What is the recommended Hepatitis B (HBV) vaccination schedule?

From the Guidelines

The standard Hepatitis B vaccination schedule consists of three doses given over a 6-month period, with the first dose administered at birth or as soon as possible, the second dose given 1 month after the first, and the third dose administered 6 months after the first dose (or 5 months after the second dose) 1. For adults, the most commonly used vaccines are Engerix-B (20 mcg per dose) or Recombivax HB (10 mcg per dose) 1. For infants and children, the vaccination typically begins at birth with appropriate pediatric dosing, with a birth dose of monovalent HepB, followed by completion of the series with either monovalent HepB or a combination vaccine containing HepB 1. An accelerated schedule may be used in certain situations, with doses at 0,1, and 2 months, plus a booster at 12 months 1. This vaccination is highly effective, with over 90% of healthy individuals developing protective antibodies after completing the series 1. The vaccine works by introducing a small amount of HBV surface antigen protein, which stimulates the immune system to produce antibodies against the virus without causing infection 1. These antibodies provide long-lasting protection against future HBV infection, with most people maintaining immunity for at least 20 years, often for life 1. 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 1
• 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 1
• Vaccine doses administered ≤4 days before the minimum interval or age are considered valid 1
• The final dose of a 3-dose series must be administered ≥8 weeks after the second dose and ≥16 weeks after the first dose; the minimum interval between the first and second doses is 4 weeks 1

From the FDA Drug Label

The usual immunization regimen 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

Table 2. Alternate Dosage and Administration Schedules Group Dose Schedules Infants born of: HBsAg-positive mothers 10 mcg/0.5 mL 0,1,2,12 months Children: Birth through 10 years of age 10 mcg/0.5 mL 0,1,2,12 months 5 through 10 years of age 10 mcg/0.5 mL 0,12,24 months Adolescents: 11 through 16 years of age 10 mcg/0.5 mL 0,12,24 months 11 through 19 years of age 20 mcg/1.0 mL 0,1,6 months 11 through 19 years of age 20 mcg/1.0 mL 0,1,2,12 months Adults (>19 years) 20 mcg/1.0 mL 0,1,2,12 months

The recommended Hepatitis B vaccination schedule is as follows:

• Infants born to HBsAg-negative mothers: 3 doses at 0,1, and 6 months
• Infants born to HBsAg-positive mothers: 3 doses at 0,1, and 6 months, or 4 doses at 0,1,2, and 12 months
• Children (birth through 10 years of age): 3 doses at 0,1, and 6 months
• Adolescents (11 through 19 years of age): 3 doses at 0,1, and 6 months, or 4 doses at 0,1,2, and 12 months
• Adults (>19 years): 3 doses at 0,1, and 6 months, or 4 doses at 0,1,2, and 12 months These schedules are based on the information provided in the drug label 2.

From the Research

Hepatitis B Vaccination Schedule

The recommended Hepatitis B (HBV) vaccination schedule varies depending on the population and risk factors.

• For children and adolescents, the typical schedule is 0,1 to 2, and 6 months 3.
• For healthy young adults, vaccination at months 0,1, and 12 seems to be preferable to vaccination at months 0,1, and 6 for achieving a high anti-HBs concentration guaranteeing its long-lasting persistence 4.
• For healthy infants, hepatitis B vaccine administered by 0,6 and 14 week versus 6,10 and 14 week schedule are comparable in terms of sero-efficacy 5.
• Accelerated schedules (0,1,2,12 months) or super-accelerated schedules (0,7,21,360 days) have been shown to result in higher proportions of healthy vaccinees reaching anti-HBs antibody levels >or=10 IU/l more rapidly, but a fourth completing dose is required to lift antibody levels to an equal height 6.
• The schedule of hepatitis B vaccination at 0,6 weeks and 9 months has the same seroefficacy as the currently recommended schedule of 0,1 and 6 months 7.

Key Considerations

• The choice of vaccination schedule should balance immunogenicity and compliance, particularly for at-risk groups 6.
• A fourth dose is often required to achieve long-term protection, regardless of the schedule used 4, 6.
• The geometric mean anti-HBs concentration can vary depending on the schedule and population, but high levels are generally achieved with completion of the vaccine series 3, 4, 5, 7.