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Hep B shots for children
Hi all,
I remember all three of my kids getting their blood tested for the antigen years ago. Two did not get the HBIG at birth and they did the shot series. My daughter who did not get either has a high titre count. My son who did not respond to the shot a few years ago and did receive the HBIG at birth had to take an additional booster shot and he finally responded and has a high count as we recently checked. However, the third child who was born overseas has had the 3 shots (1 at birth) without the HBIG and 2 additional boosters. The last booster was given in 2013. We recently got his blood taken and he did not respond to the titres which was strange.
So now the doctor wants to do a complete hepatitis panel to make sure no one is antigen negative. But I recall checking all three and they were all non-reactive. She said there is no point in giving him another booster because he already has had the 3 hep b shots and then the two boosters. His body simply isn't responding most likely but what do you all suggest? Should we give another booster now or just wait and see?
I am e-antigen negative and my viral loads fluctuate. I am hoping no one has hep b in the family but I was very confident that they were tested before. Do you just think he's not responding to the shots? What is the next step?
Thanks
I remember all three of my kids getting their blood tested for the antigen years ago. Two did not get the HBIG at birth and they did the shot series. My daughter who did not get either has a high titre count. My son who did not respond to the shot a few years ago and did receive the HBIG at birth had to take an additional booster shot and he finally responded and has a high count as we recently checked. However, the third child who was born overseas has had the 3 shots (1 at birth) without the HBIG and 2 additional boosters. The last booster was given in 2013. We recently got his blood taken and he did not respond to the titres which was strange.
So now the doctor wants to do a complete hepatitis panel to make sure no one is antigen negative. But I recall checking all three and they were all non-reactive. She said there is no point in giving him another booster because he already has had the 3 hep b shots and then the two boosters. His body simply isn't responding most likely but what do you all suggest? Should we give another booster now or just wait and see?
I am e-antigen negative and my viral loads fluctuate. I am hoping no one has hep b in the family but I was very confident that they were tested before. Do you just think he's not responding to the shots? What is the next step?
Thanks
Hi Cally,
I thought I would send an email through medhelp, since we seem to be chattering and worry people will get frustrated with us. Haha. I tried, but it wouldn't take the security letters to prove I wasn't a robot. I don't know why, so I will just post my response. Please feel free to try to email me from medhelp if you feel to in the future.
I'm sorry, by positive I meant over the protective level, over the 10 hbsab. When my kids and husband got the booster all shot up really high, way over 10.....but they all at one point were over 10 and did respond to the vaccine. Even if one does lose their immunity, as long as they once showed over 10, if exposed their body should remember that immunity and mount a response. A response would mount another titer over protection level again. If a non-vaccinated adult gets exposed to HBV 90-95% do not go chronic, their immune system is mature and naturally fights off the virus, which results in a natural hbsab protection. Most of us are chronic because we were exposed as a young child, when the immune system is not mature enough to naturally fight it off.
Since you aren't sure if your one child ever had an immunity, I personally would try at least one more booster to get that response to mount, but this is just my opinion and am by no means a doctor. My rational is that a vaccine is easy, much easier than fighting off active HBV or living with chronic HBV. If he doesn't not respond again I would ask his doctor (if knowledgeable about HBV) for advise or I'm sure you can ask your liver doctor or seek out a pediatric gastro doctor who obviously knows HBV more than a general doctor. I cannot answer why some do not ever resond with a positive (over 10) titer, but as you have read it does happen. The hope is that immunity is there on some level and if challenged would recognize the attack, but without once having that proven titer it is not necessarily so.
Two years ago I used Viread for only 6 months. When I went off (because my now liver doctor said alt is always normal in 20's and DNA never above the 2,000 iu). After I went off Viread my alt never went over the 20's and my DNA went back to normal for me which is about 200iu-800iu. I thought I was good, considering I never even had any flare at all going off the medication. I don't know why it's now creeping into the 40's with my DNA still staying low, but the virus is the only thing we can point it to. I have a few Viread bottles from last time, so I'm taking that until I run out. When I run out I'm switching over to the new Vemlidy, no real reason but my doctor said just a lower dose and might as well take a lower dose if possible.
