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Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention, Living with Hepatitis B

Kudos to HBF’s Blog Voted as a “Sexual Health Top 10, Must Read Blog”

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The team at Health Express has voted HBF’s blog as one of the “Must Read Blogs of 2013 – Sexual Health Top 10!”  HealthExpress.co.uk is an online clinic that provides support, advice and treatment for common medical conditions that patients do not always feel comfortable talking about. You can take a look at their recommended Top 10 blogs and learn more about them at healthexpress.co.uk.

The accolades from the HealthExpress team are a great opportunity to review transmission of the hepatitis B virus. HBV is transmitted through infected blood and body fluids. This includes direct blood-to-blood contact, unprotected sex, unsterile needles, and from an infected woman to her newborn baby at birth.  Sharing sharp, personal items that may have trace amounts of blood on them such a razors, toothbrushes, nail clippers and body jewelry including earrings, can also spread the virus.  Remember that the HBV virus may live up to a week on a surface resulting in possible transmission through direct blood-to-blood contact. This is why close, household contacts or family members are at greater risk of infection if one or more members are living with HBV. Don’t forget to be sure your tattoo or piercing experience is safe and that the parlor carefully follows infection control practices. Hepatitis B is also 50-100 times more infectious than the HIV virus.

Hepatitis B is also a sexually transmitted disease and is spread through infected semen, vaginal fluids and any blood that may be exchanged as part of a sexual practice – most often through sexual intercourse. In the United States, sexual transmission is the most common mode of HBV transmission and is responsible for 2/3 of acute HBV infections. A common question is “what about oral sex?” In general, oral sex would be considered less risky, but any kind of intimate sharing that may result in the exchange of bodily fluids will present some degree of risk.

So how can you prevent hepatitis B transmission between sexual partners? Fortunately there is a safe and effective hepatitis B vaccine to protect against the spread of HBV.  Get screened for HBV and vaccinate to protect – especially if you or your partner has more than one sexual partner, or if one or more partners is at greater risk.  When in doubt, get screened. Keep in mind that HBV is referred to as a “silent infection” since it may take decades for symptoms to occur. People with chronic HBV may be completely unaware of their infection and inadvertently spread HBV to their partner(s) if precautions are not taken.

Other precautions include practicing safe sex by using a latex or polyurethane condom. A lambskin condom will not prevent the spread of hepatitis B or other viral STDs. Looking for condom details?

A general comment to those with multiple sex partners– We are very fortunate to have a vaccine to protect against the hepatitis B virus. However, practicing safe sex with an effective condom is always advised to prevent the transmission of other infectious diseases that are not vaccine preventable, such as HCV and HIV, along with condom use to prevent the spread of other sexually transmitted diseases. Use common sense. No one wants a sexually transmitted disease, and if you have HBV, you really don’t want a coinfection. It can really complicate your life.

Hepatitis B Diagnosis & Monitoring, Living with Hepatitis B

Checking In On Your Hepatitis B Related 2013 Resolutions

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It’s week two of 2013.  How are your New Years’ Resolutions going?  When you were making your resolutions, did you consider hepatitis B specific New Year’s resolutions?  Here are a few ideas…

