, I found out that I just have to get a booster and then another titer, and if that one is positive then I'm all good. Hopefully it will be, because otherwise my pediatrician said it would take 6 months to get the full series done again.

 

[nwts]

Luckily for me, I found out that I just have to get a booster and then another titer, and if that one is positive then I'm all good. Hopefully it will be, because otherwise my pediatrician said it would take 6 months to get the full series done again.

I was told this as well, but I was also told that most people require the full 3 dose series again, so I'm not too optimistic 🙁

 

[Lannister]

I was told this as well, but I was also told that most people require the full 3 dose series again, so I'm not too optimistic 🙁

Shoot. I know my school does this thing where you shadow a primary care doctor during first year. Would this prevent me from participating in that, or any shadowing at all for that matter?

 

[nwts]

Shoot. I know my school does this thing where you shadow a primary care doctor during first year. Would this prevent me from participating in that, or any shadowing at all for that matter?

I have no idea. I am just as concerned as you are. Unfortunately, I'm just about to begin working at a job that will demand a lot of my time, so I don't have a lot of time right now to figure out how it will impact me if my next titer comes back negative. I figure I'll just work my job and try not to worry about it because even if I know what will happen if it comes back negative, that won't have any impact on whether or not it does come back negative.

 

[Lannister]

I have no idea. I am just as concerned as you are. Unfortunately, I'm just about to begin working at a job that will demand a lot of my time, so I don't have a lot of time right now to figure out how it will impact me if my next titer comes back negative. I figure I'll just work my job and try not to worry about it because even if I know what will happen if it comes back negative, that won't have any impact on whether or not it does come back negative.

That's true, I guess I'll just focus on enjoying my last two weeks of my job and then worry about it once I get home!

 

[DokterMom]

For those still reading and wondering, there are places out there that do lab tests direct for consumers - 'Any Lab Test Now' is one of them. Walk-In-Lab is another.

I don't know how reliable they are, but I'd have to imaging the most common tests are pretty standardized. And while their prices aren't as low as what you might have to pay if you go through your insurance company's authorization hoops and approved channels, their "retail" is considerably less than Quest's "non-insurance retail", which is obscene.

There are times when convenience trumps price --

 

[Crayola227]

whether or not where you are in the vaccine series and ultimate titer results will affect your first year precepting, is variable
in general, since you're doing what you're supposed to, the school will do what they can to keep you on track so don't stress it too much
I've known some schools if you miss some precepting days allow you to make them up later, depends on how things are done at your school

usually there's an exemption allowing you to roam the hospital despite not having some immunities if you document getting the entire vaccine series correctly and still being negative on a titer

I find it's for VSAS and actual jobs that it can hurt you more if you're unable to be vaccinated/be titer positive

in a job scenario how that affects a worker's compensation claim for contracting hep A/B would be an interesting matter
if you remain titer negative, when you get to your first real jobs it is something that would be on my radar

 

[bceagle411]

whether or not where you are in the vaccine series and ultimate titer results will affect your first year precepting, is variable
in general, since you're doing what you're supposed to, the school will do what they can to keep you on track so don't stress it too much
I've known some schools if you miss some precepting days allow you to make them up later, depends on how things are done at your school

usually there's an exemption allowing you to roam the hospital despite not having some immunities if you document getting the entire vaccine series correctly and still being negative on a titer

I find it's for VSAS and actual jobs that it can hurt you more if you're unable to be vaccinated/be titer positive

in a job scenario how that affects a worker's compensation claim for contracting hep A/B would be an interesting matter
if you remain titer negative, when you get to your first real jobs it is something that would be on my radar

i was told i will most likely always be titer negative forever due to a gene i have, but it shouldnt affect anything besides being doccumented right?

 

[nwts]

whether or not where you are in the vaccine series and ultimate titer results will affect your first year precepting, is variable
in general, since you're doing what you're supposed to, the school will do what they can to keep you on track so don't stress it too much
I've known some schools if you miss some precepting days allow you to make them up later, depends on how things are done at your school

usually there's an exemption allowing you to roam the hospital despite not having some immunities if you document getting the entire vaccine series correctly and still being negative on a titer

I find it's for VSAS and actual jobs that it can hurt you more if you're unable to be vaccinated/be titer positive

in a job scenario how that affects a worker's compensation claim for contracting hep A/B would be an interesting matter
if you remain titer negative, when you get to your first real jobs it is something that would be on my radar

Thanks so much for the info!

 

[Crayola227]

i was told i will most likely always be titer negative forever due to a gene i have, but it shouldnt affect anything besides being doccumented right?

you should be OK in the vast majority of instances, but I can't lie to you and say that it will never be a barrier at any hospital in existence

 

[ortnakas]

As long as you can show you're working on it and you get in contact with your school in advance of the deadline (not the night before), they'll probably work for you.

I had to turn everything in late when I matriculated-- after getting accepted it turned out my PCP had left the practice and I had to find a new one. My school is not exactly known for flexibility, and they worked with me very willingly.

