How Many Hepatitis B Vaccines Do You Need

Accelerated Us Children And Adult Hepatitis B Vaccine Schedules

*Please note that the first dose should be given as soon as possible. Additional doses require minimum time intervals between doses in order for the vaccine to be effective.

In some instances, it may be necessary to vaccinate within a short period of time to ensure protection before travel. There are accelerated schedules to provide the highest level of protection over a short period of time. Individuals who need an accelerated schedule must have a booster dose at 1 year to ensure long-term protection. Note that the 2-dose Heplisav-B vaccine will also ensure maximum protection over a 1-month period without the need for a booster dose at 1 year.

4-Dose Vaccine Series for Children and Adults

Engerix-B is a 3-dose vaccine that can be given on an accelerated, four-dose schedule, with 3 shots administered within 2 months, and a booster dose at 1 year to provide maximum long-term protection.

4-Dose Combination Hepatitis A and B Vaccine Series

Twinrix is a 4-dose vaccine that can be given on an accelerated schedule to provide protection against hepatitis A and B. Three doses are administered within 1 month, followed by a booster shot at 1 year. This is a common choice of vaccine for those travelling on short-notice outside the U.S. It is important to complete the booster dose at 1 year, to ensure long-term protection.

2-Dose Vaccine Series

Additional Resource Links:

• Hepatitis B Vaccine Q& A

For Adults And Children

This vaccine schedule involves three doses within 2 months, followed by a booster dose at 1 year.

The initial accelerated doses provide immediate protection from HBV, and the booster dose helps provide long-term protection.

Below is the accelerated vaccination schedule approved for both adults and children:

Persons With Chronic Diseases

Refer to Immunization of Persons with Chronic Diseases in Part 3 for additional general information about vaccination of people with chronic diseases.

Chronic renal disease and patients on dialysis

People with chronic renal disease may respond sub-optimally to HB vaccine and experience more rapid decline of anti-HBs titres, and are therefore recommended immunization with a higher vaccine dose. Individuals undergoing chronic dialysis are also at increased risk for HB infection. In people with chronic renal disease anti-HBs titre should be evaluated annually and booster doses using a higher vaccine dose should be given as necessary.

Neurologic disorders

People with conditions such as autism spectrum disorders or demyelinating disorders should receive all routinely recommended immunizations, including HB-containing vaccine.

Chronic liver disease

HB immunization is recommended for non-immune persons with chronic liver disease, including those infected with hepatitis C, because they are at risk of more severe disease if infection occurs. Vaccination should be completed early in the course of the disease, as the immune response to vaccine is suboptimal in advanced liver disease. Post-immunization serologic testing may be used to confirm vaccine response.

Non-malignant hematologic disorders

Persons with bleeding disorders and other people receiving repeated infusions of blood or blood products are considered to be at higher risk of contracting HB and should be offered HB vaccine.

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Us Children And Adult Hepatitis B Vaccine Schedules

*Please note that the first dose should be given as soon as possible. Additional doses require minimum time intervals between doses in order for the vaccine to be effective.

3-Dose Vaccine Series for Children and Adults

The hepatitis B vaccine is an injection that is generally given in the arm as a three-dose series on a 0, 1, and 6-month schedule. Alternative schedules may be considered, noting that a third dose at 6 months, meeting minimum intervals between doses, is needed for maximum, long-term protection. Completing the hepatitis B vaccine series, preferably beginning at birth, will ensure protection against hepatitis B, hepatitis delta and lower the lifetime risk of liver cancer. Greater than 90% of babies and up to 50% of young children who are not vaccinated and are infected with hepatitis B will have lifelong infection, which makes the birth dose essential to their protection.

There are four, 3-dose vaccine brands approved in the U.S.

• PreHevbrio PreHevbrio is only approved for adults age 18 and over.

2-Dose Vaccine Series

Dose And Administration Of Hepatitis B Vaccine

The dose for Engerix-B® and Recombivax HB® is 0.5 mL IM up to age 20 years or 1 mL IM for adults . The dose for Heplisav-B® is 0.5 mL IM for adults 18 years.

