What is the recommended Hepatitis B (Hep B) vaccination schedule?

Hepatitis B Vaccination Schedule

The standard hepatitis B vaccination schedule for most populations is 3 doses administered at 0,1, and 6 months, though several alternative schedules exist depending on age, vaccine product, and clinical circumstances. 1

Standard Schedules by Population

Infants and Children (Birth to 10 years)

• Standard schedule: 0,1, and 6 months using 10 μg Engerix-B (0.5 mL) or 5 μg Recombivax HB (0.5 mL) 1, 2
• For infants born to HBsAg-positive mothers: First dose within 12 hours of birth plus HBIG, then at 1-2 months and 6 months 1
• Alternative extended schedule: 0,12, and 24 months (acceptable for low-risk children aged 5-16 years) 2, 3
• The final dose must not be administered before 24 weeks of age, regardless of when earlier doses were given 1, 4

Adolescents (11-19 years)

• Standard 3-dose schedule: 0,1, and 6 months using 10 μg Engerix-B (0.5 mL) or 5 μg Recombivax HB (0.5 mL) 1, 5
• Alternative 2-dose schedule for ages 11-15: 10 μg Recombivax HB adult formulation (1.0 mL) at 0 and 4-6 months 1, 5, 6
• Alternative schedules include 0,1,4 months or 0,2,4 months 1

Adults (≥18 years)

• Traditional 3-dose vaccines: 20 μg Engerix-B (1.0 mL) or 10 μg Recombivax HB (1.0 mL) at 0,1, and 6 months 1, 5, 2
• Heplisav-B (preferred for improved compliance): 20 μg (0.5 mL) in a 2-dose schedule at 0 and 1 month 1, 5
• PreHevbrio: 10 μg (1.0 mL) at 0,1, and 6 months 5
• Accelerated 4-dose schedule: Engerix-B at 0,1,2, and 12 months (for rapid protection needs) 1, 2

Special Populations

Hemodialysis Patients and Immunocompromised Adults (≥20 years)

• Recombivax HB: 40 μg (1.0 mL) at 0,1, and 6 months 1, 5
• Engerix-B: 40 μg (2.0 mL, given as two 20 μg injections) at 0,1,2, and 6 months 1, 5, 2
• Annual anti-HBs testing recommended with booster doses when levels fall below 10 mIU/mL 1, 6

Pregnant Women

• Use Engerix-B, Recombivax HB, or Twinrix only 5
• Do not use Heplisav-B or PreHevbrio due to insufficient safety data in pregnancy 5

Minimum Dosing Intervals (Critical for Validity)

• Between doses 1 and 2: Minimum 4 weeks 1, 4, 6
• Between doses 2 and 3: Minimum 8 weeks 1, 4, 6
• Between doses 1 and 3: Minimum 16 weeks 1, 4, 6
• Grace period: Doses given ≤4 days before the minimum interval are considered valid 1, 4, 6
• For infants: Final dose cannot be given before 24 weeks of age 1, 4

Interrupted Schedules

If the vaccination series is interrupted, do not restart the series—simply continue where you left off. 1, 5, 4, 6

• If interrupted after dose 1: Give dose 2 as soon as possible, then dose 3 at least 8 weeks after dose 2 1
• If only dose 3 is delayed: Give it as soon as possible while maintaining the minimum 8-week interval from dose 2 and 16-week interval from dose 1 1
• Doses given at shorter-than-recommended intervals should be repeated using the correct schedule 1

Alternative Accelerated Schedules

For Rapid Protection (Post-Exposure, Travel, High-Risk Exposure)

• Engerix-B: 0,1,2, and 12 months (provides faster seroprotection) 1, 2, 7
• Twinrix (adults ≥18 years): 0,7, and 21-30 days, followed by a dose at 12 months 1
• These accelerated schedules achieve 99% seroprotection by month 3, but the 12-month booster is essential for long-term protection 2, 7

Immunogenicity Considerations

• After dose 1: 30-55% achieve protective antibody levels 1
• After dose 2: 75% achieve protection 1
• After dose 3: >90% achieve protection with traditional vaccines 1
• Heplisav-B achieves approximately 90% seroprotection compared to 70.5-90.2% with Engerix-B 1
• Vaccine-induced immunity persists for >30 years 1

Common Pitfalls to Avoid

• Never restart the series if interrupted—this wastes doses and delays protection 1, 5, 4, 6
• Do not give the third dose before 16 weeks from the first dose, even if 8 weeks have passed since the second dose 1, 4
• Do not give the final infant dose before 24 weeks of age, as this may compromise long-term immunity 1, 4
• Do not use standard adult doses in hemodialysis patients—they require 40 μg doses 1, 5, 6
• Do not use Heplisav-B or PreHevbrio in pregnant women, children, or hemodialysis patients 5
• Do not assume different vaccine brands cannot be interchanged—they can be used interchangeably without repeating doses 1
• Doses given >4 days before the minimum interval must be repeated 1, 4