What are the implications if I am a non-responder to the hepatitis B vaccination?

Doctor's Answers 2

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Dr Jonathan Ti

General Practitioner

Hepatitis B vaccination usually requires a series of 3 injections over a 6-month period. A single 'booster' vaccine may not be adequate for antibody response.

However, if you have completed two full rounds of the Twinrix vaccine and currently still do not have detectable antibody levels, then you would be termed a non-responder.

Hepatitis B vaccine non-responders are considered to still be at risk of hepatitis B infection, so if you are exposed to potentially infected blood or body fluids, you would be advised to attend a healthcare facility as early as possible for an injection of hepatitis B immunoglobulin (HBIG) to reduce the risk of infection.

You should also speak to a healthcare provider at that point about post-exposure prophylaxis for other potential blood-borne infections.

Photo of Dr Wai Leong Quan
Dr Wai Leong Quan

Gastroenterologist

Just to add on to the advice Dr Ti has provided, non-responders who have a strong family history of Hepatitis B carrier status should be aware of this entity known as "occult Hepatitis B" infection. This is a rare condition in which routine Hepatitis B surface protein test (aka HBsAg) is negative yet the person is actually a Hepatitis B carrier. This is the reason why repeated vaccination attempts will not induce antibody formation in that person since he or she is already infected with the virus.

A DNA test is necessary to reveal such a status which will show the presence of Hepatitis B virus in the blood stream. Such patients are usually diagnosed late as the routine tests fail to pick them up. The follow-up recommendation of such patients should be the same as any other Hepatitis B carrier with blood tests and liver ultrasound scans on a regular basis.

- Dr Quan

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When are Hep B booster vaccinations required, and how should it be administered?

Hi Kit Kit, The vaccinations which your children received obviously have not been proven to produce any protective antibodies yet. This suggest there is either no antibody production at all (i. e. non-responder) or antibodies at too low a level to be detected by routine methods after some years. One commonly employed way to distinguish the two is to provide a booster dose given as an injection and to check for the protective antibodies 1 month later.

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