Do you have mutations, since your e-negative and your viral load fluctuates over the 2,000iu? How old are you? What does your doctor say about the alt and DNA fluctuating? I'm in the US. Where are you? I know there are different guidelines based on where you live. I know I'm in the "grey zone" (with alt now almost twice what is now recommended as a female but DNA low) but for some reason this time around I feel comfort in going on the antiviral for good now. I think it's because my alt has never gone into the 40's in the 20+ year of records. My liver doctor feels in 5-10 years there will be a cure. Let's hope!
I thought I would send an email through medhelp, since we seem to be chattering and worry people will get frustrated with us. Haha. I tried, but it wouldn't take the security letters to prove I wasn't a robot. I don't know why, so I will just post my response. Please feel free to try to email me from medhelp if you feel to in the future.
I'm sorry, by positive I meant over the protective level, over the 10 hbsab. When my kids and husband got the booster all shot up really high, way over 10.....but they all at one point were over 10 and did respond to the vaccine. Even if one does lose their immunity, as long as they once showed over 10, if exposed their body should remember that immunity and mount a response. A response would mount another titer over protection level again. If a non-vaccinated adult gets exposed to HBV 90-95% do not go chronic, their immune system is mature and naturally fights off the virus, which results in a natural hbsab protection. Most of us are chronic because we were exposed as a young child, when the immune system is not mature enough to naturally fight it off.
Since you aren't sure if your one child ever had an immunity, I personally would try at least one more booster to get that response to mount, but this is just my opinion and am by no means a doctor. My rational is that a vaccine is easy, much easier than fighting off active HBV or living with chronic HBV. If he doesn't not respond again I would ask his doctor (if knowledgeable about HBV) for advise or I'm sure you can ask your liver doctor or seek out a pediatric gastro doctor who obviously knows HBV more than a general doctor. I cannot answer why some do not ever resond with a positive (over 10) titer, but as you have read it does happen. The hope is that immunity is there on some level and if challenged would recognize the attack, but without once having that proven titer it is not necessarily so.
Two years ago I used Viread for only 6 months. When I went off (because my now liver doctor said alt is always normal in 20's and DNA never above the 2,000 iu). After I went off Viread my alt never went over the 20's and my DNA went back to normal for me which is about 200iu-800iu. I thought I was good, considering I never even had any flare at all going off the medication. I don't know why it's now creeping into the 40's with my DNA still staying low, but the virus is the only thing we can point it to. I have a few Viread bottles from last time, so I'm taking that until I run out. When I run out I'm switching over to the new Vemlidy, no real reason but my doctor said just a lower dose and might as well take a lower dose if possible.
Do you have mutations, since your e-negative and your viral load fluctuates over the 2,000iu? How old are you? What does your doctor say about the alt and DNA fluctuating? I'm in the US. Where are you? I know there are different guidelines based on where you live. I know I'm in the "grey zone" (with alt now almost twice what is now recommended as a female but DNA low) but for some reason this time around I feel comfort in going on the antiviral for good now. I think it's because my alt has never gone into the 40's in the 20+ year of records. My liver doctor feels in 5-10 years there will be a cure. Let's hope!
I'm sending you an email through medhelp, so we can stop the thread chatter. Haha!
I forgot to ask you does the blood test show positive or negative titres and not necessarily numbers? What if the blood test says negative titres? I am not sure what you mean by the titres being positive even if the number is below 10?
1 Comments
I forgot to ask you does the blood test show positive or negative titres and not necessarily numbers? What if the blood test says negative titres? I am not sure what you mean by the titres being positive even if the number is below 10?
Here are some good links below. I just googled hepatitis b titers after immunization. Some articles did recommend boosters, but other sites I read said not necessary due to memory. I guess for us, being HBV positive, there can be an argument to consitantly keep titers up, but the 2 specialist I saw didn't recommend that. I'm sure the e antigen negativity and low household risk played a role in his recommendation.
