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Hepatitis B - risk of transmission if vaccinated
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Hepatitis B - risk of transmission if vaccinated

Dear Dr,

I am a 34 year old gay man. I have recently met a Thai man (aged 28) who has chronic Hep B (since birth). We are in a relationship but have not engaged in any sex at all (just kissing).

He is e-antigen negative, but I note that he did pass the virus onto his ex-boyfriend (and they only had unprotected sex twice).

My vaccination history:
In 2005, I received the super-accelerated vaccination schedule for Hep B (0, 7 and 21 days).
- Several few weeks post-vaccination, my antibody levels were "low" (I think around 30 but I can't remember). A booster was suggested but I did not take it.
- I did NOT receive a booster at 12 months (and hence, did not complete the course).

My health:
I am in reasonable health. I have asthma (take a steroid inhaler), allergies and some problems with my autonomic nervous system, related to a whiplash/head injury. I tend to get tired easily (fatigue). I get  run down easily, and get colds and allergies often.

I am in the middle of another super-accelerated vaccination for Hep B (I did this as we deep kissed a few times before I found out his status) and also to increase my antibody levels.

Once I have completed the current accerated vaccination schedule (0,7, 21 days), would it be safe for us to have regular unprotected sex (if he is negative for other STIs)? In other words, is the vaccination 100% effective?

Thank you.

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Welcome back to our Forum.  Your questions are good ones.  Here are some thoughts that I hope you will find helpful:

1.  The accelerated hepatitis B vaccination schedule is a compromise that is better than nothing but not as good as the standard, recommended schedule.
2.  The booster is an important part of the vaccination program.  Your current repeat accelerated vaccine schedule will serve as a booster to your previous vaccination, even though it is delayed.  This time I strongly recommend you complete the series.
3.  I am unaware of any cases in which hepatitis B has been transmitted by kissing, even deep kissing.
4.  Hepatitis B vaccine prevents infection in exposed persons but not perfectly, reducing the risk for infection by about 80%.  In vaccinated persons who get hepatitis B, the infection tends to be less severe.
5.  Your general health, including your inhaled steroid medication is not likely to reduce your response to the vaccine.

Hope these comments are helpful.  EWH
Dear Dr. Hook,

Many thanks for your prompt response. I have a couple of follow-up questions (if this is allowed) - if you can answer them, that would be very helpful.

Based on what you said about the accelerated course being less effective than the standard one, in order to maximise my protection, do you think I should "convert" my current vaccination schedule into the standard one (especially as, being a gay man, I am in a high risk group)?
- Currently, I have had an injection at 0 and 7 days. I am due for the third injection next week (21 days).
- Therefore, do you think I should wait until 28 days for the third injection and have another at 6 months (would be four injections all together).

80% protection does not sound high enough for me to engage in unprotected sex.
I know this is a difficult question to answer, but do you think a relationship with this man is sensible, based on the fact that I really do want to avoid catching Hep B.? Condoms break, so I am thinking that this is risky.

Thank you!
since you have already had part of one accelerated vaccine course, I think that completing this one as planned will be fine and thathtere in no need to change the scheudle.

As for the impact of the 80% protection issue. this of course is a decison that you have to make.  On one had 80% is far, far better than nothing.  On the other hand, with repeated expsoures your risk does go up.  I would not substitute vaccination alone for practicng safe sex.  As you pont out, condoms aren't perfect either but, between the two, you will be about as well protected as a person can be short of abstinence from penetrative sex.  EWH
Dear Dr. Hook,

Some of your points raised additional questions for me:

1. You said "the accelerated hepatitis B vaccination schedule is a compromise that is better than nothing but not as good as the standard, recommended schedule."

Would it not be best for me, therefore, despite currently undergoing the accelerated schedule, to have the standard, recommended schedule at some time in the future, so I know I am protected maximally? I would not want to rely on a schedule which is just "better than nothing". Obviously it would mean me having more injections.

2. You said the vaccine is 80% effective. What research study came to that conclusion?

3. If I were vaccinated and still got the Hep B virus, could it lead to an Active (and potentially Chronic) infection? Or would my immune system clear the virus before it became acute/chronic? (Again, if you have any research studies I could look at, that would be great).

Many thanks.
1.  Your situation is different from that of someone who has never received any vaccine.  You have my recommendation.  Should you choose to do something else that is up to you.  I doubt that the more traditional vaccination schedule would change your response.  

2.  Many studies have come to this conclusion.  I do not supply references.  Try a textbook or the package insert.

3.  Unlikely. In those persons who have been vaccinated, should they get hepatitis B the course of infection is typically milder than in unvaccinated persons and less likely to become chronic.  EWH
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University of Washington
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