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Ask the Expert—Timing for hepatitis B vaccination and titer

Q:  Can you give me the schedule on when the three hepatitis B vaccination shots are given and when you have the titer drawn?

A: Many answers to complying with the hepatitis B section of the bloodborne pathogens standard can be found in Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis [1]. That is because OSHA’s bloodborne pathogens standard [2] requires following USPHS guidelines, which say:

Administer the vaccine in three doses within a six month period. Give the second vaccination one month after the first dose; the third injection six months after the initial dose.

Once the hepatitis B vaccine has been administered, test the employee for immunity one to two months after the completion of the three-dose vaccination series. Use a test for anti-HBs (antibody to hepatitis B surface antigen).

Revaccinate employees who do not respond to the primary vaccination series with a second three-dose vaccine series. Then retest, unless the employee is HBsAg-positive (infected).  Employees who do not respond to the initial three-dose vaccine have a 30%–50% chance of responding to a second three-dose series.

Medically evaluate non-responders. Counsel non-responders who are HBsAg-negative about the need to obtain Hepatitis B immune globulin (HBIG) after an exposure to blood or OPIM from a hepatitis-infected patient.