During this scary time with my kids I even had my husband retested. He too lost his immunity, so all 3 kids and him! Go figure. We did the same thing as we did with the kids, did booster and rechecked all. He was negative for HBV and got his titers back after the booster, like the kids.
As for meds, I'm almost 44 and recently started antivirals. I have always had a low DNA and low alt, but in the past 6 months my alt has gone from the low 20's to the 30's and now into the 40's, which is like never before. My liver doctor said there are no other reasons for this and recommended before it continues to increase (and possibly start causing damage) to start treatment. I also have 3 lesions they continue to watch by MRI (so far don't think they are anything) but said with everything going on I finally felt comfortable to start meds again. I was on antivirals for 6 months about 2 years ago, only because a new liver doctor recommended it just for added measure. When I moved onto my liver doctor now, she recommended me go off as 2 years ago it wasn't needed. So, I knew this time around, her recommending to go back on meds, that she was honest in her recommendation.
http://www.medscape.com/viewarticle/483473
http://www.hepatitisbannual.org/article.asp?issn=0972-9747;year=2005;volume=2;issue=1;spage=56;epage=73;aulast=Lu
https://forums.studentdoctor.net/threads/hep-b-vaccine-non-responder.1146241/
http://onlinelibrary.wiley.com/store/10.1002/hep.510290349/asset/510290349_ftp.pdf;jsessionid=85B854AA305BA65CC75B30D864CD739B.f02t01?v=1&t=j50ahtb1&s=9714ff2c2e85f4d66926cabb79b65dce699068b6
http://www.tandfonline.com/doi/pdf/10.4161/hv.7.10.15990
During this scary time with my kids I even had my husband retested. He too lost his immunity, so all 3 kids and him! Go figure. We did the same thing as we did with the kids, did booster and rechecked all. He was negative for HBV and got his titers back after the booster, like the kids.
As for meds, I'm almost 44 and recently started antivirals. I have always had a low DNA and low alt, but in the past 6 months my alt has gone from the low 20's to the 30's and now into the 40's, which is like never before. My liver doctor said there are no other reasons for this and recommended before it continues to increase (and possibly start causing damage) to start treatment. I also have 3 lesions they continue to watch by MRI (so far don't think they are anything) but said with everything going on I finally felt comfortable to start meds again. I was on antivirals for 6 months about 2 years ago, only because a new liver doctor recommended it just for added measure. When I moved onto my liver doctor now, she recommended me go off as 2 years ago it wasn't needed. So, I knew this time around, her recommending to go back on meds, that she was honest in her recommendation.
http://www.medscape.com/viewarticle/483473
http://www.hepatitisbannual.org/article.asp?issn=0972-9747;year=2005;volume=2;issue=1;spage=56;epage=73;aulast=Lu
https://forums.studentdoctor.net/threads/hep-b-vaccine-non-responder.1146241/
http://onlinelibrary.wiley.com/store/10.1002/hep.510290349/asset/510290349_ftp.pdf;jsessionid=85B854AA305BA65CC75B30D864CD739B.f02t01?v=1&t=j50ahtb1&s=9714ff2c2e85f4d66926cabb79b65dce699068b6
http://www.tandfonline.com/doi/pdf/10.4161/hv.7.10.15990
1 Comments
Thank you! You have been so helpful! What antivirals are you on? I am sure my husband lost his immunity too. If they lose their immunity and get infected does their body fight it because of the vaccine/immune memory?
I remember my third had titres back in 2014 but the second child didn't so he got the booster. However my third had one series of the vaccines and two boosters that is 5 included. Do you think he's body is not responding right now and he lost his immunity?
My alt has also fluctuated from 20's, 30's 50's and 70's. My dna is usually below 100,000 but I am trying to figure out why it keeps fluctuating. I am e antigen negative and I think I also have a strain of Epstein Barr virus because when I was young I had mono and sometimes this virus attacks the liver too.
Look into the epstein barr virus, so many illnesses are caused because of this.
