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Hepatitis B Vaccine - Prescription Guide

Available Formulations

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Standard Dosing Schedules

Adults (≥20 years)

• Recombivax HB / Engerix-B / Twinrix: 3 doses at 0, 1, and 6 months - 1 mL IM each
• Heplisav-B: 2 doses at 0 and 1 month - 0.5 mL IM each (NOT recommended in pregnancy)
• Engerix-B alternative: 4 doses at 0, 1, 2, and 12 months

Children/Adolescents (≤19 years)

• 3 doses of 0.5 mL IM at 0, 1, and 6 months (pediatric/adolescent formulation)
• Children under 10 years: half the adult dose (5-10 µg) at same intervals

Newborns (Birth dose)

• Only monovalent vaccine at birth (within 24 hours of delivery)
• Followed by doses at 1 month and 6 months
• In India: birth dose + 3 doses at 6, 10, 14 weeks (4-dose schedule with DPT)

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Immunocompromised / Hemodialysis Patients

• High-dose Recombivax HB (40 µg): 3 doses at 0, 1, 6 months
• Engerix-B: 4 double-doses (2 mL each) at 0, 1, 2, and 6 months

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Administration

• Route: Intramuscular (IM) only - do NOT give intradermally (unreliable immune response)
• Site (adults): Deltoid muscle (preferred)
• Site (infants/children <2 yr): Anterolateral thigh
• Gluteal injection is NOT recommended - risk of fat deposition with lower seroconversion

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Indications (Who Needs It)

• All infants (routine)
• Healthcare and public safety workers with blood/body fluid exposure risk
• Household/sexual contacts of HBsAg-positive persons
• Patients with chronic liver disease, HIV, or ESRD/dialysis
• Injection drug users
• MSM and sexually active persons with multiple partners
• Travelers to HBV-endemic regions
• Persons with diabetes mellitus (age <60 y routinely; ≥60 y at clinician's discretion)
• Pregnant women at risk

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Contraindications / Precautions

• Severe allergic reaction to any vaccine component or to a prior dose
• Moderate or severe acute illness (with or without fever) - defer until recovery

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Efficacy & Duration

• Induces protective anti-HBs levels in >95% of infants, children, and young adults
• After age 40: protection drops to ~90%; by age 60: only 65-75% seroconvert
• Duration: at least 15 years, likely lifelong based on current evidence
• Booster doses are generally not recommended for immunocompetent individuals

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Sample Prescription Format

Rx

Inj. Engerix-B 20 µg (1 mL)           - 3 vials
Route: Intramuscular (deltoid)
Schedule: Day 0 → Month 1 → Month 6

[OR]

Inj. Heplisav-B 20 µg (0.5 mL)        - 2 vials
Route: IM (deltoid)
Schedule: Day 0 → Month 1

Sig: Administer at clinic under observation.
Store at 2-8°C. Do not freeze.

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