What is the recommended hepatitis B (HB) vaccine dose for a 35-year-old individual?

Hepatitis B Vaccine Dosing for a 35-Year-Old Adult

For a 35-year-old adult, the recommended hepatitis B vaccine dose is 20 μg (1.0 mL) of Engerix-B or Recombivax HB administered in a 3-dose schedule at 0,1, and 6 months, or alternatively, 20 μg (0.5 mL) of Heplisav-B in a 2-dose schedule at 0 and 1 month. 1

Standard Adult Dosing Options

• For adults aged 19-59 years (including a 35-year-old), universal hepatitis B vaccination is recommended by the Advisory Committee on Immunization Practices 1
• The following vaccine options are available for a 35-year-old:
  • Recombivax HB: 10 μg (1.0 mL) per dose in a 3-dose schedule at 0,1, and 6 months 1
  • Engerix-B: 20 μg (1.0 mL) per dose in a 3-dose schedule at 0,1, and 6 months 1
  • Heplisav-B: 20 μg (0.5 mL) per dose in a 2-dose schedule at 0 and 1 month 1
  • PreHevbrio: 10 μg (1.0 mL) per dose in a 3-dose schedule at 0,1, and 6 months 1
  • Twinrix (combination hepatitis A and B): 20 μg hepatitis B component (1.0 mL) in a 3-dose schedule at 0,1, and 6 months 1

Vaccine Schedule Considerations

• If the hepatitis B vaccination schedule is interrupted, the series does not need to be restarted 1
• If a 3-dose series is interrupted after the first dose, the second dose should be administered as soon as possible, with the second and third doses separated by at least 8 weeks 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
• Alternative vaccination schedules (e.g., 0,1, and 4 months or 0,2, and 4 months) have been demonstrated to elicit similar seroprotection rates 1

Efficacy Considerations

• Heplisav-B has demonstrated higher seroprotection rates (approximately 90%) compared to Engerix-B (70.5%-90.2%) in clinical trials 1, 2
• The 2-dose Heplisav-B schedule may offer better compliance compared to 3-dose schedules 1
• Age is a factor affecting immune response to hepatitis B vaccination, with adults over 40 years having lower seroconversion rates than younger adults 2, 3
• For a 35-year-old, standard dosing should provide adequate protection, as diminished immune response is more common in adults over 40 years 3

Special Considerations

• If the individual has specific risk factors such as immunocompromise or is on hemodialysis, higher doses may be required 1
• For pregnant women, Engerix-B, Recombivax HB, or Twinrix are recommended as data on Heplisav-B and PreHevbrio are currently insufficient to inform vaccine-associated risks in pregnancy 1
• Testing for hepatitis B serologic markers before vaccination is not required but may be considered in certain populations 1

Common Pitfalls to Avoid

• Do not administer the pediatric formulation (10 μg/0.5 mL of Engerix-B) to adults, as this is insufficient for optimal immune response in adults 1, 3
• Do not restart the series if doses are delayed; simply continue where left off 2
• Vaccine doses administered ≤4 days before the minimum interval are considered valid 1
• Do not administer the vaccine in the gluteal region, as this may result in lower antibody response; use the deltoid muscle for intramuscular injection 1