Do Babies with Low Hepatitis B Antibodies Need a Booster Shot?

Is it necessary to receive a booster shot for hepatitis B antibodies?

Hello, doctor.
I would like to ask about my situation.
I am a carrier of hepatitis B, with HBsAg positive and HBeAg negative.
My baby is currently 1 year and 1 month old.
At birth, he received immunoglobulin and three doses of the hepatitis B vaccine.
When I took him for a blood test at one year old, the surface antigen was negative, and the surface antibody was positive (with a value of only 13).
I would like to know if my baby's antibody level is indeed too low and if he needs an additional dose.
I have seen some experiences suggesting that it is not necessary, while others say that getting another dose is harmless.
If it is not necessary to administer another dose, is there a risk that the antibody level could drop to negative, potentially leading to me infecting him one day? Alternatively, if a booster is recommended, at what age should it be given? I have heard that there is also a check when starting elementary school, and as a concerned mother, I would appreciate your clarification.
Thank you.

Xin, 40~49 year old female. Ask Date: 2023/08/04

Dr. Chen Shidian reply Gastroenterology and Hepatology

There is limited research on catch-up vaccinations for infants and young children, and no consensus exists.
The general principle is that catch-up vaccinations can be administered, and there have been no reports of adverse effects.

Reply Date: 2023/08/04

More Info

When it comes to the management of hepatitis B vaccination and antibody levels in infants, especially those born to hepatitis B carriers, it is crucial to understand the implications of low antibody levels and the recommendations for booster vaccinations.

In your case, your baby has received the hepatitis B vaccine and the hepatitis B immunoglobulin (HBIG) at birth, which is the standard protocol for infants born to mothers who are hepatitis B surface antigen (HBsAg) positive. The fact that your baby has a positive surface antibody (anti-HBs) level of 13 indicates that there is some immune response to the vaccine, but it is on the lower end of the protective range. Generally, an anti-HBs level of 10 mIU/mL or higher is considered protective against hepatitis B infection.

The question of whether your baby needs a booster shot is a common concern among parents, especially those with a history of hepatitis B. Current guidelines suggest that if the anti-HBs level is between 10 and 100 mIU/mL, the child is considered to have adequate immunity. However, if the level is below 10 mIU/mL, it is recommended to administer a booster dose of the hepatitis B vaccine. In your case, since the level is 13, it is slightly above the threshold, but it is still advisable to consult with your pediatrician or a specialist in infectious diseases for personalized advice.

The concern about whether your baby could lose immunity and become susceptible to hepatitis B infection is valid. If the antibody levels were to drop below the protective threshold, there is a risk of infection, particularly since you are a carrier. It is important to monitor your child's antibody levels periodically, especially before significant life events such as starting school, where routine checks may occur.

If a booster is deemed necessary, it can typically be administered at any time, but it is often recommended to do so before the child enters school. This ensures that they have adequate protection against hepatitis B, especially in environments where they may be at higher risk of exposure.

In summary, while your baby's current anti-HBs level of 13 indicates some level of immunity, it is advisable to discuss the need for a booster shot with your healthcare provider. They can provide guidance based on the latest recommendations and your child's specific health needs. Regular monitoring of antibody levels and timely vaccinations are key to ensuring your child's continued protection against hepatitis B.

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