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:
- 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.
Immunization Action Coalition information