What is the recommended dose and schedule for the hepatitis B (HBV) vaccine?

Hepatitis B Vaccine Dosing and Schedule Recommendations

The recommended hepatitis B vaccine dosing and schedule varies by vaccine type, age group, and patient characteristics, with most adults requiring either a 3-dose series (0,1, and 6 months) for traditional vaccines or a 2-dose series (0 and 1 month) for Heplisav-B. 1

Adult Vaccination (Age ≥18 years)

Standard Adult Dosing by Vaccine Type

• Recombivax HB: 10 μg (1.0 mL) per dose in a 3-dose schedule at 0,1, and 6 months for adults ≥20 years 1
• Engerix-B: 20 μg (1.0 mL) per dose in a 3-dose schedule at 0,1, and 6 months for adults ≥20 years 1
• Heplisav-B: 20 μg (0.5 mL) per dose in a 2-dose schedule at 0 and 1 month for adults ≥18 years 1
• PreHevbrio: 10 μg (1.0 mL) per dose in a 3-dose schedule at 0,1, and 6 months for adults ≥18 years 1
• Twinrix (combination hepatitis A and B): 20 μg HepB component (1.0 mL total) in either:
  • Standard schedule: 3 doses at 0,1, and 6 months 1
  • Accelerated schedule: 4 doses at 0 days, 7 days, 21-30 days, and 12 months 1

Special Populations

• Hemodialysis patients and immunocompromised adults ≥20 years:

  • Recombivax HB: 40 μg (1.0 mL) per dose in a 3-dose schedule 1
  • Engerix-B: 40 μg (2.0 mL) per dose in a 4-dose schedule at 0,1,2, and 6 months 1, 2
  • Heplisav-B and PreHevbrio: Safety and effectiveness not established in hemodialysis patients 1

• Pregnant women: Should receive Engerix-B, Recombivax HB, or Twinrix as Heplisav-B and PreHevbrio have insufficient data on vaccine-associated risks in pregnancy 1

Adolescent Vaccination (Ages 11-19 years)

• Recombivax HB:

  • Ages 11-15: 10 μg (0.5 mL) in either a 2-dose schedule at 0 and 4-6 months OR a 3-dose schedule at 0,1, and 6 months 1
  • When scheduled to receive second dose, persons ≥16 years should switch to a 3-dose series 1

• Engerix-B: 10 μg (0.5 mL) per dose in a 3-dose schedule at 0,1, and 6 months 1

Alternative Schedules

• If the standard HepB vaccination schedule is interrupted, the series does not need to be restarted 1

• For interrupted 3-dose series:

  • If interrupted after first dose: administer second dose as soon as possible, with second and third doses separated by ≥8 weeks 1
  • If only third dose delayed: administer as soon as possible 1
  • Final dose must be administered ≥8 weeks after second dose and ≥16 weeks after first dose 1
  • Minimum interval between first and second doses is 4 weeks 1

• An alternative schedule of 0,1,2, and 12 months can be used for certain populations (e.g., recent exposure to virus) 2

Administration Considerations

• Administer via intramuscular injection in the deltoid muscle for adults and adolescents 2
• For patients at risk of hemorrhage (e.g., hemophiliacs), subcutaneous administration may be used, though this results in lower antibody titers 2
• Vaccine doses administered ≤4 days before the minimum interval are considered valid 1
• For Twinrix accelerated schedule, the 4-day guideline does not apply to the first 3 doses 1

Efficacy and Immunogenicity

• Standard 3-dose regimens produce seroprotection rates of 96-99% in adults and adolescents 2
• Longer intervals between doses (e.g., 0,12,24 months) have demonstrated high immunogenicity (>98% seroprotection) 3
• Older adults (>40 years) produce lower antibody titers compared to younger adults 2

Common Pitfalls to Avoid

• Do not administer in the gluteal region as this may result in suboptimal response 2
• Do not restart the series if the vaccination schedule is interrupted; simply continue where left off 1
• Do not use Heplisav-B or PreHevbrio in pregnant women, hemodialysis patients, or children 1
• Do not administer inadequate doses or use shorter-than-recommended intervals as these will require readministration 1
• Do not assume serologic testing is required before vaccination; lack of testing should not be a barrier to vaccination 1