Recommended Hepatitis B Vaccination Schedule
The recommended schedule for Hepatitis B (HBV) vaccination varies by age group, with infants receiving doses at birth, 1-2 months, and 6 months of age, while adults typically follow a 0,1, and 6-month schedule. 1
Infant Vaccination Schedule
All infants should receive their first dose of hepatitis B vaccine within 12 hours of birth, before hospital discharge 1
For infants born to HBsAg-negative mothers, the recommended schedule is: 1
- First dose: Birth (before hospital discharge)
- Second dose: 1-2 months of age
- Third dose: 6 months of age
For infants born to HBsAg-positive mothers: 1
- First dose: Within 12 hours of birth (along with HBIG)
- Second dose: 1-2 months of age
- Third dose: 6 months of age
- Post-vaccination serologic testing at 9-12 months of age
For infants born to mothers with unknown HBsAg status: 1
- First dose: Within 12 hours of birth
- If mother tests positive: Add HBIG as soon as possible (within 7 days)
- Complete series according to schedule based on mother's status
- Final dose should not be administered before 24 weeks of age
Children and Adolescent Vaccination Schedule
- Children and adolescents who were not vaccinated as infants should follow this schedule: 1
Adult Vaccination Schedule
- For adults aged ≥18 years, multiple options are available: 1
- Standard schedule: 3 doses at 0,1, and 6 months
- Recombivax HB or Engerix-B: 20 μg per dose
- Heplisav-B: 2 doses at 0 and 1 month (20 μg per dose)
- PreHevbrio: 3 doses at 0,1, and 6 months (10 μg per dose)
Special Populations
Hemodialysis patients and other immunocompromised adults: 1, 2
- Recombivax HB: 40 μg at 0,1, and 6 months
- Engerix-B: 40 μg at 0,1,2, and 6 months
- Annual anti-HBs testing recommended with booster doses when levels fall below 10 mIU/mL
Chronic kidney disease patients (pre-dialysis): 2
- Recombivax HB: 10 μg at 0,1, and 6 months
- Engerix-B: 20 μg at 0,1, and 6 months
Important Considerations
- The minimum interval between the first and second doses is 4 weeks 1
- The minimum interval between the second and third doses is 8 weeks 1
- The minimum interval between the first and third doses is 16 weeks 1
- The final dose in infants should not be administered before 24 weeks (164 days) of age 1
- Vaccine doses administered ≤4 days before the minimum interval are considered valid 1
Alternative Schedules
- An alternative schedule of 0,1,2, and 12 months may be used for certain populations 3
- For children at low risk of immediate exposure, a schedule of 0,12, and 24 months has been shown to be highly immunogenic 4
- Longer intervals between doses (especially between the second and third doses) result in higher final antibody levels 5
Post-Vaccination Testing
Post-vaccination serologic testing is recommended for: 1
- Infants born to HBsAg-positive mothers
- Healthcare personnel
- Hemodialysis patients
- HIV-infected persons
- Other immunocompromised persons
Testing should be performed 1-2 months after completing the vaccination series 2
An anti-HBs level ≥10 mIU/mL indicates adequate protection 1, 2
Common Pitfalls to Avoid
- Delaying the birth dose beyond 12 hours for infants born to HBsAg-positive mothers significantly increases risk of infection 1
- Using standard adult doses instead of higher doses (40 μg) in dialysis patients results in inadequate immune response 2
- Failing to check post-vaccination antibody titers in high-risk groups may leave patients unprotected 2
- For preterm infants with birth weights <2000g, delaying vaccination until 1 month of age may improve seroprotection rates 6