What is the recommended vaccination schedule for hepatitis prevention using Hevrevac (Hepatitis vaccine)?

Hepatitis B Vaccination Schedule with Hevrevac

The standard hepatitis B vaccination schedule is three doses administered at 0,1, and 6 months, which provides optimal long-term protection with high antibody titers. 1

Standard Vaccination Schedule

For most patients, administer hepatitis B vaccine using the 0,1, and 6-month schedule. 1 This timing achieves:

• The third dose at 6 months produces a robust booster response with geometric mean titers (GMTs) of approximately 5,800 mIU/mL 2
• The final dose must be given at least 8 weeks after the second dose and at least 16 weeks after the first dose 1
• The minimum interval between first and second doses is 4 weeks 1

Alternative Schedules

For patients requiring rapid protection (high-risk exposure scenarios), use the 0,1,2, and 12-month schedule. 1, 2 This provides:

• Earlier seroconversion after the third dose at month 2 (though with lower GMTs of ~53 IU/L) 2
• The fourth dose at month 12 produces a strong booster response comparable to the standard 0,1,12-month schedule 2
• This is particularly useful for healthcare workers or persons with imminent exposure risk 1

The 0,1, and 12-month schedule produces the highest antibody levels (GMT ~19,912 IU/L) and may be preferable when maximizing long-term antibody persistence is the priority. 2

Special Population Dosing

For hemodialysis patients, use high-dose formulations: 1

• Recombivax HB 40 μg at 0,1, and 6 months, OR
• Engerix-B 40 μg at 0,1,2, and 6 months 1

For adolescents aged 11-15 years, a two-dose adult formulation schedule (0 and 4-6 months) is an acceptable alternative. 1

Interrupted Schedules

Never restart the series if interrupted—simply continue with the next dose. 1, 3 Key principles:

• If interrupted after the first dose, give the second dose as soon as possible, then separate the second and third doses by at least 8 weeks 1
• If only the third dose is delayed, administer it as soon as possible 1
• Doses given ≤4 days before the minimum interval are considered valid 1

Post-Vaccination Testing

Test anti-HBs levels 1-2 months after the final dose for specific populations: 1, 4

• Healthcare personnel 1, 4
• Hemodialysis patients 1, 4
• HIV-infected persons 1, 4
• Infants born to HBsAg-positive mothers 1, 4
• Sex partners of HBsAg-positive persons 1, 4

Anti-HBs ≥10 mIU/mL indicates protective immunity; no further routine testing or boosters are needed in immunocompetent persons. 1, 4

Management of Non-Responders (Anti-HBs <10 mIU/mL)

Administer a complete second 3-dose series (total of 6 doses), then retest anti-HBs 1-2 months after the final dose. 1, 3 This approach:

• Results in protective antibody levels in 44-100% of initial non-responders 3
• Should be followed by HBsAg testing if still non-responsive after two complete series to rule out chronic infection 1, 3

For healthcare workers with anti-HBs <10 mIU/mL after a documented complete series, give one additional dose immediately, then test 1-2 months later. 1, 3 If still <10 mIU/mL, complete the second full series. 1, 3

Special Monitoring Requirements

For hemodialysis patients, perform annual anti-HBs testing and give booster doses when levels fall below 10 mIU/mL. 1

For other immunocompromised persons (HIV, transplant recipients, chemotherapy patients), consider annual anti-HBs testing and booster doses if ongoing exposure risk exists. 1, 4

Critical Pitfalls to Avoid

• Do not delay vaccination while waiting for serologic testing results—administer the first dose immediately after blood draw for testing 1
• Do not administer the final dose before 24 weeks of age in infants 1
• Do not restart an interrupted series—this wastes doses and delays protection 1, 3
• Do not use anti-HBs ≥10 mIU/mL as a correlate of protection in persons who did not complete a documented vaccine series—this threshold is only validated post-vaccination 4