Ask the Experts: Past HepB Vaccination, Negative Screening Anti-HBs. What Now?

Welcome to Immunize.org’s Ask the Experts resources. This Ask the Experts question is presented by Immunize.org’s Kelly L. Moore, MD, MPH.
Question: Do adults who were properly vaccinated with HepB vaccine need to be revaccinated if they have a negative surface antibody (anti-HBs) result on their triple panel screening test for hepatitis B?
Answer: For most people the answer is NO. A negative anti-HBs result is a common finding when tested years after completing vaccination, and most healthy people may be reassured that they would still be protected from illness, if exposed.
Antibody titers naturally drift lower over the years; however, studies have shown that the majority of people who were effectively immunized decades earlier can mount an effective antibody response and prevent symptomatic or chronic infection after exposure. A study of members of the Alaskan Native population published in 2022 estimated that 86% had effective protection 35 years following vaccination. Even those few with serologic evidence of hepatitis B infection at some point after vaccination showed no evidence of active infection, which is the most important health outcome.
Revaccination is indicated for certain people at ongoing high risk, as specified in the 2018 ACIP recommendation (e.g., nonresponder infants born to people who tested positive for HBsAg, health care providers at risk of occupational exposure, and people on hemodialysis or with significant immunocompromise). For further details, see the 2018 ACIP recommendation, pages 23 and 24: www.cdc.gov/mmwr/volumes/67/rr....
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