Some people may take the 3 doses of HBV vaccination, but still get infected by Hepatitis B virus. This is probably due to unwell and weak immune system or ineffective liver functions that cause the body to not create enough antibodies type IgM. Therefore, if anyone takes the full course of HBV vaccination, has to have a blood test to ensure that their body forms the required amount of HBV antibodies. Otherwise, they must retake an additional course of HBV vaccination.

Thanks for your contribution @Ali Haider Mohammed.

So, will you say HBsAg negative result is enough to go for vaccination or you advocate for liver function test in addition to HBsAg test before going for vaccination?

please see link to Interpretation of Hepatitis B Serologic Test Results

https://www.cdc.gov/hepatitis/hbv/pdfs/serologicchartv8.pdf

@Chen Stein Zamir Thanks so much for the link.

But please, what is your take on my question? Will you advise vaccination solely based on HBsAg negative result or would you consider Anti-HBc as well prior to vaccination?

Thanks in anticipation.

Liver function test(LFT)often time does not predict hepatopathy due to hepatitis BV infection as LFT may be normal even in the presence of HBV infection. LFT may not reveal any abnormalities until 70% of the liver is bad.

Thank you for your kind contribution @Yunus Abiola Wahab

practically, we recommend HBV vaccination for anyone who was both negative to HBsAg and anti HBs.

Thank you for this sir @ Van Huy Tran.

That's often the practice. The detection of anti-HBc among individuals who are fully vaccinated against HBV informed my worry, hence my question.

I am beginning to think if anti-HBc should be done as well before vaccination.

What is your take on this sir?

HBV is an enveloped virus and the HBsAg is the protein on the surface of the virion (i.e. embeded within its envelope/membrane). HBcAg is the capsid protein. The capsid is present in the envelope and protects the genome. Hence, anyone naturally exposed to the Virion will simultaneously be exposed to both HBsAg and HBcAg as part of the infectious particle and other particles produced by the virion during replication in the infected host.Therefore, anybody that is positive for HBsAg will ultimately be positive for anti-HBc (the antibody elicited by HBcAg) and anti-HBs at one point or the other. Also since the HBV vaccine is a subunit vaccine containing only HBsAg, vaccinated people should not produce anti-HBc but ultimately produce anti-HBs.

Many times infected people might not be producing HBsAg because the virus is not actively replicating. However such people will have anti-HBc. So, screening for anti-HBc before vaccination is recommended because it allows you to know if the individual had been previously exposed to infectious HBV particles even if actively replicating virus particles are not currently present in the person.

Personally I don't think there is any benefit in vaccinating a person that is HBsAg negative but anti-HBc positive. This is because the person is already infected and will ultimately produce anti-HBs if the immune system is able to control the infection. Vaccination is more valuable for protecting the previously unexposed individuals. I however stand to corrected.

This is very insightful and helpful @Dr Temitope Faleye.

I really appreciate your erudite contribution.

Just saw your question. HBsAg negative result is NOT enough to recommend someone for vaccine. All those who have been exposed to HBV will produce the core and surface antigen as well as the respective antibodies at a point during viral replication. For those who produce enough surface antibody to overcome infection and become immune due to natural infection, the HBsAg as well as the HBcAb test results will be positive. This is a good way to differentiate those immune through natural infection from those vaccinated who do not produce the core antibody. If someone has been exposed to the virus of what use is the vaccination since it is meant for prevention of infection? It is advisable to have a negative HBsAg and HBcAb to be eligible for a HBV vaccination.

@Dr Margaret Oluwatoyin Japhet Thank you so much for your kind contribution.

This implies therefore that there should be a mass sensitization and education of the public on this.

As pointed out by Prof. Van Huy Tran, vaccination is often recommended for individuals negative to HBsAg (and anti-HBs).

The importance of anti-HBc before vaccination should be well emphasized to avoid further pumping the patient with more of the virus and subsequent hepatic complications.

I have read through all the comments before mine and they are well scholarly posited. I think amidst other things, the stage of infection as at the time of test is another consideration. I personally had a case where a sample tested negative for both HBsAg and HBcIgM, upon repetition few months after, it was then HBsAg negative and HBcIgM positive. There are other reasons why HBsAg as a marker may not be detectable, while the viral particle is not necessarily absent. Temitope Faleye and Margaret Oluwatoyin Japhet your submissions are very insightful. Thanks.

@ Dr Olukunle Ogunsemowo Oluwasemowo Thanks for your input.

I agree with Temitope Faleye and Margaret Oluwatoyin Japhet. I just wanted to add 2 things:

1) Some patients may have a positive anti-HBc without detectable HBsAg or anti-HBs. Most of these patients will have a resolved hepatitis B (with very low anti-HBs titers), but some may have an occult hepatitis B (that is, with detectable DNA). Even though none of these patients have any benefit in being vaccinated, this may have treatment implications. That's why you should always check for hepatitis B DNA in patients with isolated positive anti-HBc.

2) It's always useful to have anti-HBc determined, because a positive result means that the patient has been in contact with the virus. Remember that hepatitis B never really cures (even if you have positive anti-HBs) because of the persistent cccDNA in the hepatocytes. And these patients (negative HBsAg, positive anti-HBc, positive anti-HBs) can have severe reactivations when their on immunosuppressive treatment (mainly anti-CD20 drugs like rituximab).

Concerning the case you mention, my best guess is that the patient was already anti-HBc and anti-HBs positive before he was vaccinated. Therefore he had a resolved hepatitis B and the vaccination was useless at that time.

All the best.

This is another insightful contribution. Thanks so much for this, Dr. Cristóvão Figueiredo.

Your guess is as good as mine on the case I mentioned. And I think this further emphasizes the need for Anti-HBc assay before vaccination is done.

Once again, thank you for your contribution.

HBsAg is clearly not enough for enrolling for HBV vaccine, but sadly is the case 99.5% of the time. Due to lack of awareness and cost, other markers are not done. especially in resource-poor countries like Nigeria. Many health practitioners don't know the fact that HBsAg negativity alone is not enough to say one is free from hepatitis B.