From the Guidelines
The recommended hepatitis B vaccination schedule for adults aged ≥18 years is 2-3 doses, depending on the vaccine type, with the most common schedule being 2 doses at 0 and 1 month for Heplisav-B or 3 doses at 0,1, and 6 months for Engerix-B and Recombivax HB, as outlined in the 2022 Advisory Committee on Immunization Practices (ACIP) recommendations 1.
Hepatitis B Vaccination Schedules
The hepatitis B vaccination schedule varies by age group and vaccine type. For adults aged ≥18 years, the recommended schedules are:
- Heplisav-B: 2 doses at 0 and 1 month
- Engerix-B: 3 doses at 0,1, and 6 months
- Recombivax HB: 2-3 doses, with a 2-dose schedule for adults aged 11-15 years and a 3-dose schedule for adults aged ≥20 years
- PreHevbrio: 3 doses at 0,1, and 6 months
- Twinrix (HepA-HepB combination vaccine): 3 doses at 0,1, and 6 months (standard) or 4 doses at 0,7,21-30, and 12 months (accelerated)
Special Considerations
For adults on hemodialysis and other immunocompromised adults aged ≥20, the recommended schedule is:
- Engerix-B: 4 doses at 0,1,2, and 6 months
- Recombivax HB: 3 doses, with a higher dose volume of 1 mL It is essential to note that the safety and effectiveness of Heplisav-B and PreHevbrio have not been established in adults on hemodialysis, and providers should vaccinate pregnant persons needing HepB vaccination with Engerix-B, Recombivax HB, or Twinrix, as recommended by the ACIP in 2022 1.
From the Research
Hepatitis Dosing Schedule
The hepatitis dosing schedule is dependent on various factors, including the clinical features of patients, antiviral efficacy, risk of resistance, and long-term safety profile.
- The goal of antiviral therapy is to prevent cirrhosis and hepatocellular carcinoma through persistent suppression of HBV replication 2.
- Ideal candidates for treatment are hepatitis B e antigen-positive patients with a prolonged phase of immune clearance and hepatitis B e antigen-negative patients with elevated levels of serum HBV DNA, abnormal alanine aminotransferase, and histologic evidence of moderate or severe liver necroinflammation and/or fibrosis 2.
- Treatment is generally indicated in chronic hepatitis B patients with HBV DNA >2000 IU/mL, elevated ALT, and/or at least moderate histological lesions, while all patients with cirrhosis and detectable HBV DNA should be treated 3.
Treatment Options
Several drugs are available for the treatment of chronic hepatitis B, including:
- Recombinant interferons, such as interferon-α and its pegylated formulation 4
- Nucleos(t)ide analogues, such as lamivudine, adefovir, telbivudine, entecavir, and tenofovir 5, 4
- Each agent has its own advantages and drawbacks, and the choice of treatment should be based on individual patient needs and characteristics 4
Dosing Regimens
The dosing regimens for hepatitis B treatment vary depending on the specific drug and patient population.
- Pegylated-interferon treatment has a finite duration without induction of drug resistance, but only a limited number of patients achieve a sustained virological response to therapy 4
- Nucleos(t)ide analogues require long-term treatment with a potential risk of induction of drug resistance, but higher rates of viral replication suppression are achieved 4