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.
sometimes i just think that vaccinations for some reason dont take as easily as they should. I had to take MMR 4 times before i converted. It was unreal. The titers kept coming back neg. On the 4th try however, several days later i responded with fever and lymph node swelling. When the titer was rechecked, it was off the scale high so go figure.
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.
Vaccines and boosters are different and YES, I know the difference because I have PERSONALLY taken the boosters in addition to the Hep B series.
Have you?
I have an autoimmune disease, which was highly suspected to affect my titers.
Controversial in the respect that physicians nor facilities have come up with a number of what the titer level has to be before you are considered immune. Obviously you have not researched the subject...because you will not find a consensus on the titer levels and will find just as much literature available exists that a certain titer number is "ideal" while others will say that if the vaccine did not take, you wouldn't have a titer to measure.
Vaccines are not to be devied out like candy...or were you under the impression that you could just keep giving them until the cows come home? That it was acceptable to just keep loading someone up with vaccines until you forced a response? I mean, seriously....please review vaccinations 101, because it doesn't work like that. Just because the CDC says it is safe to repeat doesn't mean that it is endless or appropriate in every circumstance.
This is where you put on your critical thinking cap...many of us, especially in my age group, were not vaccinated for Hep B as children. Therefore, when you JUST finished the series and your titers are low (my facility does 4 injections, some do 3)...you receive a booster, retest titers, one more booster, final titer test. My titer was within my facilities 'acceptable' level after the 2nd booster.
You repeat the series in circumstances where an individual cannot remember if they were not vaccinated or if there has been a major lapse in years...the CDC recommends repeating the series vs a booster because a booster will not prove to be effective....that is not the case with the OP...she JUST finished her series.
It is well documented that titers can disappear to undetectable levels after 12 years, yet WILL protect an individual in an event of an exposure. However, facilities will sometimes require action if you have low titers...so yeah, that is pretty controversial when the CDC, your facility, physicians, the infection control nurses and the USPHS doesn't agree.
Hey there, just letting you know I went through the same thing. I had a friend that I used to work with that actually looked at the CDC website and said that (i believe) if you have 5 rounds of the vaccine and your titer is low, if your immunity will go crazy if you actually get Hep B. She showed this to HR and our nurse manager and did not get her 6th dose. I did the same. Take it with a grain of salt though.
Vaccines and boosters are different and YES, I know the difference because I have PERSONALLY taken the boosters in addition to the Hep B series.
Have you?
Coat it is endless or appropriate in every circumstance.
....es will sometimes require action if you have low titers...so yeah, that is pretty controversial when the CDC, your facility, physicians, the infection control nurses and the USPHS doesn't agree.
More Hyperbole.
Booster is simply same vaccine, just called a new name, occasionally with a different dose.
Vaccinate until the cows come home? Again your speaking with hyperbole. You told an individual on an online forum that receiving another series of Hep B was not "Medically Supported", I called you out on that as inappropriate unless you happen to be her PCP. I pointed out that receiving a second series would have negligible health risks, which is true.
If you had also read my other posts, I pointed the OP to review newer literature because there is evidence that many non reporters are still in fact immune.
Again not much of a controversy, just differing recommendations based on a scarcity of data.
Also you should try to avoid personal attacks in your argumentation, it is unnecessary. ("retake vaccines 101" )
And yes, had you taken the time read the thread you would have seen that I too am a non-responder, who was vaccinated multiple times (3).
Specializes in Infectious Disease, Neuro, Research.
It is well documented that titers can disappear to undetectable levels after 12 years, yet WILL protect an individual in an event of an exposure. However, facilities will sometimes require action if you have low titers...so yeah, that is pretty controversial when the CDC, your facility, physicians, the infection control nurses and the USPHS doesn't agree.
Confrontational and condescending. The position would be more substantial without the overbearing personalized presentation. Personal experience is anecdotal, and for generalizations, I try to avoid it, but I have also had series-titer-booster-neg, repeated by two. I am a confirmed non-responder.
To the OP, this is not exactly something where you, "need to put on your critical thinking cap," just follow your institution's policy/recommendation. If you follow universal precautions, have your titer rechecked, and possibly have the series again, you're doing all you should.
No, vaccines aren't candy, but I didn't read that as a recommended dispensation model.
Regarding negative titers and "protection", that one won't fly. There are no studies(or as we say in research, "if you dissent, please present...") documenting exposure, titered measure of immune response, and suppression of infection. There are many anecdotal cases of individuals with negative titers having exposure and not converting. Is this because they are immune, because the viral load for the carrier that day was low, or because the exposure was not "profound" enough? We have no way of knowing.
Bottom line, the Hep series, in broad terms, does work. Not all individuals respond as expected; we aren't really sure of the overall implications for those individuals.
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.
i would be very interested in the research your quoted. as nurses, we should present info that is evidenced based. you research would be very helpful to this hep b non responder.
i would be very interested in the research your quoted. as nurses, we should present info that is evidenced based. you research would be very helpful to this hep b non responder.
i will be happy to post it when i get back from an event that i have to attend this evening.
on the contrary, quid pro quo...please be posting research in the meantime that states that unless you have titers that are detectable, it is to be assumed you have no immunity.
i think a few nurses are posting what they are assuming as fact, when it is in fact, not.
a simple google search for "hepatitis b" and "titers" will answer your question with the organization i have quoted.
