There are 4 different HepB vaccines approved for adults, plus the Twinrix (GSK) combination HepA-HepB vaccine. While all of the HepB vaccines licensed for adults are acceptable and recommended, with no preference among them expressed by ACIP, some of the differences among them are outlined below. Clinicians choosing among products may find it useful to consider these differences when making choices for their patient population.
The schedule for Heplisav-B (Dynavax) is 2 doses, given at least one month apart, while all other products require a 3-dose series given over a period of 6 months. Twinrix protects adults against both hepatitis A and B in 3 doses given over 6 months, if vaccination against both is desired. Heplisav-B and PreHevbrio (VBI), both show higher seroconversion rates among some groups that traditionally respond poorly to HepB; the immune response to Engerix-B (GSK) and Recombivax-HB (Merck) declines gradually after age 40, and may be lower in people who are obese or who have diabetes. PreHevbrio is the only HepB product that does not contain yeast, making it is safe for yeast-allergic recipients.
Recombivax-HB and Engerix-B are both recommended when vaccinating during pregnancy; neither Heplisav-B nor PreHevbrio are recommended during pregnancy at this time due to insufficient data available on the safety of these products when given during pregnancy. (Note: testing for pregnancy before HepB vaccination is not recommended.)