Hepatitis B

Abstract

All medically stable infants weighing ≥2,000 grams without contraindications should receive the first dose of hepatitis B vaccine (trade names: Engerix-B®, Recombivax HB®) within 24 hours of birth. Certain infants at increased risk of acquisition of hepatitis B, such as infants born to hepatitis B-infected mothers or mothers with unknown status, should receive hepatitis B vaccine as soon as possible after birth along with a dose of hepatitis B immune globulin. The second dose should be administered a minimum of 4 weeks after the first dose and between 1-2 months of age. The third dose should be administered a minimum of 8 weeks after the second and 16 weeks after the first, between 6-18 months of age. All children not previously vaccinated should receive the age-appropriate dose of hepatitis b vaccine, preferably at 11 or 12 years but up to 18 years of age. The usual schedule for adolescents is two doses separated by no less than 4 weeks, and a third dose at least 8 weeks from the second dose and 16 weeks from the first dose, and preferably 4 to 6 months after the second dose. An approved alternative schedule for adolescents 11 to 15 years of age is two 1.0-mL doses of the Recombivax HB® vaccine separated by 4 to 6 months. Adults at increased risk of hepatitis B infection (including sex partners or household contacts of hepatitis B infected persons; sexually active persons not in a long-term mutually monogamous relationship; persons seeking evaluation or treatment for a sexually transmitted disease; men who have sex with men; current or recent injection drug users; residents and staff of facilities for developmentally disabled persons; health care and public safety workers at risk of exposure to blood or body fluids; persons with end-stage renal disease or diabetes mellitus; HIV-infected individuals; and international travelers to countries with high or intermediate endemnicity) should be vaccinated. If using Recombivax HB® or Engerix-B®, the first two doses should be separated by at least 4 weeks and a third dose administered 4-6 months after the second dose. If using HEPLISAV-B™ vaccine, only two doses (0.5 mL each) are given one month apart, but both doses must be HEPLISAV-B™. Persons with chronic liver disease (including, but not limited to, those with hepatitis C virus [HCV] infection, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and an alanine aminotransferase [ALT] or aspartate aminotransferase [AST] level greater than twice the upper limit of normal) should also be vaccinated.