In the United States, there are two hepatitis B vaccines that have been approved for use in infants, children and adults. Both are equally safe and effective.
- Engerix-B (GlaxoSmithKline)
- Recombivax HB (Merck)These vaccines are synthetically prepared and do not contain blood products – you cannot get hepatitis B from either of these vaccines.
In November 2017, a third vaccine was approved by the FDA for use in the U.S. Heplisav-B (Dynavax) is a two-dose vaccine approved for use in adults.
The hepatitis B vaccine is an injection (or shot) that is generally given in the arm and as a three-dose series on a 0, 1, and 6 month schedule. The recommended doses depend on the vaccine brand and the person's age.
- 1st Shot (0 month) – Start at any time, but newborns should receive this dose in the delivery room)
- 2nd shot (1 month) – At least 1 month (or 28 days) after the 1st shot
- 3rd shot (6 month) – Six months after the 1st shot (or at least 2 months after the 2nd shot)
There is a two-dose schedule of the hepatitis B vaccine called “Recombivax HB” (Merck) that has been approved for children and adolescents 11 through 15 years of age. After the first dose is given, the second dose is given 4 to 6 months later.
The U.S. Centers for Disease Control and Prevention have made the following HBV vaccine recommendations in order to protect all babies, children, teens and adults from infection with the hepatitis B virus.
Universal Infant Vaccination ("Birth Dose")
ALL infants should receive the first dose of hepatitis B vaccine at birth in the delivery room (called the “birth dose") or within the first 12- 24 hours of life before they leave the hospital.
In 1991, universal hepatitis B vaccination of all infants born in the U.S. was recommended because newborns and babies are at the greatest risk of developing a lifelong chronic infection if they are exposed to the hepatitis B virus. Giving the "birth dose" of the hepatitis B vaccine after a baby is born helps to reduce the risk of transmission from a woman who is infected with hepatitis B to her newborn baby at the time of delivery. Unfortunately, most pregnant women do not know if they are infected with hepatitis B; therefore, it is very important that all newborns be protected against a possible exposure to the hepatitis B virus. There is no second chance to protect a newborn from a chronic hepatitis B infection after the first 12 - 24 hours of life.
Children and Adolescents (0 - 18 years)
Since 1997, the CDC has recommended that ALL children and adolescents up to age 18 years should receive the hepatitis B vaccine.
Young children are at high risk for developing a lifelong chronic infection if they are exposed to the hepatitis B virus. Currently, one-third of all chronically infected adults were exposed in childhood. Adolescents are included in this recommendation as well because of their potentially experimental lifestyle choices that place them at greater risk of a hepatitis B infection.
Adults (19 years and older)
A schedule of routine adult vaccinations was first published in 2002. The hepatitis B vaccine is now included in the current list of adult recommendations (> 19 years).
In 2011, the CDC added the recommendation the hepatitis B vaccine be given to all adults with diabetes (type 1 or 2) who are between 19 - 59 years. Clinicians can decide whether or not their diabetic patients 60 years or older should receive the hepatitis B vaccine. This recommendation has also been adopted by the Americans Diabetes Association. Learn more.
The CDC publishes a simple chart of approved hepatitis B vaccine doses for children and adults which can be printed. Learn more.
The World Health Organization recommends all infants receive the first dose of the hepatitis B vaccine within 24 hours of birth (often called the “birth dose”) and to then complete the vaccine series at 2 and 6 months. In order to meet this requirement, the first dose of the hepatitis B vaccine must be the “monovalent vaccine,” which means it is only the hepatitis B vaccine.
Many countries, however, are offering a “pentavalent vaccine” which protects against 5 diseases, including hepatitis B. Unfortunately, the first dose of the “pentavalent vaccine” is given at 6 weeks, which means babies are not being protected at birth against the hepatitis B virus.
It is very important that babies receive the “monovalent” hepatitis B vaccine at birth (not the “pentavalent vaccine”) in order to protect against a lifelong chronic hepatitis B infection. Infants born to moms who are infected with hepatitis B are at extremely high risk of becoming chronically infected after delivery, unless they receive the first dose of the hepatitis B vaccine within the first 12-24 hours of life.
There is no second chance to protect a newborn or baby from hepatitis B!
Pentavalent help: WHO writeup