Vaccination Concerns for Hepatitis B: What You Need to Know

Vaccination Issues

I want to get vaccinated because my mother has hepatitis B, but she doesn't know if she is a carrier or has been infected.
She has forgotten due to her age, but her liver function tests are normal.
Additionally, my grandfather had liver cancer, and my father has prostate cancer.
I regularly accompany family members to the hospital for check-ups, but I'm unsure if I have contracted hepatitis B.
When I was born, the government implemented a universal hepatitis B vaccination program for infants, so theoretically, I should have received the vaccine.
In my previous university health check, I wasn't specifically notified of any health issues, and my recent liver function tests are also normal.

I have several questions:
1.
Can I skip the antibody test and directly receive the three doses of the vaccine? Would there be any adverse effects?
2.
Should I get one dose and then test for antibodies? If the levels are insufficient, I can get more doses; if they are sufficient, I can skip the rest.
3.
Would completing the full three-dose series provide better protection?
4.
If I receive one dose and test positive for antibodies, would getting additional doses be unnecessary? Or should I complete all three doses and then test for antibodies?
5.
Should I undergo any specific tests before getting vaccinated? Would that make receiving the hepatitis B vaccine safer?
6.
Since I'm unsure which childhood vaccinations may have expired, are there any specific vaccines you would recommend for someone my age?
Thank you, doctor!

Xiao Wu, 30~39 year old female. Ask Date: 2021/04/30

Dr. Chen Shidian reply Gastroenterology and Hepatology

If there is no exposure risk (such as for healthcare workers), there is no need for such proactive testing or booster shots (both of which are out-of-pocket expenses).

Reply Date: 2021/04/30

More Info

When considering vaccination against Hepatitis B, especially in the context of potential exposure due to family history and caregiving responsibilities, it’s important to understand several key points about the virus, the vaccine, and the immune response.

Understanding Hepatitis B and Vaccination
Hepatitis B is a viral infection that affects the liver and can lead to chronic disease, liver cirrhosis, and even liver cancer. The virus is primarily transmitted through contact with infectious body fluids, such as blood, and can be particularly concerning in households where there is a known carrier or someone with a history of liver disease.

The Hepatitis B vaccine is highly effective and is typically administered in a series of three doses. The vaccine works by stimulating the immune system to produce antibodies against the virus, providing protection against future infections.

Addressing Your Concerns
1. Vaccination Without Antibody Testing: It is generally safe to receive the Hepatitis B vaccine without prior antibody testing. Given your family history and the potential risk of exposure, starting the vaccination series is advisable. The vaccine is well-tolerated, and while there may be minimal side effects (such as soreness at the injection site), the benefits of vaccination far outweigh the risks, especially in your situation.

2. Testing After the First Dose: While you can choose to receive the full three doses without testing, some individuals prefer to test for antibodies after the first dose. If you show adequate antibody response (anti-HBs levels of 10 mIU/mL or higher), you may not need the remaining doses. However, if the response is inadequate, completing the series is recommended to ensure full protection.

3. Completing the Full Series: Completing all three doses of the vaccine is generally recommended for optimal protection. The full series ensures that your immune system has the best chance of developing a robust and long-lasting immune response against Hepatitis B.

4. Antibody Testing After Completion: After completing the vaccine series, it’s a good practice to have your antibody levels checked. If you have developed adequate antibodies, you are considered protected. If not, further evaluation may be necessary, but this scenario is rare.

5. Pre-Vaccination Testing: If you are particularly concerned about your Hepatitis B status due to family history, you might consider getting tested for Hepatitis B surface antigen (HBsAg) and Hepatitis B surface antibody (anti-HBs) before vaccination. This can provide clarity on whether you are already infected or immune from previous vaccination.

6. General Vaccination Recommendations: If you are unsure about your vaccination history, it may be beneficial to discuss with your healthcare provider about other vaccines that may be recommended based on your age and health status. Vaccines such as the Tdap (tetanus, diphtheria, and pertussis), MMR (measles, mumps, rubella), and others may be relevant depending on your childhood vaccination history.

Conclusion
Given your family history of Hepatitis B and the potential risks associated with caregiving, it is prudent to proceed with the Hepatitis B vaccination. Starting the series without prior antibody testing is acceptable, and you can always assess your antibody levels after the first dose if you choose. Always consult with your healthcare provider for personalized advice and to ensure that you are making informed decisions regarding your health and vaccination status.

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