What is the recommended Hepatitis B (HBV) vaccination schedule?

Hepatitis B Vaccination Schedule Recommendations

The recommended Hepatitis B vaccination schedule follows a standard 3-dose regimen at 0,1, and 6 months for most individuals, with specific modifications for certain populations based on risk factors and age. 1

Standard Vaccination Schedules

Infants and Children

• For infants born to HBsAg-negative mothers:

  • First dose: At birth (preferably before hospital discharge) or by 2 months of age
  • Second dose: 1-2 months after first dose
  • Third dose: 6 months of age 2, 1

• For infants born to HBsAg-positive mothers:

  • First dose: Within 12 hours of birth (with HBIG)
  • Second dose: 1 month of age
  • Third dose: 6 months of age 2, 3
  • Post-vaccination testing at 9-15 months 1

Adolescents

• Standard schedule: 0,1, and 6 months 2
• Alternative for ages 11-15 years: 2-dose adult formulation of Recombivax HB (10 μg) at 0 and 4-6 months 1

Adults

• Standard schedule: 0,1, and 6 months 1
• Alternative accelerated schedule: 0,1,2, and 12 months (Twinrix) 1

Special Populations and Considerations

Hemodialysis Patients

• 4-dose schedule at 0,1,2, and 6 months with 40 mcg/2.0 mL dose
• Annual antibody testing recommended
• Booster dose when anti-HBs levels decline below 10 mIU/mL 2, 1

Immunocompromised Persons

• May require modified dosing regimens (doubled standard antigen dose or additional doses)
• Annual anti-HBs testing and booster doses should be considered for ongoing risk 2, 1

Interrupted Schedules and Minimum Intervals

If the vaccination schedule is interrupted, the series does not need to be restarted. Follow these guidelines:

• Minimum interval between first and second doses: 4 weeks
• Minimum interval between second and third doses: 8 weeks
• Minimum interval between first and third doses: 16 weeks
• For infants, final dose not recommended before 24 weeks of age 2, 1

Post-Vaccination Testing

Post-vaccination serologic testing is recommended for:

• Infants born to HBsAg-positive mothers
• Healthcare personnel
• Hemodialysis patients
• HIV-infected persons
• Other immunocompromised individuals
• Sex partners of HBsAg-positive persons 2

Clinical Pearls and Pitfalls

1. Pitfall: Restarting the series unnecessarily

   • If the schedule is interrupted, do not restart the series; simply continue where you left off 2, 1

2. Pitfall: Inadequate dosing intervals

   • Doses given at shorter than minimum intervals should be readministered at the correct interval 2

3. Pitfall: Missing high-risk individuals

   • Only 43.5% of high-risk patients who are screened for HBV actually receive vaccination 4
   • Patients with diabetes mellitus are less likely to be screened and vaccinated despite recommendations 4

4. Pitfall: Incorrect administration site

   • Administer in deltoid muscle for adults and older children
   • Use anterolateral thigh for infants and neonates
   • Avoid buttock injections (lower immunogenicity) 1

5. Important consideration: Duration of protection

   • Protection persists for at least 20 years in children who complete the series
   • Routine booster doses not recommended for immunocompetent individuals 1

The hepatitis B vaccine is highly effective, with seroprotection (anti-HBs ≥10 mIU/mL) achieved in over 95% of vaccinees 5. This high efficacy combined with proper administration according to recommended schedules is crucial for preventing both acute and chronic hepatitis B infection, which can lead to serious long-term consequences including cirrhosis and hepatocellular carcinoma 6, 7.