  • Organize your hepatitis B lab data and make a table with the date of the blood draw and the associated blood test results. You’ll want to start by requesting copies of all of your labs from your doctor. Then you can generate data tables using Excel, Word or a pencil and paper table for your charted data.  It will help you visualize your HBV over time, and you may find your doctor likes to see both the lab results and your table of results.
  • Generate a list of questions for your next appointment with your liver specialist.  People get nervous anticipating what their doctor might say about their health. It is very easy to forget those important questions, so be sure to write them down. If the option is available, have a family member or friend attend the appointment with you. That will allow you to pay closer attention while your friend or family member takes notes for you.
  • Avoid the use of alcohol. Hepatitis B and alcohol is a dangerous combination. An annual toast to the New Year? Sure. Drinking daily, weekly or even monthly? Not a good idea.  Binge drinking? Dangerous. A recent study shows an increased risk for liver cancer among cirrhotic patients with HBV. Don’t let it get that far. If you have HBV and you are still drinking alcohol, seek the help you need to stop.
  • Exercise. Many people think that having a chronic illness precludes them from exercise. This is rarely the case, but if you have concerns, talk to your doctor. If you consistently exercise, keep up the good work. If you don’t, please start slowly and work your way up to a more strenuous routine, and follow general physical activity guidelines for adults. Join a gym or find an exercise buddy. Don’t compare yourself to others and work at your own pace. Set realistic workout goals. You don’t need to run a marathon. Brisk, daily walking is great, too. You may find that you experience both physical and emotional benefits, and if you exercise with friends, you’ll also benefit socially. Clinical and experimental studies show that physical exercise helps prevent the progression of liver cancer and improves quality of life. Get moving. It’s good for your overall health and specifically your liver!
  • Maintain a healthy weight by eating a well-balanced diet. This is a favorite on the New Year’s Resolution list for just about everyone with or without HBV. You can’t prevent or cure HBV with a healthy diet, but it does help, and it helps prevent additional problems like the onset of fatty liver or diabetes. If you’ve been following trending health problems, then you are well aware that fatty liver disease and type 2 diabetes are huge problems in the U.S. and are growing issues globally. Both fatty liver disease and type 2 diabetes can often be prevented with a healthy diet and regular exercise. If you are overweight, or make unhealthy choices, make a commitment to change this year. Start by avoiding fast foods, and processed foods. Cut down on fatty foods. Reduce the amount of saturated fats, trans fats and hydrogenated fats in your diet. Saturated fats are found in deep fried foods, red meats and dairy products. Trans and hydrogenated fats are found in processed foods. The liver stores excess dietary fat, and which can eventually lead to fatty liver disease. A fatty liver slows down the digestion of fats. If you have hepatitis B, you want to avoid any additional complications that may arise with fatty liver disease. Diabetes and HBV together can also be very complicated.  Your doctor won’t mind if you try to avoid “white foods”, or foods that that are white in color and have been processed and refined. This includes foods like white flour, rice, pasta, bread, crackers, cereal, simple sugars and high fructose corn syrup.  (Feel free to eat plenty of white cauliflower, turnips, white beans, etc) Avoid sugary treats and drinks. So what should you eat? Eat plenty of fresh vegetables, fresh fruits, whole grains and lean meats.  Go back to the basics! If you have specific questions about your diet, be sure to talk to your doctor.
  • Don’t worry, be happy… Easy to say, but not so easy to accomplish. Anxiety and depression associated with a chronic illness are challenging problems that may be short term, or can worm their way into nearly every aspect of your life. They can even create physical symptoms that may be confusing and may result in even more worry. Please talk to your doctor if you believe your anxiety or depression is something you are unable to manage on your own. Consider joining a support group where you can talk to others facing the same challenges. Personally I found the Hepatitis B Information and Support List a wonderful source of information and support. Chronic illness can feel very lonely – especially with a disease like HBV that has a stigma associated with it. Find a trusted confident with whom you can share your story.

Hepatitis B Prevention, Living with Hepatitis B

Personal Reflection on Yesterday’s FDA Vaccine Advisory Panel Review of Dynavax’s New HBV Vaccine

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I was fortunate to have the opportunity to represent the Hepatitis B Foundation at yesterday’s FDA vaccine advisory panel review of Dynavax’s new HEPLISAV vaccine for hepatitis B.  I was there for the public comment period on the second day of the meeting with my prepared statement. I was surprised to find I was the only one there for public comment. Since I’ve never been to anything like this, I don’t know if that is typical or not.  I think my personal story with HBV, and the message from the HBF was important for the FDA panel to hear, so they were sure to be reminded that there are real people affected by chronic hepatitis B.

