What are the implications if I am a non-responder to the hepatitis B vaccination?
I have taken the Twinrix Hepatitis B vaccination twice. Both times, a blood test after showed that I did not acquire immunity. What is the implication of this, and what can I do?
Hepatitis B vaccination usually requires a series of 3 injections over a 6-month period. A single 'booster' vaccine may not be adequate for antibody response.
However, if you have completed two full rounds of the Twinrix vaccine and currently still do not have detectable antibody levels, then you would be termed a non-responder.
Hepatitis B vaccine non-responders are considered to still be at risk of hepatitis B infection, so if you are exposed to potentially infected blood or body fluids, you would be advised to attend a healthcare facility as early as possible for an injection of hepatitis B immunoglobulin (HBIG) to reduce the risk of infection.
You should also speak to a healthcare provider at that point about post-exposure prophylaxis for other potential blood-borne infections.
Just to add on to the advice Dr Ti has provided, non-responders who have a strong family history of Hepatitis B carrier status should be aware of this entity known as "occult Hepatitis B" infection. This is a rare condition in which routine Hepatitis B surface protein test (aka HBsAg) is negative yet the person is actually a Hepatitis B carrier. This is the reason why repeated vaccination attempts will not induce antibody formation in that person since he or she is already infected with the virus.
A DNA test is necessary to reveal such a status which will show the presence of Hepatitis B virus in the blood stream. Such patients are usually diagnosed late as the routine tests fail to pick them up. The follow-up recommendation of such patients should be the same as any other Hepatitis B carrier with blood tests and liver ultrasound scans on a regular basis.
- Dr Quan
Sorry to hear about your problems. Like Dr Ti has mentioned, the usual primary course of Twinrix is 3 doses.
In general, interpretation of Hepatitis B immunity tests can be quite complex and need to account for a number of factors including
- Individual risk level
- Family history
- Timing of vaccinations and tests
You should speak to a healthcare professional so all the above can be taken into account.