What is the recommended Hepatitis B (Hep B) vaccination schedule for children?

Hepatitis B Vaccination in Children

Standard Vaccination Schedule

All infants should receive the first dose of hepatitis B vaccine within 24 hours of birth before hospital discharge, followed by completion of a 3-dose series at 1-2 months and 6-18 months of age. 1

Birth Dose (First 24 Hours)

• Medically stable infants weighing ≥2,000 grams born to HBsAg-negative mothers must receive the first dose within 24 hours of birth to minimize risk from maternal testing errors, household exposures, and to increase series completion rates 1
• Only single-antigen (monovalent) hepatitis B vaccine should be used for the birth dose 1
• Infants weighing <2,000 grams born to HBsAg-negative mothers should delay the first dose until hospital discharge or age 1 month, even if weight remains <2,000 grams 1

Subsequent Doses

• Second dose: Administer at age 1-2 months, with a minimum interval of 4 weeks after the first dose 1, 2
• Third dose: Administer at age 6-18 months, with minimum requirements of at least 8 weeks after the second dose AND at least 16 weeks after the first dose 1, 2, 3
• The final dose must not be administered before age 24 weeks (164 days) 1
• Either monovalent or combination vaccine containing hepatitis B can be used to complete the series after the birth dose 1

Four-Dose Series

• When a birth dose is given followed by combination vaccines, a total of four doses may be administered to complete the series, which is acceptable 1

Special Populations

Infants Born to HBsAg-Positive Mothers

• Administer both hepatitis B vaccine AND hepatitis B immune globulin (HBIG) 0.5 mL within 12 hours of birth, regardless of birth weight 1, 4
• Complete the 3-dose vaccine series at 0,1, and 6 months 1, 4
• Test for HBsAg and anti-HBs at age 9-15 months after series completion to identify chronic infection or need for revaccination 1
• HBsAg-negative infants with anti-HBs <10 mIU/mL should be revaccinated with a single dose and retested 1-2 months later 1

Infants Born to Mothers with Unknown HBsAg Status

• Administer hepatitis B vaccine within 12 hours of birth 1
• Determine maternal HBsAg status as soon as possible 1
• If mother is found to be HBsAg-positive, administer HBIG no later than age 7 days 1, 4

Preterm Infants (<2,000 grams)

• Born to HBsAg-positive mothers: Give both vaccine and HBIG within 12 hours regardless of weight 2, 5
• Born to HBsAg-negative mothers: Defer birth dose until hospital discharge or age 1 month; this deferred dose does not count toward the series, requiring 4 total doses 1, 2

Catch-Up Vaccination for Unvaccinated Children

All unvaccinated children and adolescents aged <19 years should receive catch-up hepatitis B vaccination at any age. 1

Catch-Up Schedule

• Administer the 3-dose series with minimum intervals: 4 weeks between doses 1 and 2,8 weeks between doses 2 and 3, and 16 weeks between doses 1 and 3 2, 3
• Never restart a vaccine series regardless of time elapsed between doses—simply continue from where the child left off 3
• For children aged 11-15 years, a 2-dose series of Recombivax HB® (adult formulation) is an acceptable alternative 1

High-Risk Populations

• In populations with high rates of childhood HBV infection (Alaska Natives, Pacific Islanders, immigrant families from Asia/Africa), administer the first dose at birth and the final dose at age 6-12 months 1

Immunogenicity and Protection

• Approximately 95-100% of healthy children achieve protective antibody levels (≥10 mIU/mL) after completing the 3-dose series 5, 6
• Vaccine-induced immunity persists for at least 10-30 years in immunocompetent individuals who achieve adequate initial antibody response 5
• Routine post-vaccination serologic testing is NOT recommended for healthy children, even those who are household contacts of HBsAg-positive individuals 5
• Post-vaccination testing is reserved only for infants born to HBsAg-positive mothers, healthcare personnel, hemodialysis patients, HIV-infected persons, and other immunocompromised individuals 1, 5

Household Contacts of HBsAg-Positive Individuals

• All household contacts and sexual partners of HBsAg-positive individuals should be vaccinated using the standard 0,1,6-month schedule 5, 4
• For children aged 6-10 years, administer 10 mcg (0.5 mL) at months 0,1, and 6 5
• The 0,1,6-month schedule is preferred over extended schedules in high-risk situations to provide earlier protection 5
• HBIG is NOT indicated for routine household contact vaccination—it is only for newborns of HBsAg-positive mothers or specific post-exposure scenarios 5, 4

Critical Implementation Points

Hospital Policies

• All delivery hospitals must implement standing orders and electronic medical record prompts to ensure birth dose administration within 24 hours 1
• For infants transferred between facilities, staff must communicate regarding vaccination and HBIG status to ensure timely prophylaxis 1

Common Pitfalls to Avoid

• Do not delay the birth dose for medically stable infants ≥2,000 grams—this is a critical safety net against maternal testing errors and household exposures 1
• Do not use combination vaccines for the birth dose—only monovalent hepatitis B vaccine is acceptable 1
• Do not administer the final dose before age 24 weeks (164 days) 1
• Do not restart the series if doses are delayed—longer intervals do not reduce final antibody concentrations 3

Simultaneous Administration

• Hepatitis B vaccine can be administered simultaneously with all other routine childhood vaccines at separate anatomic sites 2, 3, 6
• Multiple vaccines should be given simultaneously when indicated to maximize protection and minimize visits required for catch-up 3