Can a healthy infant who received the hepatitis B (HepB) vaccine at birth receive 3 doses of Vaxelis (diphtheria, tetanus, pertussis, poliovirus, Haemophilus influenzae type b, and hepatitis B vaccines) at 2, 4, and 6 months?

Vaxelis Dosing After Birth Hepatitis B Vaccine

Yes, an infant who receives the hepatitis B vaccine at birth can and should receive 3 doses of Vaxelis at 2,4, and 6 months of age—this is the CDC-recommended standard schedule. 1, 2

Standard Vaccination Schedule

The recommended approach is straightforward:

• Birth: Monovalent hepatitis B vaccine (Vaxelis is NOT licensed for birth dose) 1, 2
• 2 months: First dose of Vaxelis 1, 2
• 4 months: Second dose of Vaxelis 1, 2
• 6 months: Third dose of Vaxelis 1, 2

This schedule results in a total of 4 doses of hepatitis B vaccine (1 monovalent + 3 in Vaxelis), which is safe, well-tolerated, and does not increase adverse reactions. 3

Critical Timing Requirements

The third dose of Vaxelis must be given at or after 24 weeks of age to ensure adequate hepatitis B immune response. 1, 2 Key timing parameters include:

• Minimum age for first Vaxelis dose: 6 weeks 1, 2
• Minimum interval between doses: 4 weeks 1, 2
• Minimum age for third dose: 24 weeks (approximately 6 months) 1, 2

Common Pitfall to Avoid

If the third Vaxelis dose is inadvertently given before 24 weeks of age, you must administer an additional monovalent hepatitis B vaccine dose at ≥24 weeks to complete the series. 1, 2 This is because adequate hepatitis B immune response requires the final dose at or after 24 weeks of age. 1

Maternal Hepatitis B Status Considerations

The schedule works regardless of maternal status:

• HBsAg-negative mothers: Standard schedule as above (birth HepB + Vaxelis at 2,4,6 months) 1, 2
• HBsAg-positive or unknown status mothers: Same Vaxelis schedule can be used, but these infants require monovalent hepatitis B vaccine PLUS hepatitis B immune globulin (HBIG) within 12 hours of birth 1, 2

Important Limitations

Vaxelis should NOT be used for booster doses. 1, 2 After completing the 3-dose primary series:

• A separate DTaP vaccine is needed for the fourth dose at 15-18 months 2
• A separate Hib conjugate vaccine is needed for the booster at 12-15 months 2
• A separate IPV vaccine is needed for the fourth dose at 4-6 years 2

Special Population Note

For American Indian/Alaska Native infants, the CDC does not have a preferential recommendation for Vaxelis due to limited data on antibody response after the first dose in this population. 1, 2 These infants historically benefit from vaccines containing PRP-OMP (which provides protection after the first dose), and Vaxelis does not contain this formulation. 1