 

[deleted407021]

Edit : derp

 

[bceagle411]

you should be OK in the vast majority of instances, but I can't lie to you and say that it will never be a barrier at any hospital in existence

good point. But the gene in question is present in almost 40% of Caucasians, so im sure its pretty common for hospitals to see. I was just unique that i got tested for it, most people go their lives without knowing

 

[Psai]

Not getting a positive titer to a vaccine isn't related to metabolism. I don't know the reason but I suspect that it's that you don't have the right cd protein so the viral particles aren't recognized. Or maybe your t cells and b cells didn't randomly make the right receptor shape for the viral particle. But a decent number of people don't make anti hb surface antibodies. I just had someone tell me to get the twinrix vaccine and it seems like it works for most nonresponders so I'm probably going to get that.

 

[Lannister]

Alright, so I finally got my booster and second titer done. But I'm having more issues.
So the doctor drew blood, and I got called in the next day to pick up the results. The results just said "Positive", with nothing under "units". They told me I hadn't specified that I want a quantitative test, so they couldn't give me the units. They called the lab and asked them to add on a quantitative test.

The school asks for "a lab report of positive hepatitis surface antibody (HBSAB) titer."

So I go back today to get the results and now it says:

HEPATITIS B SURFACE AB QUANT

Result: >1000.00
Units iu/l
Results greater than or equal to 10.00 IU/L imply immunity

*Result does not represent an antibody titer.

I'm super confused. How could I go from 3.9 iu/l to >1000.00? And why do the results not represent an antibody titer, isn't that exactly what it's supposed to be? Did they do the wrong test? I'm kind of annoyed because they're the ones who wrote the order for the first titer, and that was done correctly, so I'm not sure why this is happening now.

 

[Hierophant]

Alright, so I finally got my booster and second titer done. But I'm having more issues.
So the doctor drew blood, and I got called in the next day to pick up the results. The results just said "Positive", with nothing under "units". They told me I hadn't specified that I want a quantitative test, so they couldn't give me the units. They called the lab and asked them to add on a quantitative test.

The school asks for "a lab report of positive hepatitis surface antibody (HBSAB) titer."

So I go back today to get the results and now it says:

HEPATITIS B SURFACE AB QUANT

Result: >1000.00
Units iu/l
Results greater than or equal to 10.00 IU/L imply immunity

*Result does not represent an antibody titer.

I'm super confused. How could I go from 3.9 iu/l to >1000.00? And why do the results not represent an antibody titer, isn't that exactly what it's supposed to be? Did they do the wrong test? I'm kind of annoyed because they're the ones who wrote the order for the first titer, and that was done correctly, so I'm not sure why this is happening now.

You probably did not not need to get a quantitative test. If your school is only calling for "a lab report of positive hepatitis surface antibody (HBSAB) titer", an HBSAB titer that comes back positive demonstrates this. A positive AB titer just indicates that your AB concentration is above a specified valued (an AB concentration above this specified value implies immunity). A qualitative test is only going to report if your HBSAB is above or below a certain value (below xx mIU/mL = unvaccinated/negative, above xx mIU/mL = positive/implies immunity etc.). The lab won't report the exact mIU/mL.

I'm assuming your 3.9 iu/l was the result you received from your first titer before receiving the booster. It would make sense that your HBSAB concentration would increase after a booster- that's the point. I'm not an expert, so I can't really speak to the magnitude of increase if that's what you were questioning.

Titers are usually expressed as a ratio that reflects how many times blood can be diluted before no antibodies are detected, so this could explain why "*Result does not represent an antibody titer" shows up on your results.

 

[Lannister]

You probably did not not need to get a quantitative test. If your school is only calling for "a lab report of positive hepatitis surface antibody (HBSAB) titer", an HBSAB titer that comes back positive demonstrates this. A positive AB titer just indicates that your AB concentration is above a specified valued (an AB concentration above this specified value implies immunity). A qualitative test is only going to report if your HBSAB is above or below a certain value (below xx mIU/mL = unvaccinated/negative, above xx mIU/mL = positive/implies immunity etc.). The lab won't report the exact mIU/mL.

I'm assuming your 3.9 iu/l was the result you received from your first titer before receiving the booster. It would make sense that your HBSAB concentration would increase after a booster- that's the point. I'm not an expert, so I can't really speak to the magnitude of increase if that's what you were questioning.

Titers are usually expressed as a ratio that reflects how many times blood can be diluted before no antibodies are detected, so this could explain why "*Result does not represent an antibody titer" shows up on your results.

Yeah I was curious about the magnitude of the increase, it just seems really drastic! But what doI know, I didn't even know what a titer was until a few weeks ago lol.
So I guess the quantitative test will be acceptable, then?

 

[Crayola227]

Yeah I was curious about the magnitude of the increase, it just seems really drastic! But what doI know, I didn't even know what a titer was until a few weeks ago lol.
So I guess the quantitative test will be acceptable, then?

yes it should be fine

congrats on your new immunity

 

[Lannister]

yes it should be fine

congrats on your new immunity

Yayyy thanks!