The vaccine is typically given to children in a 3-dose series at age 0 months, at 1 to 2 months, and at 6 to 18 months.

Infants who did not receive a dose a birth should begin the series as soon as feasible.

All children not previously vaccinated with HepB vaccine should be vaccinated at age 11 or 12 years. A 3-dose schedule is used the 1st and 2nd doses are separated by 4 weeks, and the 3rd dose is given 4 to 6 months after the 2nd dose. However, a 2-dose schedule using Recombivax HB® can be used the 2nd dose is given 4 to 6 months after the first.

The usual schedule for adults using Engerix-B® or Recombivax HB® is a 3-dose series with 2 doses separated by 4 weeks, and a 3rd dose 4 to 6 months after the 2nd dose. Heplisav-B® is given in 2 doses at least 4 weeks apart and can be given as a substitute in a 3-dose series with a different HepB vaccine. Heplisav-B® should not be given during pregnancy because safety data are not available on its use during pregnancy.

Unvaccinated adults who are being treated with hemodialysis or who are immunocompromised should be given 1 dose of Recombivax HB® 40 mcg/mL in a 3-dose schedule at 0, 1, and 6 months or 2 doses of Engerix-B® 20 mcg/mL given simultaneously in a 4-dose schedule at 0, 1, 2, and 6 months.

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Who Should Get The Hepatitis A Vaccine

The CDC recommends that all children between ages 12 months and 23 months get this vaccine as well as for any infant aged 6 to 11 months who is traveling internationally.

The following people are also at risk for the disease and should be vaccinated:

• Children and teens through age 18 who live in states or communities that have made this vaccination routine because of a high rate of disease
• Men who have sex with men
• Anyone who uses illegal drugs
• People with chronic liver disease
• Anyone treated with blood clotting drugs, such as people with hemophilia
• People who work with HAV-infected primates or in HAV research laboratories.
• Travelers to countries where hepatitis A is common. A good source to check is the CDCâs travelersâ health website, which you can search by the country youâre going to.
• People adopting or close to a child adopted from a country where hepatitis A is common

You should not get the vaccine if you’re allergic to any ingredients in it or if you had a severe allergic reaction to an earlier dose of it. Tell your doctor or pharmacist about any allergies you have.

If you’re pregnant, let your doctor know. The safety of this vaccine for pregnant women is unknown, although the risk is considered to be very low.

Persons With Inadequate Immunization Records

Evidence of long term protection against HB has only been demonstrated in individuals who have been vaccinated according to a recommended immunization schedule. Independent of their anti-HBs titres, children and adults lacking adequate documentation of immunization should be considered susceptible and started on an immunization schedule appropriate for their age and risk factors. Refer to Immunization of Persons with Inadequate Immunization Records in Part 3 for additional information.

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What About The Hepatitis B Vaccine

The best way to prevent Hepatitis B is to get vaccinated. The Hepatitis B vaccine is now given to most babies at birth, but many adults have not had it. A member of our CVS pharmacy® team or a MinuteClinic® provider can talk with you about your risk for getting Hepatitis B and answer your questions about the vaccine. They can also administer the vaccine if you decide it is right for you.

How Is The Hepatitis B Vaccine Made

People are protected against hepatitis B virus infection by making an immune response to a protein that sits on the surface of the virus. When hepatitis B virus grows in the liver, an excess amount of this surface protein is made. The hepatitis B vaccine is made by taking the part of the virus that makes surface protein and putting it into yeast cells. The yeast cells then produce many copies of the protein that are subsequently used to make the vaccine. When the surface protein is given to children in the vaccine, their immune systems make an immune response that provides protection against infection with the hepatitis B virus.

The first hepatitis B vaccine was made in the 1980s by taking blood from people infected with hepatitis B virus and separating or purifying the surface protein from the infectious virus. Because blood was used, there was a risk of contaminating the vaccine with other viruses that might be found in blood, such as HIV. Although contamination with HIV was a theoretical risk of the early, blood-derived hepatitis B vaccine, no one ever got HIV from the hepatitis B vaccine. That is because the blood used to make vaccine was submitted to a series of chemical treatments that inactivated any possible contaminating viruses. Today, there is no risk of contaminating the vaccine with other viruses because the surface protein is manufactured in the laboratory.