Thanks I will look into the site.
I remember my third had titres back in 2014 but the second child didn't so he got the booster. However my third had one series of the vaccines and two boosters that is 5 included. Do you think he's body is not responding right now and he lost his immunity?
My alt has also fluctuated from 20's, 30's 50's and 70's. My dna is usually below 100,000 but I am trying to figure out why it keeps fluctuating. I am e antigen negative and I think I also have a strain of Epstein Barr virus because when I was young I had mono and sometimes this virus attacks the liver too.
Look into the epstein barr virus, so many illnesses are caused because of this.
Thanks I will look into the site.
You are welcome and happy to try to help! Correct, I was told by the pediatric gastroenterologist and my liver doctor that even if they lose the positive titter they will mount a memory response if exposed, and no need to keep that titer super high. If you Google about HBV non-responder vaccine you will find it does happen, that some don't ever mount a response (most that come up are in the medical field needing to test for employment). My kids did have positive titers, so I never needed to ask about how much you try before giving up on trying to get that titer to mount. I don't know if there are even clear guidelines on that, since most just get vaccinated for any virus (not just hbv) and never check titers. I just remember when my son didn't show titers after his first round the pediatrician said she called the CDC and they recommended he whole series again. As far you continue past that I don't know. I would ask your liver doctor.
I too have been e-negative for a very long time, so like you said, at low risk anyway. I'm sure your kiddos are fine and one just wants to be special. Haha!
I too have been e-negative for a very long time, so like you said, at low risk anyway. I'm sure your kiddos are fine and one just wants to be special. Haha!
2 Comments
I remember reading of studies done on children that had HBV mothers and tiers over time. Titers are meant to go down, unless there is a reason for the immune system to "wake up". I totally went crazy doing my own research while in that scary waiting period (before seeing the pediatric gastro and seeing my liver doc). All in all, I think thistle is more common than we know, since we are seeking it out, instead of getting vaccinated and moving on with life.
Yes so what was strange is that he had enough titres back in 2014 and then now when they checked they didn't see anything. My second son developed enough titres after his booster in 2014. But I do recall checking all three kids for the antigen in 2012 and they were all negative thank God.
I hope that when we do the next panel everything is normal. I think maybe he just needs 1 shot to help his body develop antibodies or maybe he just doesn't respond at this point. Not sure.
So it's common for titres to fluctuate or go down?
Also, are you on any anti0virals? I am not on any meds. I am taking the natural route but hopefully taking it easy.
THANKS SO MUCH DEAR!!
You have been a great support
I hope that when we do the next panel everything is normal. I think maybe he just needs 1 shot to help his body develop antibodies or maybe he just doesn't respond at this point. Not sure.
So it's common for titres to fluctuate or go down?
Also, are you on any anti0virals? I am not on any meds. I am taking the natural route but hopefully taking it easy.
THANKS SO MUCH DEAR!!
You have been a great support
Hi Cally. You did not mention the time frame of the vaccines, as well as how long ago this all was, and if the 3rd child initially mounted a response.
My kids are 17,17, 15. They all got HBIG, initial vaccine as newborn, and the other 2 other vaccines within 6 months. At 9 months, 2 out of the 3 responded with high titers. The 3rd (one of the twins) did not respond. His pediatrician checked HBV panel and was negative for all. She called the CDC and they recommended to do another full round of 3 shots (as some will mount a response on that 4th, 5th or 6th vaccine). We did all 3 vaccines again and right before he was 2 years old finally showed a response, not a super high titer like my other 2 but know it was well over what they say is needed for protection.
Fast forward to last year. I asked their pediatrician (mainly just to ask) if we should do a booster, just like what is done with MMR boosters, etc. She said we could test titers and go from there. We did so and low and behold all of them showed no immunity. I was floored and scared. We again did the full HBV panel, and showed negative for all, so we did one booster, got their levels checked a month later and all responded to the booster (the one twin that initially didn't respond to the 1st series did have lower titers after booster like the first time but again was well over protection).
