Tuesday, March 21, 2023
| HepB vaccine*/Age group, yrs | Dose (μg) | Volume (mL) | Schedule |
|---|---|---|---|
| Recombivax HB | |||
| 11–15 | 10 | 1 | 2 doses at 0 and 4–6 mos† |
| 11–19 | 5 | 0.5 | 3 doses at 0, 1, and 6 mos† |
| ≥20 | 10 | 1 | |
| Adults on hemodialysis and other immunocompromised adults aged ≥20 | 40 | 1 | |
| Engerix-B | |||
| 11–19 | 10 | 0.5 | 3 doses at 0, 1, and 6 mos |
| ≥20 | 20 | 1 | |
| Adults on hemodialysis and other immunocompromised adults aged ≥20 | 40 | 2 | 4 doses at 0, 1, 2, and 6 mos§ |
| Heplisav-B | |||
| ≥18¶ | 20 | 0.5 | 2 doses at 0 and 1 mos |
| Twinrix (HepA-HepB combination vaccine) | |||
| ≥18 | 20 | 1 | 3 doses at 0, 1, and 6 mos (standard) or 4 doses at 0 d, 7 d, 21–30 d, and 12 mos (accelerated) |
| PreHevbrio (ACIP-recommended in 2022) | |||
| ≥18¶ | 10 | 1 | 3 doses at 0, 1, and 6 mos |
TABLE. Recommended doses and schedules of hepatitis B vaccine for adults aged ≥18 years and persons aged 11–19 years, by vaccine type and age group*
Abbreviations: ACIP = Advisory Committee on Immunization Practices; HepA = hepatitis A; HepB = hepatitis B.
*If the HepB vaccination schedule is interrupted, the series does not need to be restarted. If a 3-dose series is interrupted after the first dose, the second dose should be administered as soon as possible; the second and third doses should be separated by an interval of ≥8 weeks. If only the third dose has been delayed, it should be administered as soon as possible. The final dose of a 3-dose series must be administered ≥8 weeks after the second dose and ≥16 weeks after the first dose; the minimum interval between the first and second doses is 4 weeks. Inadequate doses of hepatitis B vaccine or doses received after a shorter-than-recommended dosing interval should be readministered, using the correct dosage or schedule. Vaccine doses administered ≤4 days before the minimum interval or age are considered valid. Because of the unique accelerated schedule for Twinrix (https://www.fda.gov/media/119351/download), the 4-day guideline does not apply to the first 3 doses of this vaccine when administered on a 0-day, 7-day, 21–30-day, and 12-month schedule. PreHevbrio (https://www.fda.gov/media/154561/download) is a three-antigen HepB vaccine approved by the Food and Drug Administration in 2021 and recommended by ACIP in 2022.
†A 2-dose schedule of Recombivax HB adult formulation (10 μg) (https://www.fda.gov/media/74274/download) is licensed for children and adolescents aged 11–15 years. When scheduled to receive the second dose, persons aged ≥16 years should be switched to a 3-dose series, with doses 2 and 3 consisting of the pediatric formulation administered on an appropriate schedule.
§Engerix-B (https://www.fda.gov/media/119403/download) for adults on hemodialysis and is administered as a series of 4 doses
(2 mL each) as a single 2-mL dose or as two 1-mL doses on a 0-, 1-, 2-, and 6-month schedule. Recombivax HB for adults on
dialysis is a 3-dose series.
¶The safety and effectiveness of Heplisav-B and PreHevbrio have not been established in adults on hemodialysis. Data are not
available to assess the effects of Heplisav-B and PreHevbrio on breastfed infants or on maternal milk production and excretion.
Data on Heplisav-B (https://www.fda.gov/media/108745/download) and PreHevbrio are currently insufficient to inform vaccine-associated
risks in pregnancy. Thus, providers should vaccinate pregnant persons needing HepB vaccination with Engerix-B, Recombivax
HB, or Twinrix.
|
All infants
Persons aged <19 years Adults aged 19–59 years Adults aged ≥60 years with risk factors for hepatitis B:
|
| Abbreviation: HBsAg = hepatitis B surface antigen. |
BOX. Persons recommended to receive hepatitis B vaccination
Physicians - maximum of 0.50 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 0.50 ABIM MOC points
Nurses - 0.50 ANCC Contact Hour(s) (0.5 contact hours are in the area of pharmacology)
Pharmacists - 0.50 Knowledge-based ACPE (0.050 CEUs)
This activity is intended for public health officials, infectious disease clinicians, hepatologists, family practitioners, nurses, pharmacists, and other healthcare providers (HCPs) involved in hepatitis B (HepB) vaccination.
The goal of this activity is for learners to be better able to describe the latest Advisory Committee on Immunization Practices (ACIP) recommendations for HepB vaccination in the United States.
Upon completion of this activity, participants will:
Medscape, LLC designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.50 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
Awarded 0.50 contact hour(s) of continuing nursing education for RNs and APNs; 0.50 contact hours are in the area of pharmacology.
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CME / ABIM MOC / CE Released: 7/15/2022
Valid for credit through: 7/15/2023
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Hepatitis B (HepB) vaccines have demonstrated safety, immunogenicity, and efficacy during the past 4 decades.[1,2] However, vaccination coverage among adults has been suboptimal, limiting further reduction in hepatitis B virus (HBV) infections in the United States. This Advisory Committee on Immunization Practices (ACIP) recommendation expands the indicated age range for universal HepB vaccination to now include adults aged 19–59 years. Removing the risk factor assessment previously recommended to determine vaccine eligibility in this adult age group[2] could increase vaccination coverage and decrease hepatitis B cases.
