Guidelines for Offering Hepatitis B Vaccine
Hepatitis B vaccination is recommended for all unvaccinated adults aged 19-59 years regardless of risk factors, and for adults aged ≥60 years with risk factors for HBV infection. 1
Universal Vaccination Recommendations
Infants and Children
- All infants should receive the hepatitis B vaccine series beginning at birth
- For medically stable infants weighing ≥2,000 grams born to HBsAg-negative mothers, first dose should be administered within 24 hours of birth 1
- Infants weighing <2,000 grams born to HBsAg-negative mothers should have first vaccine dose delayed until hospital discharge or age 1 month 1
- All unvaccinated children and adolescents aged <19 years should receive hepatitis B vaccination 1
Adults
- All adults aged 19-59 years should receive hepatitis B vaccination 1
- Adults aged ≥60 years with risk factors for hepatitis B should receive vaccination 1
- Adults aged ≥60 years without known risk factors may receive hepatitis B vaccination 1
High-Risk Groups Requiring Vaccination
Sexual Exposure Risk
- Sex partners of HBsAg-positive persons
- Sexually active persons not in long-term monogamous relationships (>1 partner in previous 6 months)
- Persons seeking evaluation or treatment for STIs
- Men who have sex with men 1
Percutaneous/Mucosal Exposure Risk
- Current or recent injection drug users
- Household contacts of HBsAg-positive persons
- Residents and staff of facilities for developmentally disabled persons
- Healthcare and public safety personnel with anticipated risk for blood exposure
- Hemodialysis patients and predialysis, peritoneal dialysis, and home dialysis patients
- Persons with diabetes (aged 19-59 years, and ≥60 years at clinician's discretion) 1
Other Risk Groups
- International travelers to regions with HBsAg prevalence ≥2%
- Persons with HCV infection
- Persons with chronic liver disease
- Persons with HIV infection
- Incarcerated persons 1
Vaccination Implementation Strategies
Healthcare Settings
- Hepatitis B vaccine should be routinely offered to all unvaccinated persons attending STD clinics and those seeking evaluation or treatment for STIs in other settings 1
- Implement standing orders to identify and vaccinate adults recommended for HepB vaccination 1
- Offer vaccination in outreach settings serving high-risk populations (needle-exchange programs, HIV testing sites, homeless shelters) 1
Vaccination Schedule Options
- Standard schedule: 0,1, and 6 months
- Accelerated schedule: 0,1, and 2 months (may improve completion rates in high-risk populations) 2
- For specific vaccines and dosing schedules, follow manufacturer recommendations
Special Considerations
Prevaccination Testing
- Consider prevaccination serologic testing for susceptibility just before initial vaccine dose for populations with high prevalence (20%-30%) of HBV infection:
- Injection drug users
- MSM (especially older age groups)
- Persons born in regions with moderate to high HBV endemicity
- Household, sexual, and needle-sharing contacts of HBsAg-positive persons 1
- Serologic testing should not delay vaccination - first dose should be administered immediately after blood collection 1
Postvaccination Testing
- Not routinely recommended for immunocompetent persons
- Recommended for:
- Infants born to HBsAg-positive mothers (test at age 9-12 months)
- Healthcare workers
- Hemodialysis patients
- HIV-infected persons
- Sexual partners of HBsAg-positive persons 1
Postexposure Prophylaxis
- For unvaccinated persons exposed to HBV:
- Hepatitis B immune globulin (HBIG) 0.06 mL/kg IM within 24 hours of exposure when indicated
- Initiate hepatitis B vaccine series 3
- For sexual exposure to an HBsAg-positive person:
- HBIG 0.06 mL/kg IM within 14 days of last sexual contact
- Begin hepatitis B vaccine series 3
Common Pitfalls and Challenges
Low vaccination coverage in high-risk adults: Despite long-standing recommendations, vaccination rates remain low among high-risk adults. Implement standing orders and streamline vaccination processes to improve coverage 4.
Missed opportunities for vaccination: Healthcare providers should proactively offer vaccination rather than waiting for patients to request it, especially for adults ≥60 years without known risk factors 1.
Incomplete vaccination series: Accelerated schedules (0,1, and 2 months) may improve completion rates compared to standard schedules (0,1, and 6 months), particularly in high-risk populations 2.
Failure to identify risk factors: Do not require acknowledgment of specific risk factors for vaccination of adults, as this may create barriers to prevention 1.
Vaccine non-response: Factors associated with poor response include increasing age, male gender, obesity, smoking, and immunocompromising conditions. Consider revaccination for non-responders 5.
By implementing these guidelines, healthcare providers can help reduce the burden of hepatitis B infection, which remains a significant cause of morbidity and mortality worldwide despite being preventable through vaccination.