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To Hepatitis B vaccinate or not? by Bruce Ribner, M.D., Infectious Diseases Division, and Cheryl Brian, R.N., Occupational Safety and Health   Hepatitis B is a serious disease caused by a virus that attacks the liver. The virus, which is called Hepatitis B virus (HBV) can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure and death. Hepatitis B virus is so serious that it is responsible for an estimated 4,000 to 5,000 deaths each year in the United States.   Hepatitis B vaccine prevents hepatitis B disease and its serious consequences. Hepatitis B vaccine provides protection against infection with HBV by producing immunity on antibodies to the surface protein or outer coat of the virus. This outercoat is called Hepatitis B surface antigen or HbsAg.   Questions have risen about how long the protection lasts for the immunized person. Specifically, will vaccinated infants still be protected as an adolescent or even into adulthood? A number of studies have shown that the initial three-dose immunization series provides protection for years. These studies have followed vaccinated individuals for periods of time up to 15 years and indicate that immunity is long-term and probably lifelong.   While immunized people may lose antibodies circulating in their blood, they still retain protection from chronic HBV because of “immune memory.” Immune memory refers to the immune cells remembering they were vaccinated and quickly producing antibodies when exposed to HBV. For HBV the protective response is effective because of the long incubation for HBV infection.   Hep. B virus is a serious and often deadly disease. The protection from the disease once vaccinated is long-term and may be lifelong. Serologically, a vaccinated person may test negative for the antibody to HBV, but because of “immune memory” and the long incubation period for HBV, antibodies will be produced and prevent illness.  Therefore, a vaccinated individual whose blood work is HBV antibody negative does not mean they are not protected from the HBV disease.