Do I need a Hepatitis A (Hep A) and Hepatitis B (Hep B) booster dose?

Hepatitis A and B Booster Recommendations

For healthy adults who completed the primary hepatitis A and B vaccination series and demonstrated adequate antibody response, booster doses are not recommended—immunity is long-lasting due to persistent immune memory. 1

General Population (Immunocompetent Adults)

• No routine boosters needed for individuals who completed the full primary vaccination series (3 doses for hepatitis B, 2 doses for hepatitis A) and had an adequate initial response 2, 1
• Immune memory persists even when antibody levels (anti-HBs) fall below 10 mIU/mL or become undetectable 1, 3
• Long-term protection is mediated by anamnestic immune response (rapid antibody production upon re-exposure), not by circulating antibody levels 4, 3
• Studies demonstrate immune memory lasting at least 15-25 years after primary vaccination 4, 5

Special Populations Requiring Monitoring and Boosters

Hemodialysis Patients

• Annual anti-HBs testing is mandatory 2, 1
• Administer booster when anti-HBs falls below 10 mIU/mL 2, 1
• Post-booster antibody testing is not recommended for this group 2

Healthcare Personnel (HCP)

• If anti-HBs <10 mIU/mL after primary series: give one additional vaccine dose 2, 1
• Test anti-HBs 1-2 months after the additional dose 2
• If still <10 mIU/mL: complete a second full series (total 6 doses), then retest 2
• This ensures documented vaccine response status for future occupational exposures 2

Other Immunocompromised Persons

• Consider annual anti-HBs testing and boosters for those with ongoing HBV exposure risk 2, 1
• This includes: HIV-infected persons, hematopoietic stem-cell transplant recipients, and persons receiving chemotherapy 2
• Booster when anti-HBs <10 mIU/mL 3

Hepatitis A Specific Guidance

• No boosters needed for immunocompetent individuals who completed the 2-dose primary series 2, 5
• Mathematical models predict antibody persistence for at least 25 years 4
• Immune memory is established and provides long-term protection 4, 5

Key Clinical Pitfalls to Avoid

• Do not routinely test anti-HBs levels in healthy vaccinated adults—this leads to unnecessary boosters 1
• Do not give boosters based solely on low/undetectable antibody levels in immunocompetent persons—immune memory provides protection 1, 3
• Do not skip post-vaccination serologic testing in high-risk groups (HCP, hemodialysis patients, immunocompromised) 1-2 months after completing primary series—this confirms initial response 2
• Do not assume non-responders are protected—these individuals need revaccination with a second complete series and documented response 2

Documentation Requirements

• Accept only dated, written records of each vaccine dose as evidence of vaccination 2
• For persons without records: start age-appropriate vaccination schedule rather than delay 2
• Anti-HBs ≥10 mIU/mL on testing can serve as evidence of immunity if vaccination records are unavailable 2