Hepatitis B vaccination guide: Can people with positive hepatitis B core antibody get vaccinated?

Let me give you a clear answer first: Except for people who have been diagnosed as hepatitis B surface antigen positive or have latent hepatitis B infection, other people who are hepatitis B core antibody positive can receive the hepatitis B vaccine normally. It will not cause harm to the body and can also have a corresponding protective effect.

Last week, a young girl who had just graduated came to me with her employment physical examination report. She said that the physical examination only tested positive for hepatitis B core antibody. The staff at the community vaccination site said that she "has had hepatitis B and cannot be vaccinated." She was so anxious that she almost cried, fearing that she might have some infectious disease that would affect her employment. In fact, I encounter more than a dozen of this type of consultation every month. The core misunderstandings are nothing more than two: one is that core antibody positivity is equated with current hepatitis B infection, and the other is the fear that vaccination in a positive state will cause problems.

Many people don't know that hepatitis B core antibody is essentially a "virus visit record" - as long as you have been exposed to hepatitis B virus, whether it is a latent infection that has been quietly cleared by your own immunity, or you have really had hepatitis B and have recovered, or you are even in the infection period, this indicator may be positive, and it cannot be used alone to judge whether you have hepatitis B. I have seen too many people whose elders in the family had hepatitis B when they were children. They were exposed to the virus while eating and living together, but they got over it without knowing it. When they became adults, their physical examination showed positive for core antibodies, and they thought they had some serious illness. It was completely unnecessary.

Regarding whether this group of people can be vaccinated, there are actually slight differences in the guidelines in different regions: the disease control guidelines in Europe and the United States are relatively loose. It is believed that as long as there is no clear evidence of current hepatitis B infection, even if only the core antibody is found to be positive, they can be vaccinated directly without additional tests. After all, the probability of latent infection is less than 1%. It is not worth asking everyone to spend hundreds more to check DNA.； In our country, due to the large population base of hepatitis B, the current guidelines are more reliable. It is usually recommended to check hepatitis B surface antigen, surface antibody and HBV-DNA first to rule out current infection before taking the vaccine. In fact, both approaches are reasonable, and there is no absolute right or wrong.

I met a 30-year-old male patient in the past two months. The core antibody was positive, the surface antigen was negative, and the surface antibody was only 2mIU/ml. His wife was positive for hepatitis B and he was afraid of being infected through daily contact. He came to ask if he could get vaccinated. I directly suggested that he take a high-dose hepatitis B vaccine of 60 micrograms. After only one injection, a month later, the surface antibody increased to 120mIU/ml, which was completely sufficient for protection, and there was no uncomfortable reaction. There is also a retired aunt who was positive for both core and surface antibodies, with an antibody titer of over 30. She was still worried about being infected and had to take a booster shot. I also gave her the shot. After the shot, nothing happened, and she felt relieved.

Of course, there are situations where vaccination is really not necessary. That is, you find that the surface antigen is also positive after the test, or the DNA quantification is higher than the lower detection limit, which means that you are already infected with hepatitis B virus. The vaccine will not stimulate protective antibodies, which is a waste of money, but there will be no side effects, and you don’t have to worry about aggravating the condition if you get the wrong vaccine. Some people have asked me before whether vaccination with positive core antibodies will "activate" the virus. This is pure nonsense. The current hepatitis B vaccines are all genetically engineered and recombinant. They only contain surface antigen components and no live virus. Not to mention that you have only been infected before. Even a hepatitis B patient who is taking medicine will not have any problems if he accidentally takes the vaccine. At most, it is useless.

Let me remind everyone, if the physical examination shows positive for core antibodies, don’t panic, first check the hepatitis B two-and-a-half complete set and HBV-DNA. As long as the surface antigen and DNA are negative, you can get vaccinated regardless of whether you have surface antibodies or not. If you belong to a high-risk group - such as those with hepatitis B patients at home, medical staff who often come into contact with blood products, and those who often dine out and socialize, you can feel free to get vaccinated. There is no need to worry about the extremely low probability of infection. Oh, by the way, if you check that the surface antibody titer is above 10mIU/ml, you don’t need to take the injection. Of course, if you want peace of mind, it’s absolutely fine to take a booster injection. There’s no harm in it anyway.