Approximately 5-10% of people do not develop protective antibodies even after the completion of the hepatitis B vaccine series. This is confirmed with anti-HBs titers measured at least 4 weeks after the last dose. If the titer is less then 10 mIU/mL, then recommendation is to complete the series again, preferably using a different brand of vaccine.
A person is considered to be a “non-responder” if they have completed 2 full vaccination series’ without producing adequate protective antibodies.
It is also possible that a person who does not respond to the vaccine may already be infected with hepatitis B. So, testing for HBsAg) should be done before labelling a person as a “vaccine non-responder”
CDC Recommendations for Hepatitis B Vaccine Non-Responders
- Persons who do not respond to the primary hepatitis B vaccine series (i.e., anti-HBs <10 mIU/mL) should complete a second 3-dose vaccine series or be evaluated to determine if they are already HBsAg-positive.
- Revaccinated persons should be retested at the completion of the second vaccine series, 1-2 months following the last dose of the series.
- Persons exposed to HBsAg-positive blood or body fluids who are known not to have responded to a primary vaccine series should receive a single dose of hepatitis B immunoglobulin (HBIG) and restart the hepatitis B vaccine series with the first dose of the hepatitis B vaccine as soon as possible after exposure.
- For persons who previously completed a second vaccine series but failed to respond, ie who are “Non-responders”, should get 2 two doses of HBIG.