What hepatitis B vaccines are available?

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Last updated: October 28, 2026 • View editorial policy

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Available Hepatitis B Vaccines

Five hepatitis B vaccines are currently available in the United States for adults, including four single-antigen vaccines (Recombivax HB, Engerix-B, Heplisav-B, and PreHevbrio) and one combination vaccine (Twinrix, which protects against both hepatitis A and B). 1

Single-Antigen Hepatitis B Vaccines

Standard Three-Dose Vaccines

Recombivax HB:

  • Available for ages 11 and older
  • For adolescents 11-15 years: 10 μg at 0 and 4-6 months (2-dose option) OR standard 3-dose schedule at 0,1, and 6 months
  • For adults ≥20 years: 10 μg at 0,1, and 6 months
  • For hemodialysis/immunocompromised adults: 40 μg at 0,1, and 6 months 1

Engerix-B:

  • For adolescents 11-19 years: 10 μg at 0,1, and 6 months
  • For adults ≥20 years: 20 μg at 0,1, and 6 months
  • For hemodialysis/immunocompromised adults: 40 μg at 0,1,2, and 6 months (4-dose schedule) 1

PreHevbrio:

  • FDA-approved in 2021, ACIP-recommended in 2022
  • For adults ≥18 years: 10 μg at 0,1, and 6 months
  • This is a three-antigen HepB vaccine (unique formulation)
  • Important caveat: Safety and effectiveness NOT established in hemodialysis patients 1

Two-Dose Vaccine

Heplisav-B:

  • FDA-approved in 2017
  • For adults ≥18 years: 20 μg at 0 and 1 month (only 2 doses needed)
  • Contains CpG adjuvant that stimulates innate immunity through TLR9
  • Demonstrates superior seroprotection rates (90-100%) compared to Engerix-B (71-90%), particularly in traditionally poor responders (older adults, diabetics, chronic kidney disease patients) 2, 3
  • Important caveat: Safety and effectiveness NOT established in hemodialysis patients 1

Combination Vaccine

Twinrix (Hepatitis A + Hepatitis B):

  • For adults ≥18 years: 20 μg HepB component
  • Standard schedule: 3 doses at 0,1, and 6 months
  • Accelerated schedule: 4 doses at 0 days, 7 days, 21-30 days, and 12 months 1

Special Population Considerations

Pregnant Women

Use only Engerix-B, Recombivax HB, or Twinrix in pregnancy. Data on Heplisav-B and PreHevbrio are insufficient to inform vaccine-associated risks in pregnancy 1.

Hemodialysis Patients

Use higher doses of Recombivax HB (40 μg) or Engerix-B (40 μg with 4-dose schedule). Heplisav-B and PreHevbrio have not been established as safe or effective in this population 1.

Breastfeeding

Data are insufficient for Heplisav-B and PreHevbrio regarding effects on breastfed infants or milk production 1.

Key Clinical Pearls

  • All four single-antigen vaccines are equally recommended by ACIP for HBV prevention 4
  • Interrupted schedules do not require restarting the series—simply continue where you left off 1
  • Minimum intervals: 4 weeks between doses 1 and 2; 8 weeks between doses 2 and 3; 16 weeks between doses 1 and 3 1
  • Heplisav-B offers advantages: shorter completion time (1 month vs 6 months), higher adherence, and superior immunogenicity in poor responders 2, 3
  • Prevaccination testing is NOT required and should not be a barrier to vaccination 1

References

2
Research

CpG-Adjuvanted Hepatitis B Vaccine (HEPLISAV-B®) Update.

Expert review of vaccines, 2021

4
Research

Evolving considerations for choice of hepatitis B vaccine.

The American journal of managed care, 2023

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.