I had a 3-dose Hepatitis B series many years ago. I just had the titer and it came back negative (nonreactive, or not immune). What should I do now, repeat the series or get one dose? Why does this happen?


Many individuals lose the “circulating antibody” within a few years after receiving their last dose of Hepatitis B vaccine. We do not check antibody levels for the general public because we assume that this highly effective vaccine has worked. But for health care professionals we take the extra step of checking a quantitative titer to ensure immunity in case of future exposure to Hepatitis B in the workplace (i.e. a blood borne pathogen exposure).

We recommend you receive one dose of Hepatitis B vaccine now, to boost your antibodies to a detectable level. This usually takes about a month. Then, 4-6 weeks after the booster dose, you should have the QUANTITATIVE Hepatitis B Surface Antibody titer blood test drawn. Usually with this method there is a positive result (≥ 10 mIU/mL), and the documentation on the lab report should be adequate to prove your immunity to Hepatitis B for the rest of your health care career. This method of boost and titer is explained by the CDC in their latest guidelines (published in 2013) and summarized in this online algorithm: http://www.immunize.org/catg.d/p2108.pdf

Please send in your paperwork now (after the booster dose) with a notation that the titer is pending. As long as we know that something is “in process” you will continue to be in “compliance”. Send your titer report to us as soon as you’ve received the result. If the re-titer is negative then you may need to be tested for the Hepatitis B Surface Antigen (“carrier” status, or prior exposure to Hepatitis B disease). Or, perhaps you need to continue on with receiving the 2nd and 3rd doses of another Hepatitis B vaccine series. There are some individuals who need two series before they will achieve a positive antibody titer.