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  Table of Contents  
Year : 2017  |  Volume : 35  |  Issue : 2  |  Page : 315

Hepatitis B vaccination for healthcare workers

Department of Microbiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita University, Ernakulam, Kerala, India

Date of Web Publication5-Jul-2017

Correspondence Address:
Sadia Khan
Department of Microbiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita University, Ernakulam, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijmm.IJMM_16_177

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How to cite this article:
Khan S, Kumar A. Hepatitis B vaccination for healthcare workers. Indian J Med Microbiol 2017;35:315

How to cite this URL:
Khan S, Kumar A. Hepatitis B vaccination for healthcare workers. Indian J Med Microbiol [serial online] 2017 [cited 2018 Feb 20];35:315. Available from:

Dear Editor,

We read with interest the article titled, 'Seroepidemiological survey of healthcare workers in Maharashtra' by Taishete et al.[1] The authors have made commendable effort in collecting data from 11 civil hospitals and sub-district hospitals covering 8 circles of the state of Maharashtra. However, the results of the study have been lost in a contagious numerical confusion. The study also creates some misconceptions that we would like to address.

  • The authors have described that, of the 437 samples tested for hepatitis B surface antigen (HBsAg), 11 had tested positive; of which 8 were vaccinated and 3 healthcare workers (HCWs) had not taken vaccine. The authors further state that, 'Three HCWs were not vaccinated, and hence, require full vaccination'. Do the authors imply that hepatitis B positive HCWs need to take vaccines to counter the disease?
  • Booster doses: The authors have also documented the number of HCWs who have taken booster doses. This raises an often repeated question, whether booster doses are required in hepatitis B vaccinated individuals? Extensive literature reviews show that immunocompetent people known to have responded to hepatitis B vaccination in the past do not require additional passive or active immunisation.[2],[3],[4] Adults who respond to a 3-dose hepatitis B vaccine series (hepatitis B surface antibody [anti-HBs] of at least 10 mIU/mL) are protected from chronic hepatitis B virus (HBV) infection for at least 22 years even if there is no detectable anti-HBs currently.[2],[3],[4] Booster doses are usually recommended for immunocompromised individuals and certain patient groups at risk of acquiring hepatitis B like haemodialysis patients.[2]
  • Nonresponders, responders and the gulf in between: The authors have not defined non-responders and it is very likely that they have misclassified all the HCWs who have <10 IU/ml of anti-HBs antibodies as nonresponders. Technically, vaccine nonresponders are persons who do not develop surface antibodies after completing two full series of hepatitis B vaccine and for whom an acute or chronic hepatitis B infection has been ruled out.[5] The terminology of low responders is defined only by a minority of Eurosurveillance panel experts as HCWs with anti-HBs titres 10–100 mIU/ml.[6] While these individuals may develop asymptomatic hepatitis B infection, very little literature is available to decide what recommendations should be applicable to them. On the other hand, various interventions for nonresponders such as increasing the number of doses, using intradermal injections, adjuvant use or use of levamisole have been tried experimentally [7]
  • Core antibodies: There is a lack of clarity regarding the core antibody status of these HCWs. While the authors state in one paragraph, 'About 193 of the total 229 vaccinated HCWs tested positive for core antibody, meaning that they were infected prior to HBsAg vaccination leaving a total of 36 “truly” vaccinated HCWs'; the next paragraph states 'All 437 HCWs were tested for HBcIgM and all tests were negative, ruling out recent infection'. If the former statement is true, it is alarming that more than half of the study population was affected by HBV in the past
  • Numerical confusion: The authors have stated that 229 HCWs were vaccinated in few instances and 192 in some other instances. Some data add up to 192, some do not. We wish that such numerical errors had not held the entire results of this study to ransom.

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Conflicts of interest

There are no conflicts of interest.

 ~ References Top

Taishete S, Chowdhary A. Seroepidemiological survey of health care workers in Maharashtra. Indian J Med Microbiol 2016;34:237-40.  Back to cited text no. 1
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Leuridan E, Van Damme P. Hepatitis B and the need for a booster dose. Clin Infect Dis 2011;53:68-75.  Back to cited text no. 2
Zanetti AR, Mariano A, Romanò L, D'Amelio R, Chironna M, Coppola RC, et al. Long-term immunogenicity of hepatitis B vaccination and policy for booster: An Italian multicentre study. Lancet 2005;366:1379-84.  Back to cited text no. 3
Jan CF, Huang KC, Chien YC, Greydanus DE, Davies HD, Chiu TY, et al. Determination of immune memory to hepatitis B vaccination through early booster response in college students. Hepatology 2010;51:1547-54.  Back to cited text no. 4
Advisory Committee on Immunization Practices; Centers for Disease Control and Prevention (CDC). Immunization of health-care personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011;60:1-45.  Back to cited text no. 5
McMahon BJ, Bruden DL, Petersen KM, Bulkow LR, Parkinson AJ, Nainan O, et al. Antibody levels and protection after hepatitis B vaccination: Results of a 15-year follow-up. Ann Intern Med 2005;142:333-41.  Back to cited text no. 6
Lin CS, Xie SB, Liu J, Zhao ZX, Chong YT, Gao ZL. Effect of revaccination using different schemes among adults with low or undetectable anti-HBs titers after hepatitis B virus vaccination. Clin Vaccine Immunol 2010;17:1548-51.  Back to cited text no. 7


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