Hepatitis B Vaccine Administration (2024)

What to know

The Advisory Committee on Immunization Practices (ACIP) recommends hepatitis B (HepB) vaccination among all infants at birth, unvaccinated children younger than 19 years of age, adults aged 19–59 years, and adults aged 60 years and older with risk factors for hepatitis B or without identified risk factors but seeking protection.

Who should be vaccinated

ACIP recommends that the following people should receive hepatitis B (HepB) vaccination:

• All infants.
• Unvaccinated children younger than 19 years of age.
• Adults 19–59 years.
• Adults 60 years and older with risk factors for hepatitis B.

The following groups may also receive HepB vaccination:

• Adults 60 years and older without known risk factors for hepatitis B.

Recommendations for screening, testing, and vaccination

The table below provides recommendations for screening, testing, and vaccination for adults and all persons with risk. Testing should not be a barrier to vaccination of susceptible people, especially in populations that have less engagement with or access to health care. In settings where testing is not feasible or is refused by the patient, the clinician should offer vaccination and, at future visits, should offer testing again.

* For additional considerations for patients on dialysis, see Footnote AA .

† For additional considerations for healthcare personnel see Footnote BB.

§ Vaccinate susceptible persons without documentation of a completed hepatitis B vaccination series; testing should not be a barrier to vaccination.

For testing recommendations and assistance interpreting B screening results, see hepatitis B testing guidelines.

Composition and dosage

The United States Food and Drug Administration (FDA) has licensed three single-antigen vaccines (Engerix-B, Heplisav-B, and Recombivax HB), one three-antigen vaccine (PreHevbrio), and three combination vaccines (Pediarix, Vaxelis, and Twinrix) to protect against hepatitis B. All vaccines contain yeast protein and aluminum adjuvant or a small synthetic immunostimulatory (Heplisav-B).

Engerix-B

People aged 19 years and younger should receive three doses. People aged 20 years and older should receive three doses. Adults on hemodialysis should receive four doses. See package insert for detailed dosage instructions.

Heplisav-B

People aged 18 years and older should receive two doses. Data on Heplisav-B are currently insufficient to inform vaccine-associated risks in pregnancy. Thus, providers should vaccinate pregnant people needing HepB vaccination with Engerix-B, Recombivax HB, or Twinrix.

Recombivax HB

People aged 19 years and younger should receive three doses. People aged 20 years and older should receive three doses. See package insert for detailed dosage instructions.

PreHevbrio

People aged 18 years and older should receive three doses. Data on PreHevbrio are currently insufficient to inform vaccine-associated risks in pregnancy. Providers should use Engerix-B, Recombivax HB, or Twinrix for HepB vaccinations during pregnancy.

Pediarix

People between 6 weeks and 6 years of age should receive three doses. See package insert for detailed dosage instructions.

Vaxelis

People between 6 weeks and 4 years of age should receive three doses. See package insert for detailed dosage instructions.

Twinrix

People aged 18 years and older should receive either three or four doses. See package insert for detailed dosage instructions.

Vaccine effectiveness

Each of the HepB vaccines are highly effective in preventing infection. Studies indicate that immunity persists for at least 30 years among healthy people who initiate HepB vaccination at less than 6 months of age.

Safety and precautions

Scientific evidence overwhelmingly supports the safety of HepB vaccines.

As a precaution, clinicians should ask the person getting the vaccine if they've previously experienced an allergic reaction to:

• A previous dose of HepB vaccine.
• Any part of HepB vaccine.
• Yeast.

People who are moderately or severely ill should wait until they recover before getting a HepB vaccine. However, administering the vaccine to people with minor illnesses, such as a cold, is fine. Learn more about contraindications and precautions.

Reporting adverse events

The most frequently reported adverse event associated with HepB vaccination is injection site soreness. Any adverse event suspected to be associated with HepB vaccination should be reported through the Vaccine Adverse Event Reporting System (VAERS).

VAERS is an early warning system, co-managed by CDC and the FDA, that monitors potential vaccine safety problems. Clinicians and vaccine manufacturers are required by law to report certain adverse events following vaccination to VAERS. Patients and caregivers can also submit reports.

Administration

Clinicians should administer the vaccine intramuscularly into the anterolateral aspect of the thigh or the deltoid muscle of the upper arm, depending on the person’s age. When administering multiple vaccines, Clinicians should use different anatomic sites (e.g., separate limbs).

Concurrent administration of other vaccines

Clinicians can administer HepB vaccine concurrently with other vaccines to children and adults. There is no evidence that coadministration reduces the vaccine response or effectiveness.

Vaccine schedules

HepB vaccine can be given as a stand-alone vaccine or as part of a combination vaccine. For detailed information on HepB vaccine schedules, see immunization schedule for children or immunization schedule for adults.

Resources

• Universal Hepatitis B Vaccination in Adults Aged 19–59 Years — United States, 2022
  • Updated ACIP vaccination recommendations for hepatitis B.
• Screening and Testing for Hepatitis B Virus Infection: CDC Recommendations — United States, 2023
  • Updated HBV screening and testing recommendations from CDC released in March 2023.
• Hepatitis B Vaccination, Screening, and Linkage to Care
  • Best practice advice from the American College of Physicians and CDC.
• Immunization Practices for Use of a Hepatitis B Vaccine with a Novel Adjuvant
  • Recommendations from ACIP on prevention of HBV infection and immunization practices.
• Driving Hepatitis B Management: Universal Screening and Vaccination in Primary Care
  • Free continuing education credits and hepatitis B screening, testing, and vaccination recommendations from CDC and ACIP.

Immunization schedules

• Adult Immunization Schedule
  • Vaccination recommendations for people ages 19 or older by age (for health care providers).
• Birth–18 Years Immunization Schedule
  • Vaccination recommendations for infants, children, and adolescents by age (for health care providers).

Standing orders

• Use of Standing Orders Programs to Increase Adult Vaccination Rates
  • MMWR covers the effectiveness of these programs, describes implementation, and recommends initiating these programs to improve immunization coverage.

Vaccine assistance programs

• Merck Vaccine Patient Assistance Program
  • This site outlines the Merck Vaccine Patient Assistance Program for people who need help with paying for medications and vaccines.
• GSK Patient Assistance Program
  • This site outlines the GSK Patient Assistance Program for people who need help with paying for medications and vaccines.

Specific sites and tools

• Current Issues in Immunization Webinar
  • A webinar featuring updates on ACIP recommendations for HepB vaccination.
• Vaccine Storage and Handling
  • Proper vaccine storage and handling practices for clinicians.
• Vaccine Administration
  • Vaccine administration protocols for clinicians.
• University of Washington Hepatitis B Online Resource
  • Free continuing education credits and more information on HBV immunizations.
• Vaccinating Adults
  • A step-by-step guide from the Immunization Action Coalition providing information to help implement or enhance adult immunization services in your health care setting.

Related pages

• Traveler's Health
  • Clinician resources for traveling patients.
• • Learn more about 2024 immunization schedules for your patients.

Vaccine Information Statement (VIS)

Vaccine Information Statements (VISs) are information sheets produced by CDC that explain both the benefits and risks of a vaccine. View the VIS for HepB vaccine.