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20. HBV vaccine: Anti-HBs

Anti-HBs (antibody to hepatitis B surface antigen) testing after 3 doses of HBV vaccine:

Anti-HBs >100 IU/mL: Responder to HBV vaccination. If immunocompetent, further assessment of antibody levels is not indicated. A reinforcing dose at five years maybe required. Individuals at continuing risk of infection should be offered a single booster dose of vaccine, once only, around five years after primary immunisation. Measurement of anti-HBs levels is not required either before or after this dose. Boosters are also recommended after exposure to the virus. (Please consult UK immunisation guidance for further details: ‘Hepatitis B: the green book, chapter 18’).

Anti-HBs 10-100 IU/mL: Responder to HBV vaccination. One additional dose of vaccine should be administered now. If immunocompetent, further assessment of antibody levels is not indicated. A reinforcing dose at five years maybe required. Individuals at continuing risk of infection should be offered a single booster dose of vaccine, once only, around five years after primary immunisation. Measurement of anti-HBs levels is not required either before or after this dose. Boosters are also recommended after exposure to the virus. (Please consult UK immunisation guidance for further details: ‘Hepatitis B: the green book, chapter 18’). 

Anti-HBs <10 IU/mL: Non-responder to HBV vaccination. Patient should be tested for markers of current (HBsAg) or past infection (anti-HBc). A repeat course of vaccine (3 doses) is recommended, followed by retesting 1-4 months after the second course (6 in total). Those who still have anti-HBs levels below 10IU/ml, and who have no markers of current or past infection, will require HBIG for protection if exposed to the virus. (Please consult UK immunisation guidance ‘Hepatitis B: the green book, chapter 18’).

Please note that a positive anti-HBs titre is not evidence that a patient is not currently infected with HBV. HBsAg (or anti-HBc) testing is required to exclude current HBV infection.