There has been a great deal of good press about the new Dynavax vaccine. In studies it has superior immunogenicity when compared to the currently available vaccines. Immunity is generated in 2 doses given one month apart, versus the currently available vaccines where it is a three shot series over 6 months. This is particularly important to subpopulations such as those undergoing dialysis, and diabetic adults who are encouraged to be vaccinated against hepatitis B – a new recommendation by the CDC this year. It is also important to the general adult population, where it is found that 30-50% of adults may not complete the 3 shot HBV vaccine series making them vulnerable to infection. This  need for HBV prevention via a more effective vaccine, particularly in needy subpopulations was what was stressed in HBF’s public statement.

I do believe the panel was well aware of the importance of HBV prevention and one doctor made mention of the importance based on “the public comment”, so they were listening. Another doctor mentioned the burden of the disease not only globally, but also in the US. That is often understated.

The FDA panel met both Wednesday and Thursday. The public comment period was Thursday, and I remained there for the vote on two vital questions.  The first question was about whether the immunogenicity data was adequate to support the effectiveness of HEPLISAV for the prevention of hepatitis B infection in adults 18 through 70 years of age? The vote cast showed unanimous agreement in the efficacy of the vaccine.

The other question was about whether the data was adequate to support the safety of HEPLISAV when administered to adults 18 through 70 years. Five members said “yes”, 1 abstained and 8 voted “no”.

Prior to both votes there was a great deal of discussion amongst the panelists, and the representative from Dynavax who responded directly to questions.

Ultimately it came down to a few key points.  It was clear that the panel was impressed with efficacy or level of immunity generated by this new, 2 shot series. This vaccine uses a unique adjuvant. An adjuvant is a substance that is added to the vaccine in order to increase the body’s immune response to the vaccine.  In this case it was a nucleic acid versus a lipid – details of which I do not even pretend to understand. Although this new adjuvant was exciting based on the great immunogenicity data presented by Dynavax, it was also a source of concern because the panel was not sure if there was enough study data that represented all demographics. In other words, this vaccine performed really well, but they weren’t sure if it had been proven safe in different ethnic groups such as African Americans, Asian-Americans, and Hispanics. Since the US is a melting pot, this is important.

The other concern was that the vaccine had not been administered along with other vaccines. Because this vaccine is to be given to adults, they felt it was important that it could be given when an adult came in for their annual flu shot, or another immunization. Adults just don’t get to the doctor’s office that often! Although this was clearly of interest, it was not a deal breaker like the lack of safety data among all demographics. There was the suggestion to introduce the vaccine into the current sub-populations that were in particular need, but not much discussion beyond.

The votes were cast and the panel and the audience dispersed. Looks like Dynavax will need to complete further studies before the vaccine is once again reviewed by the FDA panel for approval. Personally, I believe there’s a real  need and a place for this vaccine, but of course safety always comes first.

Hepatitis B Diagnosis & Monitoring, Hepatitis B Prevention, Living with Hepatitis B

Why Give the Hepatitis B Vaccine to Infants?

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The CDC recommends a birth dose of the hepatitis B vaccine for all babies. Pediatrician, Dr. Allison Shuman explains why in this informative video.

If you live in a part of the world where chronic HBV is at a medium (2-7% of population) or high prevalence rate (greater than 8% of population), your child is especially susceptible and at-risk for hepatitis B, with HBV transmission often occurring vertically from mother to child at birth, and horizontally from an HBV infected adult or another child’s infected body fluids to an unvaccinated baby or child. Please be sure that pregnant women are screened for hepatitis B. If mom tests positive for HBV, be sure baby receives a birth dose of the HBV vaccine and a shot of HBIG within 12 hours of birth. If mom tests negative for HBV, be sure that baby receives a birth dose of the HBV vaccine before leaving the hospital. Both babies of HBV infected and uninfected mom’s should receives shots 2 and 3 of the series according to schedule. Babies of infected mom’s should be tested at 18 months to be sure baby is hepatitis B free.

