What is the recommended hepatitis B (Hep B) vaccine schedule for a 59-year-old male with no evidence of immunity to hepatitis B?

From the Guidelines

For a 59-year-old male without immunity to hepatitis B, the recommended vaccine schedule is a 2-dose series of the Heplisav-B vaccine, with doses administered at 0 and 1 month, as this schedule has been shown to provide protection against hepatitis B virus 1.

Vaccine Options

The available hepatitis B vaccine options for adults include:

• Heplisav-B: 2 doses at 0 and 1 month 1
• Engerix-B: 3 doses at 0,1, and 6 months 1
• Recombivax HB: 2 or 3 doses, with the 2-dose schedule at 0 and 4-6 months and the 3-dose schedule at 0,1, and 6 months 1
• PreHevbrio: 3 doses at 0,1, and 6 months 1
• Twinrix (HepA-HepB combination vaccine): 3 doses at 0,1, and 6 months (standard) or 4 doses at 0 day, 7 days, 21-30 days, and 12 months (accelerated) 1

Importance of Vaccination

Hepatitis B vaccination is crucial for providing protection against the hepatitis B virus, which can cause acute and chronic liver disease, including cirrhosis and liver cancer 1. Completing the entire vaccination series is essential to ensure adequate protection.

Administration and Booster Doses

The hepatitis B vaccine should be administered as an intramuscular injection in the deltoid muscle. After completing the vaccination series, no routine booster doses are recommended for immunocompetent adults 1. However, certain individuals with immunocompromising conditions or other health issues may require higher doses or additional doses.

From the FDA Drug Label

Immunization with 20 mcg using a 0-, 1-, and 6-month schedule produced a seroprotection rate of 99% at month 8 (N = 122) with a GMT of 7,672 mIU/mL (N = 122,95% confidence intervals = 5,248-10,965) Clinical trials in healthy adult and adolescent subjects have shown that following a course of 3 doses of 20 mcg ENGERIX-B given according to the ACIP-recommended schedule of injections at months 0,1, and 6, the seroprotection (antibody titers ≥10 mIU/mL) rate for all individuals was 79% at month 6 and 96% at month 7; the GMT for seroconverters at month 7 was 2,204 mIU/mL.

The recommended vaccine schedule for a 59-year-old male with no immunity to hepatitis B is 20 mcg at 0,1, and 6 months. This schedule has been shown to produce a high seroprotection rate and GMT in healthy adults and adolescents 2.

From the Research

Hepatitis B Vaccine Schedule

The recommended vaccine schedule for a 59-year-old male with no immunity to Hepatitis B is not explicitly stated in the provided studies. However, the studies suggest the following:

• A standard protocol of 3 doses of Hepatitis B vaccine (Engerix B) at 0,1, and 6 months can be used 3.
• A quick and double-dose schedule (0,1, and 2 months) can also be effective, but the response rate may be lower in older patients and those receiving anti-TNF therapy 4.
• If the patient does not respond to the initial vaccination series, a revaccination strategy with 3 additional doses of vaccine may be considered 5.

Factors Affecting Vaccine Response

The following factors may affect the response to Hepatitis B vaccination:

• Age: Older patients may have a lower response rate to the vaccine 4, 3.
• Immunosuppressive therapy: Patients receiving anti-TNF therapy may have a lower response rate to the vaccine 4, but other studies suggest that immunosuppressive therapy may not affect the vaccine response 3, 6.
• Ileal disease: Patients with ileal disease may have a lower response to the vaccine 3.

Revaccination Strategies

If the patient does not respond to the initial vaccination series, the following revaccination strategies may be considered:

• Administration of 3 additional doses of vaccine, which may be more effective than 1 or 2 doses 5.
• A challenge dose of Hepatitis B vaccine to assess for anamnestic response and sustained seroprotection 6.