What are the guidelines for Hepatitis A (HAV) and Hepatitis B (HBV) booster doses for individuals who have completed the initial vaccination series?

Hepatitis A and B Booster Vaccination Guidelines

For immunocompetent individuals who completed the primary hepatitis A and B vaccination series and demonstrated adequate antibody response, routine booster doses are not recommended, as long-term immune memory provides durable protection without the need for additional doses. 1

Hepatitis B Booster Recommendations

Immunocompetent Individuals (No Boosters Needed)

• Healthy individuals who responded to the complete primary vaccination series do not require routine booster doses, as immune memory persists even when antibody levels decline below detectable levels 1
• The CDC Advisory Committee on Immunization Practices emphasizes that immune memory, rather than circulating antibody levels, is the key determinant of long-term protection against clinical disease 1
• Protection has been demonstrated to last at least 15 years in immunocompetent individuals, with no evidence of clinically significant breakthrough infections 2

Special Populations Requiring Boosters

Hemodialysis Patients:

• Annual anti-HBs testing is mandatory 1
• Administer a booster dose when anti-HBs levels decline below 10 mIU/mL 1

Healthcare Personnel:

• If anti-HBs <10 mIU/mL after primary vaccination, administer one additional dose of hepatitis B vaccine 1
• If anti-HBs remains <10 mIU/mL after the additional dose, complete a second 3-dose series 1
• Test for anti-HBs 1-2 months after the final dose 3

Immunocompromised Individuals:

• Annual anti-HBs testing should be considered if ongoing risk for exposure exists 1
• Administer boosters when levels fall below 10 mIU/mL 1

Non-responders to Primary Series:

• Persons with anti-HBs <10 mIU/mL after the primary vaccine series should be revaccinated with a complete 3-dose series 3
• Retest anti-HBs 1-2 months after the third dose 3
• If still non-responsive, test for HBsAg and HBc to rule out chronic infection 3

Hepatitis A Booster Recommendations

Standard Recommendations

• Hepatitis A vaccine requires a booster dose 6-12 months after the initial dose to complete the primary series 4
• For children and adolescents: 0.5-mL initial dose with 0.5-mL booster at 6-12 months 4
• For adults: 1-mL initial dose with 1-mL booster at 6-12 months 4

Long-term Protection

• Following completion of the 2-dose primary series, antibodies are predicted to persist for at least 25 years 5
• No additional booster doses beyond the primary 2-dose series are recommended for immunocompetent individuals 5
• Vaccination induces immunological memory that provides long-term protection even if antibody levels decline 5

Postexposure Prophylaxis Considerations

For Previously Vaccinated Individuals with Unknown Response

• If written documentation of complete hepatitis B vaccine series exists but no postvaccination testing was performed, administer a single vaccine booster dose after HBsAg-positive exposure 3
• No booster is needed for persons with documented serologic response (anti-HBs ≥10 mIU/mL) 3

Interrupted Vaccination Schedules

• If the hepatitis B vaccination schedule is interrupted, do not restart the series—simply administer the remaining doses as soon as possible 6
• For Twinrix (combined hepatitis A and B vaccine), if only the final 12-month dose is delayed, administer it as soon as possible without restarting 6

Common Pitfalls to Avoid

• Do not administer unnecessary boosters to healthy individuals who completed the primary series, as this is not supported by evidence and wastes resources 1
• Do not rely solely on antibody levels in immunocompetent individuals—immune memory persists even when anti-HBs is undetectable 1
• Do not overlook post-vaccination serologic testing in high-risk groups (healthcare workers, hemodialysis patients, immunocompromised individuals) to confirm initial response 1
• Do not forget annual monitoring for hemodialysis patients and other specified high-risk groups, as they require ongoing surveillance 1
• Do not confuse the primary 2-dose hepatitis A series with booster recommendations—the second dose at 6-12 months completes the primary series, not a booster 4