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Question #51

My girlfriend is chronic active carrier of the hepatitis B virus. After second vaccination with twinrex my antibody titer shows 4 units. How protected am I? What activities are safe and which ones are not? Does this mean that I am not responding to the vaccine? Does this mean that if I am going to get the disease I am likely to become a chronic carrier?

 Answer:  

This is a good question.  When the writer indicates that he finished his "second vaccination", I'm not sure if he means that he completed his second series of three shots, or whether he just finished his second shot of the three-shot series.  If he has just completed his second shot, then he should certainly complete the series before he assesses whether he will respond.  The series consists of three shots: the second given one month after the first, and the third given 5 months after the second.  His titer should then be evaluated about three months later.  A small percentage of people will not convert (i.e. they will not gain an antibody titer which is considered protective--viz. above 10 mIU/ml).  It is recommended by most specialists that these people receive one of two more shots separated by 2 to 3 months.  If they still do not respond after this regimen, they are unlike to ever respond. 

Is he at risk for contracting this disease?  Yes.  The level of his risk depends on a number of factors.  Sexual relations certainly place him at higher risk.  Other close personal contact (kissing, sharing eating utensils, toothbrushes, etc) also place him at risk.  Casual contact is less likely to transmit the virus.  If his girlfriend is Hepatitis B "e" antigen positive, there is much higher risk of transmission than if she is simple hepatitis B "s" antigen positive.  If her viral load is higher, there is also higher risk of transmission.  She should certainly be considered for treatment with antiviral therapy--it may be possible to eradicate the virus. It is not known whether he would be at higher risk for development of chronic Hep B because he has heretofore no mounted an immune response to the vaccine.  Statistically, about 10 % of those infected with the disease will go on to have chronic Hep B. 

It would be advisable on all levels (medical, spiritual and psychological) to avoid sexual contact with his girlfriend.  It would also be wise to avoid close personal contact.  Should he marry this woman, then he would certainly be at risk in light of the discussion above.  If he were to marry her, he may contract the disease.  Just because he has not responded to the vaccine does not necessarily mean that he won’t mount a vigorous response to an actual infection.  In addition, if he does contract the disease, treatment may be successful.

John Gisla, MD, NFPMC is Board Certified by the American Academy of Family Physicians,
and Certified as a Medical Consultant for Natural Family Planning and NaPro Technology
by the Pope Paul VI Institute. He is Chairman of the Department of Family Practice at
Methodist Hospital operated by Mercy Healthcare Sacramento and on the NFP Advisory Board
for the Diocese of Sacramento. He has been married five years and has two daughters.

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