Hepatitis B is a viral infection of the liver. Being in research, I wager most readers know that. However, what many may not know is that Hepatitis B virus (HBV) can result in a chronic infection. People with chronic infections are more likely to pass the infection on to others. Also, some patients with chronic infection will progress to liver failure or liver cancer. Both conditions can result in either death or need for a liver transplant. Currently, the Centers for Disease Control and Prevention (CDC) estimates that there are about 1 million people in the U.S. living with chronic Hepatitis B infection. In addition, there are 3,000 deaths annually in the US because of Hepatitis B.
Are treatment options available for Hepatitis B?
Fortunately, HBV is a preventable infection. Since 1991, the CDC’s Advisory Committee on Immunization Practices has recommended the HBV immunization for all infants in the US. Additionally, the Occupational Safety and Health Administration’s (OSHA) Bloodborne Pathogen Standard requires every employer to offer the HBV immunization at no cost to healthcare workers and other employees who may come into contact with human blood, human body fluids, or other potential infectious material.
If an employee decides to be immunized, they must complete the entire vaccination series. According to CDC guidelines, which OSHA follows, a complete HBV immunization includes three doses and a titer check. The first dose must be administered before the employee performs tasks or procedures involving blood borne pathogens. The second dose of HBV is administered one month after the initial dose. The third dose is administered 6 months after the initial dose. The vaccination is complete once the antibody is performed.
The antibody titer check must be conducted after the employee receives the HBV vaccine. The results of the antibody titer check will indicate whether the employee responded to the HBV immunization. If the employee didn’t respond to the immunization, then he or she will need a second series of three shots with another recheck of the antibody titer.
Why check the antibody titer after each vaccination series?
Ten to fifteen percent of recipients will not respond to the vaccine. However, 67-75% of non-responders will respond to a second series. Without adequate antibodies against the HBV surface antigen, a non-responder is susceptible to infection with hepatitis B. In addition, many experts believe that if a non-responder is infected, the person is more likely to develop a chronic infection with HBV. Thus, it’s important to know whether one has responded after the vaccination series. Knowing an employee’s HBV titer can also help streamline Employee Health’s response in the event of a blood or body fluid exposure.
If exposed to HBV in the workplace, there are measures which can be taken to prevent infection. The employee can receive passive immunization with Hepatitis B immunoglobulin, or the employee can receive antiviral medicines against HBV. Either can be effective in preventing infection and ultimate morbidity or mortality from HBV infection. So, while it may seem like a hassle, employees should return for another visit after receiving their third HBV vaccination dose to receive their antibody titer check. In the end, it may save a lot of time and worry for employees and their families.
By Dr. Marshall Lyon, Associate Professor of Medicine in the Infectious Diseases Division