When there's no immunity after hep B shots
ANDREW NG, MD, of Mississauga, ON, writes, "A patient received six intramuscular injections of hepatitis B vaccine, followed by another eight intradermal shots of hep B -- and he's still not immune. His partner is a hepatitis B virus (HBV) carrier." Dr. Ng then asks, "Any further suggestions?"
Patients who receive two full courses of properly administered vaccines and don't seroconvert at any point afterwards are unlikely to do so with further repeated doses. Unfortunately, these individuals remain at risk for HBV infection. Encourage and educate patients to make every effort to reduce the risk of infection by taking proper precautions (e.g. using condoms, avoid sharing razors, toothbrushes, etc.). If you haven't already done so, check the patient's hepatitis B surface antigen to make sure an active infection isn't the cause of his failure to seroconvert. It's also important that his partner receives treatment to reduce viral replication. KL