Published on in Vaccine Update for Healthcare Providers
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
- Hepatitis A and Hepatitis B Vaccines: Be Sure Your Patients Get the Correct Dose
- Should You Be Vaccinated Against Hepatitis B?
- Do I Need Any Vaccinations Today?
- Standing Orders for Administering Hepatitis B Vaccine to Adults
Resources from CDC
- A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: Immunization of Adults
- Use of Hepatitis B Vaccination for Adults with Diabetes Mellitus: Recommendations of the Advisory Committee on Immunization Practices (ACIP)
Materials in this section are updated as new information and vaccines become available. The Vaccine Education Center staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family's personal health. You should not use it to replace any relationship with a physician or other qualified healthcare professional. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult your physician or, in serious cases, seek immediate assistance from emergency personnel.