What is the recommended Hepatitis B (HBV) vaccine schedule for adults?

Hepatitis B Vaccination Schedule for Adults

All adults aged 19-59 years should receive hepatitis B vaccination regardless of risk factors, and adults aged ≥60 years with risk factors should also be vaccinated, while those ≥60 years without risk factors may receive the vaccine. 1

Recommended Vaccine Products and Schedules

Standard Adult Vaccination Schedules by Product:

• Recombivax HB: 3 doses (10 μg, 1.0 mL each) at 0,1, and 6 months 2
• Engerix-B: 3 doses (20 μg, 1.0 mL each) at 0,1, and 6 months 2
• Heplisav-B: 2 doses (20 μg, 0.5 mL each) at 0 and 1 month 1, 3
• PreHevbrio: 3 doses (10 μg, 1.0 mL each) at 0,1, and 6 months 1, 3
• Twinrix (combination HepA-HepB): 3 doses at 0,1, and 6 months (standard) or 4 doses at 0,7,21-30 days, and 12 months (accelerated) 1

Special Populations:

• Adults on hemodialysis: Higher doses required - 40 μg (2 × 20 μg) of Engerix-B at 0,1,2, and 6 months 2
• Immunocompromised patients: May require stricter adherence to schedules and additional monitoring 3

Administration Guidelines

• Injection site: Deltoid muscle in adults (not gluteal region, which results in suboptimal response) 2
• Needle size: 1-inch, 23-gauge needle is appropriate for adults 2
• Alternative route: Subcutaneous administration only for persons at risk of hemorrhage (e.g., hemophiliacs), though this results in lower antibody titers 2

Interrupted Schedules

If the vaccination schedule is interrupted, the series does not need to be restarted:

• If interrupted after first dose: Give second dose as soon as possible
• Second and third doses should be separated by ≥8 weeks
• Final dose must be administered ≥8 weeks after second dose and ≥16 weeks after first dose 1, 3

Post-Vaccination Testing

• Not routinely recommended for most adults 3
• Recommended for specific groups:
  • Healthcare workers
  • Hemodialysis patients
  • Immunocompromised individuals
  • Sexual partners of HBsAg-positive persons 1, 3
• Testing should be performed 1-2 months after final dose
• Protective antibody level: anti-HBs ≥10 mIU/mL 3

Booster Doses

• Not routinely recommended for immunocompetent individuals who have completed the primary series 3
• For hemodialysis patients: Annual antibody testing recommended with 40 μg booster doses when antibody levels decline below 10 mIU/mL 2

Factors Affecting Vaccine Response

• Age >40 years
• Smoking
• Obesity
• Immunosuppression
• Diabetes mellitus 3, 4

Clinical Pitfalls to Avoid

• Gluteal injection: Avoid administering in the gluteal region as this results in suboptimal immune response 2
• Inadequate dosing: Ensure correct dose based on age and condition (standard vs. hemodialysis) 1, 2
• Improper storage: Vaccine should be stored according to manufacturer specifications
• Incomplete series: While even incomplete vaccination provides some protection, completing the full series is crucial for optimal long-term protection 3, 5
• Failure to identify high-risk patients: Studies show that many high-risk adults are not adequately screened or vaccinated for hepatitis B 4

The 2022 ACIP recommendation for universal adult HepB vaccination through age 59 years removes the need for risk factor screening and disclosure, which should increase vaccination coverage and decrease hepatitis B cases 1, 6.