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

Hepatitis B (HBV) Vaccination Dosage Recommendations

The recommended dosage for Hepatitis B vaccination varies by vaccine type, age, and special population considerations, with adults aged 19-59 years universally recommended to receive HBV vaccination regardless of risk factors. 1

Adult Vaccination Schedules (Age ≥18 years)

• For adults ≥20 years, Recombivax HB is administered as 10 μg (1.0 mL) per dose in a 3-dose schedule at 0,1, and 6 months 2
• For adults ≥20 years, Engerix-B is administered as 20 μg (1.0 mL) per dose in a 3-dose schedule at 0,1, and 6 months 2
• For adults ≥18 years, Heplisav-B is administered as 20 μg (0.5 mL) per dose in a 2-dose schedule at 0 and 1 month 2
• For adults ≥18 years, PreHevbrio is administered as 10 μg (1.0 mL) per dose in a 3-dose schedule at 0,1, and 6 months 1, 2
• Twinrix (HepA-HepB combination vaccine) for adults ≥18 years is administered as 20 μg (1.0 mL) per dose 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

• For hemodialysis patients and immunocompromised adults ≥20 years:
  • Recombivax HB: 40 μg (1.0 mL) per dose in a 3-dose schedule 1, 2
  • 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 have not been established as safe or effective in hemodialysis patients 1

Pregnant Women

• Pregnant women should receive Engerix-B, Recombivax HB, or Twinrix as there is insufficient data on vaccine-associated risks in pregnancy with Heplisav-B and PreHevbrio 1, 2

Adolescent Vaccination (Ages 11-19 years)

• For adolescents aged 11-15 years, Recombivax HB can be administered as:
  • 10 μg (1.0 mL) in a 2-dose schedule at 0 and 4-6 months 1, 2, OR
  • 5 μg (0.5 mL) in a 3-dose schedule at 0,1, and 6 months 1
• For adolescents aged 11-19 years, Engerix-B is administered as 10 μg (0.5 mL) per dose in a 3-dose schedule at 0,1, and 6 months 1, 2

Interrupted Schedules and Minimum Intervals

• If the HBV vaccination schedule is interrupted, the series does not need to be restarted 1
• For interrupted 3-dose series after the first dose, administer the second dose as soon as possible 1
• The second and third doses should be separated by at least 8 weeks 1
• If only the third dose is delayed, administer it as soon as possible 1
• The final dose of a 3-dose series must be administered at least 8 weeks after the second dose and at least 16 weeks after the first dose 1
• The minimum interval between the first and second doses is 4 weeks 1
• 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

Long-term Protection

• Vaccine-induced immune memory has been demonstrated to persist for >30 years 1
• A study of individuals vaccinated 35 years prior showed approximately 86% still had evidence of protection, suggesting booster doses are not needed for the general population 3
• Higher geometric mean antibody titers are associated with longer persistence of measurable anti-HBs 1

Common Pitfalls to Avoid

• Do not restart the series if the vaccination schedule is interrupted; simply continue where left off 1, 2
• Do not use Heplisav-B or PreHevbrio in pregnant women, hemodialysis patients, or children 1, 2
• Do not assume serologic testing is required before vaccination; lack of testing should not be a barrier to vaccination 1
• For adolescents who start with the 2-dose Recombivax HB schedule but turn 16 years before the second dose, switch to a 3-dose series with doses 2 and 3 consisting of the pediatric formulation 1