The Centers for Disease Control and Prevention (CDC) published an article about Hepatitis B (Hep B) immunization management issues in the most recent Morbidity and Mortality Weekly Report (MMWR), emphasizing the following information:

• Recommendations for Hep B vaccine dosage vary depending on the product, age of recipient, and needs of the individual belonging to a certain population (e.g., immunocompromised, infant, or older children). Follow specific recommendations provided by the CDC and manufacturer.

• Vaccine injections should be intramuscular, preferably on the deltoid area in the adult. Injection into the buttocks decreases immunogenicity. If a site other than the deltoids or anterolateral thigh is used, vaccination is not counted as valid unless serologic testing proves that adequate response was achieved.

• The needle needs to be long enough to reach muscle mass.

• Only written, dated records are considered reliable vaccination history. Persons with no records should be considered susceptible and vaccination should be started.

• If the vaccine schedule is interrupted, the series need not be restarted; rather, give the next dose as soon as possible.

In response to a letter from a concerned employee, the Occupational Safety and Health Administration’s (OSHA) Directorate of Enforcement reiterated that the employer need not provide a new series of Hep B vaccinations or a booster even if antibody titers drop to undetectable levels.

According to OSHA, it is the employers responsibility to provide Hepatitis B vaccination to “all employees who have occupational exposure, and post-exposure follow-up to all employees who have had an exposure incident…including prophylaxis...at no cost to the employee...at a reasonable time and place, and ...according to recommendations of the U.S. Public Health Service (USPHS) current at the time these evaluations and procedures take place.” Since the USPHS currently does not recommend a new series or routine booster shots, it is therefore not required by the Bloodborne Pathogens Standard at this time. OSHA stated that if USPHS changes its recommendations in the future, then requirements under the Bloodborne Pathogens Standard will also change.

CDC also does not recommend a routine booster or a new Hep B series when low titers are detected; vaccine-induced antibodies to HBV fall over time, with the majority losing detectable Ab over 12 years. A booster is unnecessary because research in adults has shown that, despite declining levels of detectable antibody, vaccine-induced immunity continues to prevent clinical disease or detectable viremic HBV infection. Periodic monitoring of antibody concentrations after completion of the three-dose series is likewise not recommended.

Related Link:
Standard Interpretation
MMWR Hep B Dose and Administration