What is the recommended Hepatitis B (HBV) vaccine schedule for a general population?

Hepatitis B Vaccine Schedule

For adults aged 18 years and older, use either the traditional 3-dose series at 0,1, and 6 months (Engerix-B, Recombivax HB, or PreHevbrio) or the 2-dose Heplisav-B series at 0 and 1 month, with the 2-dose option offering faster completion and similar protection. 1

Standard Adult Schedules (≥18 years)

Traditional 3-Dose Series (0,1,6 months):

• Recombivax HB: 10 μg (1.0 mL) per dose for adults ≥20 years 1
• Engerix-B: 20 μg (1.0 mL) per dose for adults ≥20 years 1
• PreHevbrio: 10 μg (1.0 mL) per dose for adults ≥18 years 1

Accelerated 2-Dose Series:

• Heplisav-B: 20 μg (0.5 mL) at 0 and 1 month for adults ≥18 years, achieving approximately 90% seroprotection compared to 70.5-90.2% with traditional vaccines 1, 2

Adolescent Schedules (11-19 years)

For ages 11-15 years (Recombivax HB):

• Either 10 μg (0.5 mL) in a 2-dose schedule at 0 and 4-6 months, OR a 3-dose schedule at 0,1, and 6 months 1

For ages 11-19 years (Engerix-B):

• 10 μg (0.5 mL) per dose in a 3-dose schedule at 0,1, and 6 months 1

Infant Schedule

All infants should receive:

• First dose at birth, followed by completion of the series by 6-18 months of age 3
• The final dose must not be administered before 24 weeks of age 2, 3

For infants born to HBsAg-positive mothers:

• First dose within 12 hours of birth plus HBIG, then at 1-2 months and 6 months 2
• Delaying the birth dose beyond 12 hours significantly increases infection risk 2
• Post-vaccination testing at 9-15 months for HBsAg and anti-HBs 2

Special Populations

Hemodialysis and Immunocompromised Adults (≥20 years):

• Recombivax HB: 40 μg (1.0 mL) per dose in a 3-dose schedule at 0,1, and 6 months 1, 2
• Engerix-B: 40 μg (2.0 mL) per dose in a 4-dose schedule at 0,1,2, and 6 months 1, 2
• Annual anti-HBs testing with booster doses when levels fall below 10 mIU/mL 2

Pregnant Women:

• Use only Engerix-B, Recombivax HB, or Twinrix 1, 2, 3
• Do NOT use Heplisav-B or PreHevbrio due to insufficient safety data in pregnancy 1, 2, 3

Alternative Accelerated Schedules

For rapid protection when needed:

• 4-dose schedule at 0,1,2, and 12 months provides earlier seroprotection but requires the fourth dose at 12 months for long-term protection 1, 3
• After dose 1,30-55% achieve protection; after dose 2,75% achieve protection; after dose 3, >90% achieve protection 2

Twinrix (combined hepatitis A and B):

• Standard: 3 doses at 0,1, and 6 months 1
• Accelerated: 4 doses at 0 days, 7 days, 21-30 days, and 12 months 1, 3
• Reserve for patients requiring both hepatitis A and B protection (international travelers, men who have sex with men, chronic liver disease patients) 2

Critical Minimum Intervals

Mandatory spacing requirements:

• Minimum 4 weeks between doses 1 and 2 2, 3
• Minimum 8 weeks between doses 2 and 3 2, 3
• Minimum 16 weeks between doses 1 and 3 2, 3
• Doses administered ≤4 days before the minimum interval are considered valid 1, 2

Interrupted Schedules

If vaccination is interrupted:

• Never restart the series—simply continue where you left off 1, 2, 3
• If interrupted after dose 1, give dose 2 as soon as possible, then dose 3 at least 8 weeks after dose 2 2
• The second and third doses should be separated by ≥8 weeks 1, 3
• Increasing intervals between doses has little effect on final immunogenicity, but longer intervals between the last 2 doses result in higher final antibody levels 2

Immunogenicity Considerations

Timing impacts antibody response:

• Longer intervals between the second and third doses produce higher antibody titers 4
• The 0,1,12-month schedule produces higher GMTs (19,912 IU/L) compared to 0,1,6-month schedule (5,846 IU/L) 4
• Vaccine-induced immunity persists for >30 years 2
• Standard schedules produce protective antibody response in >90% of adults under 40 years, but response rates decline with age 2

Common Pitfalls to Avoid

• Do not restart the series if interrupted—this wastes doses and delays protection 1, 2, 3
• Do not give the third dose before 16 weeks from the first dose, even if 8 weeks have passed since the second dose 2, 3
• Do not give the final infant dose before 24 weeks of age, as this may compromise long-term immunity 2, 3
• Do not use standard adult doses in hemodialysis patients—they require 40 μg doses 2
• Do not use Heplisav-B or PreHevbrio in pregnant women, children, or hemodialysis patients 1, 2, 3
• Do not use Twinrix simply for hepatitis B vaccination when the patient has no indication for hepatitis A protection 2