[MCOH-EH] Can Heplisav-B be used for booster dose?

[Swift, Melanie D., M.D.]

Hi Tim,

It's a really good question. I think this depends upon your population - primarily their age and likelihood of having an anamnestic response to the challenge dose. There is no literature to test this yet, but here is my theory. I'm hoping to evaluate these hypotheses at some point:

If you have a younger cohort such as healthcare students who were likely vaccinated in infancy, you're going to end up doing a lot of challenge doses as a hefty percentage (30 - 70% depending on the study you want to cite) but almost everyone will demonstrate a good response to standard hep B vaccine and won't need the rest of the series. The downside of Heplisav in this population is that one dose of Heplisav is much more expensive than one dose of standard vaccine. In a young cohort such as this, so you'd be giving a much more expensive single challenge dose to everyone, and the follow-up dose to only a few.

On the other hand, if you have an older cohort with more people whose initial vaccine series was in adulthood, Heplisav likely makes sense as the challenge dose, with a second dose to complete the series if the post-challenge sAb is negative. It is more immunogenic in adults, and has the advantage of finishing the second series in one month instead of six.

So I would look at the population and then do some math based on the estimated percent who might need both doses of Heplisav, and what it costs you compared to standard HBV vaccine.

Melanie

Melanie Swift, MD, MPH
Medical Director, Mayo Clinic Physician Health Center
Senior Associate Consultant
Assistant Professor of Medicine
Division of Preventive, Occupational, and Aerospace Medicine
Phone 507.284.2560
_______________________________
Mayo Clinic
200 First Street SW
Rochester, MN 55905
www.mayoclinic.org<http://www.mayoclinic.org/>


From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Tim Crump
Sent: Tuesday, August 20, 2019 2:08 PM
To: MCOH-EH
Subject: [EXTERNAL] [MCOH-EH] Can Heplisav-B be used for booster dose?

We are transitioning over to mostly Heplisav-B for our Hep B vaccinations.  Does anyone have thoughts whether Heplisav-B can be used for a booster dose?  (For example, if a worker had a full documented Hep B series in 2001, but never got a titer till now and it is negative, can we use one Heplisav-B for booster dose, and if the worker has a positive titer after, call them long-term immune?)

*         Our drug rep says no, that Heplisav is always given as a series of 2 and never as a single dose.


*         To my mind though, anyone with a full Hep B series and a subsequent positive titer has long term immunity, and it shouldn't matter which vaccine boosts to demonstrate this.


What do others think?  The advantage of boosting w/ Heplisav-B would be that if the titer is negative, it would take a lot less time to complete the second series.  Best, Tim


Tim Crump, MSN, FNP
Tim Crump, MSN, FNP
Family Nurse Practitioner
Multnomah Pavilion 1 SE, Suite 1110
Occupational Health
Healthcare Human Resources

Oregon Health & Science University
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Email: crumpt at ohsu.edu<mailto:crumpt at ohsu.edu>

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