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Indications For Hepatitis B Vaccine

HepB vaccine is a routine childhood vaccination .

HepB vaccine also is indicated for adults who have not been previously vaccinated when any of the following is present:

• A desire for protection from hepatitis B in people who have not been previously vaccinated

• A sexually active lifestyle in people who are not in a long-term, mutually monogamous relationship

• Need for evaluation or treatment of a sexually transmitted infection

• Current or recent use of illicit injection drugs

• Sex between men

• Employment in which workers may be exposed to blood or other potentially infectious body fluids

• Diabetes in people < 60 years and sometimes in those 60 years

• End-stage renal disease

• A chronic liver disorder

• Household contact and/or sexual contact with people who are positive for hepatitis B surface antigen

• Travel to endemic areas

• Time spent in correctional facilities or in facilities that provide sexually transmitted infection treatment, HIV testing and treatment, drug abuse treatment and prevention services, services to injection-drug users or men who have sex with men, or care for patients with developmental disabilities or with end-stage renal disease

• Pregnant women if at risk of infection or severe outcome resulting from infection during pregnancy

The combination HepA and HepB vaccine can be used in people 18 years who have indications for either hepatitis A or hepatitis B vaccine and who have not been previously vaccinated with one of the vaccine components.

Us Infant Hepatitis B Vaccine Schedules

*Please note that the first dose should be given as soon as possible. Additional doses require minimum time intervals between doses in order for the vaccine to be effective.

3-Dose Vaccine Series for Infants

Since 1991, ALL medically stable infants with a birth weight of at least 2,000 g in the U.S. are recommended to receive the first dose of hepatitis B vaccine within 24 hours of birth. The additional 2 doses are given at 1 month and 6 months of age.

4-Dose Vaccine Combination Series for Infants

Combination vaccines, such as the pentavalent and hexavalent vaccines, include protection against 5 or 6 diseases, including hepatitis B. The first shot is usually given at 6 weeks of age, but in order to protect infants from hepatitis B beginning at birth, a monovalent or single dose of the hepatitis B vaccine is also recommended within 24 hours of birth. The hepatitis B vaccine series can then be completed with the pentavalent or hexavalent vaccine with the recommended schedule.

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Why Do You Need A Hepatitis B Shot

Hepatitis B is a viral infection that cant be transferred person-to-person unless you have contact with an infected persons bodily fluids. Annual infection rates of HBV are going down in the United States thanks to vaccines. So you might be wondering if you or your child needs a shot to protect against hepatitis B.

Important Information About Vaccine And Hepatitis B Immunoglobulin Shot Administration

Where available, the hepatitis B birth-dose and HBIG should be administered within 24 hours of birth in order to prevent the transmission of hepatitis B from mother to child. It is very important that the shots be given in opposite limbs, to ensure the highest effectiveness. Please see chart above for more information.

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Who Should Receive Hepatitis B Vaccination

• All newborns before hospital discharge. Infants born to hepatitis B-positive women need hepatitis B vaccine and HBIG within 12 hours of birth.
• All children and adolescents not previously vaccinated.
• Children born in the U.S. to individuals born in a country with high hepatitis B endemicity.
• All individuals at risk of hepatitis B infection:
• Sex partners of hepatitis B-positive persons
• Sexually active persons who are not in a long-term, mutually monogamous relationship
• Persons seeking evaluation or treatment for a sexually-transmitted disease
• Men who have sex with men
• Persons who inject drugs
• Household contacts of hepatitis B-positive persons
• Persons born in countries where hepatitis B infection is endemic should be tested and vaccinated if susceptible
• International travelers to regions with high or intermediate rates of endemic hepatitis B infection
• Health care and public safety workers that may be exposed to blood or blood-contaminated body fluids
• Residents and staff of facilities for developmentally disabled persons, corrections facilities, and other facilities that serve adults at risk for hepatitis B infection
• Persons with end-stage renal disease, including pre-dialysis, hemodialysis, peritoneal dialysis, and home dialysis patients
• Persons with chronic liver disease
• Persons to age 60 years with diabetes
• Persons with HIV infection

• All other persons seeking protection from hepatitis B infection.

