What is the recommended schedule and dosage for the hepatitis B vaccine (HBV)?

From the Guidelines

The recommended hepatitis B vaccine (HBV) schedule for most adults consists of three doses: the initial dose, followed by a second dose 1 month later, and a third dose 6 months after the first dose, as recommended by the most recent guidelines 1. For infants, the first dose is typically given at birth, the second dose at 1-2 months of age, and the third dose at 6-18 months of age. The standard adult dose is 10-20 micrograms (depending on the specific vaccine brand), while children receive a pediatric formulation of 5-10 micrograms per dose, as outlined in the guidelines 1. Some specific populations may require modified schedules or dosing - for example, dialysis patients often need a higher dose (40 micrograms), and certain immunocompromised individuals may require additional doses to achieve immunity, as noted in the recommendations 1. Accelerated schedules are available for those needing rapid protection, with doses given at 0,1, and 4 months or even 0,7, and 21 days with a booster at 12 months, as described in the guidelines 1. The hepatitis B vaccine works by introducing a small amount of hepatitis B surface antigen, which stimulates the immune system to produce protective antibodies without causing infection, providing long-lasting immunity against this serious liver disease. Key considerations for vaccination include:

• The vaccine series does not need to be restarted if the schedule is interrupted, with the second dose administered as soon as possible and the second and third doses separated by at least 8 weeks 1.
• Inadequate doses or doses received after a shorter-than-recommended interval should be readministered using the correct dosage or schedule.
• Vaccine doses administered ≤4 days before the minimum interval or age are considered valid, unless part of the unique accelerated schedule for Twinrix. Overall, following the recommended hepatitis B vaccine schedule and dosing guidelines is crucial for preventing HBV infection and ensuring long-term protection against this serious liver disease, as emphasized in the most recent recommendations 1.

From the FDA Drug Label

The usual immunization regimen (see Table 1) consists of 3 doses of vaccine given according to the following schedule: first dose: at elected date; second dose: 1 month later; third dose: 6 months after first dose. Table 1. Recommended Dosage and Administration Schedules Group Dose Schedules Infants born of: HBsAg-negative mothers 10 mcg/0.5 mL 0,1,6 months HBsAg-positive mothers 10 mcg/0.5 mL 0,1,6 months Children: Birth through 10 years of age 10 mcg/0.5 mL 0,1,6 months Adolescents: 11 through 19 years of age 10 mcg/0.5 mL 0,1,6 months Adults (>19 years) 20 mcg/1.0 mL 0,1,6 months Adult hemodialysis 40 mcg/2.0 mL 0,1,2,6 months

The recommended schedule and dosage for the hepatitis B vaccine (HBV) are as follows:

• Infants born to HBsAg-negative mothers: 10 mcg/0.5 mL at 0,1, and 6 months
• Infants born to HBsAg-positive mothers: 10 mcg/0.5 mL at 0,1, and 6 months
• Children (birth through 10 years): 10 mcg/0.5 mL at 0,1, and 6 months
• Adolescents (11 through 19 years): 10 mcg/0.5 mL at 0,1, and 6 months
• Adults (>19 years): 20 mcg/1.0 mL at 0,1, and 6 months
• Adult hemodialysis patients: 40 mcg/2.0 mL at 0,1,2, and 6 months 2

From the Research

Hepatitis B Vaccine Schedule and Dosage

The recommended schedule and dosage for the hepatitis B vaccine (HBV) can vary depending on the individual's risk factors and age.

• For infants of carrier mothers, a three-dose regimen of plasma-derived vaccine administered at a conventional (0,1,6 months), delayed (2,3,8 months), or accelerated (0,1,2 months) schedule is effective in preventing chronic infection, with a protective efficacy of 88.9% from hepatitis B surface antigen (HBsAg) carriage 3.
• A program of immunization against hepatitis B, consisting of one dose of hepatitis B immune globulin within 12 hours of birth and three doses of hepatitis B vaccine at 0,1, and 6 months of age, has been shown to be effective in preventing hepatitis B infection in infants of carrier mothers, with an overall antibody against hepatitis B surface antigen seropositivity rate of 87.9% 4.
• The vaccine is typically administered intramuscularly in three doses, with 95% of individuals showing long-lasting serologic immunity 5.
• For individuals who do not respond to the standard dose, an additional fourth dose or a repeated higher dose three-course regimen may be given 5.
• An accelerated vaccination schedule, such as a 0-, 7-, and 21-day schedule, may be used for travelers to areas with high endemicity for hepatitis B, although more data are needed to assess the efficacy of accelerated schedules in persons aged >40 years 6.

Special Considerations

• For hemodialysis staff members who are accidentally exposed to needlestick contaminated with blood containing hepatitis B surface antigen, combined hepatitis B immune globulin and vaccine for postexposure prophylaxis is effective in preventing hepatitis B virus infection, with a protective efficacy significantly higher than hepatitis B immune globulin alone 7.
• Individuals with chronic disease states, such as kidney disease, liver disease, diabetes mellitus, as well as those with a genetic predisposition, and those on immunomodulation therapy, may have a higher likelihood of non-response to the vaccine and may require alternative strategies to elicit an immune response 5.