What is the recommended dose of Hepatitis B (HBV) vaccine for adults and infants?

Hepatitis B Vaccine Dosing Recommendations

For adults ≥20 years, administer Recombivax HB 10 μg (1.0 mL) or Engerix-B 20 μg (1.0 mL) in a 3-dose series at 0,1, and 6 months; for infants, administer 5 μg (0.5 mL) of Recombivax HB or 10 μg (0.5 mL) of Engerix-B in a 3-dose series starting at birth. 1

Adult Dosing (≥18 years)

Standard Vaccines (3-dose series)

• Recombivax HB: 10 μg (1.0 mL) per dose for adults ≥20 years, administered at 0,1, and 6 months 1, 2
• Engerix-B: 20 μg (1.0 mL) per dose for adults ≥20 years, administered at 0,1, and 6 months 1, 2
• Alternative schedules of 0,1,4 months or 0,2,4 months produce equivalent seroprotection rates 1

Newer Vaccine Options

• Heplisav-B: 20 μg (0.5 mL) per dose for adults ≥18 years in a 2-dose series at 0 and 1 month 1, 2

  • Achieves approximately 90% seroprotection compared to 70.5-90.2% with Engerix-B 1
  • Do not use in pregnant women, children, or hemodialysis patients 2

• PreHevbrio: 10 μg (1.0 mL) per dose for adults ≥18 years in a 3-dose series at 0,1, and 6 months 2

  • Do not use in pregnant women 2

Combination Vaccine

• Twinrix (hepatitis A + B): 20 μg hepatitis B component (1.0 mL) for adults ≥18 years at 0,1, and 6 months 1
  • Accelerated schedule: 0 days, 7 days, 21-30 days, and 12 months 2, 3

Infant Dosing (<1 year)

Birth Dose (Critical Safety Net)

• All medically stable infants ≥2,000 grams born to HBsAg-negative mothers: Administer first dose within 24 hours of birth 1
• Infants born to HBsAg-positive mothers: Administer first dose within 12 hours of birth plus HBIG (0.06 mL/kg) 1, 3
  • Delaying beyond 12 hours significantly increases infection risk 3

Standard Infant Doses

• Recombivax HB: 5 μg (0.5 mL) per dose 1
• Engerix-B: 10 μg (0.5 mL) per dose 1
• Complete series at 0,1-2, and 6 months 1
• The final dose must not be administered before 24 weeks (164 days) of age 1, 3

Preterm Infants

• Infants <2,000 grams born to HBsAg-negative mothers should delay the first dose until hospital discharge or 1 month of age 1
• Preterm infants have decreased response to vaccine before 1 month of age 1

Children and Adolescents (1-19 years)

Children (1-10 years)

• Recombivax HB: 5 μg (0.5 mL) per dose 1
• Engerix-B: 10 μg (0.5 mL) per dose 1
• Administer at 0,1, and 6 months 1

Adolescents (11-19 years)

• Standard 3-dose schedule: Same as children (5 μg Recombivax HB or 10 μg Engerix-B) at 0,1, and 6 months 1
• Alternative 2-dose schedule for ages 11-15: Recombivax HB adult formulation 10 μg (1.0 mL) at 0 and 4-6 months 1
  • Produces equivalent antibody levels to 3-dose pediatric schedule 1
  • No long-term persistence data available 1

Special Populations

Hemodialysis and Immunocompromised Patients (≥20 years)

• Recombivax HB: 40 μg (1.0 mL) dialysis formulation at 0,1, and 6 months 1, 2
• Engerix-B: 40 μg (2.0 mL—two 1.0 mL doses at one site) at 0,1,2, and 6 months 1, 2
• Heplisav-B: 20 μg (0.5 mL) at 0 and 1 month can be used 2
• Annual anti-HBs testing recommended with booster when <10 mIU/mL 3

Pregnant Women

• Only use Engerix-B, Recombivax HB, or Twinrix 2, 3
• Heplisav-B and PreHevbrio have insufficient pregnancy safety data 2

Interrupted Schedules

If the vaccination series is interrupted, do not restart—simply continue where you left off 2, 3

Minimum Intervals

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

Immunogenicity with Interrupted Schedules

• Increasing intervals between doses has little effect on final immunogenicity 1
• Longer intervals between the last 2 doses result in higher final antibody levels 1

Expected Response Rates

• After dose 1: 30-55% achieve protective antibody levels (anti-HBs ≥10 mIU/mL) 1
• After dose 2: 75% achieve protection 1
• After dose 3: >90% achieve protection 1
• Vaccine-induced immunity persists for >30 years 1, 3

Critical Pitfalls to Avoid

• Never restart the series if interrupted—this wastes doses and delays protection 2, 3
• Never give the final infant dose before 24 weeks of age—this may compromise long-term immunity 1, 3
• Never give dose 3 before 16 weeks from dose 1, even if 8 weeks have passed since dose 2 3
• Never use standard adult doses in hemodialysis patients—they require 40 μg doses 1, 2
• Never use Heplisav-B or PreHevbrio in pregnant women, children, or hemodialysis patients 2
• Never delay the birth dose beyond 12 hours in infants born to HBsAg-positive mothers 3
• Never use combination vaccines (Twinrix) for the birth dose—only single-antigen vaccine 1