Hepatitis B Vaccine Schedule: Doses and Intervals - Verywell Health

Hepatitis B (sometimes referred to as hep B) is a liver infection caused by the hepatitis B virus (HBV). It typically causes symptoms like stomach pain, dark urine, fatigue, fever, jaundice (yellowing of the skin and eyes), diarrhea, vomiting, and clay-colored stools. In rare cases, hepatitis B can lead to life-threatening complications like liver failure, liver cancer, or cirrhosis (liver scarring). 

The hepatitis B vaccine is a shot, typically injected into the arm, that protects against hepatitis B in babies, children, and adults. It is an important way to protect yourself and your children from HBV infection.

Hepatitis B vaccine is universally recommended for infants, children, and adults up to age 60 without regard for risk factors. It is recommended for those 60 and over who have risk factors and is optional for any in that age group who want protection.

This article will discuss the recommended hepatitis vaccine schedule for children and adults, including doses, timing, side effects, and who should get the vaccine.

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Hepatitis B Vaccination Schedule for Children and Infants

The Centers for Disease Control and Prevention (CDC) recommends that babies and children receive three 0.5 milliliter doses of either Engerix-B or Recombivax HB, starting just after birth. 

The current recommended hepatitis B vaccine schedule for children and infants is as follows:

Hepatitis B Vaccination Schedule for Infants and Children
Hepatitis B Vaccine Dose	Age
 1	0 (shortly after birth)
 2	1–2 months old
 3	6–18 months old

If your child is undergoing hemodialysis, your healthcare provider may recommend that they receive additional doses of the HBV vaccine.

Combination Vaccines

The following vaccines are approved by the Food and Drug Administration (FDA) to prevent hepatitis B as well as other conditions:

• Pediarix prevents hepatitis B, poliomyelitis, diphtheria, tetanus, and pertussis in infants and children ages 6 weeks to 6 years. It is typically given in three doses across six months.
• Twinrix prevents hepatitis B and hepatitis A in both children and adults. It is delivered in three doses over six months. Adults can receive four doses of Twinrix on a rapid schedule.
• Vaxelis protects children ages 6 weeks to 4 years against tetanus, diphtheria, hepatitis B, poliomyelitis, and invasive forms of Haemophilus influenzae type b (Hib). It is typically given in three doses with at least four weeks between the first two doses. The third dose should not be given before the age of 6 months.
  

How Common Is Hepatitis B?

One U.S. study following trends in hepatitis B infection over a three-year period found that 4.3% of the population had a past or present HBV infection.

Estimates suggest that about 240 million people around the world have chronic hepatitis B. Up to 1.89 million people in the United States have a chronic HBV infection.

Hepatitis B Vaccination Schedule for Adults

The following vaccines are currently approved by the FDA for the prevention of hepatitis B: 

Adults typically receive the hepatitis B vaccine in a two- or three-dose series. Engerix-B is also offered as a four-dose series for adults who are undergoing hemodialysis (kidney dialysis). 

The current recommended hepatitis B vaccine schedule for adults who have not previously completed vaccination is as follows:

Hepatitis B Vaccination Schedule for Adults
Hepatitis B Vaccine	Recommended Schedule
Engerix-B	Three 1 milliliter doses at 0, 1, and 6 months; four 2 milliliter doses at 0, 1, 2, and 6 months (for people undergoing kidney dialysis)
Recombivax HB	Three 1 milliliter doses at 0, 1, and 6 months
Heplisav-B	Two 0.5 milliliter doses, one month apart
PreHevbrio	Three 1 milliliter doses at 0, 1, and 6 months

Who Should Receive the Hepatitis B Vaccine?

For most people, the hepatitis B vaccine is safe and effective. About 90% of people who receive three vaccine doses are protected against hepatitis B for over 30 years.

The CDC's Advisory Committee on Immunization Practices (ACIP) recommends the hepatitis B vaccine for the following groups:

• All babies, starting just after birth
• Children and adolescents under 19 years old
• Adults ages 19–59 who have not previously completed vaccination
• Adults ages 60 and over with a high risk of contracting HBV

Adults ages 60 and over who do not have any hepatitis B risk factors can receive the hepatitis B vaccine, but it is optional.

