What is the hepatitis B (HBV) 3 dose series?

Hepatitis B Vaccine 3-Dose Series

The standard hepatitis B (HBV) 3-dose series for adults consists of doses administered at 0,1, and 6 months, which produces seroprotection rates >95% with long-term immunity. 1, 2

Standard 3-Dose Schedules by Age Group

Adults (≥20 years)

• For adults ≥20 years, the recommended dose for Recombivax HB is 10 μg (1.0 mL) per dose in a 3-dose schedule at 0,1, and 6 months 2
• For adults ≥20 years, the recommended dose for Engerix-B is 20 μg (1.0 mL) per dose in a 3-dose schedule at 0,1, and 6 months 2, 3
• Alternative schedule options include 0,1,2, and 12 months or 0,1,2, and 6 months 1

Adolescents (11-19 years)

• For adolescents aged 11-19, the recommended dose for Engerix-B is 10 μg (0.5 mL) per dose in a 3-dose schedule at 0,1, and 6 months 2
• For adolescents aged 11-15, Recombivax HB offers both a 2-dose schedule (10 μg at 0 and 4-6 months) or the standard 3-dose schedule 2
• Alternative schedules include 0,12, and 24 months or 0,1,2, and 12 months 1, 4

Children (1-10 years)

• For children aged 1-10 years, the standard 3-dose schedule is 0,1, and 6 months 1
• An alternative 4-dose schedule of 0,1,2, and 12 months is also approved 1

Immunogenicity of the 3-Dose Series

• The 3-dose series produces seroprotection rates (anti-HBs ≥10 mIU/mL) of >95% in healthy adults and >98% in children and adolescents 3, 4
• After the first dose, approximately 30-55% of recipients achieve protective antibody levels; after the second dose, approximately 75% are protected; and after the third dose, >90% achieve protection 1
• The third dose acts primarily as a booster and provides optimal long-term protection, with vaccine-induced immunity demonstrated to persist for >30 years 1
• Longer intervals between the second and third doses (e.g., 5 months vs. 1 month) result in higher final antibody levels 1, 5

Special Populations

• For hemodialysis patients and immunocompromised adults ≥20 years, higher doses are recommended 2:
  • Recombivax HB: 40 μg (1.0 mL) per dose in a 3-dose schedule
  • Engerix-B: 40 μg (2.0 mL) per dose in a 4-dose schedule at 0,1,2, and 6 months
• These populations typically have lower seroconversion rates and require modified dosing regimens 3

Interrupted Schedules

• If the hepatitis B vaccination schedule is interrupted, the series does not need to be restarted 1, 2
• For interrupted series, the second and third doses should be separated by at least 8 weeks 1
• The final dose should be administered at least 16 weeks after the first dose and at least 8 weeks after the second dose 1

Clinical Considerations

• Vaccine doses administered ≤4 days before the minimum interval are considered valid 1, 2
• Inadequate doses or doses received after shorter-than-recommended intervals should be readministered 1
• Different hepatitis B vaccines can be used interchangeably to complete a series, as they produce comparable antibody responses 3

Common Pitfalls to Avoid

• Do not restart the series if the vaccination schedule is interrupted; simply continue where left off 1, 2
• Do not assume that a longer interval between doses reduces effectiveness; in fact, longer intervals between the second and third doses may result in higher antibody levels 5, 4
• Do not miss the opportunity to vaccinate high-risk individuals, as even partial series completion provides some protection 1