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Forum Name: Liver Diseases

Question: HepB Vaccination Question


 worrywart911 - Sun Sep 02, 2007 10:19 pm

Hello-
I am a 27 year old young physician early on in training who needs some help in deciphering my tests. I am very healthy and have tested negative for HIV and HCV recently. No risk factors (no drugs, tattoos, and never sexually active).

I was vaccinated for HepB back in 1997 with a full course. I however was never titered. When I started medical school they required me to be titered and my HepBSAb came back negative. At the time, one doctor suggested I be tested for HepB Core Ab to see if I had been previously infected. Another physican told me that according to the CDC, a titer outside of 1-2 months after the last dose is meaningless as Ab levels can diminish over time and be below the qualitative threshold (e.g. <10mIU/ml) and hence a negative test. She recommended a booster dose and a re-titer. I did this, and my Hep B S Ab screen at one month post vaccine was positive. I felt relieved knowing I was immune, and really haven't given it much thought since.

Recently though, what the first doctor said has been creeping into my head and has me worried a bit. I have never had any elevated LFTs and also was getting repeat testing while on Accutane for acne, and did not have a bump at any point. I feel fine, but am worried that even though I am now "immune" based on the Hep S Ab result, I may be a heterotypic case or may have been someone who was vaccinated even though I was infected.

Would you recommend testing for HepB C Ab and HepB S Ag? Again, I have absolutely no risk factors (and the positve Hep B S Ab result was obtained prior to being on the wards without significant patient exposure). I was born in Lebanon (not listed as an endemic region on the CDC website), and I am assuming my mother is Hep B negative as she is alive and healthy without any apparent liver dz or LFT abnormalities. She was a health care worker as well, however.

Help would be appreciated. Thank you :)
 Dr. Chan Lowe - Mon Sep 03, 2007 6:02 pm

User avatar Hi Worrywart911,

I don't think you need to pursue being tested for HBV core Ab or HBVsAg. It is unlikely that you have contracted HBV without any exposure to the transmission routes.

Most likely your antibody levels slipped below the "positive" mark for the titer. In that case, it was completely appropriate to get a booster. Your + titer is indicative of immunity now.

Best wishes and good luck in your training. Medicine is a great choice.
 worrywart911 - Mon Sep 03, 2007 8:34 pm

Thanks!

I know sometimes we just get a little paranoid about things.

Just a quick follow-up question: I know I don't have any traditional risk factors prior to being vaccinated, but there have been a couple of times when I was knicked while getting a haircut, etc while in the US, one definately prior to vaccination.

Is this a real exposure? Also, would having consistently negative LFTs on my physicals argue against chronic infection?
 Dr. Chan Lowe - Mon Sep 03, 2007 11:51 pm

User avatar Transmission of the virus from such a nick is very unlikely. The risk is much higher when there is a hollow object, such as an injection needle, that pierces the skin. Solid objects don't typically transfer enough virus to cause infection. (This isn't a guarantee but the odds are very much against an infection from this.)

Best wishes.
 worrywart911 - Tue Sep 04, 2007 12:33 am

I think I am just going to move on and not think of all the what ifs in the world! Because there can be a lot of those.

Thank you for your prompt reply. I will just continue with my routine health check-ups and if something comes up, it comes up.

Thank you and you are doing a great service for everyone.

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