Massachusetts Hepatitis B Vaccine Acceptance Declination Form
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How to fill out Hepatitis B Vaccine Acceptance Declination Form?
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FAQ
People who are non-responders after receiving the booster should be tested for hepatitis B virus infection. If negative, they are recommended to receive 2 more doses of hepatitis B vaccine 1 month apart. Count the 4th booster dose as the 1st of the 3 repeat doses.
Approximately 5-10% of vaccinees are defined as non-responders, i.e. they do not develop a protective anti-HBs titer after completing a full primary series of the hepatitis B vaccine (58).
It is also possible that a person who does not respond to the vaccine may already be infected with hepatitis B. Therefore, testing for the presence of the hepatitis B virus (hepatitis B surface antigen or HBsAg) is recommended before diagnosing a person as a "vaccine non-responder."
I Decline the Hepatitis B Vaccination I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself. However, I decline hepatitis B vaccination at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B, a serious disease.
For instance, sometimes the hepatitis B vaccination is delayed if a baby is premature, has a low birth weight, or is medically challenged. Still, parents always have the option to refuse a vaccination if they want to. But the risks associated with a hepatitis B infection far outweigh the risks of the vaccine.
A hepatitis B vaccine non-responder" refers to a person who does not develop protective surface antibodies after completing two full series of the hepatitis B vaccine and for whom an acute or chronic hepatitis B infection has been ruled out.
If an employee initially declines the vaccination, and then decides to have it, the employer must pay for the initial vaccination series and post-vaccination testing, and second vaccination series and testing, if necessary.
Hepatitis B vaccination is recommended for healthcare workers who may have direct contact with patients' blood or blood-stained body fluids.
Employers must ensure that workers who decline vaccination sign a declination form. The purpose of this is to encourage greater participation in the vaccination program by stating that a worker declin- ing the vaccination remains at risk of acquiring hepatitis B.
