Hepatitis B Vaccine Booster Schedule
For immunocompetent adults who have completed the standard 3-dose hepatitis B vaccine series, routine booster doses are not recommended. 1
General Population: No Routine Boosters Required
Immunocompetent individuals who complete the primary 3-dose series (at 0,1, and 6 months) do not need booster doses. 2, 1
Healthcare personnel with documented immunity require no additional vaccination or routine serologic testing throughout their careers. 1
Periodic testing to determine antibody levels after routine vaccination among immunocompetent persons is unnecessary. 2
Special Populations Requiring Ongoing Monitoring and Boosters
Hemodialysis Patients
Annual anti-HBs testing is mandatory, with booster doses administered when antibody levels decline below 10 mIU/mL. 1
These patients receive higher initial doses (40 μg Recombivax HB or 40 μg Engerix-B) due to impaired immune response. 2
Other Immunocompromised Individuals
HIV-infected persons and other immunocompromised patients require regular anti-HBs testing with booster injections when titers fall below 10 mIU/mL. 1
Post-vaccination serologic testing 1-2 months after completing the series is recommended to document initial response. 1
Healthcare Personnel with Specific Exposure Scenarios
Workers with documented immunity require no postexposure prophylaxis or additional vaccination after workplace exposures. 1
Those with no documentation of postvaccination response who are exposed to HBsAg-positive sources should receive immediate anti-HBs testing; if <10 mIU/mL, they need one booster dose plus HBIG. 1
Management of Non-Responders
Individuals who fail to achieve anti-HBs ≥10 mIU/mL after the first 3-dose series should receive a second complete 3-dose series. 1
After the second series, if still non-responsive, these individuals are considered permanent non-responders and require 2 doses of HBIG for any HBsAg-positive exposures rather than additional vaccine doses. 1
Hepatitis A Vaccine Booster Schedule
For hepatitis A vaccines (Havrix, Vaqta):
A single booster dose is required 6-12 months after the initial dose for adults. 3
Children aged 2-17 years receive the same two-dose schedule with the booster at 6-18 months. 3
If the booster is delayed beyond the recommended timeframe (even up to 20-31 months), it remains highly immunogenic in persons >2 years of age. 4
Combined Hepatitis A and B Vaccine (Twinrix)
Standard schedule: 3 doses at 0,1, and 6 months. 2
Accelerated schedule: 4 doses at days 0,7,21-30, followed by a booster at month 12. 2, 5
The final dose at 12 months in the accelerated schedule is crucial for long-term immunity and should not be omitted. 5
Critical Pitfalls to Avoid
Never restart the vaccination series if interrupted—simply continue where left off, as immunological memory is maintained. 1, 6
Do not confuse the need for post-vaccination serologic testing (required for high-risk groups) with the need for routine boosters (not required for immunocompetent individuals). 1
For interrupted schedules, respect minimum intervals: 4 weeks between doses 1 and 2,8 weeks between doses 2 and 3, and at least 16 weeks between doses 1 and 3. 6