Hepatitis B Vaccines

Engerix-B and Recombivax HBV: HBV only
For any age: These single-antigen hepatitis B vaccines are typically given as a 3-shot series.  These are the only vaccines acceptable for birth dose.  For adolescents 11-15 years old, an alternative 2-dose Recombivax HBV regimen may be used.  Energix-B and Recombix HB can be used interchangeably and administered concurrently with hepatitis B immune globulin (HBIG) or other vaccines.

Combination Vaccines

Pediarix: HBV + diphtheria + tetanus + pertussis + polio
For children (6 weeks – 7 years of age): All newborns, regardless of their mother’s HBsAg status, should receive a birth dose of the hepatitis B vaccine with either Engerix-B or Recombivax HBV.  After the initial birth dose, a 3-dose Comvax regimen can be used to complete the series.

Twinrix: HBV + hepatitis A
For adults (18 years of age and older): Suitable for anyone seeking protection from HBV and/or hepatitis A virus (HAV), and high risk groups such as travelers to countries of high endemicity, men who have sex with men, injection drug users, medical or laboratory workers handling HBV or HAV, and patients with chronic liver disease.  Whereas hepatitis B vaccine is usually given in three shots and hepatitis A vaccine is given in two shots, Twinrix is given as a 3-shot series.

If your patient is NOT immune after vaccination

Although uncommon, about 5% of people who complete the hepatitis B vaccination series may not acquire immunity (anti-HBs levels are <10 mIU/mL).  In these cases, take the following steps:

1. Administer another 3-shot series at the normal schedule using a different hepatitis B vaccine.
2. Test again for anti-HBs 1-2 months after completion of the series to confirm protection.  44-100% of these patients will successfully develop immunity.

The rare group of people not protected after six doses should take care to avoid HBV transmission (e.g. cover wounds, use condoms).  Nonresponders exposed to HBV-infected bodily fluids should get the hepatitis B immune globulin (HBIG) shot to prevent infection.

Postexposure prophylaxis

HBIG (Hepatitis B Immune Globulin)
For any age: Provides passively acquired anti-HBs and temporary protection against HBV infection (i.e. 3-6 months).  HBIG is typically administered along with hepatitis B vaccine after unvaccinated persons are exposed to blood or bodily fluids infected with HBV (e.g. when infants are born to HBsAg-positive women, after needlestick injuries, and after sexual contact with an infected person).  HBIG alone is the primary means of protection for nonresponders to hepatitis B vaccine. 

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Notes regarding preterm infants weighing less than 2000 grams:

  • For premature infants born to HBsAg-negative mothers: delay administration of the vaccine series until age 1 month or hospital discharge, then resume the series according to the schedule.

  • For premature infants born to HBsAg-positive mothers: give the HBIG shot and HBV vaccine within 12 hours of birth, then start the vaccine series beginning at age 1-2 months (do not count birth dose as part of the vaccine series).

Vaccine administration and storage

Follow these simple precautions to protect your patients:

  • Shake the vaccine before use.  Hepatitis B vaccine normally looks cloudy, but if the vaccine stands for a long time, it may separate from the liquid and look like fine sand at the bottom of the vial.

  • Do NOT freeze or expose to freezing temperatures.  Store hepatitis B vaccine at 2-8°C (36-46°F).  The “shake test” will determine if the vaccine has been damaged by freezing.  If the vaccine fails the shake test (the vaccine and liquid do not mix) you must discard it.

  • Administer the hepatitis B vaccine intramuscularly (i.e. in the arm for children and adults, and in the thigh for infants).  It is ineffective if given subcutaneously in fatty tissue (i.e. in the buttocks).

  • Do NOT reuse needles.  Always use sterile syringes, preferably with auto-disable features to prevent reuse.

  • Immediately dispose of used needles into puncture-resistant safety containers.