question about hepatitis B vaccine

  1. this is about a person who has already had the series of shots to protect against hepatitis B back in the 80s

    Person goes to the doctor for other testing, and the doctor says "do you want anything else tested?" - they agree to have hepatitis testing done at the lab.
    Lab results show that the hepatitis B antibodies are under 10.

    The lab said that results of 15 would show immunity.

    Second doctor who reads the lab result says "should get the hepatitis shots"

    The school nurse says "we didn't ask to have the testing done for hepatitis, school children have been given the vaccine and it isn't showing effectiveness for them, but they're not all going to be retested. But now that we know the result we have to give the booster shot."

    Can anyone explain why the nurse is not concerned (yet planning to give the booser) and why both doctors are?
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  2. 5 Comments

  3. by   KristiePDX
    Sounds like the nurse was coming from the vantage point of helping this person fulfill requirments for school enrollment. If they know for sure that the person is not immune, then they are obligated to immunize for enrollment. Like if your have had the shot then you have met the requirments unless you have proof to the contrary. The nurse may have seen other cases like your friend.

    I have had a similar situation like this happen to me.
    I have had all my childhood vaccinations. When both my parents died, my records were given to my aunt that took care of me. She used those records to enroll me into public schools. There was never a question as to my imminization status.
    Those records had been long lost when I applied to nursing school. Since I had no "proof" I was required to get all the required booster shots. One of them being MMR. (which I should have already been against)

    A couple years later and I am applying for a job. They titre my blood and low and behold I am STILL not immune to measles (I am immune to mumps and rubella). Employee health notifies me and gives me another measles only vaccination. It has been about a year now, why havent they called me in to draw another titre to determine if I am immune to measles yet?
    Simply put, I have fulfilled the requirments of immunization.

    Why are they not concerned that I have had my childhood immunizations, and a adult booster shot and was still not immune to measles? Dont you think that they would want to check because I have a history of not building immunity to measles? Nope, I have met the immunization requirment............
  4. by   kittagirl
    Me too Me too
    I cannot 'hold' immunity to rubella. I've actually had it as a child twice, and had the vac three times, as a baby, as a teen and when I started my training, recently had it checked due to family planning reasons. Knew, but didn't absorb that they were checking it, picked up my results at work and was discussing them with my boss whose a doc. She got all in a flap as it appeared from my blood that I'm never been vac'd. Had to explain it all to her too (Had previously spoken to Occupational Health and legally I'm covered as I've had the vac)
    Anyway I work in research (no pregnant ladies near me) but my boss keeps looking at me thoughtfully and ‘hmmmmmmmmm ing’

    Getting a funny feeling that I might be giving a blood sample today………………
    She’s got that look in her eye

    She's now reading this over my shoulder claiming that she wasn't in a flap (she was!)
    Last edit by kittagirl on Apr 18, '07 : Reason: Rotten grammer
  5. by   CrufflerJJ
    Quote from GingerSue
    this is about a person who has already had the series of shots to protect against hepatitis B back in the 80s

    Person goes to the doctor for other testing, and the doctor says "do you want anything else tested?" - they agree to have hepatitis testing done at the lab.
    Lab results show that the hepatitis B antibodies are under 10.

    The lab said that results of 15 would show immunity.

    Second doctor who reads the lab result says "should get the hepatitis shots"

    The school nurse says "we didn't ask to have the testing done for hepatitis, school children have been given the vaccine and it isn't showing effectiveness for them, but they're not all going to be retested. But now that we know the result we have to give the booster shot."

    Can anyone explain why the nurse is not concerned (yet planning to give the booser) and why both doctors are?
    The school nurse might be looking at things from the perspective of school aged kids, not expected to be exposed to Hep B in their everyday activities. The docs might be looking at it from the perspective of those who regularly come into contact with Hep B positive (infected) patients.

    Not everybody who goes through the immunization series develops antibodies (an adequate titer). I had to go through the series twice myself, and did seroconvert the second time.

    This issue was discussed in my recent pathophysiology class. The prof's monograph says "Once the healthcare worker is confirmed positive for anti-HBs, future screening is not required nor is there a need for booster injections. The worker is considered immune for life, despite the fact that anti-HBs titers may decline below detectable levels. Should an exposure occur, memory cells will respond to HBV challenge by producing antibody; in essence, an exposure will act as the booster." I believe he's stating this on the basis of work by the CDC.

    It is important to distinguish between somebody who has gone through the series, been tested as having a good titer, versus somebody who went through the series and was never re-tested. If the first person has low titers years down the road, they're still protected. If the second (untested originally) person has low titers years down the road, they might very well be unprotected.

    Some people NEVER develop immunity to HBV. If they are slimed at work, they'll have to do HBIG (immunoglobulin), which will protect them from that single exposure, but won't provide lifelong protection.
  6. by   realnursealso/LPN
    I also have no immunity to rubella. I had a titer drawn when I went to nursing school a long time ago. No one ever said anything was wrong with it. Fast forward to when I started doing homecare. One of the office people was going over records, apparently my titer was written in the old method, and when someone who knew the old values looked at mine, I got a phone call. Seems my titer showed I had no immunity to rubella. My doc said to get another mmr, so I did, new titer done, same answer. No immunity! So then my doc says to get another mmr, so I did, and he said that is the end of it. He said that I had rubella as a child had two mmr injections, that was all the proof I needed. Thank goodness that was over. So I thought my ordeal was over..........Until I went to the doctor because I felt rundown. My usual doc had the day off, so I saw one of the other docs,he orders a cbc. Get a call, you need to have your cbc redrawn, so I go, get it redrawn. Another call, my doc, can you go to the lab and have it redrawn one more time. So my nurse brain is in overdrive, what the heck? The next day, my doc is calling me and telling me I don't have enough platletts, that I need to be seen by a hematologist. :uhoh21: By this time I am scared to death. I call around and get an appointment for in a few days, seems like years. I am so scared. Get to the appointment, they make me fill out all these forms like I have cancer. I am almost in tears. Go in the exam room, and the first thing they do is drawn blood. Then I wait, thank goodness my mom was with me. Finally the doc comes in and she says,"you are fine" Just tell them that your plateletts don't like what is in the regular tubes. When my blood is drawn, you cannot have that stuff, (is it called citrate?) in there, my blood reacts to it and clumps my plateletts together, so ther machine reads I don't have enough. I must have weird blood. Don't know if their is a medic alert bracelet for that, but
    I always tell the doctor if they are gonna do a cbc, to do it with an empty tube. Sorry this was so long, I would hate for anyone else to go through what I did. So I try to let others kn ow it can happen.
  7. by   GingerSue
    thanks, these are helpful and interesting

    so, it sounds like the person who has already had the heptatitis series, but with a current low hepatitis antibodies level, can {maybe} rely on their memory cells, if the person is exposed to hepatitis B?

    for the person then, is it better to not have been recently tested - so that no current levels are even known, because the memory cells will create antibodies if needed? Or is it better protection for the person to have the booster?
    Just trying to clarify my understanding about - what is better protection for this individual?
    thanks

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