What is the recommended dose for a hepatitis B (HB) booster shot in a patient who has previously completed a hepatitis B vaccination series and is at ongoing risk of exposure?

Hepatitis B Booster Dose Recommendation

For previously vaccinated individuals at ongoing risk of hepatitis B exposure, administer a single standard adult dose of hepatitis B vaccine (10 μg Recombivax HB or 20 μg Engerix-B) as the booster dose. 1

Standard Booster Dosing by Vaccine Product

The booster dose should match standard adult formulations:

• Recombivax HB: 10 μg (1.0 mL) intramuscularly 1
• Engerix-B: 20 μg (1.0 mL) intramuscularly 1
• Heplisav-B: 20 μg (0.5 mL) intramuscularly 1
• Twinrix (combination HepA-HepB): 20 μg HBsAg component (1.0 mL) intramuscularly 1

Population-Specific Booster Recommendations

Healthcare Personnel (HCP)

For completely vaccinated HCP with anti-HBs <10 mIU/mL, give one additional standard dose of HepB vaccine, followed by anti-HBs testing 1-2 months later. 1 If anti-HBs remains <10 mIU/mL after this single booster, complete a second full 3-dose series (total of 6 doses), followed by repeat anti-HBs testing 1-2 months after the final dose. 1

Hemodialysis Patients

Hemodialysis patients require higher booster doses: 40 μg (either two 20 μg doses of Engerix-B or two 10 μg doses of Recombivax HB given at different sites). 1 Annual anti-HBs testing is mandatory, with booster administration when levels decline to <10 mIU/mL. 1, 2 Notably, anti-HBs testing 1-2 months following the booster dose is not recommended for this population. 1

Other Immunocompromised Persons

For HIV-infected persons, hematopoietic stem-cell transplant recipients, and persons receiving chemotherapy, consider high-dose boosters (40 μg/dose for adults). 1 Annual anti-HBs testing and booster doses should be considered for those with ongoing risk for exposure. 1, 2 If initial vaccination fails to achieve anti-HBs ≥10 mIU/mL, administer a second complete 3-dose series using high-dose formulations (40 μg for adults, 40 μg for adolescents). 1

Critical Clinical Considerations

When NOT to Give Boosters

Immunocompetent individuals who previously achieved anti-HBs ≥10 mIU/mL after completing the primary series do not need routine booster doses, even if current anti-HBs levels are undetectable. 2 Vaccine-induced immune memory persists for >30 years in immunocompetent persons. 1

Post-Booster Testing Strategy

• Test anti-HBs 1-2 months after booster administration for HCP, immunocompromised persons, and sex partners of HBsAg-positive individuals 1
• Do NOT test after boosters in hemodialysis patients 1
• Use assays that detect protective concentrations ≥10 mIU/mL (e.g., ELISA) 1

Management of Non-Responders

If a person fails to achieve anti-HBs ≥10 mIU/mL after a single booster dose, they should receive a complete second 3-dose series. 1 After completing the second series (6 total doses), retest anti-HBs 1-2 months later. 1 Persons who remain non-responsive after 6 total doses should be tested for HBsAg to rule out chronic infection. 1 If HBsAg-negative, these individuals are considered susceptible and require hepatitis B immune globulin (HBIG) at 0.06 mL/kg for any known HBsAg-positive exposures. 3

Common Pitfalls to Avoid

• Do not restart the entire vaccination series if interrupted—simply administer the delayed dose as soon as possible 1, 4
• Do not use reduced doses for boosters unless specifically indicated (e.g., adolescents aged 11-15 years may receive 10 μg Recombivax HB as a 2-dose series, but this is for primary vaccination, not boosters) 1
• Do not confuse the need for post-vaccination serologic testing with the need for routine boosters—testing documents response, but immunocompetent responders don't need ongoing boosters 2
• Do not administer boosters to immunocompetent individuals based solely on declining or undetectable anti-HBs titers—immune memory provides protection even when antibodies are undetectable 2