From the Guidelines
For a 59-year-old male with low hepatitis B immunity and unknown vaccination history, I strongly recommend the Heplisav-B vaccine, which consists of two doses of 20 mcg administered intramuscularly 1 month apart, as it provides a more convenient and potentially immunogenic option compared to other available vaccines. According to the most recent guidelines from the Advisory Committee on Immunization Practices (ACIP) in 2022 1, Heplisav-B is a recommended option for adults aged ≥18 years. The dosing schedule for Heplisav-B is 2 doses at 0 and 1 month, which is a more accelerated schedule compared to other hepatitis B vaccines. The benefits of hepatitis B vaccination in preventing liver infection, chronic disease, cirrhosis, and hepatocellular carcinoma outweigh the risks, and the vaccine is generally well-tolerated with minimal side effects, typically limited to soreness at the injection site. Some key points to consider when administering the hepatitis B vaccine include:
- The vaccine series does not need to be restarted if it is interrupted, and the second dose should be administered as soon as possible if the series is interrupted after the first dose.
- Inadequate doses of hepatitis B vaccine or doses received after a shorter-than-recommended dosing interval should be readministered, using the correct dosage or schedule.
- After completing the vaccination series, antibody testing (anti-HBs) should be performed 1-2 months later to confirm immunity development. It is essential to note that the safety and effectiveness of Heplisav-B have not been established in adults on hemodialysis, and data are not available to assess the effects of Heplisav-B on breastfed infants or on maternal milk production and excretion 1.
From the FDA Drug Label
For persons who are unvaccinated, the recommendation is to initiate the HB Vaccine Series. The HB Vaccine dose is 20 μg IM for adults; 10 μg IM for infants or children under 10 years of age. The first dose should be given within 1 week; second and third doses, 1 and 6 months later.
The recommended vaccine for a 59-year-old male with unknown vaccine history and low Hep B immunity is the Hepatitis B Vaccine. The dose is 20 μg IM for adults, with the first dose given within 1 week, and second and third doses given 1 and 6 months later, respectively 2.
From the Research
Hepatitis B Vaccine Recommendation
Given the individual's low hepatitis B immunity, vaccination is recommended. The following points highlight the key considerations:
- Hepatitis B immune globulin (HBIG) is not a substitute for vaccination, but rather provides immediate passive protection against infection with hepatitis B virus [(3,4)].
- The hepatitis B vaccine is safe and effective in inducing an immune response, preventing replication of the hepatitis B virus 5.
- The vaccine is recommended for individuals with low immunity, including those with unknown vaccine history 6.
- Administration of HBIG with the hepatitis B vaccine may delay and reduce responses to the vaccine, but this does not impact the overall recommendation for vaccination 7.
Key Indications for Hepatitis B Vaccine
The following situations indicate the need for hepatitis B vaccination: