Hepatitis B Vaccination Declination Form

Q. If an employee who handles blood as part of their job is offered the hepatitis B vaccine, but refuses it... what paper work is required?

A. Below is an example of a declination statement which should be signed/dated by the employee and kept on file in the office.

“ I understand that due to my occupational exposure to blood and/or other potentially infectious body fluids, I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine at no cost to myself. However, I decline the hepatitis B vaccine at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B which is a serious disease. If in the future I continue to have occupational exposure to blood and/or other potentially infectious body fluids and I want to be vaccinated with the hepatitis B vaccine, I can receive the vaccination at no cost to me.”

Hepatitis B Vaccination Declination Form

Q. If an employee who handles blood as part of their job is offered the hepatitis B vaccine, but refuses it... what paper work is required?

A. Below is an example of a declination statement which should be signed/dated by the employee and kept on file in the office.

“ I understand that due to my occupational exposure to blood and/or other potentially infectious body fluids, I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine at no cost to myself. However, I decline the hepatitis B vaccine at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring hepatitis B which is a serious disease. If in the future I continue to have occupational exposure to blood and/or other potentially infectious body fluids and I want to be vaccinated with the hepatitis B vaccine, I can receive the vaccination at no cost to me.”

Hepatitis B Vaccine Booster Shots

Q: I was vaccinated several years ago. Should I periodically be tested for my hepatitis B antibody level, and should I have a booster shot?

A: Current data show that vaccine-induced hepatitis B surface antibody (anti-HBs) levels may decline over time; however, immune memory (anamnestic anti-HBs response) remains intact indefinitely following immunization. Persons with declining antibody levels are still protected against clinical illness and chronic disease. For dental and other health care workers with normal immune status who have demonstrated an anti-HBs response following vaccination, booster doses of vaccine are not recommended nor is periodic anti-HBs testing. Note that all dental offices should maintain the hepatitis B immunization records for their staff including declination statements if applicable.