Ask the expert: When to test after Hepatitis B vaccination

By: May 21st, 2012 Email This Post Print This Post

Q: After employees have the Hepatitis B virus (HBV) vaccination, when should they be tested for immunity and which test should be ordered?

A: Perform the HBsAb test one to two months after the last dose of the HBV vaccine, according to the U.S. Public Health Service guidelines.


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By Cheryl Myers on May 22nd, 2012 at 9:15 am

Is this an OSHA requirement? I have conflicting information on this.
Thank you.


Paragraph (f)(1)(ii)(D). This paragraph takes into consideration the changing nature of medical treatment relating to Hepatitis B. The CDC is the U.S. Public Health Service (USPHS) agency responsible for issuing guidelines and making recommendations regarding infectious agents. OSHA requires employers to follow the CDC guidelines current at the time of the evaluation or procedure. Copies of the current guidelines and other CDC documents can be obtained on CDC’s web site, The hepatitis B vaccination must be given in the standard dose and through the standard route of administration as recommended in the USPHS/CDC guidelines. The most current CDC guideline regarding Hepatitis B is Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis published in Morbidity and Mortality Weekly Report Vol 50, No. RR-11, June 29, 2001. (Attached as Appendix E) It states that employees who have ongoing contact with patients or blood and are at ongoing risk for percutaneous injuries are to be tested for antibody to Hepatitis B surface antigen, one to two months after the completion of the three-dose vaccination series. Employees who do not respond to the primary vaccination series must be revaccinated with a second three-dose vaccine series and retested, unless they are HbsAg-positive (infected). Non-responders must be medically evaluated.

INSPECTION GUIDELINES: It is important that the compliance officer investigate thoroughly whether the employer knows of the contents of the CDC guidelines. Evidence may include statements from supervisors or managers that they were aware of the guidelines; an interview with the employer, employer’s attendance at conferences or seminars where in- service training about the CDC guidelines was provided; knowledge of interactive webpages associated with the CDC guidelines; or actual copies of the MMWR.

CITATION GUIDELINES: Paragraph (f)(1)(ii)(D) should be cited if the employer failed to provide vaccinations, evaluations, or follow-up procedures for Hepatitis B in accordance with the CDC recommendations that were current at the time these procedures took place. Any additional requirements (such as obtaining a written healthcare professional’s opinion) specified in paragraph (f) must also be met.

If an employee requests the vaccination but fails to follow through on completing the series, is the facility at risk?

By David LaHoda on June 7th, 2012 at 2:49 pm

There is no regulation that says you can force an employee to complete the titer. You should however, document that you have explained to the employee why the titer is needed and that in the absence of post vaccination testing you would be required to manage any exposure to Hepatitis B as vaccinated but non-responsive. This category of immunity requires different and more involved post-exposure management than the vaccinated and responsive category.


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