Q: If a healthcare worker did not have titer drawn after the HBV vaccine was completed, how long afterward could we assume that he/she is a responder/nonresponder? Many titers wane after years and are no longer detectable. How do we know the worker continues to be protected?
A: If the healthcare worker did not have a titer, you must assume non-responder status according to the CDC/USPHS guidelines (See Table 3) .
With regard to serologic testing, and boosters, the same source says:
“Booster doses of hepatitis B vaccine are not necessary, and periodic serologic testing to monitor antibody concentrations after completion of the vaccine series is not recommended. Any blood or body fluid exposure sustained by an unvaccinated, susceptible person should lead to the initiation of the hepatitis B vaccine series.”
Note the use of the word “periodic,” which means other than the titer drawn one to two months after vaccination, in the citation above.
A November 9, 2005 letter of interpretation  confirms this recommendation for OSHA compliance purposes.
“Hepatitis B and the healthcare worker,” from the IAC  does a good job of explaining how you can still have immunity despite a low titer years after your vaccination.
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