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Microbiology · Hepatitis B vaccination of healthcare workers
Sample itemA hospital nurse completed a 3-dose hepatitis B vaccine series. One month after the last dose, her anti-HBs is 6 mIU/mL and HBsAg is negative. What is the next step?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
A. Give a second complete 3-dose series and recheck anti-HBs 1 to 2 months later
Anti-HBs of at least 10 mIU/mL after vaccination indicates seroprotection. A level below this is a non-response, so after excluding infection with HBsAg, a further series is given and antibody is rechecked. Persistent non-responders are considered susceptible and need immunoglobulin after any exposure.
Option by option
A. Give a second complete 3-dose series and recheck anti-HBs 1 to 2 months later (correct)
Correct. Revaccination and retesting is the standard approach to non-response.
B. Give hepatitis B immunoglobulin and no further vaccine
Immunoglobulin gives only temporary passive protection and does not replace vaccination.
C. Repeat the same single dose every 5 years without testing
Booster-only strategies without testing do not address non-response.
D. Reassure her that she is protected
Six is below the protective threshold of 10 mIU/mL, so she is not protected.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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