Hepatitis B Vaccine Recommendations

Introduction to Hepatitis B Vaccination

The Centers for Disease Control and Prevention recommends that all infants should receive the hepatitis B vaccine series beginning at birth, and all unvaccinated children, adolescents, and at-risk adults should receive the vaccine to prevent HBV infection, which can lead to chronic liver disease and hepatocellular carcinoma 1, 2

All infants should receive the hepatitis B vaccine series as part of the recommended childhood immunization schedule, beginning at birth as a safety net 1
For all medically stable infants weighing ≥2,000 grams at birth and born to HBsAg-negative mothers, the first dose of vaccine should be administered within 24 hours of birth 3
Only single-antigen HepB vaccine should be used for the birth dose 4
Infants weighing <2,000 grams and born to HBsAg-negative mothers should have their first vaccine dose delayed to the time of hospital discharge or age 1 month (even if weight is still <2,000 grams) due to decreased immune response when administered before age 1 month 5
The final dose in the vaccine series should not be administered before age 24 weeks (164 days) 6
In populations with currently or previously high rates of childhood HBV infection, the first dose of HepB vaccine should be administered at birth and the final dose at age 6–12 months 7

All infants born to HBsAg-positive women should receive HepB vaccine and HBIG within 12 hours of birth, administered at different injection sites 7
For infants weighing <2,000 grams born to HBsAg-positive mothers, the birth dose should not be counted as part of the vaccine series; 3 additional doses should be administered beginning when the infant reaches age 1 month (total of 4 doses) 7
Postvaccination serologic testing for anti-HBs and HBsAg should be performed after completion of the vaccine series at age 9–12 months 7
For infants transferred to a different facility after birth, staff at the transferring and receiving facilities should communicate regarding the infant's HepB vaccination and HBIG receipt status 1

HepB vaccination is recommended for all unvaccinated children and adolescents aged <19 years 8
Children and adolescents who have not previously received HepB vaccine should be vaccinated routinely at any age (catch-up vaccination) 8

HepB vaccination is recommended for all unvaccinated adults at risk for HBV infection and for all adults requesting protection from HBV infection 9
High-risk adults who should receive the vaccine include sex partners of HBsAg-positive persons, sexually active persons who are not in a long-term, mutually monogamous relationship, persons seeking evaluation or treatment for a sexually transmitted infection, men who have sex with men, current or recent injection-drug users, household contacts of HBsAg-positive persons, healthcare and public safety personnel with risk for exposure to blood, hemodialysis patients and predialysis, peritoneal dialysis, and home dialysis patients, persons with diabetes aged 19–59 years, international travelers to countries with high or intermediate levels of endemic HBV infection, persons with hepatitis C virus infection or chronic liver disease, persons with HIV infection, and incarcerated persons 9

Pregnant women who are identified as being at risk for HBV infection during pregnancy should be vaccinated 10
Risk factors include having more than one sex partner during the previous 6 months, being evaluated or treated for an STI, recent or current injection-drug use, or having had an HBsAg-positive sex partner 10

All delivery hospitals and birthing facilities should implement policies and procedures to ensure identification of infants born to HBsAg-positive mothers and initiation of appropriate prophylaxis 10
In settings where a high proportion of persons have risk factors for HBV infection, all adults should be assumed to be at risk and offered vaccination 8
Healthcare providers should implement standing orders to administer HepB vaccine as part of routine services 8