People at risk of hepatitis B are recommended to have serological testing 4–8 weeks after they complete the primary hepatitis B vaccine course
Post-vaccination serological testing is recommended 4–8 weeks after completing the primary course for:
- people at significant occupational risk, such as healthcare workers whose work involves frequent exposure to human tissue, blood or body fluids
- people at risk of severe or complicated hepatitis B, such as people who are immunocompromised and people with pre-existing liver disease not related to hepatitis B
- people who may respond poorly to hepatitis B vaccination, such as haemodialysis patients and people with bleeding disorders who received the vaccine subcutaneously
- close contacts of people who are infected with hepatitis B virus, including sexual partners, household contacts and household-like contacts22
If serological testing 4–8 weeks after the primary course shows levels of antibody to hepatitis B surface antigen (anti-HBs) of <10 mIU per mL, check the person for acute or chronic hepatitis B virus infection by testing for serological markers, including antibodies to anti-HBs and hepatitis B core antigen.
If there are no markers of hepatitis B virus infection, manage the person as a non-responder to hepatitis B vaccination. See Non-responders to hepatitis B vaccine are recommended to receive further doses and serological testing.
People who are at significant risk of hepatitis B (such as healthcare workers) are recommended to be tested for immunity if they were not tested for anti-HBs 4–8 weeks after finishing a primary course of hepatitis B vaccine.
If people who receive serological testing after a primary course of hepatitis B vaccine have an anti-HBs level of <10 mIU per mL, they are recommended to receive a single booster dose (4th dose) of vaccine.
People with immune memory established from effective previous vaccination should respond to this booster dose.
After the booster dose, check for anti-HBs again 4 weeks later:
- If the anti-HBs levels remain <10 mIU per mL, investigate the possibility of hepatitis B virus infection.
- If the person does not have hepatitis B virus infection, manage them as a non-responder to vaccination (see Non-responders to hepatitis B vaccine are recommended to receive further doses and serological testing).
- If the anti-HBs level is ≥10 mIU per mL, the person is considered immune.
- antibody to hepatitis B surface antigen