Management of non-response to Hepatitis B re-vaccination

Bloodborne viruses, including Hepatitis B (HBV), are a known occupational hazard for healthcare workers (HCWs), particularly those involved in exposure-prone procedures. Whilst standard vaccines can provide immunity, 5-10% of people remain non-responders (anti-HBs titre <10IU/L) despite repeated vaccinations. Fendrix® (HBV recombinant DNA vaccine) has been shown to be highly effective in renal patients and those with human immunodeficiency virus, implying it may also have benefits for healthy non-responders.

Our analysis set out to identify and compare response rates to re-vaccination (with Fendrix® or HBvaxPro40®) in HCWs with non-response to standard vaccination procedures.

Between 1 March 2010 and 30 April 2024, either Fendrix® or HBvaxPro40® was offered to HCWs with inadequate response to two courses of Engerix B® standard vaccination. Antibody tests were performed 6 weeks post-final vaccine dose. Serological results from this period were retrospectively statistically analysed to compare differential vaccine responses.

Eighty-five HCWs were identified as non-responders and offered further vaccination (42 received Fendrix® and 43 received HBvaxPro40®). Fendrix® resulted in a seroconversion rate of 95% (40/42) compared to 72% (31/43) with HBvaxPro40®; a significantly higher number responded more strongly to Fendrix® (74% versus 23%).

Our results demonstrate the rationale for offering additional vaccination with Fendrix® to HCWs when standard vaccination and repeated administration has not elicited an adequate immune response. Multi-centre evaluation of this vaccination strategy for non-responder HCWs should be considered to generate evidence for the most acceptable and efficacious approach.