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

Hepatitis B Vaccine Schedule

The standard hepatitis B vaccine schedule is 3 doses administered at 0,1, and 6 months for most populations, with all infants receiving their first dose within 12 hours of birth before hospital discharge. 1, 2, 3

Standard Schedules by Population

Infants

• All infants should receive the first dose within 12 hours of birth before hospital discharge, regardless of maternal HBsAg status 2, 4
• For infants born to HBsAg-negative mothers: 10 mcg at 0,1-2, and 6 months 1, 2, 4
• For infants born to HBsAg-positive mothers: 10 mcg at 0 (within 12 hours), 1-2, and 6 months plus HBIG within 12 hours of birth 1, 2, 4
• The final infant dose must not be given before 24 weeks of age, regardless of when earlier doses were administered 1
• Delaying the birth dose beyond 12 hours in infants of HBsAg-positive mothers significantly increases infection risk 1, 2

Children and Adolescents

• Children birth through 10 years: 10 mcg at 0,1, and 6 months 3, 4
• Adolescents 11-19 years: 10 mcg at 0,1, and 6 months 3, 4
• Alternative 2-dose schedule for ages 11-15 years: Adult formulation (20 mcg) at 0 and 4-6 months 2, 3

Adults

• Adults ≥19 years: 20 mcg at 0,1, and 6 months 1, 3, 4

Hemodialysis Patients

• 40 mcg doses (two 20 mcg injections) at 0,1,2, and 6 months 1, 2, 3, 4
• Annual anti-HBs testing required with booster doses when levels fall below 10 mIU/mL 1, 2, 3, 4
• Standard adult doses are inadequate for this population 1, 3

Minimum Dosing Intervals (Critical for Validity)

• Between doses 1 and 2: Minimum 4 weeks 1, 2, 3
• Between doses 2 and 3: Minimum 8 weeks 1, 2, 3
• Between doses 1 and 3: Minimum 16 weeks 1, 2, 3
• Doses given ≤4 days before the minimum interval are considered valid 1, 3
• Do not give the third dose before 16 weeks from the first dose, even if 8 weeks have passed since the second dose 1, 3

Alternative Accelerated Schedules

For Rapid Protection (Recent Exposure or High-Risk Travel)

• Engerix-B: 0,1,2, and 12 months 1, 4
• Twinrix (for combined hepatitis A and B protection): 0,7, and 21-30 days, followed by a dose at 12 months 1
• These schedules achieve 99% seroprotection by month 3 4

Extended Schedules (Low-Risk Populations)

• Children and adolescents 5-16 years: 0,12, and 24 months 4, 5
• This schedule produces 98.1% seroprotection with GMT of 3,159 mIU/mL, though slightly lower than the standard schedule 4, 5

Interrupted Schedules

If the vaccination series is interrupted, never restart the series—simply continue where you left off. 1, 2, 3

• If interrupted after dose 1: Give dose 2 as soon as possible, then dose 3 at least 8 weeks after dose 2 1
• Increasing intervals between doses has little effect on final immunogenicity 1
• Longer intervals between the last 2 doses actually result in higher final antibody levels 1

Immunogenicity by Schedule

• 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
• Vaccine-induced immunity persists for >30 years 1
• Response rates decline with age, particularly in adults over 40 years 4

Administration Technique

• Route: Intramuscular injection; never intravenous or intradermal 4
• Site for adults: Deltoid region 4
• Site for neonates and infants: Anterolateral thigh (preferred due to smaller deltoid muscles) 4
• Never inject in the gluteal region, as this results in suboptimal response 4
• Subcutaneous administration may be used only for patients at risk of hemorrhage (e.g., hemophiliacs), but results in lower antibody titers 4

Post-Vaccination Testing

Testing is recommended 1-2 months after completing the series for: 2

• Infants born to HBsAg-positive mothers (test at 9-15 months for HBsAg and anti-HBs) 1, 2
• Healthcare personnel 2
• Hemodialysis patients 2
• HIV-infected persons 2
• Other immunocompromised persons 2

Anti-HBs level ≥10 mIU/mL indicates adequate protection 2

Common Pitfalls to Avoid

• Never restart the series if interrupted—this wastes doses and delays protection 1, 2, 3
• Do not give the third dose before 16 weeks from the first dose, even if 8 weeks have passed since the second dose 1, 3
• Do not give the final infant dose before 24 weeks of age, as this may compromise long-term immunity 1
• Do not use standard adult doses in hemodialysis patients—they require 40 mcg doses 1, 3
• Do not use Heplisav-B or PreHevbrio in pregnant women, children, or hemodialysis patients 1
• Do not use Twinrix simply for hepatitis B vaccination when the patient has no indication for hepatitis A protection 1