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

Hepatitis B Vaccination Schedule and Dosage

The recommended standard hepatitis B vaccination schedule for most adults is 3 doses administered at 0,1, and 6 months, while certain newer vaccines like Heplisav-B require only 2 doses administered at 0 and 1 month. 1

Standard Vaccination Schedules by Age Group and Vaccine Type

For Infants and Children

• Universal vaccination recommended for all infants
• First dose: At birth or before hospital discharge (no later than 2 months of age)
• Preferred schedule: 0,1, and 6 months 1
• Alternative schedule: 0,2, and 4 months (aligns with other childhood vaccines) 1
• Special attention needed for high-risk populations (Alaskan Natives, Pacific Islanders, infants of immigrants from endemic countries) 1

For Adolescents

• Preferred schedule: 0,1, and 6 months 1
• Alternative schedule: 0,2, and 4 months (if completion feasibility is a concern) 1
• Recombivax HB for ages 11-15: 2-dose schedule (0 and 4-6 months) with adult formulation (10 μg/0.5 mL) 1

For Adults (19-59 years)

• Universal vaccination now recommended for all adults aged 19-59 years 1
• Vaccine options and schedules:
  • Engerix-B: 3 doses (20 μg/1 mL) at 0,1, and 6 months 1
  • Recombivax HB: 3 doses (10 μg/1 mL) at 0,1, and 6 months 1
  • Heplisav-B: 2 doses (20 μg/0.5 mL) at 0 and 1 month (for ages ≥18 years) 1

Special Populations and Considerations

Hemodialysis Patients and Immunocompromised Adults

• Engerix-B: 4 doses (40 μg/2 mL) at 0,1,2, and 6 months 1
• Recombivax HB: 3 doses (40 μg/1 mL) at 0,1, and 6 months 1
• Annual anti-HBs testing recommended for hemodialysis patients 1
• Booster dose needed when anti-HBs levels decline to <10 mIU/mL 1

High-Risk Groups Requiring Vaccination

• Healthcare workers with blood exposure risk 1
• Persons with multiple sex partners 1
• Men who have sex with men 1
• Injection drug users 1
• Household contacts of HBsAg-positive individuals 1
• Persons with chronic liver disease 1
• Persons with HIV infection 1
• Hemodialysis patients 1
• Persons with diabetes 1
• International travelers to endemic regions (HBsAg prevalence ≥2%) 1

Important Clinical Considerations

Interrupted Vaccination Schedules

• If schedule is interrupted, the series does not need to be restarted 1
• For interrupted series after first dose:
  • Give second dose as soon as possible
  • Ensure at least 8 weeks between second and third doses
  • Final dose must be at least 16 weeks after first dose 1
• Minimum interval between first and second doses is 4 weeks 1

Prevaccination Testing

• Consider serologic testing before vaccination for:
  • Persons born in countries with high/intermediate HBV endemicity (≥2%)
  • Household contacts of HBsAg-positive persons
  • HIV-positive persons
  • Injection drug users
  • Men who have sex with men 1
• Testing should not delay vaccination - first dose should be given immediately after blood collection 1

Vaccine Effectiveness and Safety

• Seroprotection (anti-HBs ≥10 mIU/mL) achieved in >95% of vaccinees 2
• No need for routine booster doses in immunocompetent persons 1
• Vaccine is generally well-tolerated with minimal adverse effects 2
• Common factors for non-response: increasing age, male gender, obesity, smoking, immunocompromising conditions 2

Implementation Pitfalls and Solutions

• Despite availability, vaccination rates remain low in high-risk adults 3, 4
• On-site free vaccine availability significantly increases vaccination acceptance (from 14% to 75.6%) 5
• Combined healthcare worker training and free on-site vaccination is most effective (increasing acceptance to 85.8%) 5
• Vaccination should be initiated at the initial visit, even if concerns about series completion exist 1
• Different vaccine brands can be used to complete a series if necessary, though using the same brand is preferred when feasible 1