Hepatitis B spreads when the bodily fluids of an infected person enter another person's body. Sexual contact is one way it can be spread. A person with HBV can spread it to their baby during childbirth. Other ways in which HBV may be transmitted include:

• Sharing medical equipment, whether at home or in a hospital setting, with a person who has an HBV infection
• Sharing syringes with a person who has hepatitis B, such as during injection drug use or at-home piercing or tattooing
• Sharing personal items, such as razors or toothbrushes, with someone who has hepatitis B
• Coming into contact with the sores or blood of a person who has hepatitis B

Hepatitis B vaccination is recommended regardless of whether a person has any risk factors. If you have an increased risk of contracting HBV, it's especially important to protect yourself with the hepatitis B vaccine. Some of the risk factors for hepatitis B include:

• Living with someone who has hepatitis B
• Having a sexual partner who has hepatitis B
• Having multiple sexual partners
• Being a man who has sex with men
• Working in a healthcare facility, assisted living facility, prison, or care facility for people with developmental disabilities
• Having a human immunodeficiency virus (HIV) infection
• Injection drug use
• Having diabetes
• Traveling to parts of the world with high rates of hepatitis B
• Being on kidney dialysis
• Having hepatitis C
  

Who Should Not Receive the Hepatitis B Vaccine?

Talk to your healthcare provider before getting the hepatitis B vaccine if:

• You have had a severe allergic reaction to the hepatitis B vaccine or any of its ingredients in the past. 
• You have had an allergic reaction to yeast in the past.
• You are moderately or severely ill.
• You are currently taking immunosuppressive medications.

In addition, pregnant people should not receive the Heplisav-B or PreHevbrio vaccines until more safety information is available.

Vaccination Side Effects

Most side effects from the hepatitis B vaccine are mild and resolve on their own within a few days. Common side effects include:

• Fever
• Swelling, pain, and/or redness of skin at the injection site
• Headache
• Nausea and vomiting

Very rarely, the hepatitis B vaccine can cause a severe allergic reaction. Symptoms may include:

• Swelling of the face, throat, or tongue
• Muscle weakness
• Difficulty breathing
• Rapid heart rate 
• Hives
• Dizziness or light-headedness

Seek immediate medical help if you have any signs of an allergic reaction after receiving the hepatitis B vaccine.

Summary

Hepatitis B is a viral infection that causes inflammation of the liver. In rare cases, hepatitis B can lead to serious medical problems like liver cancer or liver failure. The hepatitis B vaccine offers effective protection against HBV for infants, children, adolescents, and adults. 

Infants should receive one dose of the vaccine just after birth, followed by a second dose at 1–2 months and the third dose at 6–18 months.

Adults ages 19–59 should receive the hepatitis B vaccine in a two- or three-dose series, typically over the span of six months. Adults ages 60 and older who have a high risk of contracting hepatitis B should also receive the vaccine.

A Word From Verywell

The hepatitis B vaccine is an effective, safe way to protect yourself and others from HBV infection and related complications. Talk to your healthcare provider if you have any concerns about potential side effects or complications from the Hep B vaccine.

Frequently Asked Questions

• Babies should receive one dose of the hep B vaccine just after birth, as well as second and third doses at 1–2 and 6–18 months. Adults under 60 who did not previously complete vaccination should typically get a two- or three-dose series over the course of six months. People with certain risk factors, such as people on hemodialysis, may need additional doses.

• Most healthy adults who are not high-risk for hepatitis B and have previously been vaccinated don't need a booster dose. If you are immunocompromised, your healthcare provider may recommend that you receive an additional dose. People who have at least one hepatitis B risk factor should also talk to their healthcare provider about getting a booster shot.

• Most people experience only mild side effects from the hep B vaccine. Common side effects include local pain at the injection site, headache, and fever. Very rarely, more serious adverse reactions—such as a severe allergic reaction—may occur.