Australian Technical Advisory Group on Immunisation (ATAGI) (2016) The Australian immunisation handbook 10th ed (2017 update). Canberra: Australian Government Department of Health. Accessed July 2018
Derived from Hepatitis B Testing and Vaccination at Canberra Sexual Health Centre. April 2017
Who may already be vaccinated?
NSW Relevant information:
Most people born in and attended school in NSW would have been offered primary course of vaccination for Hepatitis B through infant immunisation or school based programs.
2000: Infant hepatitis B vaccination added to national schedule.
2004-2013: NSW commenced adolescent school-based two-dose vaccination for 11-15 year olds.
People may have been vaccinated through GPs or other local programs.
If born overseas or location of schooling was outside Australia consider if they received their primary course of Hepatitis B.
Who should have anti-HBs testing post vaccination?
Post-vaccination serological testing (anti-HBs) at 4 to 8 weeks is recommended after completion of the primary course only for persons in the following categories:
- significant occupational risk (e.g. healthcare workers with frequent exposure to human tissue, blood and body fluids)
- risk of severe or complicated HBV disease (e.g. HIV/immune-compromised, pre-existing liver disease)
- risk of poor response to hepatitis B vaccination (e.g. haemodialysis, bleeding disorders)
- sexual partners and household, or other close household-like, contacts of persons with HBV
If person from above category did not have anti-HBs testing within 4 to 8 weeks after completing primary course proceed with anti-HBs serology.
In both cases, if anti-HBs levels ≥10 mIU/mL are not reached further follow up is required. Refer Serological Testing after Hepatitis B vaccination in Immunisation Handbook.
What if the patient is HIV positive?
HIV-positive adults may respond less well to vaccination.
Recommended to have 4 dose schedule (0, 1, 2 and 6 month) using a double dose.
Require post-vaccination serological testing 4-8 weeks after completion of primary course. See above.
What if patient serology results show they are non-immune?
If there is NO documented completed primary course of vaccination
- offer full course vaccination
- single dose at 0, 1 and 6 months if HIV negative
- double dose 0, 1, 2 and 6 months if HIV positive
If they have a documented primary course of vaccination and not in a high risk category then no action is needed.
Reassure patient that antibody levels may decline with time and become undetectable without loss of immunity.
What if the patient is late for the next vaccine?
The course does not need to be repeated or started again – just carry on with the next vaccination as there is no maximum interval between doses.
What if the patient is early for the next vaccine?
Note minimum intervals between doses
- minimum interval between the 1st and 2nd doses is 1 month
- minimum interval between the 2nd and 3rd doses is 2 months
- minimum interval between the 1st and 3rd doses is 4 months
What is a ‘non-responder’?
This refers to a person without HBV infection who has a documented history of a primary course of hepatitis B vaccine but with a current anti-HBs level <10 mIU/mL.
They are still at risk for being infected with Hepatitis B.
Refer to Immunisation Handbook for management of non-responders to primary vaccination, Hepatitis B.
- Where can I get help with interpretation of serology?
Do we need to inform people who have a positive anti-HBc?
Yes, review to be reviewed and action according to result management table.
Refer to serology interpretation link.
Result requires review.
If Isolated anti-HBc (uncommon)
= indicates distant resolved infection, with the anti-HBs having fallen below the threshold of the assay, with risk of reactivation in significant immune-suppression. However, consider also false positive or current infection.