What are the recommended vaccines for hepatitis?

Recommended Vaccines for Hepatitis

All children in the United States should receive hepatitis A vaccine as a 2-dose regimen starting at 1 year of age, and all individuals should receive the hepatitis B vaccine series, with specific formulations and schedules based on age and risk factors. 1, 2

Hepatitis A Vaccination

Recommended Vaccines and Schedule

• Pediatric formulations (12 months to 18 years):

  • Havrix: 0.5 mL (720 ELU), 2 doses at 0 and 6-12 months
  • Vaqta: 0.5 mL (25 U), 2 doses at 0 and 6-18 months 1

• Adult formulations (≥19 years):

  • Havrix: 1.0 mL (1440 ELU), 2 doses at 0 and 6-12 months
  • Vaqta: 1.0 mL (50 U), 2 doses at 0 and 6-12 months 1, 3

High-Risk Groups Requiring Hepatitis A Vaccination

• Children traveling to or living in areas with intermediate/high hepatitis A endemicity
• Men who have sex with men (adolescents and adults)
• Users of injectable or non-injectable illicit drugs
• Recipients of clotting factors
• Laboratory workers handling hepatitis A virus
• Persons with chronic liver disease 1

Hepatitis B Vaccination

Recommended Vaccines and Schedule

• Standard 3-dose schedule: 0,1, and 6 months
• Available vaccines:
  • Recombivax HB
  • Engerix-B
  • PreHevbrio (for adults ≥18 years) 2

Special Considerations

• Hemodialysis patients: Require higher doses

  • Recombivax HB: 40 μg (1.0 mL)
  • Engerix-B: 40 μg (2.0 mL) in a 4-dose schedule 2

• Pregnancy: Engerix-B and Recombivax HB are preferred due to more extensive safety data 2

• Alternative options:

  • Heplisav-B: 2-dose regimen over 1 month (adults only), which may improve compliance 4

Combined Hepatitis A and B Vaccination

Twinrix (Combined Hepatitis A and B Vaccine)

• Adult formulation (≥18 years):

  • Standard schedule: 3 doses at 0,1, and 6 months
  • Accelerated schedule: 4 doses at 0,7,21-30 days, and 12 months 2, 5, 6

• Pediatric formulation:

  • 3-dose schedule: 0,1, and 6 months
  • Alternative 2-dose schedule: 0 and 6-12 months 6

Benefits of Combined Vaccination

• Provides dual protection with fewer injections
• Comparable immunogenicity to individual vaccines
• Potentially better compliance
• Cost-effective for certain populations 5, 6, 7

Important Administration Considerations

Hepatitis A Vaccines

• Administered intramuscularly
• No need to restart interrupted series; just complete remaining doses
• Serologic testing after vaccination not recommended due to high seroconversion rates and insensitivity of standard assays 1

Hepatitis B Vaccines

• Administer in deltoid muscle (not buttock) for optimal immunogenicity
• If schedule is interrupted, no need to restart series
  • Minimum interval: ≥8 weeks between second and third doses
  • Final dose: ≥16 weeks after first dose 2

Vaccine Efficacy and Safety

Hepatitis A

• Efficacy: 94-100% in clinical trials
• Effectiveness: 97-98% in post-licensure studies
• Extremely safe with mild, transient side effects (pain at injection site, redness, swelling) 1

Hepatitis B

• Produces protective antibody response in >90% of healthy adults <40 years and >95% of children
• Protection persists for >30 years
• Response decreases with age (approximately 75% by age 60) 2

Combined Vaccine

• Nearly 100% seroprotection for hepatitis A and >95% for hepatitis B after complete series
• Protection remains high (>95% for hepatitis B) at 48-month follow-up 5

Common Pitfalls to Avoid

• Administering hepatitis B vaccine in the buttock rather than deltoid muscle
• Restarting vaccine series when only completion is needed
• Neglecting to vaccinate high-risk individuals
• Failing to complete the full vaccine series
• Overlooking the need for higher doses in hemodialysis patients 1, 2