A physician ordered a 40-mcg dose of hepatitis B vaccine for a hemodialysis patient. The clinic does not stock the Recombivax HB 40-mcg dose dialysis formulation (Merck) and would like to give 2 doses of Engerix-B 20-mcg dose (GSK) for each dose in the series. Is this acceptable?

Yes. If given on the same day as separate injections in separate sites, two injections of Engerix-B 20 mcg can be counted as the equivalent of one Recombivax HB 40-mcg dose. According to the package insert, Engerix-B is licensed for use in this manner (vaccine package inserts for all vaccines are available at www.immunize.org/fda). Note that an all-Engerix-B or mixed-brand dialysis schedule is a 4-dose series (doses at 0, 1, 2, and 6 months). Vaccination using only Recombivax HB dialysis formulation is a 3-dose schedule (doses at 0, 1, and 6 months). Heplisav-B and PreHevbrio have not been evaluated for use in dialysis patients.