It's been a while since I've posted. Dr. Killian has been so prolific! It's been hard to match - but look for most posts from me from here on out...
Here's an interesting one on Hepatitis B vaccination and immunity:
"My boyfriend and I are both Poz and excellent health. Tcells normal, viral loads undetectable and liver/pancreatic enzymes are great. One thing, he has Hep B and I’ve been immunized for both A and B over two years ago. Should there be a concern about me for both of us? It’s my understanding that once you are immunized then you are good."
This a great question that I get from my patients a lot. Let me start the answer generally and get more specific as I try to answer the poster's question.
Hepatitis B vaccination:
Hepatitis B vaccination has been in place as a universal childhood vaccination since about 1991, so anyone born after that should consider catch-up vaccination if they're not sure of their immunization status. The vaccination consists of three shots given over about six months. There's the first one, then the second one a month later, and then the third one given 5-6 months after that. The Hep B vaccine isn't "ouchy" like tetanus - you may feel a little something as it's going in, but most people will not experience the same shoulder soreness after a hepatitis vaccination as you would with tetanus. If you go through all three vaccinations on the correct schedule, you have about a 90-95% chance of mounting enough antibodies against Hepatitis B to be considered "immune," which brings me to the next section...
Hepatitis B "vaccination" vs. "immunization":
Not everyone who gets vaccinated will be immunized. The vaccination is 90-95% effective, so for the general US population, from a public health point of view, this is good enough. But because patients of Capitol Hill Medical are primarily members of the GLBT community, they are considered a high-risk group when it comes to potential Hep B infection. Other high-risk groups include healthcare workers, IV drug users, patients born in areas where Hep B is moderately or highly endemic (Southeast Asia for example), and spouses of patients chronically infected with Hepatitis B. These high-risk groups should have prevaccination screening done.
Prevaccination screening:
Because there's a chance that these high-risk groups have already been exposed, it has been shown to be cost-effective to do a prevaccination lab test to see if they even need vaccination.
The providers of Capitol Hill Medical will often do prevaccination screening during your first physical exam, which can tell us a few things. In patients who haven't yet been vaccinated, it can tell us if they've been exposed to Hep B and are now immune or not. Or in patients who have been vaccinated, it can tell us if those vaccinations worked, or if those patients need another round of vaccinations.
More vaccinations for Hep B??
The good news is, if the 5-10% of patients who aren't immune after the first round start a second three-shot Hep B series, 60-70% will become immune after the second round. After that, we may have to conclude that your body just doesn't mount an antibody response to Hep B, and are thus at a higher risk of getting a chronic Hep B infection if you are exposed. So, practice safe sex!
Postvaccination testing:
I will often offer post-vaccination screening at least two months after I administer the Hep B vaccination (your body needs that long to generate the long-term antibodies). If you are found to be immune, I will note this in your medical record so that you don't have to have that test run again if you have to move and switch providers. Postvaccination testing is recommended mostly for patients "at high risk for recurrent Hep B exposure" including healthcare workers and spouses of those with chronic Hep B infection. However, I consider anyone in the GLBT population at risk for recurrent exposure, and so my patients get postvaccination screening :)
A quick aside on Hepatitis A vaccination:
I've pretty much ignored Hepatitis A so far, and here's the reason why: the vaccination for Hep A is as much as 99.9% effective, so if you've gotten vaccinated, you're pretty much good to go. Our prevaccination panel at CHM does include a check for this anyways,
Finally, a word on Hep B vaccination in those patients with HIV:
Immunocompromised patients (including chronic dialysis patients and HIV patients with low CD4 counts) might not always mount a robust antibody response to the Hep B vaccination.
So, in response to the original person who asked the question: Because your CD4 counts are in a healthy range (at least now - was it in a good range when you got vaccinated?), your vaccination against Hep B was likely successful, and you needn't worry about getting Hep B from your partner, but if you haven't had your immunity verified, I would do so.
We're still accepting new patients at Capitol Hill Medical for anyone who needs help with vaccination or testing!
Vy Chu, MD
