Fast-Track Vaccination Schedules for Hepatitis A and B
For rapid protection against both hepatitis A and B, the recommended fast-track schedule is the accelerated 4-dose Twinrix regimen administered on days 0,7,21-30, followed by a booster dose at 12 months. 1, 2
Hepatitis A and B Combined Vaccination (Twinrix)
Standard vs. Accelerated Schedules:
- Standard schedule: 3 doses at 0,1, and 6 months
- Accelerated schedule: 4 doses at 0,7,21-30 days, with a booster at 12 months 1, 2
The accelerated schedule provides faster seroprotection:
- By day 37, approximately 98.5% of recipients develop protective antibodies against hepatitis A 3
- By day 37, about 63.2% develop protective antibodies against hepatitis B (compared to only 43.5% with monovalent vaccines) 3
- After the 12-month booster, nearly 100% of recipients achieve seroprotection against both viruses 3, 4
Monovalent Vaccine Options
Hepatitis A Vaccine:
- Standard schedule: 2 doses
- Havrix: 0 and 6-12 months
- Vaqta: 0 and 6-18 months 1
Hepatitis B Vaccine:
- Standard schedule: 3 doses at 0,1, and 6 months
- Alternative schedules:
- 0,1, and 4 months
- 0,2, and 4 months 1
- For hemodialysis patients: Higher doses required
- Recombivax HB (40 μg): 0,1, and 6 months
- Engerix-B (40 μg): 0,1,2, and 6 months 1
Clinical Considerations
When to Use Fast-Track Schedules:
- Travelers requiring rapid protection before departure
- Healthcare workers with occupational exposure risk
- Persons with high-risk sexual behaviors
- Injection drug users
- Close contacts of persons with chronic HBV infection
- Persons with chronic liver disease 1, 2, 5
Advantages of Accelerated Schedules:
- Enhanced adherence to vaccination course
- Faster initial protection
- Convenience for recipients
- Reduced administration costs 5
Important Caveats:
- The 12-month booster dose is essential for long-term protection, especially with accelerated schedules 2, 3
- Completion rates for the final booster dose tend to be lower with accelerated schedules 6
- Post-vaccination serologic testing is not routinely recommended for healthy adults but is important for high-risk groups (e.g., healthcare workers, immunocompromised patients) 2
Special Populations
- Immunocompromised patients: May require modified dosing regimens or additional doses 2
- Pregnant women: Hepatitis B vaccination is not contraindicated during pregnancy 2
- Children and adolescents: Different dosing schedules may apply; Twinrix can be used in a 2-dose schedule (adult formulation) for ages 11-15 years 7
The fast-track vaccination schedule using Twinrix provides the most rapid and comprehensive protection against both hepatitis A and B viruses when time is limited, with excellent immunogenicity and a safety profile comparable to that of monovalent vaccines.