I am not responding to the vaccine!?

This is a common call from med students about 1 in 50 may have this problem. There are a few things to consider

one some people just do not get above 10 even after 3 sets of 3 shots.......
however these super immune type systems are very good at clearing HBV should someone catch it

two the shots have a level of protection in this case where we cannot say for certain that we are completely measuring them via the anti body level. Meaning ok you have had 6 shots in 6 months it is very unlikely even if exposed to HBV you would catch it, to date we have some non responders who have 3 shots a year with no response but we do not heard of them getting infected.
Again there needs to be more than just our limited to 50 callers at different times not calling back infected type research to back this up.

three we have many nurses who non respond and instead closely observe gloves and scrubs hygiene and again we are not getting calls from them due to infection.

Four with this group we insist you know where and how to get PEP post exposure prolaxis within 48 hours of a risk from a known source.

Remember ultimately no healthcare worker is safe from blood viral infection HCV HIV have no vaccines. So there is not really an answer more these 4 suggestions. That said it is nurses 20 years from their last HBV vaccination who drop below 10 who catch HBV, studies on whether nurses 1 year after a shot with 10 CAN catch it are still lacking and I have often looked and also tried to compile as best I can.

So the answer here is we need to keep doing all we can to have immunity at least 3 shots a year and we need to observe rigorous gloves and scrubs.