What are the risk factors that should trigger routine administration of hepatitis B vaccine (HepB) in adults age 60 years or older, now that vaccination is routinely recommended for everyone younger than age 60?

In general, one HepB series is needed in a lifetime, with rare exceptions described at the end of this answer.

As of April 2022, CDC recommends HepB vaccination of all adults age 60 or older who are in any of the following risk groups (vaccination also may be offered to age 60 and older, regardless of risk):

• All adults age 60 years and older with risk factors for hepatitis B:
  • People at risk for infection by sexual exposure
    • Sex partners of people testing positive for HBsAg
    • Sexually active people who are not in a long-term, mutually monogamous relationship (e.g., those with more than one sex partner during the previous 6 months)
    • People seeking evaluation or treatment for a sexually transmitted infection
    • Men who have sex with men
  • People at risk for infection by percutaneous or mucosal exposure to blood
    • People with current or recent injection drug use
    • Household contacts of people testing positive for HBsAg
    • Residents and staff members of facilities for people with developmental disabilities
    • Healthcare and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids
    • People on maintenance dialysis, including in-center or home hemodialysis and peritoneal dialysis, and people who are predialysis
    • People with diabetes, at the discretion of the treating clinician
  • Others
    • International travelers to countries with high or intermediate levels of endemic hepatitis B virus (HBV) infection (HBsAg prevalence of 2% or higher)
    • People with hepatitis C virus infection
    • People with chronic liver disease (including, but not limited to, people with cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and an alanine aminotransferase or aspartate aminotransferase level greater than twice the upper limit of normal)
    • People with HIV infection
    • People who are incarcerated

The official CDC recommendations for HepB vaccination of adults are available at www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7113a1-H.pdf. Immunize.org has developed a standing order template for adult HepB vaccination: www.immunize.org/catg.d/p3076.pdf.

In general, people who have documented completion of a HepB series at any point or who have a history of previous HBV infection should not receive additional HepB vaccination, although there is no evidence that additional vaccination is harmful. In settings where the patient population has a high rate of previous HBV infection, prevaccination testing, which may be performed at the same visit when the first dose of vaccine is administered, might reduce costs by avoiding complete vaccination of people who are already immune. However, prevaccination testing is not required and should not create a barrier to vaccination.

Revaccination may be indicated for certain high-risk adults, including healthcare workers who are documented non-responders to an initial HepB series, and certain people who receive dialysis or who are immunocompromised. For specific revaccination guidance, see the 2018 ACIP recommendations for the prevention of hepatitis B at www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6701-H.pdf (pages 23–24).

People with risk factors who are 60 and older should be vaccinated and other people older than 60 may be vaccinated.