Do I Need Another Hepatitis B Vaccine After Testing Negative for Antibodies?

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I received the hepatitis B vaccine when I was young, but during a blood test in fifth grade, it showed that I had no antibodies.
I also underwent core testing at the hospital, which confirmed the absence of antibodies.
However, the doctor mentioned that white blood cells have memory, so there is no need for revaccination.
Is it true that I really do not need to receive the vaccine again?

Lai, 10~19 year old female. Ask Date: 2009/09/01

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, the hepatitis B vaccine is a recombinant vaccine.
Since it is an inactivated vaccine, antibody levels may decline significantly after several years post-vaccination, but this does not necessarily mean that protection is lost, as memory cells in the body can produce antibodies upon viral invasion to prevent infection.
However, a certain level of antibodies is required for protection, so there is no definitive conclusion on whether booster shots are needed or how to administer them.
For individuals who have received the hepatitis B vaccine but do not have detectable hepatitis B surface antibodies, it is recommended to rule out the possibility of being a "hepatitis B carrier" or having "previous hepatitis B infection." If Anti-HBc is negative (indicating core antigen is negative) and there is a potential risk of exposure to hepatitis B, a booster shot may be considered.
One additional dose can be administered, followed by testing for hepatitis B antibody levels one month later to determine whether to proceed with the complete three-dose series.
Best regards, Dr.
Lin Ming-Hui, Taoyuan Hospital, Health Department.

Reply Date: 2009/09/01

More Info

When considering whether you need another Hepatitis B vaccine after testing negative for antibodies, it's essential to understand the context of your previous vaccinations and the nature of the antibody tests.

First, let's clarify the role of the Hepatitis B vaccine. The vaccine is designed to stimulate your immune system to produce antibodies against the Hepatitis B virus (HBV). The presence of these antibodies, specifically the Hepatitis B surface antibody (Anti-HBs), indicates that you have immunity against the virus. If you have received the vaccine and your body has responded appropriately, you should have detectable levels of these antibodies.

In your case, you mentioned that you received the Hepatitis B vaccine during childhood but tested negative for antibodies during a blood test in fifth grade. This negative result suggests that your body did not produce sufficient antibodies in response to the vaccine. However, it's important to note that a negative antibody test does not necessarily mean you are unprotected against the virus. Some individuals may have a memory immune response that can be activated upon exposure to the virus, even if they do not have detectable antibodies at the time of testing.

Your physician's comment about white blood cells having "memory" refers to the immune system's ability to remember past infections or vaccinations. This memory can lead to a rapid immune response if you are exposed to the virus in the future. However, this does not guarantee that you are fully protected, especially if you have not had a robust antibody response in the past.

Given your situation, there are a few considerations:
1. Testing for Immunity: If you have not had a detectable level of Anti-HBs in your tests, it may be prudent to consider revaccination. The absence of antibodies suggests that your immune system may not have developed the necessary protection from the initial vaccination series.

2. Revaccination: The Centers for Disease Control and Prevention (CDC) recommends that individuals who are at risk for Hepatitis B, including those who test negative for antibodies after vaccination, should receive a complete series of the vaccine. This typically consists of three doses administered over a six-month period.

3. Risk Assessment: Consider your risk factors for Hepatitis B. If you are in a high-risk group (e.g., healthcare workers, individuals with multiple sexual partners, or those who may be exposed to contaminated blood), getting revaccinated is advisable.

4. Consultation with a Specialist: If you are uncertain about your vaccination status or the need for revaccination, it may be beneficial to consult with a specialist in infectious diseases or a hepatologist. They can provide personalized recommendations based on your medical history and risk factors.

In summary, while your physician's advice about the immune memory is valid, the absence of detectable antibodies suggests that you may not be fully protected against Hepatitis B. Therefore, it is generally recommended to consider revaccination, especially if you are at risk for exposure to the virus. Always consult with your healthcare provider to make the best decision based on your individual health circumstances.

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