Heplisav-B Vaccination Schedule: Managing Delayed Doses
If the Heplisav-B vaccination series is interrupted with doses given more than 1 month apart, you do not need to restart the series; simply administer the second dose as soon as possible. 1
Understanding Heplisav-B Dosing Schedule
- Heplisav-B is administered as a 2-dose series with doses given at 0 and 1 month for adults aged ≥18 years 1, 2
- Unlike other hepatitis B vaccines that require 3 doses over 6 months, Heplisav-B's 2-dose schedule over 1 month can improve patient compliance 3
- Heplisav-B features a novel CpG adjuvant that provides higher seroprotection rates (90.0%-100.0%) compared to traditional vaccines like Engerix-B (70.5%-90.2%) 2
Management of Interrupted Vaccination Schedules
- When any hepatitis B vaccine schedule is interrupted, the Advisory Committee on Immunization Practices (ACIP) clearly states that the series does not need to be restarted 1
- For interrupted schedules, the delayed dose should be administered as soon as possible 1
- This guidance applies to all hepatitis B vaccines, including Heplisav-B 1
Evidence-Based Rationale
- The ACIP guidelines explicitly state: "If the HepB vaccination schedule is interrupted, the series does not need to be restarted" 1
- This recommendation is based on the understanding that the immune system maintains memory of previous vaccine doses, even with extended intervals 1
- While the recommended interval between Heplisav-B doses is 1 month, administering the second dose later than scheduled still provides protection 1
Special Considerations
- For immunocompromised patients who may have reduced vaccine response, completing the series as soon as possible is particularly important 1
- Recent studies show that even when Heplisav-B doses are given at extended intervals, the vaccine maintains efficacy 4
- In a study of inflammatory bowel disease patients, Heplisav-B remained effective despite a median intervaccination time of 416 days between doses 4
Common Pitfalls to Avoid
- Do not restart the Heplisav-B series if the interval between doses exceeds 1 month 1
- Do not administer additional doses beyond the recommended 2-dose series unless dealing with specific non-responder populations 5, 6
- Do not confuse Heplisav-B's 2-dose schedule with the 3-dose schedule of other hepatitis B vaccines like Engerix-B or Recombivax HB 1, 7
Monitoring After Vaccination
- For most healthy adults, routine post-vaccination serologic testing is not required after completing the Heplisav-B series 1
- Post-vaccination serologic testing is recommended for certain high-risk groups including healthcare personnel, hemodialysis patients, HIV-infected persons, and other immunocompromised individuals 1
- Testing should be performed 1-2 months after the final dose to confirm seroprotection (anti-HBs ≥10 mIU/mL) 1
By following these evidence-based guidelines, clinicians can ensure optimal protection against hepatitis B virus infection while accommodating real-world scheduling challenges that may result in delayed administration of the second Heplisav-B dose.