Hepatitis B Vaccine Options for a 35-Year-Old Adult
For a 35-year-old adult, the recommended hepatitis B vaccines include Engerix-B, Recombivax HB, Heplisav-B, or PreHevbrio, with Heplisav-B being particularly advantageous due to its 2-dose schedule and higher seroprotection rates. 1, 2
Available Vaccine Options
- Engerix-B: 20 μg (1.0 mL) per dose in a 3-dose schedule at 0,1, and 6 months 2
- Recombivax HB: 10 μg (1.0 mL) per dose in a 3-dose schedule at 0,1, and 6 months 2
- Heplisav-B: 20 μg (0.5 mL) per dose in a 2-dose schedule at 0 and 1 month 2
- PreHevbrio: 10 μg (1.0 mL) per dose in a 3-dose schedule at 0,1, and 6 months 2
- Twinrix (combination hepatitis A and B vaccine): 20 μg (1.0 mL) per dose in a 3-dose schedule at 0,1, and 6 months for adults ≥18 years 1, 2
Advantages of Different Vaccine Options
Heplisav-B
- Requires only 2 doses (0 and 1 month) compared to 3 doses for other vaccines 1, 2
- Demonstrates higher seroprotection rates (approximately 90%) compared to Engerix-B (70.5%-90.2%) in clinical trials 1, 3
- Particularly beneficial for individuals who may have difficulty completing a 3-dose series 1
Traditional 3-Dose Vaccines
- Engerix-B and Recombivax HB have extensive safety data spanning over 30 years 4
- Can be administered on flexible schedules (0,1, and 6 months; 0,1, and 4 months; or 0,2, and 4 months) 1
- Approved for use in all populations including pregnant women 1, 2
PreHevbrio
- Newer three-antigen HepB vaccine approved by FDA in 2021 1
- May provide broader protection due to its three-antigen formulation 1
Special Considerations
- If the vaccination schedule is interrupted, the series does not need to be restarted; simply continue where left off 2
- For interrupted 3-dose series, the second and third doses should be separated by ≥8 weeks 1
- The final dose of a 3-dose series must be administered ≥8 weeks after the second dose and ≥16 weeks after the first dose 1
- Vaccine doses administered ≤4 days before the minimum interval are considered valid 1, 2
Vaccine Selection Based on Special Circumstances
- For pregnant women: Use Engerix-B, Recombivax HB, or Twinrix as Heplisav-B and PreHevbrio have insufficient data on vaccine-associated risks in pregnancy 1, 2
- For hemodialysis patients: Higher doses are recommended - Recombivax HB 40 μg (1.0 mL) or Engerix-B 40 μg (2.0 mL) 1, 2
- For immunocompromised individuals: Consider higher doses as recommended for hemodialysis patients 2
Monitoring Response
- Testing for anti-HBs levels 1-2 months after completing the vaccination series can confirm seroprotection (defined as anti-HBs levels ≥10 mIU/mL) 3
- For non-responders, a high-dose revaccination series or switching to Heplisav-B may be considered 3