What is the recommended hepatitis B vaccination schedule, dosing, and post‑vaccination serologic testing for an adult health‑care worker who has never received hepatitis B vaccine?

Hepatitis B Vaccination for Healthcare Workers

Recommended Vaccination Schedule and Dosing

All unvaccinated healthcare workers with reasonably anticipated risk for exposure to blood or body fluids must complete a 3-dose hepatitis B vaccine series administered at 0,1, and 6 months. 1

• The standard schedule provides protective antibody levels (anti-HBs ≥10 mIU/mL) in >90% of healthy adults under 40 years after completing all three doses 2
• After dose 1, only 30-55% achieve protection; after dose 2,75% achieve protection; the third dose is essential for optimal immunity 2
• If the series is interrupted at any point, do not restart—simply continue where you left off 2, 3
• The minimum interval between doses 1 and 2 is 4 weeks, between doses 2 and 3 is 8 weeks, and between doses 1 and 3 is 16 weeks 2

Mandatory Post-Vaccination Serologic Testing

All healthcare workers at high risk for occupational percutaneous or mucosal exposure to blood or body fluids must undergo postvaccination serologic testing 1-2 months after the final vaccine dose. 1

• Testing should measure anti-HBs using a method that detects the protective concentration of ≥10 mIU/mL 1
• This testing is critical to determine immune status, guide future postexposure prophylaxis decisions, and identify non-responders who need revaccination 1, 3
• Healthcare workers determined to have anti-HBs ≥10 mIU/mL are considered immune, and this result must be documented 1
• Immunocompetent persons with documented adequate response have long-term protection and do not need further periodic testing 1, 4

Management of Non-Responders (Anti-HBs <10 mIU/mL)

Healthcare workers with anti-HBs <10 mIU/mL after the primary series must be revaccinated with a complete second 3-dose series, followed by repeat anti-HBs testing 1-2 months after the third dose. 1, 3

• Administering a second complete 3-dose series is more practical than testing after each additional dose 1
• Research demonstrates that 44-100% of initial non-responders achieve protective levels after revaccination 3
• If anti-HBs remains <10 mIU/mL after 6 total doses, test for HBsAg and anti-HBc to determine infection status 1, 3
• Confirmed non-responders (after 6 doses) should be counseled about their susceptibility and the critical need for hepatitis B immune globulin (HBIG) plus vaccine dose for any known or likely exposure to HBsAg-positive blood 1, 3

Critical Timing Considerations

The vaccination series should be completed before healthcare trainees have contact with blood, as higher risk has been reported during the professional training period. 1

• Vaccination should be offered in schools of medicine, dentistry, nursing, laboratory technology, and other allied health professions before clinical exposure 1
• Under OSHA regulations, healthcare personnel have mandatory vaccination requirements, with vaccine provided at the employer's expense 3

Common Pitfalls to Avoid

• Never restart an interrupted series—this wastes doses and delays protection; always continue from where you left off 2, 3
• Do not skip postvaccination testing in high-risk healthcare workers, as this is essential to confirm immunity and guide postexposure management 1, 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
• Do not assume immunity without documented serologic testing—29% of vaccinated healthcare workers in one study showed no serologic evidence of immunity 5
• Do not use standard adult doses in hemodialysis patients—they require 40 μg doses at 0,1, and 6 months with annual anti-HBs monitoring 2