Hepatitis B Vaccination: Indications, Antibody Titers, and Non-Responder Management
- Mayta
- 8 hours ago
- 2 min read
1. Who Should Receive the Hepatitis B Vaccine
Universal vaccination is recommended by CDC, WHO, and Thai MOPH:
A. Infants
Birth dose within 24 hours of delivery (prevents perinatal transmission)
Complete 3-dose primary series at 0, 1, and 6 months.
B. Unvaccinated Children & Adolescents (<19 years old)
Catch-up schedule: 3 doses at 0, 1, and 6 months.
C. Unvaccinated Adults (Any Age) Who Are at Risk
Healthcare workers
People with multiple sex partners or recent STI
Men who have sex with men (MSM)
Injection drug users
Household/sexual contacts of HBsAg-positive individuals
Chronic liver disease patients (HCV, NAFLD, cirrhosis)
End-stage renal disease/dialysis patients
Travelers to HBV-endemic areas
Persons with HIV infection
D. Anyone Who Requests Vaccination
Regardless of risk factors.
2. Anti-HBs Titer Interpretation & Action
Anti-HBs (mIU/mL) | Meaning | Action |
≥10 mIU/mL | Protective immunity | If completed 3 doses → no further vaccine.If incomplete → give remaining doses. |
<10 mIU/mL (never vaccinated/incomplete series) | Not immune | Start or complete 3-dose series (0, 1, 6 months). |
<10 mIU/mL (after complete 3-dose series) | Primary non-responder | Repeat another full 3-dose series, retest 1–2 months after last dose. |
<10 mIU/mL (after 6 doses) | Permanent non-responder | Test HBsAg & anti-HBc to rule out chronic HBV; give HBIG if exposed. |
≥100 mIU/mL | High responder | No booster in immunocompetent persons. |
10–99 mIU/mL | Low responder but still protected | No booster if completed series; if incomplete, finish doses. |
Key threshold: 10 mIU/mL = protective immunity.
3. Management of Non-Responders
Definition: Anti-HBs <10 mIU/mL 1–2 months after completing the 3-dose series.
Steps:
Give a repeat full series (3 doses).
Retest anti-HBs 1–2 months after last dose.
If still <10 mIU/mL:
Classify as permanent non-responder.
Test for HBsAg and anti-HBc to check for chronic infection.
Educate about risk avoidance.
Provide HBIG if exposed to HBV.
4. Missed or Delayed Doses (“Missing Announcement” Scenario)
Never restart the series, regardless of time elapsed.
Just continue from where left off, respecting minimum intervals:
Dose 1 → Dose 2: ≥4 weeks
Dose 2 → Dose 3: ≥8 weeks
Dose 1 → Dose 3: ≥16 weeks
5. Special Case: Two Doses Only, Protective Titer
If anti-HBs ≥10 mIU/mL but series incomplete → give final dose now.
Even if last dose was >1 year ago, do not restart.
Third dose ensures long-term immunity.
6. Co-Administration with Influenza Vaccine
Safe to give both on the same day.
Use different arms, or if same arm, separate sites by ≥2.5 cm.
Both are intramuscular (IM):
HepB: Deltoid (adult) or anterolateral thigh (child)
Influenza: Same sites as above.
Document site for each vaccine.
7. Practical Summary Table
Scenario | Anti-HBs Result | Action |
Never vaccinated | N/A | Start full 3-dose series |
Incomplete series | ≥10 | Complete series |
Incomplete series | <10 | Complete series |
Completed series | ≥10 | No action |
Completed series | <10 | Repeat full series |
After 6 total doses | <10 | Permanent non-responder protocol |
8. Clinical Bottom Line
10 mIU/mL = protective immunity.
Always complete the 3-dose series, even if early titer is positive.
Never restart — just continue.
Non-responders get another full series; if still negative, classify as permanent non-responder.
Can co-administer with influenza vaccine safely.