Hep B Vaccine - Non-responder?

[Inventor of Post-Its]

So I'm starting medical school at the end of the summer, and my school, like many I understand, required me to get a quantitative titer of hep B antibodies. Lo and behold, despite getting the series as a baby, mine came back negative. The doctor commented on the lab results that I should get the entire series again, but when I sent my paperwork to the med school a nurse responded that in their experience students with a negative titer only need a single booster, then a month later their titer is usually positive.

That was a month ago, so I came back today to get both the second vaccine in the series and a second titer taken, to see if the first dose of vaccine was enough. The doctor I saw, however, was extremely skeptical that this would work, as some people just never respond to the vaccine and I shouldn't even bother getting another titer until I've at least completed the series. I did some research and it looks like she has a point: http://www.hepb.org/professionals/vaccine_non-responders.htm - I don't know where those numbers are from but they look pretty concerning.

So if anyone else received a negative hep B antibody titer, what was your experience with how and when (or if) you got a positive one? I understand getting a negative titer isn't terribly uncommon, but different sources seem to have a wildly different idea of how concerning this is.

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[Mad Jack]

The hep B vaccine doesn't last for life. Usually a booster is needed- I titered negative, got the booster, have been positive since, going on 8 years now.

 

[Inventor of Post-Its]

The hep B vaccine doesn't last for life. Usually a booster is needed- I titered negative, got the booster, have been positive since, going on 8 years now.

Well that's good to hear. Do you know if the booster is any different than the first vaccine in the usual 3-vaccine series? I went ahead and started the series again because that's what the doctor recommended, but I'm not sure if a booster would have had a higher concentration of antigen or something that would have been more useful in getting a response.

 

[Mad Jack]

Well that's good to hear. Do you know if the booster is any different than the first vaccine in the usual 3-vaccine series? I went ahead and started the series again because that's what the doctor recommended, but I'm not sure if a booster would have had a higher concentration of antigen or something that would have been more useful in getting a response.

Couldn't tell you off the top of my head. I'm sure you'll be fine though, true nonresponders are very rare unless they are somehow immunocompromised.

 

[CharlieKelly]

im a non responder, had the total series performed 3 times so far to no avail. the nurse at my school hasn't heard of this and ask i do the series again and am doing it now to have a proper record of it (have a record of when i had it done as a baby, none of the other 2 times, although im sure i can find it with enough prying). Actually took shot 2 of 3 today. My doc told me he's never heard of that, but another doc in the office told me shes a non responder, and knows 2 other docs that are as well. Said some people just don't convert. It's rare but it happens, we just need to be cautious (although with no additional precautions than what others take).

I've worked in healthcare my whole adult life, and its only been a problem when getting a new job (thus taking the series 2 more times when i changed jobs), and now, when starting school. Kind of a pain as its hard to prove.

 

[kurena]

I'm currently going through the same thing for pharmacy school! Had proof of receiving the full series as a baby but my titer came up negative. When I asked the school what I should do next they told me to get a booster, then get the titer again, and THEN if I'm still negative to finish the series and get a third titer! I decided to get the first two and then get the blood test again, trying to avoid having to do that three times. Right now I'm waiting to hear back from my doctor's office, but my doctor was also really skeptical about it when I told her what the school had advised me to do. Even after getting the booster it's going to take a while for a titer to pick up the antigens.

 

[Serous Demilune]

im a non responder, had the total series performed 3 times so far to no avail. the nurse at my school hasn't heard of this and ask i do the series again and am doing it now to have a proper record of it (have a record of when i had it done as a baby, none of the other 2 times, although im sure i can find it with enough prying). Actually took shot 2 of 3 today. My doc told me shes a non responser, and knows 2 others that are as well. Said some people just don't convert. It's rare but it happens.

Everything about your profile is perfect.

I also haven't seroconverted. I'm starting MS3 now and so far I've found it enough to just give the date of immunization instead of the titer.

 

[Inventor of Post-Its]

I'm currently going through the same thing for pharmacy school! Had proof of receiving the full series as a baby but my titer came up negative. When I asked the school what I should do next they told me to get a booster, then get the titer again, and THEN if I'm still negative to finish the series and get a third titer! I decided to get the first two and then get the blood test again, trying to avoid having to do that three times. Right now I'm waiting to hear back from my doctor's office, but my doctor was also really skeptical about it when I told her what the school had advised me to do. Even after getting the booster it's going to take a while for a titer to pick up the antigens.

Well I'll be crossing my fingers for you, sounds like we're in exactly the same boat. I want to trust my school, because they deal with hundreds of students getting titers every year and probably have more experience with them coming back negative, but I'm still nervous. My school seems adamant that you can't start at clinical sites until you have proof of a positive titer.

 

[operaman]

The HBV vaccine wasn't invented yet when I was a baby, so I only had it as an adult. I was a non-responder to the first 3-shot series. My recollection of the data is that there are a certain percentage who don't convert on the first series; of those, 50% or so will convert with a second 3-shot series. The rest likely never will.