Please make arrangements with your doctor and the hospital to receive the HBV vaccine for your baby, prior to delivery, so you are sure the vaccine and/or HBIG are available at the hospital so prophylaxis can be given within 12 hours of birth. Please feel free to print and distribute  Chronic Hepatitis B in Pregnancy: Screening, Evaluation and Management (Part I and Part II) to your doctor.

 

Hepatitis B Prevention

Love Safely This Valentine’s Day

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Please be sure to love safely this Valentine’s Day.  Are you living with HBV or hoping to avoid living with HBV? HBV is a vaccine preventable disease that is effectively transmitted sexually. If you are not infected with HBV, why not get vaccinated and protect yourself for life? The HBV vaccine is a safe and effective, 3 shot series. If you think you might be in a high risk group for HBV, talk to your doctor about first being screened for HBV before being vaccinated.

If you already have HBV, the vaccine won’t protect you. You need to talk to your doctor about your HBV status and whether or not you would benefit from treatment at this time (Not everyone needs treatment, but you need blood work interpreted by an HBV knowledgeable doctor to be sure).

Show the love by protecting yourself and your sexual partners by wearing a condom. They protect the mouth, vagina or rectum from infected semen if used consistently and correctly.  Keep in mind that the riskiest sexual activity is unprotected receptive anal intercourse. This is because the lining of the rectum is very thin and more likely to bleed leading to the possibility of infection with blood borne pathogens like HBV, HCV and HIV, along with other sexually transmitted diseases. Receptive vaginal intercourse is the next highest risk. Although the lining of the vagina is stronger than the rectum, inflammation, infection, or microscopic scrapes make the vagina vulnerable to unprotected intercourse. The likelihood of blood borne pathogen transmission with oral sex is least risky, but that is because the risk of blood contact is much lower. However, any kind of intimate sharing of bodily fluids presents some degree of risk of transmitting blood borne pathogens like HBV, HCV and HIV, and may effectively transmit other sexually transmitted diseases.

It’s important if you’re living with HBV, not living with HBV, or not quite sure of your infectious disease status. If you are living with HBV, properly wearing a condom keeps you safe from becoming co-infected with another infectious disease. No one wants a co-infection.  It complicated and dangerous for your health.  If you do not have HBV, then avoid getting an infection by you or your partner wearing a condom. HBV is vaccine preventable, but HCV, HIV and other STDs are not vaccine preventable. Considering the health and safety of yourself and your sexual partners is paramount. You may not know what they have, and they may not know what you have. Why take the risk? Love safely, get vaccinated against HBV, and wear a condom consistently and correctly. “Share affection, not infection”.

Hepatitis B Prevention

Considering the Transmission of HBV Through Tattooing or Piercing

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This month’s Clinical Infectious Diseases evaluated the transmission of HCV through tattooing and piercing. It is important to note that HBV is also of great concern when considering a tattoo or piercing. Unless you are vaccinated against hepatitis B, you are at risk for HBV if you are tattooed or pierced under unsterile conditions. The net-net is if you have a tattoo or piercing in a professional parlor – one that follows infection control practices and uses single-use items whenever possible and sterilizes re-used equipment using ultrasonic cleaning and sterilization with an autoclave , there does not appear to be an increased risk, though additional study is warranted. However, tattoos or piercings in prisons, or other settings that are not performed under sterile conditions are a serious danger.

The process of tattooing entails repeated injections of tiny drops of ink. That’s thousands of tiny needle sticks per minute, and a very effective transmission route for blood borne pathogens like HBV, HCV and HIV. This does not mean getting a tattoo will expose you to infectious disease, but if you choose a tattoo parlor that is not well regulated and safely follows all infection control practices, then you greatly increase your risk of infection.

