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

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 medically stable newborns weighing ≥2,000 g receiving their first dose before hospital discharge. 1, 2

Infant Vaccination Schedule

Standard Newborn Protocol

• All medically stable infants weighing ≥2,000 g must receive the first dose of hepatitis B vaccine before hospital discharge, ideally within 12 hours of birth 1, 2
• Subsequent doses are administered at 1-2 months and 6 months of age 1, 3
• The final dose must not be given before 24 weeks of age, regardless of when earlier doses were administered 2, 3

High-Risk Infants (HBsAg-Positive Mothers)

• Infants born to HBsAg-positive mothers require both hepatitis B vaccine AND hepatitis B immune globulin (HBIG) within 12 hours of birth 1, 4
• Delaying the birth dose beyond 12 hours in these infants significantly increases infection risk 1, 2
• Follow-up doses at 1-2 months and 6 months 1
• Post-vaccination serologic testing (anti-HBs and HBsAg) should be performed at 9-15 months of age 2

Children and Adolescent Schedules

Standard Schedule (All Ages)

• Three doses at 0,1, and 6 months 1, 2, 3

Alternative Adolescent Schedule (Ages 11-15 Years Only)

• Two-dose schedule using adult formulation of Recombivax HB at 0 and 4-6 months 1, 3
• This simplified schedule improves compliance in this age group 3

Adult Vaccination Schedules

Standard Adult Schedule

• Three doses at 0,1, and 6 months 1, 2, 3
• Alternative schedules include 0,2, and 4 months, which produce similar seroprotection rates 2
• After dose 1, only 30-55% achieve protection; after dose 2,75% achieve protection; after dose 3, >90% achieve protection 2

Accelerated Schedule (When Rapid Protection Needed)

• Engerix-B: 0,1,2, and 12 months 2, 3
• Twinrix (combined hepatitis A and B): 0,7, and 21-30 days, followed by a dose at 12 months 2
• The 4-day grace period for minimum intervals does NOT apply to the first 3 doses of Twinrix on the accelerated schedule 5

Special Populations

Hemodialysis Patients

• Require higher doses: 40 μg (Recombivax HB) at 0,1, and 6 months 1, 2
• Alternative 4-dose schedule with Engerix-B at 0,1,2, and 6 months 3
• Annual anti-HBs testing is mandatory, with booster doses when levels fall below 10 mIU/mL 5, 1, 2

Other Immunocompromised Persons

• Consider annual anti-HBs testing and booster doses for those with ongoing exposure risk 5
• Post-vaccination serologic testing recommended 1-2 months after completing the series 1, 3

Healthcare Personnel and Public Safety Workers

• Standard 3-dose schedule at 0,1, and 6 months 3
• Mandatory post-vaccination serologic testing 1-2 months after series completion 5, 1
• If anti-HBs <10 mIU/mL, administer one additional dose followed by repeat testing 1-2 months later 5
• If still <10 mIU/mL after the additional dose, complete a second full series (6 doses total), then retest 5

Critical Minimum Dosing Intervals

Absolute Minimum Intervals

• Between doses 1 and 2: 4 weeks minimum 5, 1, 2, 3
• Between doses 2 and 3: 8 weeks minimum 5, 1, 2, 3
• Between doses 1 and 3: 16 weeks minimum 5, 1, 2, 3
• Doses given ≤4 days before the minimum interval are considered valid 5, 2, 3

Interrupted Schedules

Key Management Principle

• Never restart the series if interrupted—simply continue where you left off 5, 2, 3
• 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 5, 2
• If only dose 3 is delayed, administer it as soon as possible 5
• Longer intervals between doses do not reduce final immunogenicity; in fact, longer intervals between the last 2 doses result in higher final antibody levels 2

Post-Vaccination Testing Requirements

Populations Requiring Testing

• Infants born to HBsAg-positive mothers (test at 9-15 months) 1, 2
• Healthcare personnel and public safety workers 5, 1
• Hemodialysis patients 5, 1
• HIV-infected persons 1
• Other immunocompromised persons 5, 1

Testing Protocol

• Perform anti-HBs testing 1-2 months after completing the vaccination series 5, 1, 3
• Anti-HBs ≥10 mIU/mL indicates adequate protection 1, 2

Common Pitfalls to Avoid

• Never restart the series if interrupted—this wastes doses and delays protection 5, 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 2, 3
• Do not give the final infant dose before 24 weeks of age, as this may compromise long-term immunity 2, 3
• Do not use standard adult doses in hemodialysis patients—they require 40 μg doses 1, 2
• Do not use Heplisav-B or PreHevbrio in pregnant women, children, or hemodialysis patients due to insufficient safety data 2
• Do not use Twinrix when only hepatitis B protection is needed—reserve it for patients requiring both hepatitis A and B vaccination 2
• Do not accept undated vaccination records as evidence of vaccination 5