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

Hepatitis B Vaccine Schedule

The standard hepatitis B vaccine schedule consists of three intramuscular doses administered at 0,1, and 6 months for most populations, with all medically stable newborns weighing ≥2,000 g receiving their first dose within 24 hours of birth. 1

Infant Vaccination Schedules

Standard Newborn Protocol

• All medically stable infants weighing ≥2,000 g should receive the first dose of hepatitis B vaccine within 12 hours of birth, before hospital discharge. 2, 3
• For infants born to HBsAg-negative mothers: administer doses at birth, 1-2 months, and 6 months of age. 1, 2
• The final dose must not be administered before 24 weeks (164 days) of age. 1

High-Risk Infants (HBsAg-Positive Mothers)

• Infants born to HBsAg-positive mothers require both hepatitis B vaccine AND hepatitis B immune globulin (HBIG) within 12 hours of birth, administered at separate anatomical sites. 1, 2
• For infants ≥2,000 g: vaccine doses at birth, 1-2 months, and 6 months. 1
• For infants <2,000 g: vaccine doses at birth, 1 month, 2-3 months, and 6 months (4-dose series). 1
• Post-vaccination serologic testing (anti-HBs and HBsAg) is mandatory 1-2 months after completing the series. 1, 2

Unknown Maternal Status

• If maternal HBsAg status is unknown at delivery, administer the first vaccine dose within 12 hours of birth. 1
• Test the mother's blood for HBsAg immediately; if positive, administer HBIG to the infant as soon as possible but no later than 7 days of age. 1

Children and Adolescents

Previously Unvaccinated Children

• Standard 3-dose schedule: 0,1, and 6 months. 2, 4
• Alternative 2-dose schedule available for adolescents aged 11-15 years using adult formulation of Recombivax HB at 0 and 4-6 months. 1, 5

Adult Vaccination

Standard Adult Schedule

• Three doses administered at 0,1, and 6 months. 2, 4, 5
• Alternative 4-dose schedule: 0,1,2, and 12 months (for certain high-risk populations). 4, 5

Accelerated Schedule (Twinrix for Travelers)

• For pre-travel or urgent protection: 0,7, and 21-30 days, followed by a booster at 12 months. 1
• The standard 4-day grace period for early vaccine administration does NOT apply to the first three doses of this accelerated schedule. 1

Special Populations

Hemodialysis Patients

• Require high-dose vaccination: 40 μg Recombivax HB at 0,1, and 6 months OR 40 μg Engerix-B at 0,1,2, and 6 months. 1, 6, 5
• Annual anti-HBs testing is mandatory; administer booster doses when levels decline below 10 mIU/mL. 1, 6
• Standard adult doses (20 μg) are inadequate and result in poor immune response in this population. 6

Healthcare Personnel

• Standard 3-dose schedule at 0,1, and 6 months. 1
• Post-vaccination serologic testing (anti-HBs) is required 1-2 months after completing the series. 1, 2
• If anti-HBs <10 mIU/mL after initial series, administer one additional dose and retest; if still <10 mIU/mL, complete a second full series (6 doses total). 1

Other Immunocompromised Persons

• Consider annual anti-HBs testing and booster doses for those with ongoing exposure risk (HIV-infected persons, transplant recipients, chemotherapy patients). 1
• Post-vaccination testing 1-2 months after series completion is recommended. 2, 4

Critical Timing Intervals

Minimum Dosing Intervals

• First to second dose: minimum 4 weeks. 1, 4
• Second to third dose: minimum 8 weeks. 1, 4
• First to third dose: minimum 16 weeks. 1, 4
• Doses administered ≤4 days before the minimum interval are considered valid. 1, 4

Interrupted Schedules

• If the vaccination series is interrupted, do NOT restart the series—simply continue where you left off. 1, 4
• If interrupted after the first dose, give the second dose as soon as possible, ensuring at least 8 weeks between doses 2 and 3. 1
• If only the third dose is delayed, administer it as soon as possible. 1

Post-Vaccination Testing

Who Requires Testing

• Infants born to HBsAg-positive or unknown status mothers. 1, 2
• Healthcare personnel and public safety workers. 1, 2
• Hemodialysis patients. 1, 2
• HIV-infected persons and other immunocompromised individuals. 2, 4

Testing Protocol

• Perform anti-HBs testing 1-2 months after completing the vaccination series. 1, 2
• Anti-HBs ≥10 mIU/mL indicates adequate protection. 2, 6
• An anti-HBs ≥10 mIU/mL is a serologic correlate of protection only when following a documented, complete series. 1

Common Pitfalls to Avoid

• Never delay the birth dose beyond 12 hours for infants born to HBsAg-positive mothers—this significantly increases infection risk. 2, 7
• Do not restart an interrupted vaccine series; this wastes doses and delays protection. 1, 4
• Do not use standard adult doses in hemodialysis patients—they require double doses (40 μg). 6, 5
• Do not administer the final infant dose before 24 weeks of age, as this may result in suboptimal long-term immunity. 1
• Do not accept undated vaccination records as evidence of immunity. 1
• Avoid administering hepatitis B vaccine in the gluteal region, as this results in suboptimal immune response. 5