A: In general, one HepB series is needed in a lifetime, with rare exceptions described at the end of this answer.
 
As of April 2022, CDC recommends HepB vaccination of adults in the following groups:

• All adults through age 59 years
• All adults age 60 years and older with risk factors for hepatitis B:
  • People at risk for infection by sexual exposure
    • Sex partners of people testing positive for HBsAg
    • Sexually active people who are not in a long-term, mutually monogamous relationship (e.g., those with more than one sex partner during the previous 6 months)
    • People seeking evaluation or treatment for a sexually transmitted infection
    • Men who have sex with men
  • People at risk for infection by percutaneous or mucosal exposure to blood
    • People with current or recent injection drug use
    • Household contacts of people testing positive for HBsAg
    • Residents and staff members of facilities for people with developmental disabilities
    • Healthcare and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids
    • People on maintenance dialysis, including in-center or home hemodialysis and peritoneal dialysis, and people who are predialysis
    • People with diabetes, at the discretion of the treating clinician
  • Others
    • International travelers to countries with high or intermediate levels of endemic hepatitis B virus (HBV) infection (HBsAg prevalence of 2% or higher)
    • People with hepatitis C virus infection
    • People with chronic liver disease (including, but not limited to, people with cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and an alanine aminotransferase or aspartate aminotransferase level greater than twice the upper limit of normal)
    • People with HIV infection
    • People who are incarcerated
• Adults age 60 or older years without known risk factors for HBV infection may receive HepB vaccination

The official CDC recommendations for HepB vaccination of adults are available at www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7113a1-H.pdf. Immunize.org has developed a standing order template for adult HepB vaccination: www.immunize.org/catg.d/p3076.pdf.  
 
In general, people who have documented completion of a HepB series at any point or who have a history of previous HBV infection should not receive additional HepB vaccination, although there is no evidence that additional vaccination is harmful. In settings where the patient population has a high rate of previous HBV infection, prevaccination testing, which may be performed at the same visit when the first dose of vaccine is administered, might reduce costs by avoiding complete vaccination of people who are already immune. However, prevaccination testing is not required and should not create a barrier to vaccination.
 
Revaccination may be indicated for certain high-risk adults, including healthcare workers who are documented non-responders to an initial HepB series, and certain people who receive dialysis or who are immunocompromised. For specific revaccination guidance, see the 2018 ACIP recommendations for the prevention of hepatitis B at www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6701-H.pdf (pages 23–24).

A: The most recent comprehensive recommendations for HepB vaccination were published April 1, 2022. The document is available at www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7113a1-H.pdf.  
 
In addition to the published recommendations, CDC has produced a frequently asked questions page for HBV infection and HepB vaccination: www.cdc.gov/hepatitis/hbv/hbvfaq.htm.

A: PreHevbrio (VBI, 3-dose series), Heplisav-B (Dynavax, 2-dose series), and Twinrix (GSK, combination HepA-HepB, 3-dose series) are approved for adults age 18 years and older. Engerix-B (GSK) and Recombivax HB (Merck), both administered as a 1.0 mL 3-dose series, are approved for adults age 20 years and older; young adults who are age 19 receive the 0.5 mL pediatric dose of Engerix-B and Recombivax HB.

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A: PreHevbrio (VBI) was approved by the FDA in November 2021 for people age 18 years and older. It is a triple-antigen (containing S, Pre-S1, and Pre-S2 HBV surface proteins) recombinant vaccine produced in mammalian cells (Chinese hamster ovary cells), and containing an alum adjuvant. It is given intramuscularly in a 3-dose series of 1.0 mL (10 mcg) doses administered on a 0-, 1-, and 6-month schedule. The most common side effects of vaccination are injection site pain and tenderness, as well as fatigue, muscle aches, and headache.
 
PreHevbrio was approved based on clinical trials conducted in adults age 18 years and older that compared seroprotection rates (SPR, defined as anti-HBs of 10 mIU or higher, and indicative of protection against HBV infection) following 3 doses of PreHevbrio to rates following 3 doses of Engerix-B (GSK). The SPR for PreHevbrio among adults age 18 years or older ranged from 83.6% to 99.2% (overall, 91.2% for all adults) compared to Engerix-B, which ranged from 64.7% to 91.1% (overall, 76.5% for all adults).
 
