Hepatitis B Vaccine Schedule: When to Get Vaccinated

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.1 In rare cases, hepatitis B can lead to life-threatening complications like liver failure, liver cancer, or cirrhosis (liver scarring).2 

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.3

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

Hepatitis B Vaccination Schedule for Children and Infants

The AAP recommends that babies and children receive three doses of Engerix-B or Recombivax HB, starting just after birth.4 The current AAP-recommended hepatitis B vaccine schedule for children and infants is as follows:4

If your child is undergoing hemodialysis, your healthcare provider may recommend that they receive additional doses of the HBV vaccine. There also may be dosage changes if you had a hepatitis B infection while pregnant and tested positive for HBV.

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.6
• Twinrix prevents hepatitis B and hepatitis A in people 18 years and older. It is generally administered in 3 doses over six months. Twinrix may also be administered on an accelerated schedule before travel as 3 doses over one month followed by a booster dose at 12 months.7
• Vaxelis protects children ages 6 weeks to 4 years against tetanus, diphtheria, pertussis, hepatitis B, poliomyelitis, and invasive forms of Haemophilus influenzae type b (Hib). It is typically given in three doses at 2, 4, and 6 months of age.8
  

Hepatitis B Vaccination Schedule for Adults

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

• Engerix-B11
• Recombivax HB12
• Heplisav-B13
• Twinrix (protects against hepatitis A and B)14

Adults typically receive the hepatitis B vaccine in a two- or three-dose series.3 Engerix-B is also offered as a four-dose series for adults who are undergoing hemodialysis (kidney dialysis).11 

The current recommended hepatitis B vaccine schedule for adults who have not previously completed vaccination is as follows:15

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.16

The CDC's Advisory Committee on Immunization Practices (ACIP) recommends the hepatitis B vaccine for the following groups:35

• Newborns, if the mother tests HBV positive (or after parent and pediatrician consultation)
• 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.17 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 B3

Hepatitis B vaccination is recommended regardless of whether a person has any risk factors.18 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 C19
  

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.20