Confrontational and condescending. The position would be more substantial without the overbearing personalized presentation. Personal experience is anecdotal, and for generalizations, I try to avoid it, but I have also had series-titer-booster-neg, repeated by two. I am a confirmed non-responder..
As was the post I responded to...but then again, that would be assuming you read it.
By the way, my titers were low, not undetectable.
I never made a generalization....I simply stated personal experience and facts from my own reading and was CLEAR about that.
i will be happy to post it when i get back from an event that i have to attend this evening.
on the contrary, quid pro quo...please be posting research in the meantime that states that unless you have titers that are detectable, it is to be assumed you have no immunity.
i think a few nurses are posting what they are assuming as fact, when it is in fact, not.
a simple google search for "hepatitis b" and "titers" will answer your question with the organization i have quoted.
not hard to find folks!!![/quote]
actually, i did post my research (with web address) that an immune response to the hep b vaccine is based on one's alleles. while i could not locate the exact info i was seeking, i was able to locate research that those with crohns disease experience the same issue of non converting. although non converting is not limited to those with crohns disease.
Peripheral blood lymphocytes from nonresponders to hepatitis B vaccine (HBsAg) failed to undergo a proliferative response to recombinant HBsAg in vitro, whereas cells from responders proliferated vigorously. The lack of proliferative response was not due to defective antigen presentation in that MHC-identical responder and nonresponder antigen presenting cells were equally effective in stimulating responder T cells. Nonresponder T cells did not proliferate in response to antigen-pulsed MHC identical responder antigen presenting cells. The present study demonstrated that: 1) there were no detectable (1 in
Contribution of human leukocyte antigens to the antibody response to hepatitis B vaccination.
McDermott AB, Zuckerman JN, Sabin CA, Marsh SG, Madrigal JA.
SourceAnthony Nolan Research Institute, Royal Free Hospital, London, United Kingdom.
Abstract
We present here the analysis of 86 individuals who were true antibody nonresponders to a vaccine containing hepatitis B surface antigen. The HLA type of these individuals and of 248 controls were determined by serology for HLA class I and by molecular typing for the HLA class II loci DRB1 and DQB1. Subsequent analysis of the results revealed that HLA-DRB1*0701 and HLA-DQB1*02 were significantly associated with antibody non-response to the "S"-containing vaccine compared with the HLA control population. Further, we found that the antibody non-response was also significantly associated with the above antigens when found in linkage disequilibrium on the HLA haplotype DRB1*0701; DQB1*0202. The hepatitis B surface antigen vaccine antibody nonresponder group, comprising 86 individuals, were revaccinated with a novel vaccine Hep B-3, containing both preS1- and preS2-derived proteins in addition to hepatitis B surface antigen, to circumvent their previous nonresponsiveness. The hepatitis B surface antigen antibody results from this group of patients show that 30 of the 86 individuals remained antibody non-responders and that 24 individuals (80%) expressed the HLA-DQB1*02 and that 21 individuals (70%) expressed HLA-DRB1*0701.
Our results indicate that antibody nonresponse to the Hep B-3 vaccine issignificantly associated with an extended HLA haplotype B44; DRB1*0701; DQB1*0202. A possible indication of these results is that antibody nonresponse to Hep B-3 vaccine is linked with the HLA allele DQB1*0202. These findings may have an important impact on future vaccine design.
Specializes in Infectious Disease, Neuro, Research.
On the contrary, quid pro quo...please be posting research in the meantime that states that unless you have titers that are detectable, it is to be assumed you have no immunity.
That is a clinical lab standard interpretation. If one have no antibodies, one shows no indication of immunity- you won't find a pathologist saying otherwise. One may feel immune. One may think they are immune. One may desire to be immune. One may feel horribly at risk, think they will die, and desire certainty. There is (in the instance) no definite proof.
If I understand you correctly, this:
"... the Hep series, in broad terms, does work. Not all individuals respond as expected; we aren't really sure of the overall implications for those individuals.
sums up the situation(until we have a new vaccine), without the bluster and preening.
That is a clinical lab standard interpretation. If one have no antibodies, one shows no indication of immunity- you won't find a pathologist saying otherwise. One may feel immune. One may think they are immune. One may desire to be immune. One may feel horribly at risk, think they will die, and desire certainty. There is (in the instance) no definite proof.
Critical thinking is central in nursing and you have to temper that with a little common sense.
If a pathologist knew NOTHING of a patient's history other than the sample in front of them, yes, they would say that if there are no titers then there "reasonably" no immunity".
However, if you told that same pathologist, "Oh, Mr. Smith is perfectly healthy, had the Hep B series 15 years ago"...the pathologist would not be so quick to draw that conclusion.
By the way, here is a summary from the Washington State Clinical Laboratory Advisory Council (references at the bottom of the summary), that clearly states that just because titers may fall below detectable levels, doesn't mean that the individual has no immunity.
JisforJanet
8 Posts
sometimes i just think that vaccinations for some reason dont take as easily as they should. I had to take MMR 4 times before i converted. It was unreal. The titers kept coming back neg. On the 4th try however, several days later i responded with fever and lymph node swelling. When the titer was rechecked, it was off the scale high so go figure.