Checking vaccination response

Approximately 10-15% of adults fail to respond or respond poorly to 3 doses of vaccine.

The role of titres and booster doses

Sexual health services should follow the procedure which has been adopted in their board to address the issue of titre checks and booster doses as published national guidance is contradictory.

BASHH guidelines published in 2017 recommend testing for response in all patients who have been vaccinated.

• Those at high risk of Hepatitis B infection are likely to have received a 0, 7, 21 day and 12 month (or 0,1,2,12 month) schedule and a test for response to vaccination can be done 4-12 weeks after the third dose
• For those at lower risk of Hepatitis B irrespective of the schedule adopted a test for response to vaccination can be delayed until 4-12 weeks after the final dose.

The aim is for surface antibody titre >10 iu/l but it is preferable to achieve levels > 100 iu/l. Based 
on the result further doses should be considered.

The ‘Green Book’ – Immunisation against infectious disease, updated online 2017 does not recommend testing Hepatitis B surface antibody titres except in those at continued occupational risk and those with renal failure. They do recommend that all at continuing risk of infection should be offered a single booster dose of vaccine once only - around five years after the primary immunisation. Measurement of Hepatitis B surface antibody titres is also not required before or after this booster dose