Ask the Doc :: Too Many Needles!

Question:
Dear Doctor Jason,

Please explain this to me: I've had the Hepatitis B series twice now, and my primary care physician says it still didn't take. He wants me to have another three shots. Apart from the fact that I'm tired of running to his office to get stuck with needles, why isn't this working? And do I *really* need to have this vaccination?

Signed, Too Many Needles!

Doctor Jason's Response:

The Hepatitis B virus can be transmitted sexually and via blood, very similarly to HIV. Hepatitis B infection comes in 2 stages: acute and chronic. The acute infection can make you really sick with nausea, vomiting, diarrhea, fever, and abdominal pain.

After this acute illness, there is a potential for the infection to become chronic and persistent in your liver for many years. The risk here is that it can lead to cirrhosis, liver failure, and cancer. The vaccine--although painful as a series of 3 shots over a 6-month period--is quite effective at preventing chronic infection if you were to be exposed to Hepatitis B.

There are a small number of people who do not develop "demonstrable immunity," meaning that blood testing does not reveal that you made antibodies, despite having been correctly immunized. Studies have shown that these people are capable of developing detectable antibodies if infected with the virus, and those antibodies are protective (indicating that the vaccination did work).

It is recommended that all individuals (starting from infancy) be immunized against Hepatitis B, with few exceptions due to other health concerns. In your situation, if you have completed the appropriate series of vaccinations twice, and you still do not have demonstrable immunity, then I would recommend that you discuss with your health care provider the possibility of being a non-converter but still protected and to ensure that you are protected against other common illnesses, such as mumps and rubella.

Stay healthy,
Doctor Jason

Dr. Faulhaber is a graduate of Tulane University in Psychology and Cellular and Molecular Biology and received his medical degree from the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School. He performed his residency training in Internal Medicine and Pediatrics at Saint Vincent's Hospital in Manhattan, where he then served as a Chief Resident in Internal Medicine. He completed his fellowship in Infectious Diseases at New York University, where he specialized in HIV/AIDS, Hepatitis, and fungal infections. Since fellowship, he has been working as an Internal Medicine/Infectious Diseases physician at Fenway Community Health in Boston. He is a Clinical Instructor in Medicine at Harvard Medical School, and he is affiliated with Beth Israel Deaconess Medical Center. He has been the lead author or co-author of several journal articles and textbook chapters on infections with HIV, other viruses, bacteria, and fungi. He is also accredited by the American Academy of HIV Medicine.

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