Here’s the problem with tattoo parlors in the United States. They are not carefully or consistently regulated. There are no federal regulations. For the most part they are state regulated, with each state having its own rules and regulations.  Regulated states require that tattoo parlors have permits, and be inspected. Who inspects the parlor? – Sometimes it’s the State Department of Health, and sometimes it’s the local health department, so the inspections vary. There are some states with local regulations within the state, and even a few states with NO regulations. That is worrisome and dangerous. What are the rules and regulations for your state on this unofficial list? (Please read the site disclaimer) Do the research on the rules in regulations in your state, or city before looking for a tattoo parlor.

What does this mean if you’re considering a tattoo? Your tattoo is a personal decision that will live with you for the rest of your life. You don’t want to contract an infectious disease that may also live with you for the rest of your life and potentially threatens your life.  Shop for a clean, parlor that treats each tattoo like a mini, out-patient procedure – with all infection control practices followed. You want a tattoo parlor that uses single-use needles, ink, ink cups, and gloves. You want to see these tools come out of their sterile packaging –right in front of your eyes. You want a tattoo parlor with a functioning, inspected autoclave so that re-usable tools such as tattoo machines and needle bars can be properly sterilized. You want a tattoo parlor that is clean and an artist that washes his hands and wears gloves. If the shop is dirty, keep looking.  Speak up and ask the artist questions about his shop and his infection control practices. Don’t forget to ask to see the autoclave. If anything makes you wary about the visit, look else-where.

 

Hepatitis B Diagnosis & Monitoring, Living with Hepatitis B

China Approves Hepatitis E Vaccine – What that means if you have HBV

It was an interesting couple of weeks for viral hepatitis vaccines.  A potential vaccine for Hepatitis C appears to be on the horizon, and China announced it has approved a vaccine for use for hepatitis E virus (HEV).

What does this mean if you have hepatitis B?  I’m not sure. If you are living with HBV, it is clear that it is best to avoid coinfection with another hepatitis virus or infectious agent.  Coinfection will likely hasten liver disease progression and increase the risk for liver cancer.  At this time, the hepatitis A vaccine is recommended for those who are infected with HBV in order to avoid additional stress to the liver. Please keep in mind that the mode of transmission is the same for HBV and HCV, but is different for HAV and HEV.  It’s important to keep your viral hepatitis ABC’s straight!

Hepatitis E is a self-limiting disease, which is shed in the feces and transmitted via contaminated water and food – very much like HAV.  Although HEV is an acute infection like hepatitis A (HAV), it has about a 3% overall mortality rate and a much higher rate among pregnant women, and solid organ transplant recipients. It predominantly affects those between the ages of 15 and 40 years. HEV is endemic in Central and South-East Asia,  North and West Africa, Mexico and developing nations where there may not be access to clean water and proper sanitation and hygiene.  At this time, it is not prevalent in the U.S., but we are a traveling nation, and it’s something to think about when traveling abroad.

The HEV vaccine, developed by Xiamen University and Xiamen Innovax Biotech Co. Ltd. is a three-shot series : shot one followed one month later by shot 2, followed by shot 3 six-months after the third shot. The phase III trial results were found to be well tolerated and safe for the general adult population.  This would make the HEV vaccine a good choice for travelers in endemic areas who can receive adequate protection with a 2-shot series in one month.

However, these results for the phase III study were for the general population only and did not include children, adults over 65 years, pregnant women and those living with chronic liver diseases such as HBV or HCV.  If you are infected with HBV, it would make sense to be vaccinated against a virus that can cause additional harm to the liver, but at this time, additional research needs to be done ensuring the vaccine will benefit those living with hepatitis B or C.

Hepatitis B Prevention

Many Parents Request Delays in Vaccine Schedule -Why the HBV Vaccine is Important for Infants and Young Children

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Last week’s report of a recent study shows that more parents are opting out or delaying some vaccines for their children, and the hepatitis B vaccine is one of those parents sometimes choose to skip or delay.  What is even more disappointing is that the majority of pediatricians polled were comfortable with an alternative HBV vaccine schedule for their young patients.

