Resolution No. 6/19-3 

ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES 

VACCINES FOR CHILDREN PROGRAM 

VACCINES TO PREVENT HEPATITIS B

The purpose of this resolution is to update the Recommended Vaccination Schedule and Intervals section to 

reflect the currently available hepatitis B-containing vaccines that can be used to prevent hepatitis B. 

VFC resolution 2/17-1 is repealed and replaced by the following: 

Eligible groups 

All children and adolescents birth through 18 years of age. 

Recommended Vaccination Schedule and Intervals 

The tables below list acceptable vaccination schedules for children and adolescents birth through 18 years of 

age. 

Infants

Single antigen vaccine Single-antigen1 and combination 

vaccine2,3,4

Birth 

weight 

Maternal 

HBsAg status 

Dose Age Dose Age 

≥2000 g Positive 1 Birth (≤12 hrs)1 1 Birth (≤12 hrs )1

2 1-2 months 2 2 months 

3 6 months 3 4 months 

4 6 months 

Unknown 1 Birth (≤12 hrs)1 1 Birth (≤12 hrs)1

2 1-2 months 2 2 months 

3 6 months 3 4 months 

4 6 months 

Negative 1 Birth (≤24 hrs)1 1 Birth (≤24 hrs)1

2 1-2 months 2 2 months 

3 6 -18 months 3 4 months 

4 6 months 

<2000 g Positive 1 Birth (≤12 hrs)1 1 Birth (≤12 hrs)1

2 1 month 2 2 months 

3 2-3 months 3 4 months 

4 6 months 4 6 months 

Unknown 1 Birth (≤12 hrs)1 1 Birth (≤12 hrs)1

2 1 month 2 2 months 

3 2-3 months 3 4 months 

4 6 months 4 6 months 

Negative 1 Age 1 month or at hospital 

discharge1

1 Age 1 month or at hospital 

discharge1
2 2 months 2 2 months 

3 6 -18 months 3 4 months 

4 6 months 

 

Table Notes:

 

1. Only a single antigen hepatitis B vaccine (ENGERIX-B or RECOMBIVAX HB) can be given at 

birth. 

2. Pediarix [DTaP-IPV-HepB] is licensed for children 6 weeks through 6 years of age. For adequate 

immune response, the last dose of hepatitis B vaccine should be given >24 weeks of age and 

therefore this combination vaccine should not be administered as a complete primary series on an 

accelerated schedule at 4-week intervals for prevention of pertussis. 

3. Vaxelis [DTaP-IPV-Hib-HepB] is licensed for children 6 weeks through 4 years of age. For 

adequate immune response, the last dose of hepatitis B vaccine should be given >24 weeks of age 

and therefore this combination vaccine should not be administered as a complete primary series on an 

accelerated schedule at 4-week intervals for prevention of pertussis. 

4. Use of brand names is not meant to preclude the use of other comparable US licensed vaccines. 

Children and Adolescents 

 

Age Schedule1, 6

Children (1through10 years) 0, 1, and 6 months2 

0, 2, and 4 months2 

0, 1, 2, and 12 months2,4 

Adolescents (11 through 18 years) 0, 1, and 6 months2

0, 1, and 4 months2 

0, 2, and 4 months2

 

0, 12, and 24 months2

 

0 and 4-6 months3

 

0, 1, 2, and 12 months2,4 

0, 7 days, 21-30 days, 12 months5

 

 

 Table Notes: 

1. Children and adolescents may be vaccinated according to any of the schedules indicated, except 

as noted. Selection of a schedule should consider the need to optimize compliance with 

vaccination. 

2. Pediatric/adolescent formulation. 

3. A two-dose schedule of Recombivax-HB Adult Formulation is (10 micrograms) is licensed for 

adolescents aged 11 through 15 years. When scheduled to receive the second dose, adolescents 

aged > 15 years should be switched to a three-dose series, with doses 2 and 3 consisting of the 

pediatric formulation administered on an appropriate schedule. 