What Is Hepatitis B Virus

Hepatitis B virus attacks the liver. Hepatitis B virus infections are known as the “silent epidemic” because many infected people don’t experience symptoms until decades later when they develop hepatitis , cirrhosis , or cancer of the liver . Every year in the United States about 22,000 new hepatitis B infections occur and about 2,000 people die from their infections.

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How To Get Vaccinated Against Hepatitis B

All babies in the UK born on or after 1 August 2017 are given 3 doses of hepatitis B-containing vaccine as part of the NHS routine vaccination schedule.

These doses are given at 8, 12 and 16 weeks of age.

Babies at high risk of developing hepatitis B infection from infected mothers are given extra doses of the hepatitis B vaccine at birth, 4 weeks and 1 year of age.

If you think you’re at risk and need the hepatitis B vaccine, ask your GP to vaccinate you, or visit any sexual health or genitourinary medicine clinic.

If your job places you at risk of hepatitis B infection, it’s your employer’s responsibility to arrange vaccination for you, rather than your GP. Contact your occupational health department.

Is It Okay To Get An Extra Dose Of Hepatitis B Vaccine

Yes. Although extra doses of vaccine are not recommended, you can think of the extra dose as another chance for the immune system to see the hepatitis B virus. A vaccine is not the only time the immune system will see the virus or bacteria contained in it. People may be exposed to the virus or bacteria at school or the store or when visiting family or friends. An extra dose of vaccine is like one more exposure, except the difference is that the virus or bacteria in any vaccine has been made safe, so it wont make you ill.

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Facts About Hepatitis B

• Two billion people, or one in three, have been infected with hepatitis B worldwide. Of these, almost 300 million live with chronic hepatitis B. This means about 1 of every 26 people throughout the world are living with a chronic hepatitis B infection.
• Each year about 900,000 people die from hepatitis B worldwide, and about 2,000 of these deaths occur in the United States.
• Hepatitis B is transmitted through blood and is 100 times more infectious than HIV. An estimated one billion infectious viruses are in one-fifth of a teaspoon of blood of an infected person, so exposure to even a very small amount, such as on a shared toothbrush, can cause infection.
• Hepatitis B is sometimes referred to as the silent epidemic because most people who are infected do not experience any symptoms.
• Liver cancer accounted for about 5% of cancer deaths in the U.S. during 2020.
• Almost half of liver cancers are caused by chronic infection with hepatitis B.
• The World Health Organization recommends the inclusion of hepatitis B vaccine in immunization programs of all countries in 2019, more than 8 of 10 infants born throughout the world received three doses of hepatitis B vaccine.

Who Should Get Hepatitis Vaccinations

Since the vaccines were first developed, the hepatitis A and B vaccines have become part of the regular childhood immunization schedule. They are not considered a routine adult immunization.

“When we’re talking about adults, I would say yes, get the vaccine if they fit into one of these risk factors” says Poland. “If they don’t fit into the risk factors, their risk is so low that there’s no compelling reason to do it.”

People at risk for hepatitis A include:

• Anyone traveling to or working in areas where hepatitis A is more widespread.
• People whose work puts them in potential contact with hepatitis A, such as those who work with the hepatitis A virus in research labs
• People who are treated with clotting-factor concentrates
• People who have chronic liver disease
• People who use recreational drugs, injected or not
• Men who have sex with men

People at risk for hepatitis B include:

• Anyone traveling to or working in areas where hepatitis B is more widespread.
• Health care workers and other people whose job exposes them to human blood
• People with HIV infection, end-stage kidney disease, or chronic liver disease
• People who live with someone with hepatitis B
• People who inject street drugs
• Sexually active people who have had more than one partner
• Anyone who has had an STD
• Men who have sex with men
• Sex partners of people with hepatitis B

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