Timing of titer following vaccines

pecanpies · Jun 26, 2012

At my hospital we wait 60 days from the 3rd Hep B shot (or booster) to draw Hep B titers. I don't know about varicella - sorry! Most people getting varicella titers drawn that I know of have never had the vaccine, so we've never had to think about any kind of timing.

DawnJ · Jun 27, 2012

Thanks for the info. I wonder if you get a false positive if the titer is done sooner? My RN program requires a positive titer but only give you 2 (whole) weeks between notification of program acceptance to the time when you are supposed to have your medical paperwork in and the start of classes. Considering it is a month between varicella shots and 6 months for Hep B, unless you are already immune you are not going to meet the timeline.

I will ask them at orientation, they must have a policy for this, I'd think

pecanpies · Jun 27, 2012

I'd definitely ask at orientation. I'm sure you're not the first to run into this!

mama.RN · Jun 28, 2012

For Hep B, a titre should not be done sooner than 1 to 2 months after the third/last dose.

Double-Helix, BSN, RN · Jul 1, 2012

If you're in the process of getting your immunizations, then I imagine you would be compliant with the school's policy if you submit your most current vaccination information to date. Definitely ask the school, because it's likely that if you've just recently received the immunization then you don't have to provide titers at all. I think my school's policy was that you had to provide a positive titer or show proof of immunization within the past X years- depending on the vaccine.

DawnJ · Jul 1, 2012

They do still require titers, but since I submitted proof of vaccination, and I have 1 more Hep shot coming, they will defer the requirement for titers until the end of the year. Thanks for everyone's input!

mariebailey, MSN, RN · Jul 5, 2012

One more comment: I believe it is really recommended that you perform serological testing exactly 1-2 months post-completion of series because titers may fall below 10mlU/ml after that, which does NOT mean protective levels are inadequate. "anti-HBs concentrations decline over time and immunocompetent HCWs who had anti-HBs levels >10 mIU/mL 1-2 months after primary vaccination series remain protected even if their anti-HBs concentration declines to below 10 mIU/mL." Ask the Experts about Hepatitis B Vaccines - CDC experts answer Q&As

Hep B vaccination may provide protection for >20 years, but you may be required to re-start the series just b/c you delayed serological testing after vaccination.

DawnJ · Jul 5, 2012

Yes, I read that for varicella over time titers will show not immune, however if the vaccinated person is exposed they do have a sufficient immune response to protect them. I didn't realize it could happen as soon as a few months after vaccination though. Thanks

kenny23 · Oct 19, 2012

6-8 weeks is what's recommended. The weird part is do titers even matter? Won't your body generate an adequate antibody response if you do get exposed to the disease?

mariebailey, MSN, RN · Oct 25, 2012

6-8 weeks is what's recommended. The weird part is do titers even matter? Won't your body generate an adequate antibody response if you do get exposed to the disease?

Titers tell you how many times the serum can be diluted and still have detectable antibody levels. I agree to an extent b/c they are not a direct measurement vaccine efficacy. Also, you can have sub-detectable levels and still be adequately protected. However, it's the best information you can get short of being exposed to the disease and seeing what happens!

SexyInScrubs · May 21, 2013

Hep B titers should be drawn 30 days after the 3rd dose is administered, ideally no more than 6 weeks. The titer level peaks during this time, after which the number could decline. The ref range is now anything >12.0 IU/mL. Titers CAN be drawn at any time following the third dose, but the results are not optimal. You wouldnt want to wait too long and be, say, 11.0f at 8 weeks when you may have turned up 12.0f at 6 weeks. You may still have adequate Ab to Hep B if exposed, yes, but most schools and health care systems follow CDC guidelines for confirmed immunity. Also, many schools and hc systems will accept just the three doses. (We do). Depends on the policy.

(I know this post is old, but it's sort of right up my alley and I hope my answer can help others).

Source: I am Employee Health Nurse at large hospital