What is the recommended Hepatitis B (HBV) vaccine schedule for adults?

Hepatitis B Vaccine Schedule for Adults

For adults aged 18 years and older, the Advisory Committee on Immunization Practices (ACIP) recommends universal hepatitis B vaccination for all adults aged 19-59 years, with several approved vaccine options and schedules available depending on the specific product used. 1

Standard Vaccination Schedules by Vaccine Type

Recombivax HB

• Dose: 10 μg (1.0 mL) per injection 1, 2
• Schedule: 3 doses at 0,1, and 6 months 1, 2
• Special populations (hemodialysis/immunocompromised): 40 μg (1.0 mL) per dose, 3-dose schedule 1, 2

Engerix-B

• Dose: 20 μg (1.0 mL) per injection 1, 2
• Schedule: 3 doses at 0,1, and 6 months 1, 2
• Special populations (hemodialysis/immunocompromised): 40 μg (2.0 mL) per dose, 4 doses at 0,1,2, and 6 months 1, 2

Heplisav-B (Preferred for Faster Completion)

• Dose: 20 μg (0.5 mL) per injection 1, 2
• Schedule: 2 doses at 0 and 1 month 1, 2
• Advantage: This is the fastest schedule to complete and has demonstrated higher seroprotection rates (approximately 90%) compared to traditional vaccines 3
• Limitation: Not approved for hemodialysis patients, pregnant women, or breastfeeding women 1, 2

PreHevbrio (Newest Option, ACIP-Recommended 2022)

• Dose: 10 μg (1.0 mL) per injection 1, 2
• Schedule: 3 doses at 0,1, and 6 months 1, 2
• Limitation: Not approved for hemodialysis patients, pregnant women, or breastfeeding women 1, 2

Twinrix (Combined Hepatitis A and B)

• Dose: 20 μg HepB component (1.0 mL) per injection 1
• Standard schedule: 3 doses at 0,1, and 6 months 1
• Accelerated schedule: 4 doses at 0 days, 7 days, 21-30 days, and 12 months 1

Special Considerations for Pregnancy

Pregnant women requiring hepatitis B vaccination should receive only Engerix-B, Recombivax HB, or Twinrix, as Heplisav-B and PreHevbrio have insufficient safety data in pregnancy. 1, 2

Interrupted Vaccination Series

• If the vaccination schedule is interrupted, do not restart the series—simply continue where you left off. 1, 2
• For a 3-dose series interrupted after the first dose, administer the second dose as soon as possible; the second and third doses must be separated by at least 8 weeks 1
• The final dose must be administered at least 8 weeks after the second dose and at least 16 weeks after the first dose 1
• The minimum interval between the first and second doses is 4 weeks 1
• Vaccine doses administered ≤4 days before the minimum interval are considered valid 1, 2

Accelerated Schedules for High-Risk Situations

For individuals requiring rapid protection (recent exposure, imminent travel to endemic areas):

• Alternative 4-dose schedule: 0,1,2, and 12 months with standard vaccines 1
• Twinrix accelerated schedule: 0 days, 7 days, 21-30 days, and 12 months 1
• These accelerated schedules provide earlier seroprotection but require a fourth dose at 12 months for long-term protection 1

Pre-Vaccination Testing

• Pre-vaccination serologic testing is not required and should not be a barrier to vaccination. 1
• Testing for HBsAg, anti-HBs, and anti-HBc can be performed if desired to identify those already immune, but lack of access to testing should never delay vaccination 1

Common Pitfalls to Avoid

• Do not use Heplisav-B or PreHevbrio in pregnant women, hemodialysis patients, or individuals with insufficient safety data. 1, 2
• Do not restart an interrupted series—this wastes doses and delays protection. 1, 2
• Do not assume serologic testing is mandatory before vaccination—this creates unnecessary barriers. 1
• Do not administer hepatitis B vaccine in the gluteal region, as this results in suboptimal immune response. 4
• Do not forget that hemodialysis patients require higher doses (40 μg) and may need different schedules. 1, 2

Age-Specific Recommendations

The 2022 ACIP guidelines now recommend universal hepatitis B vaccination for all adults aged 19-59 years, removing the previous requirement for risk factor assessment. 1 This universal recommendation eliminates the need for risk factor screening and disclosure, which should increase vaccination coverage and decrease hepatitis B cases 1.