Nonresponder to HepB Vaccine

NurseLoveJoy88, ASN, RN · Jun 14, 2011

Talk to your PCP. AN is not allowed to give medical advice.

BTW- I'm also not immune to the HEP B vaccine so I understand your concerns.

demylenated, BSN, RN · Jun 14, 2011

Being a non-responder to the vaccination does not mean we can not get Hep B.

I was a non-responder for the first 2 full series. I received my first series in 1994, and one in 1996. When I went back to nursing school, I received a 3rd full series (1999). I converted. I had my titers checked before starting school this summer and I am still immune (some people need booster/another series after 10 years).

Frozen08 · Jun 14, 2011

This is a common issue. I too am a non responder.

There has been some new research that shows that we have antibodies to Hep B, they are just not high enough for the screening test. Even though we are non responders, we still have immunity to Hep B. Check out PubMed.

That said. No immunizatoin is always 100% across the population and always take all precautions.

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Jun 14, 2011

Discuss with your doctor. Depending on your timing you might have received either of 2 different Hep B vaccines. Maybe that makes a difference, maybe not. The Original was Heptavax, later they had Recombivax.

NewlyGradBSN · Jun 14, 2011

Im planning to get another full series. Ill check with my doctor anyway. I also read that. We are immune to the disease from the vaccine we got when we were babies but it does not give a medically accepted titer. You have a point there. Im planning to check my hbsag every 6 months or a year depending on my budget.

LadyinScrubs, ASN, RN · Jun 14, 2011

I had three full series before everyone agreed that I was a non responder. I was told various explanations for the problem--the funny one was: as you age, your immune response decreases. I was 40 at the time.

Just recently there was a study done. Apparently it is your genes--or alleles--responsible for the non response. Do a search on the study, it may answer some of your questions.

Southern Magnolia · Jun 14, 2011

I'm going through this now. I had the series in 2008. I'm starting school in the fall so I had a titer done. The titer came back low. Rather than the booster the dr recommended I do the series again and then do the titer again. This way I can confirm that I'm a non-converter. I have read however that I may still have immunity even though the titer comes back low.

BabyLady, BSN, RN · Jun 14, 2011

Fellow nurses,
In college, we had to test for our immunity for hepatitis B. And my titer was below normal. I was vaccinated as a baby. So I opted to get a booster shot. Just recently, I checked for my titer and still it was below normal. I went to a doctor and since I had 2 series of vaccines, she said that I am a non-responder. As a nurse, I believe we are more at risk with blood borne infections. Being a non-responder can mean two things right? Either I am immune to the disease altogether or I am susceptible.
So here is my question, would I get myself restarted with a series of vaccines to confirm that I am really a non-responder? because another person advised me at work that maybe I just need to start it all over again.

My advice is to see a physician that is more familiar with what to do. Having TWO series of Hep B is NOT what is supposed to happen.

You get the Hep B vaccine series then IF you do not respond, you get boosters. If your titers are still low, that is it...you are a non-responder, but for your own health I would NOT elect to repeat the Hep B series...that is crazy and not medically supported.

However, keep in mind that titers are CONTROVERSIAL.

Titers, of what is considered immunity, varies drastically per facility.

Some research will show that unless you show ZERO titers, that ANY titer level demonstrates immunity....on the theory that your body has no reason to respond to Hep B unless there is an invasion of actual Hep B.

LadyinScrubs, ASN, RN · Jun 14, 2011

celiac patients unresponsive to hepatitis b vaccine

http://celiachometest.typepad.com/celiac_home_test/2009/09/celiac-patients-unresponsive-to-hepatitis-b-vaccine.html]

"the researchers say that the study confirms that people with celiac have a "lower percentage of response to hepatitis b vaccination than healthy subjects" and that the findings provide "useful information to evaluate the current vaccine strategies." they note that the hla and dq2 genes are considered the most important genetic markers for not responding to the vaccine and since celiac is also linked to those genes, it explains why the celiac patients do not fare well with the vaccine."

to read the full study, please visit vaccine at http://www.sciencedirect.com/science?_ob=articleurl&_udi=b6td4-4x06pb1-1&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_searchstrid=

Frozen08 · Jun 15, 2011

My advice is to see a physician that is more familiar with what to do. Having TWO series of Hep B is NOT what is supposed to happen.
You get the Hep B vaccine series then IF you do not respond, you get boosters. If your titers are still low, that is it...you are a non-responder, but for your own health I would NOT elect to repeat the Hep B series...that is crazy and not medically supported.
However, keep in mind that titers are CONTROVERSIAL.
Titers, of what is considered immunity, varies drastically per facility.
Some research will show that unless you show ZERO titers, that ANY titer level demonstrates immunity....on the theory that your body has no reason to respond to Hep B unless there is an invasion of actual Hep B.

Controversial? That's stretching the issue, and hyperbole.

Risk from hep b vaccine is pretty negligible.

You should probably look up the differences between a "booster" and vaccine.

Not medically supported by whom, YOU ? Repeat Hep B is recommended by the CDC for non responders before declaring them non responders if subsequent titers are still low.

DeLana_RN, BSN, RN · Jun 15, 2011

There is another possibility, although it may not apply here if you were vaccinated as a newborn.

A good friend of mine, who started nursing school in her early 40s, was a nonresponder. She was advised to see an infectious disease specialist who told her the reason was that she was already infected with Hep B and a chronic (asymptomatic) carrier. She might have gotten it when she got exchange transfusions back in 1959 as an Rh disease newborn.

Like I said, this probably couldn't be the case with the OP, I just wanted to mention it.

DeLana