Hepatitis B Vaccination Schedule
Standard Adult Schedule (≥18 years)
For adults, administer hepatitis B vaccine using either a 3-dose series at 0,1, and 6 months (Engerix-B, Recombivax HB, or PreHevbrio) or a 2-dose series at 0 and 1 month (Heplisav-B). 1, 2
Three-Dose Regimens
- Engerix-B: 20 μg (1.0 mL) per dose at 0,1, and 6 months 1, 2
- Recombivax HB: 10 μg (1.0 mL) per dose at 0,1, and 6 months 1, 2
- PreHevbrio: 10 μg (1.0 mL) per dose at 0,1, and 6 months 2
Two-Dose Regimen
- Heplisav-B: 20 μg (0.5 mL) per dose at 0 and 1 month 1, 2
- This option provides higher seroprotection rates (approximately 90%) compared to traditional vaccines (70.5%-90.2%) 3
Pediatric and Adolescent Schedule
Infants (Birth through 12 months)
All infants should receive the first dose of hepatitis B vaccine at birth, followed by completion of the series by 6-18 months of age. 1
For Infants ≥2,000 g with HBsAg-Negative Mothers:
- Dose 1: Birth (within 24 hours preferred)
- Dose 2: 1-2 months
- Dose 3: 6-18 months (not before 24 weeks of age) 1
For Infants Born to HBsAg-Positive Mothers:
- Dose 1: Birth (within 12 hours) PLUS hepatitis B immune globulin (HBIG) at separate site 1
- Dose 2: 1-2 months
- Dose 3: 6 months (not before 24 weeks of age) 1
For Low Birth Weight Infants (<2,000 g) with HBsAg-Negative Mothers:
Children and Adolescents (Catch-up Vaccination)
For unvaccinated children and adolescents, administer a 3-dose series at 0,1, and 6 months. 1
Adolescent-Specific Options (Ages 11-15):
- Standard: Recombivax HB 10 μg (0.5 mL) at 0,1, and 6 months 2
- Alternative 2-dose: Recombivax HB adult formulation (10 μg/1.0 mL) at 0 and 4-6 months 1, 2
Special Population Schedules
Hemodialysis Patients and Immunocompromised Adults
Use high-dose formulations with either 3 or 4 doses depending on the vaccine product. 1, 2
- Recombivax HB: 40 μg (1.0 mL) at 0,1, and 6 months 1, 2
- Engerix-B: 40 μg (2.0 mL) at 0,1,2, and 6 months 1, 2
Pregnant Women
Pregnant women requiring hepatitis B vaccination should receive only Engerix-B, Recombivax HB, or Twinrix, as Heplisav-B and PreHevbrio lack sufficient safety data in pregnancy. 2
Alternative and Accelerated Schedules
Accelerated 4-Dose Schedule
For individuals requiring rapid protection, administer doses at 0,1,2, and 12 months to achieve earlier seroprotection. 1, 2, 4
- This schedule provides faster antibody response after the first two doses (>80% seroprotection within 1 month) 5
- The 12-month dose remains essential for long-term protection 1, 2
Twinrix Accelerated Schedule
For combined hepatitis A and B protection, Twinrix can be given at 0 days, 7 days, 21-30 days, and 12 months. 1, 2
- If day 21 is missed, administer within the 21-30 day window; if that window is missed, give immediately when patient returns 6
- The 12-month dose should be given 12 months after the first dose, not adjusted based on third dose timing 6
Critical Management Principles
Interrupted Schedules
If the vaccination schedule is interrupted, never restart the series—simply continue where you left off. 6, 3, 2
- The second and third doses should be separated by ≥8 weeks 2
- The final dose must be administered at least 16 weeks after the first dose 2
- Vaccine doses given ≤4 days before the minimum interval are considered valid 2
Minimum Intervals
- Between doses 1 and 2: 4 weeks 1
- Between doses 2 and 3: 8 weeks 1, 2
- Between doses 1 and 3: 16 weeks 1
Common Pitfalls to Avoid
- Do not restart the series if doses are delayed—there is no maximum interval between doses 6, 3, 2
- Do not use Heplisav-B or PreHevbrio in pregnant women, hemodialysis patients, or children 2
- Do not administer the final dose before 24 weeks of age in infants 1
- Do not assume pre-vaccination testing is required—lack of testing should not delay vaccination 2
- Do not use Pediarix for the birth dose—it is only approved for ages 6 weeks and older 1