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Particularly For CHB Parents
By Will Boggs, MD

NEW YORK (Reuters Health) - Protection against hepatitis B appears to drop off
in adolescents who got the hepatitis B vaccine beginning at birth, according
to a new report.

Dr. Stephanie R. Bialek from the US Centers for Disease Control and
Prevention, Atlanta, Georgia, and colleagues evaluated the occurrence of
breakthrough infections and the persistence of protective levels of antibodies
against hepatitis B in 105 teens who had been given the recommended series of
hepatitis B vaccine starting at birth 15 years earlier.

Only eight of them showed evidence of new hepatitis B infection, the authors
report, and no participant was chronically infected.

On the other hand, only seven of the other 97 participants had relatively high
antibody levels against hepatitis B at the 15-year follow-up, the researchers
report in The Pediatric Infectious Disease.

Less than half of the participants who elected to get a booster dose of
hepatitis B vaccine had an expected antibody response at 14 days, which "might
indicate waning immunity," Bialek's team found.

"At this point in time, we do not have any evidence from our surveillance
systems of breakthrough hepatitis B virus infections occurring among
vaccinated adolescents and therefore do not recommend additional doses of
hepatitis B vaccine for adolescents or children who already received three
doses of hepatitis B vaccine," Bialek told Reuters Health.

However, he added, "We need to continue surveillance for hepatitis B among
vaccinated adolescents ... for making decisions about whether the additional
doses of hepatitis B vaccine should be recommended in the future."

SOURCE: The Pediatric Infectious Disease Journal, October 2008.
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7 Answers
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Valuable info to parents.  Thanks, zellyf.
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The guideline is 10 ul/ml. Is it safe for those without detectable antibody titers? As you know, 3 of my kids have no antibody - I have them gone through 3 shots again. Can we assume it is perfectly o.k with 3 shots at birth even w/o detectable antibody level now? I read some research but none clearly put down the antibody level. Thanks  
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They have no antibodies after the second round of shots?
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2007 Guideline:

Hepatitis B Vaccination
Recommendations for vaccination are outlined in a recent CDC and Advisory Committee on Immunization Practices (ACIP) guideline.9,9a Follow-up testing is recommended for those who remain at risk of infection such as health care workers, infants of HBsAg-positive mothers and sexual partners of persons with chronic HBV infection. Furthermore, annual testing of hemodialysis patients is recommended since immunity wanes rapidly in these individuals who are at a high risk of continued exposure to HBV.
Recommendations for Counseling and Prevention of Transmission of Hepatitis B from Individuals with Chronic HBV Infection:
2. Carriers should be counseled regarding prevention of transmission of HBV (Table 3). (III)
3. Sexual and household contacts of carriers who are negative for HBV seromarkers should receive hepatitis B vaccination. (III)
4. Newborns of HBV-infected mothers should receive HBIG and hepatitis B vaccine at delivery and complete the recommended vaccination series. (I)
5. Persons who remain at risk for HBV infection such as infants of HBsAg-positive mothers, health care workers, dialysis patients, and sexual partners of carriers should be tested for response to vaccination. (III)
● Postvaccination testing should be performed at 9 to 15 months of age in infants of carrier mothers and 1-2 months after the last dose in other persons. (III)
● Follow-up testing of vaccine responders is recommended annually for chronic hemodialysis patients. (III)
6. Abstinence or only limited use of alcohol is recommended in hepatitis B carriers. (III)
7. Persons who are positive only for anti-HBc and who are from a low endemic area with no risk factors for HBV should be given the full series of hepatitis B vaccine. (II-2)
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Done 2nd shot. Will be going for 3rd soon and measure the antibody after 1mth. My worry is whether the antibody will show up and if it doesn't can I assume they are safe?
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I don't know if you can but I would assume that they will test positive for antibodies.  Most people do.  Keep us posted.
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644497 tn?1225385226
Those people who are tested negative hep b surface antibodies after a series of hep b vaccine are called non-responders. I know that my husband's doctor had 3 sets of hep b vaccine series before he developed an immunity. Just have their status monitored after after 1-2 months of their complete hep b series.
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