|Hepatitis B vaccination
recommendations vary by a person’s age and risk factors. In the
Technically Speaking column in August, we discussed routine
hepatitis B vaccination of infants, children and teens. This
month, let’s review hepatitis B vaccination of adults, including
vaccination guidance for high-risk groups. In an upcoming column,
we will review the issues surrounding hepatitis B serologic tests
and vaccination, including who needs testing and when.
administration schedule for hepatitis B vaccine in adults
- The dosing schedule is 0, 1 to 2 months, and 4 to 6 months.
- There is some flexibility in the schedule, but be sure to
keep in mind the minimum intervals between doses:
- At least four weeks between doses #1 and #2
- At least eight weeks between doses #2 and #3
- At least 16 weeks between doses #1 and #3
- If your patient falls behind on the hepatitis B vaccination
schedule (even if a year or more has elapsed), continue
vaccinating from where your patient left off. The series does
NOT need to be restarted.
Recommended adult dosing volume of monovalent hepatitis B
- Age 19 years and younger: Use 0.5 mL per dose (Engerix®-B
pediatric, GlaxoSmithKline; Recombivax HB® pediatric, Merck).
- Age 20 years and older: 1.0 mL per dose (Engerix-B adult,
GlaxoSmithKline; Recombivax HB adult, Merck). (For dialysis
patients, a larger dose is needed. See the prescribing
For a one-page sheet reviewing the hepatitis B dosing schedule
for children and adults, consult IAC’s
Hepatitis A and B Vaccines:
Be Sure Your Patients Get the Correct Dose. For complete dosing
consult the ACIP hepatitis B vaccine recommendations
Which adults should be vaccinated against hepatitis B?
According to CDC recommendations, adults in the following
groups are recommended to receive hepatitis B vaccine:
- All people age 18 years and younger. (CDC includes 18-year-olds
in their child/teen immunization recommendations.)
- Anyone 19 years and older who wants to be protected from hepatitis
People at risk for infection by sexual exposure
- Sex partners of people who are hepatitis B surface antigen
- Sexually active people who are not in long-term, mutually
- People seeking evaluation or treatment for a sexually transmitted
- Men who have sex with men.
People at risk for infection by percutaneous or permucosal
exposure to blood or body fluids
- Current or recent illegal injection drug users.
- Household contacts of people who are HBsAg-positive.
- Residents and staff of facilities for developmentally challenged
- Healthcare and public safety workers with reasonably anticipated
risk for exposure to blood or blood-contaminated body fluids.
- People with end-stage renal disease, including predialysis, hemo-,
peritoneal- and home-dialysis patients.
- International travelers to regions with intermediate or high
levels of endemic HBV infection.
- People with chronic liver disease.
- People with HIV infection.
- People with diabetes who are age 19 through 59 years. For those
age 60 and older, clinicians should make a determination of need
- vaccination based on their patients' situation.
According to ACIP recommendations, patients do not need to
identify (or admit to) a particular risk factor in order to be
eligible for vaccination. Anyone who wishes to be protected from
hepatitis B should be vaccinated.
Some patients (e.g., foreign-born persons from regions with
medium or high levels of HBV infection) are recommended to have
their blood tested for evidence of past or present hepatitis B
virus infection at the same time that they receive the first dose
of hepatitis B vaccine. Blood testing should be done at the same
visit as administering the first dose of hepatitis B vaccine.
Blood should be drawn prior to hepatitis B vaccine being
In a future issue, we will review the various hepatitis B
serologic tests, who needs testing, and when they need it (pre- or
Resources from IAC
Resources from CDC