4. A four-dose schedule of Engerix B is licensed for all age groups. 

5. Twinrix can be administered to persons 18 years of age before travel or any other potential 

exposure on an accelerated schedule at 0, 7, and 21-30 days, followed by a dose at 12 months. 

6. Use of brand names is not meant to preclude the use of other comparable US licensed vaccines. 

 
Interrupted schedules and minimum dosing intervals 

 

• When the HepB vaccine schedule is interrupted, the vaccine series does not need to be restarted. If 

the series is interrupted after the first dose, the second dose should be administered as soon as 

possible, and the second and third doses should be separated by an interval of at least eight weeks. If 

only the third dose has been delayed, it should be administered as soon as possible. 

 

• The final dose of vaccine must be administered at least eight weeks after the second dose and should 

follow the first dose by at least 16 weeks; the minimum interval between the first and second doses is 

four weeks. Inadequate doses of hepatitis B vaccine or doses received after a shorter-than 

recommended dosing interval should be re-administered, using the correct dosage or schedule. 

 

• Vaccine doses administered ≤4 days before the minimum interval or age are considered valid. 

Because of the unique accelerated schedule for Twinrix, the four-day guideline does not apply to 

the first three doses of this vaccine when administered on a 0 day, 7 day, 21-30 day, and 12 month 

schedule. 

 

• In infants, administration of the final dose is not recommended before age 24 weeks (164 days). 

 

Revaccination 

Revaccination (i.e., booster dose, challenge dose, or revaccination with a complete series) is not generally 

recommended for persons with a normal immune status who were vaccinated as infants, children, or 

adolescents. Revaccination when anti-HBs is <10 mIU/mL is recommended for the following: 

 

• Infants born to HBsAg-positive mothers. HBsAg-negative infants with anti-HBs <10 mIU/mL 

should be re-vaccinated with a single dose of HepB vaccine and receive post vaccination serologic 

testing 1-2 months later. Infants whose anti-HBs remains <10 mIU/mL following single dose 

revaccination should receive two additional doses of HepB vaccine, followed by PVST 1-2 months 

after the final dose. 

o Based on clinical circumstances or family preference, HBsAg-negative infants with anti-HBs 

<10 mIU/mL may instead be revaccinated with a second, complete 3-dose series, followed by 

post vaccination serologic testing (PVST) performed 1-2 months after the final dose of 

vaccine. 

• Hemodialysis patients. For hemodialysis patients, the need for booster doses should be assessed by 

annual anti-HBs testing. A booster dose should be administered when anti-HBs levels decline to <10 

mIU/mL. 

 

• Other immunocompromised persons. For other immunocompromised persons (e.g., HIV-infected 

persons, hematopoietic stem-cell transplant recipients, and persons receiving chemotherapy), the 

need for booster doses has not been determined. When anti-HBs levels decline to <10 mIU/mL, 

annual anti-HBs testing and booster doses should be considered for persons with an ongoing risk for 

exposure. 

 

• Persons with postvaccination serologic testing results that do not demonstrate protection. This 

includes children and adolescents through age 18 years who are chronic hemodialysis patients, 

HIVinfected, otherwise immunocompromised (e.g., hematopoietic stem-cell transplant recipients or 
persons receiving chemotherapy), or sex partners of HBsAg-positive persons. Persons in these groups 

found to have anti-HBs concentrations of <10 mIU/mL after the primary vaccine series should be 

revaccinated. 

 

Recommended dosage 

 

Refer to product package inserts.

Contraindications and Precautions 

 

Contraindications and Precautions can be found in the package inserts available at 

https://www.fda.gov/vaccines-blood-biologics/vaccines/vaccines-licensed-use-united-states

 

[If an ACIP recommendation or notice regarding hepatitis B vaccination is published within 6 months 

following this resolution, the relevant language above (except in the eligible groups sections) will be 

replaced with the language in the recommendation and incorporated by reference to the publication URL.] 

 Adopted and Effective: June 26, 2019 

This document can be found on the CDC website at: 

https://www.cdc.gov/vaccines/programs/vfc/providers/resolutions.html