How many times do come across patients who don’t know their vaccination history? Whether or not they had measles? Chickenpox? Completed an immunization series? if you work in health care, I bet you’ve have titers for measles, rubella, mumps, varicella, hepatitis B. What of your titers are subpar? Or zero?
Here’s a great, short video about whether titers should replace vaccines, definitely worth your time. Watch it here.
How do you determine immunity to hepatitis B? Ideally 1 month after completing a hepatitis B vaccination series, a titer should be draw. If the HBSAg is greater than 10 then that person is immune and will be for life, regardless of the result of future titers. In fact, that person never needs future titers. If the titer was not done 1 month post vaccination series completion, draw a titer, if less than 10 repeat the vaccine, do a titer 1 month later. If over 10, they are immune for life.
If you or a patient has had the series of three hepatitis B vaccines, with Engerix B or Recombivax and didn’t get full seroconversion, consider getting the new hepatitis B vaccine, Heplisav-B. The major difference between this and the older vaccine is the adjuvant which in 18-29 year olds resulted in 100% seroconversion compared to 93.9% seroconversion with Engerix B. In the same study those ages 50-59 had 95.2% seroconversion with Heplisav-B compared to 79.7% with Engerix B.
Heplisav-B is a series of 2 injections given 4 weeks apart. This schedule protects faster and with 2 doses compared to the older vaccines. Since more people seroconvert, those who have had Engerix B in the past can receive Heplisav-B. This is an important advantage for health care personnel who are at higher risk for contracting hepatitis B. Full info on Heplisav -B here.
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