From the Guidelines
Hepatitis B vaccine boosters are generally not recommended for elderly individuals who have previously completed the standard vaccination series. The standard hepatitis B vaccine series consists of three doses given over a 6-month period, which typically provides long-lasting immunity for most people. For healthy adults who have completed the initial series and developed adequate antibody levels (≥10 mIU/mL), routine booster doses are not necessary, as supported by the Advisory Committee on Immunization Practices (ACIP) recommendations 1. However, certain high-risk elderly individuals may benefit from antibody testing and potential booster vaccination, including those with compromised immune systems, those on dialysis, or those with ongoing exposure risk.
Some key points to consider:
- The ACIP recommends hepatitis B vaccination for adults aged 19-59 years, as well as for adults aged ≥60 years with risk factors for hepatitis B 1.
- The recommended doses and schedules of hepatitis B vaccine for adults aged ≥18 years vary depending on the vaccine type and age group, as outlined in the ACIP recommendations 1.
- For adults on hemodialysis and other immunocompromised adults, a higher dose of hepatitis B vaccine is recommended, such as 40 μg of Engerix-B at 0,1,2, and 6 months or 40 μg of Recombivax HB at 0,1, and 6 months 1.
- If an elderly person has never been vaccinated against hepatitis B, they can still receive the primary series, which typically follows a 0,1, and 6-month schedule using either Engerix-B (20 mcg per dose) or Recombivax HB (10 mcg per dose) 1.
The decision to vaccinate should be based on individual risk factors and discussed with a healthcare provider, taking into account the potential benefits and risks of vaccination, as well as the individual's overall health status and medical history.
From the Research
Hepatitis B Vaccine for the Elderly
The question of whether to top up the hepatitis B vaccine for the elderly can be addressed by considering several studies on the durability of antibody response and the need for booster doses.
Durability of Antibody Response
- A 22-year follow-up study found that 60% of participants had an anti-HBs level ≥10 mIU/mL, and 77% of those who received a booster dose responded with an anti-HBs level ≥10 mIU/mL at 10-14 days 2.
- A 30-year follow-up study found that 51% of participants had an anti-HBs level ≥10 mIU/mL, and 88% of those who received a booster dose responded with an anti-HBs level ≥10 mIU/mL at 30 days 3.
- A study on healthcare workers vaccinated as adults found that anti-HBs levels decreased over time, but a booster dose was effective in increasing antibody levels in 94% of participants 4.
Need for Booster Doses
- The studies suggest that booster doses are not necessarily needed, as the protection afforded by primary immunization with hepatitis B vaccine can last for at least 22-30 years 2, 3.
- However, a study on older adults found that a fourth vaccine dose was well tolerated and resulted in improved immunogenic response in poor and non-responders 5.
- Another study found that younger healthcare workers and those who received the vaccine more recently were more likely to have a protective immune response, suggesting that booster doses may be necessary for older adults or those vaccinated long ago 6.
Key Findings
- The durability of antibody response to hepatitis B vaccine decreases over time, but a booster dose can be effective in increasing antibody levels.
- The need for booster doses depends on various factors, including age, time since vaccination, and individual immune response.
- Further research is needed to determine the optimal vaccination strategy for the elderly and other high-risk groups.