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This page will assist in determining what records you need to collect and submit in order to fulfill the Hepatitis B requirement in your CastleBranch Clinical Requirements tracker. It is broken into steps and has you choose between a couple different tracks.
Step 1
Locate and understand existing medical records
The first step for completing any of the CastleBranch requirements for medical records is to determine if you already have those records, or otherwise have access to them.
1. Health Provider Records
Providers that administered vaccinations to you should retain records. You can contact your provider directly, but if it is a larger entity like MultiCare Health System or Virginia Mason Franciscan Health, there may be a patient portal you can access.
2. State Records
In some cases, states will retain vaccination records that were submitted by a school or healthcare provider.
Additionally, documents like the Washington Department of Health Lifetime Immunization Record can fulfil some CastleBranch requirements, or in the case of Hepatitis B, show a record that you have received vaccine doses.
Look for a list of vaccine doses and which brand of vaccine you received. There are two types of Hepatitis B vaccines: a 2-dose series and a 3-dose series.
- 2-series (Heplisav) Two doses are administered one month apart.
- 3-series (Recombinex HB or Energix-B or Recombivax HB) Three doses; first dose is followed by second one month later, third dose six months after first (0, 1, 6).
When reading your record, identify the type of vaccine and determine if you received all the required doses. If the record does not specify the brand of vaccine, contact the provider and see if they have the record of the specific doses.
Additionally, if you already have record of a positive Hepatitis B Surface Antibody blood test, skip to step 3a) below. The test result will most likely be reported in a separate medical record from your list of vaccinations, such as a lab result report, either on its own or with other blood testing for items like Measles and Chicken Pox. The test may be listed as "Hepatitis B Surface Antibody", "HBsAb" or "anti-HBs."
Of all of the required medical records, Hepatitis B vaccination and confirmation takes the absolute most time. For those who have not started the Hepatitis B vaccination series, it can take nearly 9 months to receive all doses and have a blood test.
| Event | Steps | Wait |
|---|---|---|
| Initial child or adult vaccination | 1st dose | As soon as possible |
| 2nd dose |
4 weeks after 1st |
|
| 3rd dose | 24 weeks after 1st (Engerix-B, PreHevbrio, Recombivax HB, 3 dose Twinrix Hep A/B vaccine) |
|
| Testing | Hepatitis B Surface Antibody blood test | 6 weeks after last dose of series (2nd or 3rd) |
| Blood test result | At least 1 week from collection | |
| If Negative blood test result follow-up vaccination | 1st dose | As soon as possible |
| 2nd dose | 4 weeks after 1st (Heplisav-B, Engerix-B, PreHevbrio, Recombivax HB, 3 dose Twinrix Hep A/B vaccine) |
|
| 3rd dose | 16 weeks after 1st (Engerix-B, PreHevbrio, Recombivax HB, 3 dose Twinrix Hep A/B vaccine) |
|
| Testing | Hepatitis B Surface Antibody blood test | 6 weeks after last dose of series (2nd or 3rd) |
| Blood test result | At least 1 week from collection |
You want your blood test result to either show a positive Hepatitis B Surface Antibody result OR for the report to include a note from your doctor which says you are immune to Hepatitis B.
Blood testing for Hepatitis B is done as a panel, meaning multiple markers of your blood specimen are evaluated and together the results of all of those are used to determine immunity. Of the markers examined in the Hepatitis B panel, the most directly related to evidence of immunity is the Surface Antibody measurement (noted as HBsAb or anti-HBs in records). If that result is positive it means you show immunity because of either vaccination or prior infection. You can read more about how this testing is evaluated on the CDC website.
Step 2
Order a Blood Test or Finish Vaccination Series
If you have determined that you have finished the vaccination series, seek out a Hepatitis B blood test (2a). If you have not completed the vaccination series, schedule your remaining doses and a blood test for 6 weeks after final dose (2b).
2a) Order a blood test
You must have a Hepatitis B blood test panel drawn in order to complete this requirement. The result of this test will indicate if you are presumed immune to Hepatitis B because of the presence antibodies. If the test is negative, you will need to follow-up as described in 3b).
2b) Start or finish vaccination series and follow-up with blood test
If you have no record at all of Hepatitis B vaccination, then you must start the series. As described above, to go from no doses to a positive blood test may take at least 31 weeks, or about 8 months, assuming your timing is perfect. You must start this as early as possible.
If your record showed an incomplete vaccination series, for example if you received only 2 doses of a 3-dose vaccine, you must receive the remaining doses no matter how long it has been. Luckily, you don't have to start over from the first dose. If you have a record of two doses (at least 4 weeks apart) and it has been more than 20 weeks since your 2nd dose, you can receive the third dose right away.
At least 6 weeks after the end of your vaccine or booster series, you must have a Hepatitis B blood test panel drawn in order to complete this requirement. The result of this test will indicate if you are presumed immune to Hepatitis B because of the presence antibodies. If the test is negative, you will need to follow-up as described in 3b).
Step 3
Review blood test results and submit to CastleBranch
The results of your blood test will determine if you have everything you need to fulfil the requirement (3a) or you must seek out a second vaccine series and test again (3b).
3a) Do you have a positive (or reactive) test result?
You are done! Upload the lab results to the item in CastleBranch and it will be approved.
3b) Do you have a negative, non-reactive or equivocal test result?
Many people who have been vaccinated for Hepatitis B will receive a negative Hep B surface antibody blood test result. To follow-up, they must receive another vaccine series from a different brand. Obtain that series as soon as possible because, as discussed below, the process of re-testing will take at least 6 weeks.
At least 6 weeks after completing your second Hepatitis B booster vaccine series you can be tested again.
If the test results are positive, upload them to CastleBranch and they will be approved.
If the test results are negative, this may still be acceptable. However, please contact our office at tnursing@uw.edu as soon as possible after receiving negative results. They will provide your next steps.
