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

From: MCOH-EH [mailto:mcoh-eh-bounces@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

3181 SW Sam Jackson Park Rd

Mail code: UHN 89

Portland, OR 97239-3098

Department Phone: 503-494-5271

Office Phone: 503-346-1152

Fax: 503-494-4457

Email: crumpt@ohsu.edu

Mon-Fri, 7:30-4:00

The information contained in this EMAIL message is confidential and protected by law. The information is intended only for the person or business identified in the document. If you are not the intended recipient, by sharing or copying the information you are breaking the law. If you have received this EMAIL by mistake, please notify the sender of this EMAIL and do not return, copy or keep the information in the EMAIL.