When I told my liver doctor of all this he said this was all unnecessary. He said their body has a memory of that vaccine and if ever challenged would mount a fight, which of course was proven by the booster.
I remember doing research when they lost their titers. Some do not mount a response no matter how many shots given, for whatever unknown reason (a lot of these examples come up with healthcare workers needing proof of vaccinate for employment in the US). If your son mounted a response and positive titer at one point there is no need to continue to give a booster. Even if he did not mount a response to all he had he may not ever mount a full response. I understand you wanting peace of mind though as a mother. If it makes you feel better, ask your liver doctor what to do. Most pediatricians (at least in the US) are totally clueless as to HBV. I wish I would have asked my liver doctor first because it would have saved me and my kids a lot of extra unnecessary worry. I remember making an appointment with my liver doctor just to show him all of my kids labs. He took one look at all of them and said they are fine, were always fine, and all we did was totally unnecessary. My pediatrician even had me take the kids to a pediatric gastroenterologist, again for no reason and just added extra worry for nothing.
I hope this helps!
My kids are 17,17, 15. They all got HBIG, initial vaccine as newborn, and the other 2 other vaccines within 6 months. At 9 months, 2 out of the 3 responded with high titers. The 3rd (one of the twins) did not respond. His pediatrician checked HBV panel and was negative for all. She called the CDC and they recommended to do another full round of 3 shots (as some will mount a response on that 4th, 5th or 6th vaccine). We did all 3 vaccines again and right before he was 2 years old finally showed a response, not a super high titer like my other 2 but know it was well over what they say is needed for protection.
Fast forward to last year. I asked their pediatrician (mainly just to ask) if we should do a booster, just like what is done with MMR boosters, etc. She said we could test titers and go from there. We did so and low and behold all of them showed no immunity. I was floored and scared. We again did the full HBV panel, and showed negative for all, so we did one booster, got their levels checked a month later and all responded to the booster (the one twin that initially didn't respond to the 1st series did have lower titers after booster like the first time but again was well over protection).
When I told my liver doctor of all this he said this was all unnecessary. He said their body has a memory of that vaccine and if ever challenged would mount a fight, which of course was proven by the booster.
I remember doing research when they lost their titers. Some do not mount a response no matter how many shots given, for whatever unknown reason (a lot of these examples come up with healthcare workers needing proof of vaccinate for employment in the US). If your son mounted a response and positive titer at one point there is no need to continue to give a booster. Even if he did not mount a response to all he had he may not ever mount a full response. I understand you wanting peace of mind though as a mother. If it makes you feel better, ask your liver doctor what to do. Most pediatricians (at least in the US) are totally clueless as to HBV. I wish I would have asked my liver doctor first because it would have saved me and my kids a lot of extra unnecessary worry. I remember making an appointment with my liver doctor just to show him all of my kids labs. He took one look at all of them and said they are fine, were always fine, and all we did was totally unnecessary. My pediatrician even had me take the kids to a pediatric gastroenterologist, again for no reason and just added extra worry for nothing.
I hope this helps!
1 Comments
Thank you for your excellent response. Yes my third at one point did show titers but now it's showing nothing. He did 3 shots (not HBIG at birth but the Hep B shot at birth) and then the due schedule routine shots. He did 2 boosters and perhaps at one point the booster did show some titers. My second son didn't show titers so they gave him a booster and now when we checked he's fine. The third one did not respond. So I am not sure if he is a nonresponder and what I should do? She is doing another hep b panel for all three to make sure but I know they are negative because we checked several years ago. I am also e antigen negative so i am not very infectious compared to some others.
I will await and see once we do the lab work. So do you recommend that they don't do any booster as he has a immune memory already in his system?
THANKS
I will await and see once we do the lab work. So do you recommend that they don't do any booster as he has a immune memory already in his system?
THANKS
According to the World Health Organization, the HepB vaccine gives protection to 95% of those who get vaccinated. So you see, it doesn't give 100% protection. Anyways, I don't see any danger in trying again and vaccinating your son to see if he could develop protective antibodies to hbv.
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