Hepatitis B Vaccine Schedule with Booster Recommendations
For immunocompetent individuals who complete the primary 3-dose hepatitis B vaccine series, routine booster doses are not recommended, as vaccine-induced immunity persists for more than 30 years. 1
Standard Primary Vaccination Schedule
The CDC recommends the following standard schedules based on population 2, 1, 3:
Infants and Children
- Infants born to HBsAg-negative mothers: 10 mcg at 0 (birth or by 2 months), 1-2 months, and 6 months 1, 3
- Infants born to HBsAg-positive mothers: 10 mcg within 12 hours of birth (plus HBIG), then at 1-2 months and 6 months 1, 3
- Children birth through 10 years: 10 mcg at 0,1, and 6 months 3
Adolescents and Adults
- Adolescents 11-19 years: 10 mcg at 0,1, and 6 months (or 20 mcg at 0,1, and 6 months) 3
- Adults >19 years: 20 mcg at 0,1, and 6 months 1, 3
- Hemodialysis patients: 40 mcg (two 20 mcg doses) at 0,1,2, and 6 months 2, 3
Critical Timing Requirements
The third dose must be administered at least 16 weeks after the first dose AND at least 8 weeks after the second dose, with the minimum interval between doses 1 and 2 being 4 weeks. 2, 4, 1
- For infants, the final dose cannot be given before 24 weeks of age, regardless of when earlier doses were administered 2, 4, 1
- A 4-day grace period applies for doses given before the minimum interval (these are considered valid) 2, 4
- The grace period does NOT apply to the first three doses of Twinrix on the accelerated schedule 2, 5
Interrupted Schedules
If the vaccination series is interrupted at any point, never restart the series—simply continue where you left off. 2, 4, 5, 1
- If interrupted after dose 1: Give dose 2 as soon as possible, then dose 3 at least 8 weeks after dose 2 and at least 16 weeks after dose 1 2, 1
- If only dose 3 is delayed: Give it as soon as possible while respecting the minimum intervals 2, 4
Booster Dose Recommendations by Population
Hemodialysis Patients
Annual anti-HBs testing is required, with a booster dose (40 mcg) administered when antibody levels decline below 10 mIU/mL. 2, 3
- Anti-HBs testing 1-2 months following the booster dose is not recommended 2
- This is the only population with a clearly defined booster schedule 2, 3
Healthcare Personnel (HCP)
Completely vaccinated HCP with anti-HBs <10 mIU/mL should receive one additional dose, followed by anti-HBs testing 1-2 months later. 2
- If anti-HBs remains <10 mIU/mL after the additional dose, complete a second full series (6 doses total), then retest 1-2 months after the final dose 2
- This represents revaccination for non-responders, not routine boosters 2
Other Immunocompromised Persons
For HIV-infected persons, hematopoietic stem-cell transplant recipients, and persons receiving chemotherapy, the need for booster doses has not been determined. 2
- Consider annual anti-HBs testing and booster doses for those with ongoing risk for exposure 2
- This is a clinical judgment call rather than a firm recommendation 2
Immunocompetent Individuals
No routine booster doses are recommended for immunocompetent individuals who have completed the primary series, as vaccine-induced immunity persists for more than 30 years. 1
Alternative Accelerated Schedules
For rapid protection in high-risk situations 1, 3:
- Engerix-B: 0,1,2, and 12 months 1, 3
- Twinrix: 0,7, and 21-30 days, followed by a dose at 12 months 5, 1
These accelerated schedules achieve 96-99% seroprotection by month 3-4, but the 12-month booster is essential for long-term immunity 3, 6
Common Pitfalls to Avoid
- Never restart the series if interrupted—this wastes doses and delays protection 4, 5, 1
- Do not give the third dose before 16 weeks from the first dose, even if 8 weeks have passed since the second dose 2, 4, 1
- Do not give the final infant dose before 24 weeks of age, as this may compromise long-term immunity 2, 4, 1
- Do not use standard adult doses in hemodialysis patients—they require 40 mcg doses 1, 3
- Do not routinely order booster doses for immunocompetent adults—vaccine-induced immunity is durable 1