PreHevbrio was included as an option for HepB vaccination of adults age 18 years or older in the current ACIP recommendations published on April 1, 2022: www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7113a1-H.pdf.  
 
The package insert for PreHevbrio is available here: www.fda.gov/media/154561/download.

A: Yes. However, data are limited on the safety and immunogenicity effects when Heplisav-B or PreHevbrio are interchanged with HepB products from other manufacturers. When feasible, the same manufacturer's vaccines should be used to complete the series. However, vaccination should not be deferred when the manufacturer of the previously administered vaccine is unknown or when the vaccine from the same manufacturer is unavailable.
 
The 2-dose, 4-week HepB series for adults only applies when both doses in the series consist of Heplisav-B. Series consisting of a combination of 1 dose of Heplisav-B and a vaccine from a different manufacturer should consist of 3 total vaccine doses and should adhere to the 3-dose schedule minimum intervals of 4 weeks between dose 1 and 2, 8 weeks between dose 2 and 3, and 16 weeks between dose 1 and 3. Doses administered at less than the minimum interval should be repeated. However, a series containing 2 doses of Heplisav-B administered at least 4 weeks apart is valid, even if the patient received a single earlier dose from another manufacturer.

A: Yes. Many years of experience with Engerix-B and Recombivax HB brands of HepB vaccines indicate no apparent risk for adverse events to a developing fetus. Current HepB products contain noninfectious hepatitis B surface antigen (HBsAg) and should pose no risk to the fetus. If not vaccinated, a pregnant person may contract an HBV infection during pregnancy, which might result in severe disease for the newborn.
 
Available human data on Heplisav-B and PreHevbrio administered during pregnancy are insufficient to assess vaccine-associated risks in pregnancy. For this reason, until safety data are available for Heplisav-B or PreHevbrio, providers should continue to vaccinate people needing HepB during pregnancy with either Engerix-B or Recombivax HB. Pregnancy testing prior to vaccination is not recommended.
 
Mothers who breastfeed their babies and need HepB can be vaccinated. Although data are not available to assess the effects of Heplisav-B and PreHevbrio on breastfed infants or on maternal milk production and excretion, there is no theoretical risk to the infant and vaccination with any HepB product is acceptable.

A: Do nothing. Data show that vaccine-induced anti-HBs levels might decline over time; however, immune memory (anamnestic anti-HBs response) remains intact following immunization. People with anti-HBs concentrations that decline to less than 10 mIU/mL are still protected against HBV infection. For healthcare professionals with normal immune status who have demonstrated adequate anti-HBs (at least 10 mIU/ mL) following full vaccination, booster doses of vaccine or periodic anti-HBs testing are not recommended.

A: A serious allergic reaction to a prior dose of HepB or a vaccine component is a contraindication to further doses of HepB. Engerix-B, Recombivax HB, Twinrix, and Heplisav-B are synthesized in yeast cells into which a plasmid containing the gene for HBsAg has been inserted. People with a severe allergic reaction to yeast should not be vaccinated with vaccines produced in yeast cells. PreHevbrio is produced in mammalian cells and may be used (in the absence of other contraindications) in an adult with a severe allergic reaction to yeast.
 
As with other vaccines, vaccination of people with moderate or severe acute illness, with or without fever, should be deferred until the illness improves. Vaccination is not contraindicated in people with a history of multiple sclerosis, Guillain-Barré syndrome, or autoimmune diseases such as systemic lupus erythematosus or rheumatoid arthritis.

A: As of May 18, 2022, ACIP recommends that all people age 5 years or older who completed a primary series of an mRNA COVID-19 vaccine should receive a booster dose of an age-appropriate COVID-19 vaccine (preferably an mRNA vaccine). Among those who are immunocompetent, the interval between the final primary series dose and the booster dose should be at least 5 months. Those who are moderately or severely immunocompromised should receive their first booster dose at least 3 months after the third dose of their primary series.
 
Among those who receive an mRNA vaccine primary series and who have had a first booster dose, some also should receive a second mRNA booster dose at least 4 months after the first booster. Those who should receive a second booster dose include all age 50 years or older and all age 12 years or older who are moderately or severely immunocompromised.