hepatitis b vaccine (Rx)

3-dose series

• Engerix B: 1 mL (20 mcg) IM at 0, 1, and 6 months
• Recombivax HB: 1 mL (10 mcg) IM at 0, 1, and 6 months
• Heplisav-B: Can be used as a substitute in a 3-dose series with a different hepatitis B vaccine

2-dose series

• Heplisav-B (aged ≥18 years): 0.5 mL IM at 0 and 1 month

Adults receiving dialysis or other immunocompromising conditions

• Recombivax HB (40 mcg/mL): 40 mcg IM at 0, 1, and 6 months, OR
• Engerix-B (20 mcg/mL): 40 mcg IM at 0, 1, and 6 months

Adults with diabetes mellitus

• CDC ACIP guidelines recommends immunization with hepatitis B vaccine for all unvaccinated adults with diabetes mellitus through age 59 years
• Persons with diabetes are at increased risk of hepatitis B infection
• Vaccinate diabetics aged ≥60 yr at the discretion of the treating clinician, based on increased need for assisted blood glucose monitoring in long-term care facilities, likelihood of acquiring hepatitis B infection, its complications or chronic sequelae, and likelihood of immune response to vaccination
• Vaccination for older unvaccinated diabetic patients may be done at the physician's discretion MMWR Dec 23, 2011/Vol 60(50);1709-11

Targeted groups that should receive HepB vaccination series include

• Sexually active persons who are not in a long-term, mutually monogamous relationship persons seeking evaluation or treatment for a sexually transmitted disease (STD); current or recent injection-drug users; and men who have sex with men
• Health-care personnel and public-safety workers who are potentially exposed to blood or other infectious body fluids
• Persons with diabetes, HIV infection, or chronic liver disease
• Persons with end-stage renal disease, including patients receiving hemodialysis
• Household contacts and sex partners of hepatitis B surface antigen-positive persons; clients and staff members of institutions for persons with developmental disabilities; and international travelers to countries with high or intermediate prevalence of chronic HBV infection
• All adults in the following settings: STD treatment facilities; HIV testing and treatment facilities; facilities providing drug-abuse treatment and prevention services; health-care settings targeting services to injection-drug users or men who have sex with men; correctional facilities; end-stage renal disease programs and facilities for chronic hemodialysis patients; and institutions and nonresidential daycare facilities for persons with developmental disabilities
• Pregnant women who are at risk for hepatitis B virus infection during pregnancy (eg, >1 sex partner during the previous 6 months, been evaluated or treated for a sexually transmitted infection, recent or current injection drug use, or had an HBsAg-positive sex partner)
• International travelers to regions with high or intermediate levels of endemic hepatitis B virus infection should receive a HepB series

Primary immunization

• First dose
  • Medically stable infants weighing ≥2,000 grams born to HBsAg-negative mothers: 0.5 ML IM within 24h of birth
  • Preterm infants weighing <2,000 g born to HBsAg-negative mothers: 0.5 mL IM 1 month after birth or at hospital discharge
  • Infants born to HBsAg-positive mothers: 0.5 mL IM within 12 hr of birth PLUS hepatitis B immune globulin (HBIG); test for HBsAg and antibody to HBsAg (anti-HBs) 1-2 months after completion of hepatitis B vaccination series, at age 9 through 18 months
  • Mother's HBsAg status unknown: 0.5 mL IM within 12 hr of birth PLUS give HBIG; if newborn wt <2 kg, determine mother's HBsAg status as soon as possible and, if she is HBsAg-positive, also administer HBIG for infants weighing 2 kg or more (no later than age 1 week)
• Second dose
  • Administered at age 1-2 months Monovalent HepB vaccine should be used for doses administered before age 6 weeks
  • Infants who did not receive a birth dose should receive 3 doses of a HepB-containing vaccine on a schedule of 0, 1 to 2 months, and 6 months starting as soon as feasible
  • Minimum interval between dose 1 and dose 2 is 4 weeks, and between dose 2 and 3 is 8 weeks
• Final (3rd or 4th) dose
  • Administered no earlier than age 24 weeks, and at least 16 weeks after the first dose
  • A total of 4 doses of HepB vaccine is recommended when a combination vaccine containing HepB is administered after the birth dose

Catch-up schedule

• Unvaccinated children should complete a 3-dose series
• Children aged 11-15 years: 2-dose series (doses separated by at least 4 months) of adult formulation
• Recombivax HB is licensed for use in children aged 11 through 15 years