Hepatitis B

Hepatitis B vaccination
  • A 3 dose vaccination schedule with doses given at 0, 1 and 6 months is recommended.
  • Either HbVax Pro10 or Engerix b vaccine can be used.
  • In general hepatitis B products, except Fendrix, are interchangeable.
  • Fendrix is recommended for patients with renal insuffiency, the schedule is 0,1,2,6 months.

HbVaxPro40 is recommended for adult dialysis and pre dialysis

Post-vaccination serological testing of those at high risk of infection

Testing for immunity after vaccination is recommended only for persons whose subsequent clinical management or occupational risk depends on knowledge of their immune status.

Such persons are Healthcare and public safety workers at high risk of continued exposure to blood or body fluids containing blood.

This includes:

  • HCWs with direct patient contact
  • HCWs that have a risk of needle stick or sharps injury
  • Laboratory workers who draw or test blood
  • Immunocompromised persons
  • Sex or needle-sharing partners of HBsAg-positive persons
  • Infants born to HBsAg positive mothers

Anti-HBs testing should only be performed 2 months after the last dose of vaccine

Anti-HBs levels above 10 mIU/ml are accepted as protecting against HBV for those at low risk and do not require repeating.

If anti-HBs levels are between 10-99 mIU/m and patient is in a high risk group, confirm by two different assays and give booster dose.

There is no need to retest for anti-HBs.

Advice when antibody levels are not protective

1. For those with a level of anti-HBs <10m IU/ml. 2 months after the third dose:

A repeated course of vaccination, preferably with an alternative hepatitis B vaccine, is recommended. If an alternative hepatitis B vaccine is not available the same brand can be given again.

This results in protective anti-HBs titres in 50 to 100% of previous non-responders.

2. If there is still no response (anti-HBs <10m IU/ml. 2 months after the third dose) of the second course of hepB vaccine:

Administration of a course of a double dose (2mls) of combined hepatitis A and B vaccine (Twinrix) at 0,1 and 6 months is recommended.

This can induce a protective anti-HBs response in >90% of non-responders.

3 If there is still no response (anti-HBs <10mIU/ml two months after 3rd dose): 

A single dose of Fendrix should be offered and anti-HBs checked 2 months later.

If the Anti-HBs levels are still below 10 mIU/ml this person remains susceptible to  hepatitis B infection

Anti-HBs titre declines post-vaccination but a rapid anamnestic response develops after exposure to the virus.

Please note any queries about laboratory results should be directed to the laboratory and not to the National Immunisation Office.

This page was added on 24 July 2019