Should a 9-year-old receive the hepatitis B (Hep B) vaccine series if they have no history of receiving the hepatitis B (Hep B) vaccine?

Hepatitis B Vaccination for a 9-Year-Old Without Prior Vaccination

Yes, a 9-year-old child without any history of hepatitis B vaccination should receive the complete hepatitis B vaccine series as soon as possible. 1

Rationale for Vaccination

The Advisory Committee on Immunization Practices (ACIP) strongly recommends that all children and adolescents who have not previously been vaccinated against hepatitis B should begin the series during any visit, regardless of age. This is particularly important because:

• Hepatitis B infection acquired in childhood has a high risk (up to 90%) of progressing to chronic infection
• Children with chronic hepatitis B are at increased risk for cirrhosis and hepatocellular carcinoma later in life
• The vaccine is highly effective at preventing infection when the complete series is administered

Vaccination Schedule for a 9-Year-Old

For a 9-year-old child who has never received hepatitis B vaccine, the following schedule should be implemented:

• 3-dose series at 0,1-2, and 6 months 1, 2
• The vaccine should be administered in the deltoid muscle (not in the buttock, which significantly reduces immunogenicity) 2

Vaccine Efficacy and Protection

• The hepatitis B vaccine is highly immunogenic in children, with approximately 95-100% achieving protective antibody levels (≥10 mIU/mL) after completing the 3-dose series 3
• Protection from the vaccine is long-lasting - children who complete the 3-dose series maintain protection against clinical disease and chronic hepatitis B infection for at least 20 years, even if antibody levels decline over time 2

Important Considerations

• No need to restart the series: If a dose is missed or delayed, the vaccination series does not need to be restarted - simply continue where left off 2
• Co-administration: Hepatitis B vaccine can be safely administered with other age-appropriate vaccines during the same visit 2
• No routine post-vaccination testing: For healthy children, post-vaccination serologic testing is not routinely recommended 2

Potential Concerns

Some parents may have concerns about the safety of the hepatitis B vaccine. It's important to note that:

• The hepatitis B vaccine has an excellent safety record with millions of doses administered worldwide 3
• Most children experience no adverse reactions or only minor local reactions (soreness at injection site) that resolve quickly 3
• The benefits of vaccination far outweigh any potential risks, especially considering the serious long-term consequences of hepatitis B infection acquired in childhood 4

Catch-Up Vaccination Importance

Catch-up vaccination for previously unvaccinated children is crucial for preventing hepatitis B infection and its potential long-term consequences. The CDC and ACIP have specifically created catch-up immunization schedules for children who start late or who are more than one month behind in their vaccinations 1.

By ensuring this 9-year-old receives the complete hepatitis B vaccine series, you are providing protection against a serious infection that could otherwise lead to significant morbidity and mortality later in life.