Get the hepatitis B blood panel (“two-and-a-half pairs,” 乙肝两对半) and use your vaccination record to decide whether you need a catch-up vaccine
- High value
- Evidence A
- Buys life
- Costs a little
- Takes minutes
- No willpower
In plain words
In the Qidong study, people vaccinated against hepatitis B at birth were 84% less likely to get liver cancer later. Adults can't simply apply that drop to themselves, and low antibodies alone are not a reason to get all 3 shots. People who finished the full series, once had protective antibodies and have a normal immune system usually don't need a booster. If you aren't sure whether you were ever vaccinated, take your lab report to a vaccination clinic for assessment.
- Cost
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The test costs a few dozen CNY. For adults who need the vaccine, 3 doses of hepatitis B vaccine total about 100 to 300 CNY; the price depends on the local clinic. The usual schedule is months 0, 1 and 6.
- What you get
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The Qidong trial was randomized by community, not by individual, and followed people for 30 years. Vaccinating newborns against hepatitis B lowered primary liver cancer by 84% (95% CI 23% to 97%, the plausible range). The rate of hepatitis B surface antigen (HBsAg) positivity fell 72% (95% CI 68% to 75%); this rate is the share of people found to be carrying the virus. In the control group, 67.8% were vaccinated later, at ages 10 to 14. That later vaccination was only 21% effective against HBsAg positivity in early adulthood (95% CI 10% to 30%), much weaker than vaccination at birth. The HBsAg-positive share of China's whole population fell 52% from 1992 to 2014, and 97% among children under 5. These numbers can't be applied directly to catch-up vaccination in adults. People with a normal immune system who finished the full series and once developed protective antibodies keep an immune memory after the antibodies fall, and usually don't need a booster. Immune memory means the body can quickly mobilize its defenses when it meets the virus again. Whether to get a catch-up vaccine depends on your vaccination record together with the surface antigen, surface antibody and core antibody results. If your vaccination history is unclear, go to a vaccination clinic for assessment.
- Notes
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Adults who were never vaccinated, didn't finish the series or whose vaccination history is unclear should take their vaccination record and lab reports to a vaccination clinic. If the doctor confirms you could still be infected, you get vaccinated or complete the series by the standard schedule. A single negative antibody result many years later is not enough to conclude that the original vaccination failed. Most people who finished the full series do not need repeated antibody tests to decide whether to get a booster. If, after the full series, a test at the prescribed time finds no protective antibodies, have a doctor arrange another vaccination and a recheck. People on dialysis, with weakened immunity or with occupational exposure to blood also need to be assessed individually. A positive core antibody may mean a past infection, so it can't simply be treated as never infected and in need of a catch-up shot. The vaccine does not treat an infection that is already there. If your surface antigen (HBsAg) is positive, see a liver clinic for assessment; see §16.11 (if the hepatitis B surface antigen is positive, a liver ultrasound every 6 months).
- Evidence grade
- A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.
- Sources
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- Qu C et al. (2014). Efficacy of neonatal HBV vaccination on liver cancer and other liver diseases over 30-year follow-up of the Qidong hepatitis B intervention study. PLoS Medicine: "The estimated efficacy of catch-up vaccination on HBsAg seroprevalence in early adulthood was 21% (95% CI 10%-30%), substantially weaker than that of the neonatal vaccination (72%, 95% CI 68%-75%)." https://doi.org/10.1371/journal.pmed.1001774
- Cui F et al. (2017). Prevention of Chronic Hepatitis B after 3 Decades of Escalating Vaccination Policy, China. Emerging Infectious Diseases. https://doi.org/10.3201/eid2305.161477
- Chinese Center for Disease Control and Prevention. Hepatitis B (vaccine immunization, FAQ question 4) [in Chinese]. https://www.chinacdc.cn/jkyj/mygh02/ymkyfjb/yxgy/
- CDC. Pink Book, Chapter 10: Hepatitis B (Immunogenicity and Vaccine Efficacy, Serologic Testing of Vaccine Recipients). https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-10-hepatitis-b.html
- CDC (2023). Screening and Testing for Hepatitis B Virus Infection: CDC Recommendations — United States, 2023 (Table 1, Persons Who Are Fully Vaccinated Against HBV Infection). https://www.cdc.gov/mmwr/volumes/72/rr/rr7201a1.htm
Mentioned in
- Get one hepatitis C antibody test as an adult; if positive, get a nucleic acid test, and if confirmed, take an oral drug for 8 to 12 weeks, which cures the great majority
- If peanuts, corn, nuts or rice and flour at home have gone moldy, throw out the whole bag and don't pick out the moldy parts and eat the rest; spit out any nut that tastes bitter right away
- Don't eat raw freshwater fish or shrimp such as yusheng (鱼生), sashimi, raw-fish congee or drunken shrimp; if you have often eaten them, get checked once for liver flukes, and if found, take praziquantel as your doctor says
- Don't rely on a general checkup package to prevent disease; get the few screenings that have evidence for your age and sex
- If tests find hepatitis B surface antigen positive, get a liver ultrasound plus an alpha-fetoprotein test every 6 months, let your doctor's assessment decide whether you take antiviral drugs, and once you start, don't stop on your own
Translated from the Chinese original. Original book, section 1, tip 14. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer