Hepatitis B Vaccination for Adults — Who Needs It 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:

General

• 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.

Others

• 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)