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
Resources from CDC