 

[Inventor of Post-Its]

The HBV vaccine wasn't invented yet when I was a baby, so I only had it as an adult. I was a non-responder to the first 3-shot series. My recollection of the data is that there are a certain percentage who don't convert on the first series; of those, 50% or so will convert with a second 3-shot series. The rest likely never will.

What was your result after the second 3-shot series, if you don't mind my asking? The link I included in my first post gave the 50% figure, but I've also read that immunization wears off eventually in 60% or so of people so I'm not positive if I'm a true non-responder.

 

[Smurfette]

I converted after having the series twice. I have not been required to repeat my titers since then---well over 10 yrs now---I just have to provide a copy of the appropriate test result everytime I work somewhere new. I keep a copy of all those required titers and vaccination documentation specifically for this purpose, along with copies of all diplomas, board certifications, etc.

 

[NickNaylor]

If and when you seroconvert, keep your titers with you in a safe place as @Smurfette said. I would recommend buying a small, fire-proof document safe for keeping important records like this as they will prove to be extremely valuable. It will suck having to repeat the series at every new job you get because you didn't keep the documentation.

In terms of whether this is a "problem" or not, I would rate it pretty low on the problem scale. One of my co-interns was seronegative despite having positive titers in the past, and he simply got the booster during orientation and that was that.

 

[KarmaIsTruth]

I'm also not immune according to the titer.

How do I get the booster? My primary care physician said the booster does not exist.

He said I just need to get the regular shot. Is this true?

 

[Rumor13]

My titer came back negative as well despite having the series as a baby (I heard from a friend that well over 2/3 of her entering PT class had negative Hep B results as well as negative titers for others). My school requires any negative student to re-complete the series and then take another titer. If that titer is also negative, you must re-complete the series one last time and titer. Only after proof of 3 series in your life (2 of which must have been started no more than 6 months prior to matriculation) will they allow a negative titer and simply mark you as a non-responder and instruct clinical instructors that you be granted limited exposure to known Hep B positive patients if you so wish.

 

[kurena]

I'm also not immune according to the titer.

How do I get the booster? My primary care physician said the booster does not exist.

He said I just need to get the regular shot. Is this true?

Yeah, it's just the Hep B series given to you again. So I guess your doctor is right in saying it's not just one "booster" shot, but jeez...he/she should have known what you meant! lol

 

[Inventor of Post-Its]

If anyone is wondering, I got my titer results back today and I have a positive titer! Like, waaaay positive...I went from under the detection threshold (<5) to over the detection threshold (>1000). However, my doctor left a comment that as per the CDC recommendations, non-responders should still complete a second series and get a titer done 1-2 months after completion. I'm not sure this is necessary, since there is no evidence that I was truly a "non-responder" to the first series, my immunity could have just worn off after 23 years. But if anyone here is more knowledgeable than I on this subject and would like to chime in, I'd appreciate it!

 

[QueenofBoardGames]

If anyone is wondering, I got my titer results back today and I have a positive titer! Like, waaaay positive...I went from under the detection threshold (<5) to over the detection threshold (>1000). However, my doctor left a comment that as per the CDC recommendations, non-responders should still complete a second series and get a titer done 1-2 months after completion. I'm not sure this is necessary, since there is no evidence that I was truly a "non-responder" to the first series, my immunity could have just worn off after 23 years. But if anyone here is more knowledgeable than I on this subject and would like to chime in, I'd appreciate it!

I am very excited for you! I actually have a low titer right now similar to you and just had my second shot today. I was searching around trying to see if I was alone in my non-responsive nature because I am quite honestly freaking out about it. Thanks for the update.

 

[styphon]

Somewhat related, I am a rubella non-responder.

I received the two normal MMRs as a child, then one in high school (there was a measles outbreak), then for EMS I had titers checked, neg for rubella - received only 1 vaccine with no recheck. During residency I tested neg again for rubella titers and received another 2 MMRs and was not rechecked.

So I have received 6 MMRs (normal of course being 2) - and I am betting if checked yet again my rubella titers will be negative.

 

[HelpPleaseMD]

If anyone is wondering, I got my titer results back today and I have a positive titer! Like, waaaay positive...I went from under the detection threshold (<5) to over the detection threshold (>1000). However, my doctor left a comment that as per the CDC recommendations, non-responders should still complete a second series and get a titer done 1-2 months after completion. I'm not sure this is necessary, since there is no evidence that I was truly a "non-responder" to the first series, my immunity could have just worn off after 23 years. But if anyone here is more knowledgeable than I on this subject and would like to chime in, I'd appreciate it!

For patients with prior immunization but no antiHbs titers, the typical approach is to give boosters. first booster tends to solve the issue in 15-25% of patients if still not responding additional boosters are given, up to 3 in total with a response rate of about 50%. Given the low % of responders after 1 booster shot, most practitioners check titers after completing the series. SDN cannot give medical recommendations, so I will leave it up to you to decide given my above comments.

source: uptodate

 

[chronicidal]

All you non-responders should check your HBsAg to make sure that current infection is not the reason, especially if you have Asian-born parents and were not vaccinated at birth.