The unfortunate thing about HBV is that it is very effectively passed from an HBV infected mother to her child during the birth process. Children that are infected with hepatitis B at birth, or as a baby, have a 90% chance of being chronically infected for life.   Young children that are infected horizontally have up to a 50% chance of being chronically infected for life. Children living with HBV are typically highly infectious and very effective at unknowingly spreading the virus to little friends or family members. HBV is present in blood and body fluids and we all know how kids are fascinated by one anothers’ boo-boos, and half of them have some sort of rash or scrapes that are tough to keep covered at all times. The beauty of vaccination is that infants and little ones are protected when they are at day care and pre-school, and when they are playing with the neighborhood kids.  Protocols are in place, but accidents do happen and rules are not always followed. You may think your child’s world is HBV free, but but you may be wrong.  Is it worth the risk when there is a safe and effective vaccine available?

Later in life, HBV is effectively transmitted horizontally in the mode that is often associated with infectious disease – sexually.  We are all sexual beings and at some point sex will become part of our lives.  Will you be thinking about having your teen or college student vaccinated, or will you be like most of us and too busy to even think about it?  What about when your teen or college student comes home with a tattoo or body piercing they got at a bargain tattoo/piercing parlor?  No one likes to think about their children making impulsive decisions, but the reality is that most do.  They have lapses in judgment and they make mistakes. A parent can only control so much, but why not eliminate the chance of HBV infection later in life?

You might think you will deal with HBV if you are faced with it. Even if your child is infected, or playing with a child that is infected, there will be no notable symptoms.  That’s why they call it a “silent infection“. Your liver is a non-complaining organ so symptoms rarely appear unless your liver is in distress. HBV will likely go unnoticed for decades unless it is picked up with routine blood work, during a blood donation, or a blood screening. That doesn’t mean liver damage is not occurring over decades of infection.

Our world keeps getting smaller, and travel to exotic lands is common. The U.S. is a melting pot of countries around the globe – many where HBV is prevalent.  Do you know that 2 billion people in the world have been infected with hepatitis B and that 400 million are living with a chronic, life-long infection? That is 1 out of 3 people in our world that have had an HBV infection!  There are good treatments out there, but there is no complete cure.  Many live long, lives, but lifelong HBV puts you at high risk for advanced liver disease, liver cancer and death.  The stigma associated with HBV leaves many throughout the world unemployable, and even those in the U.S. may suffer from discrimination and judgment by others due to their disease.

People write to HBF and tell us their HBV story.  Many have no idea how they were infected.  It is not casually transmitted, but it is an infectious disease – 50 to 100 times more infectious than HIV and 5 to 10 times more infectious than HCV.  The U.S. is fortunate to have a vaccine available to all children born in this country. Parents worldwide would give anything to have their infant vaccinated to prevent a lifetime with HBV.  Some countries have HBV vaccine shortages.  Many cannot afford the vaccine, and many are unaware of the vaccine until they learn they are infected. In the U.S. we have an opportunity to prevent a life-long infection with HBV with a simple vaccine.  Please don’t choose to delay or omit the hepatitis B vaccine from your child’s vaccine schedule.

Hepatitis B Prevention

ACIP Recommends HBV Vaccine for those with Diabetes

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What’s new in the world of HBV lately?  Perhaps the biggest HBV story over the last week is the Advisory Committee on Immunization Practices (ACIP) strong recommendation for those with diabetes under the age of 60 years to be vaccinated against HBV.  Diabetics under the age of 60 have twice risk of acquiring HBV than those without. The recommendations for vaccination apply to those with type 1 or type 2 diabetes. The sooner those living with diabetes are vaccinated, the better.

