A healthy young adult patient who received the HepB vaccine series before college recently had a triple panel screen and discovered that he had chronic hepatitis B. Did the vaccine fail? What do I tell the patient?

While breakthrough infections can happen, it is very uncommon in an otherwise healthy young adult. In this scenario, it is unknown when the HBV infection occurred. It is possible that the person had an unrecognized exposure to hepatitis B virus at some time before they were vaccinated: they may even have been born to a hepatitis B-infected mother and infected at birth. This is the reason triple panel screening of every adult, regardless of vaccination history, is recommended. People who decline or defer screening but accept vaccination should understand that vaccination will not alter a pre-existing infection, which is why hepatitis B screening is important for everyone.