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

Recommended Hepatitis B Vaccination Schedule

The standard recommended schedule for Hepatitis B vaccination is a 3-dose series administered at 0,1, and 6 months for most individuals, with specific modifications for different age groups and special populations. 1

Standard Vaccination Schedules by Age Group

Infants

• Infants born to HBsAg-negative mothers should receive:

  • First dose: at birth (within 24 hours)
  • Second dose: at 1-2 months of age
  • Third dose: at 6 months of age 1

• Infants born to HBsAg-positive mothers should receive:

  • First dose: within 12 hours of birth (along with HBIG)
  • Second dose: at 1-2 months of age
  • Third dose: at 6 months of age 1

Children and Adolescents

• Children who were not vaccinated as infants should follow:

  • 3-dose schedule: 0,1, and 6 months, OR
  • Alternative 2-dose schedule: adult formulation at 0 and 4-6 months (for specific age groups) 1

• For children 5-10 years and adolescents 11-16 years, an alternative schedule of 0,12, and 24 months may be considered for those at low risk of immediate exposure 2, 3

Adults

• Standard adult schedule (≥18 years):
  • 3 doses at 0,1, and 6 months (20 mcg per dose) 1, 2
  • Alternative schedule: 0,1,2, and 12 months for certain populations at higher risk 2

Special Populations

Chronic Kidney Disease and Hemodialysis Patients

• For pre-dialysis CKD patients:

  • Recombivax HB: 10 μg at 0,1, and 6 months, OR
  • Engerix-B: 20 μg at 0,1, and 6 months 4

• For dialysis-dependent patients:

  • Recombivax HB: 40 μg at 0,1, and 6 months, OR
  • Engerix-B: 40 μg at 0,1,2, and 6 months 4, 2
  • Annual anti-HBs testing with booster doses when levels fall below 10 mIU/mL 1, 4

Immunocompromised Adults

• Higher doses (40 μg) at 0,1, and 6 months
• Annual anti-HBs testing with booster doses when levels fall below 10 mIU/mL 1

Low Birth Weight Infants

• For infants with birth weight <2000g:
  • Delay first dose until 1 month of age or hospital discharge (whichever comes first) if born to HBsAg-negative mothers 5
  • For infants born to HBsAg-positive mothers, administer first dose within 12 hours of birth regardless of weight, but this dose may not count toward the 3-dose series 6, 5

Post-Vaccination Testing

• Post-vaccination serologic testing is recommended 1-2 months after completing the vaccination series for:

  • Infants born to HBsAg-positive mothers
  • Healthcare personnel
  • Hemodialysis patients
  • HIV-infected persons
  • Other immunocompromised individuals 1, 4

• An anti-HBs level ≥10 mIU/mL indicates adequate protection 1, 4

Important Considerations and Pitfalls

• Minimum intervals between doses must be maintained:

  • Between 1st and 2nd doses: 4 weeks
  • Between 2nd and 3rd doses: 8 weeks
  • Between 1st and 3rd doses: 16 weeks 1

• Delaying the birth dose beyond 12 hours for infants born to HBsAg-positive mothers significantly increases infection risk 1, 7

• Using standard adult doses (20 μg) instead of higher doses (40 μg) in dialysis patients results in inadequate immune response 4

• Failure to check post-vaccination antibody titers in high-risk groups may leave patients unprotected 4

• While longer intervals between doses (such as the 0,12,24-month schedule) produce adequate protection, the standard 0,1,6-month schedule generally produces higher final antibody levels 3, 8