Those living in long-term care facilities that require assisted glucose monitoring are also at greater risk for HBV.  This increased risk occurs during the monitoring process, where the accidental re-use of lancets and needles may occur from one patient to another. It is imperative that infection control practices be strictly followed in this environment to prevent small, HBV outbreaks among the elderly in long-term care facilities. HBV vaccination is not recommended for the majority of those over age 60 because the HBV vaccine is not as effective in the frail and elderly population. The earlier in life one is vaccinated against HBV, the better.

Speak up and make sure your loved-one living in long term care and living with diabetes and/or HBV has a personal glucose meter, or that proper infection control practices are being followed at their long-term care facility.

Diabetes and hepatitis B are each challenging chronic conditions to manage alone, but in combination, they can be very complicated. If you are a diabetic with HBV, it is essential that you follow the recommendations provided by both treating physicians (for both diabetes and HBV), and that both are in synch with one another.  It comes down to you faithfully adhering to all medications prescribed, strict monitoring of both your diabetes and your HBV status as dictated by your doctor(s), and following all recommended lifestyle changes.  Be sure to keep your doctor apprised on new issues that may come up as a diabetic with HBV.

If you have HBV, and do not have diabetes, but have a family history of diabetes, take precautions now. Talk to your doctor and be sure to monitor your blood pressure, cholesterol, and weight.  Maintain a healthy weight through diet and exercise.  Know that risk of type 2 diabetes increases with age, (greater than 45) and that your ethnic background may also be a risk factor. This would include Hispanics, African-Americans, Native Americans, and Asians.

Hepatitis B Prevention

Options for HBV Vaccine Non-Responders

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Are you a hepatitis B vaccine non-responder? Approximately 5-15% of people who receive the vaccine are considered non-responders. This is especially important for health care workers, families living in households with people that have HBV, and others who may be at increased risk of exposure to HBV.  A vaccine non-responder is someone that does not build up an adequate immune response after receiving two, 3-shot series of the HBV vaccine.  In other words, they complete one series of the HBV vaccine, and follow it with a surface antibody test (HBsAb or Anti-HBs) 4-6 weeks following the last injection of the series.  If the anti-HBs titre is not greater than 10IU/l, than the series is repeated, preferably with an HBV vaccine from a different manufacturer, and the person is once again tested for immunity by testing for adequate anti-HBs. (See previous blog, “Got Hepatitis B? Keeping loved ones safe though HBV vaccination” for details)

Fortunately there are other options for those concerned with being an HBV vaccine non-responder. There is a higher concentration of the HBV vaccine recommended by the CDC that is used for patients undergoing dialysis, and for those that are immune suppressed.  It is a 40µg/ml concentration. If it has been one year or less since you completed the three-shot series of the regular concentration of the vaccine, you can try one intramuscular dose of 1.0 ml of the 40µg HBV vaccine.  If it has been more than one year since your last three shot series of the vaccine, you can repeat the entire three-shot series with the 40µg concentration of the vaccine.  Follow up with an anti-HBs titre test 4 to 6 weeks following the last injection to ensure it is greater than 10 IU/l, and that you have adequate immunity.

If you continue to remain a non-responder, you can try a series of as many as five intra-dermal injections, given every two weeks, using the 40µg concentration of the HBV vaccine.  Dose one consists of 0.10 ml of the 40µg/ml vaccine, followed by the same dose two 2-weeks later.  At that time an anti-HBs titre test would be drawn to check for immunity.  If there was not adequate immunity, a third-intra-dermal dose of the vaccine would be given two weeks later.  Anti-HBs titres would be checked every two weeks and the patient would be given another intra-dermal injection up to a total of 5 intradermal injections of the 40µg concentration of the HBV vaccine. Don’t forget to ensure that your anti-HBs titre is greater than 10IU/l.

Please note that the schedule for the series might vary depending on the study your doctor chooses to follow.  However, it is recommended that the higher concentration (40µg) of the hepatitis B vaccine be used for best results.

Baruch S. Blumberg Institute