What is the recommended schedule for the Hepatitis B (HBV) vaccine?

Hepatitis B Vaccine Schedule Recommendations

The standard recommended schedule for Hepatitis B vaccine administration is 0,1, and 6 months for children, adolescents, and adults. 1

Standard Vaccination Schedules by Age Group

Adults (≥20 years)

• The recommended schedule for adults is 3 doses at 0,1, and 6 months 1, 2
• Alternative adult schedules include:
  • 4-dose schedule: 0,1,2, and 12 months 1
  • Accelerated schedule (Twinrix): 0,7 days, 21-30 days, and 12 months 1
• For hemodialysis patients: 4-dose schedule of Engerix-B (40 μg) at 0,1,2, and 6 months 1, 3

Adolescents (11-19 years)

• Standard schedule: 3 doses at 0,1, and 6 months 1
• Alternative adolescent schedules include:
  • 2-dose schedule: 0 and 4-6 months (using adult formulation of Recombivax HB for ages 11-15 years) 1
  • 4-dose schedule: 0,1,2, and 12 months 1
• Accelerated schedule (Twinrix for ≥18 years): 0,7 days, 21-30 days, and 12 months 1

Children (1-10 years)

• Standard schedule: 3 doses at 0,1, and 6 months 1
• Alternative schedule: 4 doses at 0,1,2, and 12 months 1

Important Schedule Considerations

Minimum Intervals

• Minimum interval between first and second doses: 4 weeks 1
• Minimum interval between second and third doses: 8 weeks 1
• Minimum interval between first and third doses: 16 weeks 1
• Vaccine doses administered ≤4 days before the minimum interval are considered valid 1

Interrupted Schedules

• If the vaccination schedule is interrupted, the series does not need to be restarted 1, 2
• For interrupted series after the first dose, administer the second dose as soon as possible, with second and third doses separated by at least 8 weeks 1
• If only the third dose is delayed, administer it as soon as possible 1

Special Populations

Hemodialysis Patients

• For adult hemodialysis patients:
  • Recombivax HB: 40 μg at 0,1, and 6 months 1, 3
  • Engerix-B: 40 μg at 0,1,2, and 6 months 1, 3
• Annual anti-HBs testing is recommended with booster doses when levels fall below 10 mIU/mL 4, 3

Immunocompromised Patients

• Higher doses and more frequent monitoring are recommended 4, 3
• Post-vaccination serologic testing is recommended 1-2 months after completing the series 4, 3

Scientific Rationale for the 0,1,6 Month Schedule

• The standard 0,1,6 month schedule produces high antibody levels due to the longer interval between the second and third doses 5, 6
• Longer intervals between the last two doses (at least 4 months apart) result in higher final antibody levels 1, 5
• Alternative schedules with shorter intervals (0,1,2 months) produce adequate initial protection but may require an additional dose at 12 months for long-term immunity 5, 6

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 standard adult doses (20 μg) in hemodialysis patients instead of the recommended higher doses (40 μg) 3
• Do not assume that all accelerated schedules provide long-term protection without a completing dose (typically at 12 months) 5, 6
• Do not administer doses at shorter-than-recommended intervals, as this may result in suboptimal immune response 1