| Many healthcare professionals have questions, as well as some
misconceptions, about the hepatitis B vaccination schedule for infants,
children and teens. But the routine guidance for using this vaccine is
straightforward: CDC, AAP, AAFP and ACOG all recommend that all children
ages 0 through 18 years be vaccinated against hepatitis B. What sometimes
can be confusing is the testing and vaccination guidance for certain
high-risk groups, which include healthcare personnel and foreign-born
individuals. This special guidance will be addressed in a future
Technically Speaking column. Here is a summary of CDC/AAP/AAFP/ACOG
recommendations for routine vaccination of infants, children and teens:
For newborns
- Dose #1: Administer to every newborn before hospital discharge.
- Dose #2: Administer at 1 to 2 months of age.
- Dose #3: Administer at 6 to 18 months of age, and no earlier than 24
weeks of age.
Note about using combination vaccines:
When using Comvax® (Hib/HepB; Merck) or Pediarix®(DTaP/IPV/HepB; GSK), a
total of four doses of hepatitis B vaccine, including the monovalent birth
dose, is recommended. The four doses are covered by the Vaccines for
Children program and private insurers.
For children and teens not vaccinated beginning at birth
- The dosing schedule is 0, 1 to 2 months, and 4 to 6 months.
- There is some flexibility in this schedule. Just keep in mind the
minimum intervals between doses. For hepatitis B vaccine, there must be:
- At least four (4) weeks between doses #1 and #2
- At least eight (8) weeks between doses #2 and #3
- At least 16 weeks between doses #1 and #3
Note: A two-dose series instead of three
doses may be administered to adolescents ages 11 through 15 years if using
Recombivax HB® adult dose (1.0 mL, Merck). Dose #2 is given four to six
months after dose #1.
How do I complete an incomplete series?
Only doses documented in writing should be accepted. If only one or two
doses of hepatitis B vaccine have been given and it has been months or
years since the most recent dose, do not start the series over.
Simply continue from where it was interrupted, and follow the minimum
dosing intervals outlined above. For example, if the series was
interrupted after dose #1, dose #2 should be given as soon as possible;
doses #2 and #3 should be separated by an interval of eight (8) weeks or
more. If only dose #3 is delayed, administer it as soon as possible.
Serologic testing is not an alternative to completing the hepatitis B
vaccine series. More on this below.
What if a dose was given too early?
A dose can be counted as valid as long as the minimum intervals are
met, as described above for hepatitis B vaccine. Keep in mind the
additional guidance that an infant should not receive the last dose in the
series earlier than 24 weeks of age. In general, CDC allows a four-day
"grace period" for vaccines, i.e., vaccine doses administered up to four
(4) days before the minimum interval or age can be counted as valid. If a
dose was administered five (5) or more days earlier than the recommended
minimum interval between doses, it is not valid and should be repeated.
The repeat dose should be spaced after the invalid dose by an interval at
least equal to the recommended minimum interval.
What about simply testing for immunity with a hepatitis B surface
antibody (anti-HBs) blood test after one or two doses?
CDC does not recommend routine testing of children and teens who are
vaccinated against hepatitis B.
If a child/teen who has had only one or two documented doses of
hepatitis B vaccine is tested and found to be immune by anti-HBs serology,
CDC still recommends that the child/teen receive three (3) doses in order
to assure long-term protection.
Resources
CDC information
Immunization Action Coalition information
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ACIP Recommendations
Vaccine Information Statements 
