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Hepatitis B Vaccination for Adults — Who Needs It and When?

October 2016

Technically Speaking
Monthly Column by Deborah Wexler, MD
Deborah Wexler MD
Technically Speaking is a monthly column written by IAC’s Executive Director Deborah Wexler, MD. The column is featured in The Children’s Hospital of Philadelphia Vaccine Education Center’s (VEC’s) monthly e-newsletter for healthcare professionals. Technically Speaking columns cover practical topics in immunization delivery such as needle length, vaccine administration, cold chain, and immunization schedules.
Check out a recent issue of Vaccine Update for Healthcare Providers. The VEC e-newsletter keeps providers up to date on vaccine-related issues and includes reviews of recently published journal articles, media recaps, announcements about new resources, and a regularly updated calendar of events.
Hepatitis B Vaccination for Adults — Who Needs It and When?
Published October 2016
Information presented in this article may have changed since the original publication date. For the most current immunization recommendations from the Advisory Committee on Immunization Practices, visit
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.

Routine 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 vaccine

  • 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 information.)

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 information, consult the ACIP hepatitis B vaccine recommendations for adults.

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 B.

People at risk for infection by sexual exposure

  • Sex partners of people who are hepatitis B surface antigen (HBsAg)-positive.
  • Sexually active people who are not in long-term, mutually monogamous relationships.
  • People seeking evaluation or treatment for a sexually transmitted disease.
  • 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 people.
  • 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 for
  • 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 administered.

In a future issue, we will review the various hepatitis B serologic tests, who needs testing, and when they need it (pre- or post-vaccination).

Resources from IAC

Resources from CDC

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