A Clinician’s Handbook for Childhood & Adult Immunizations in Georgia

Hepatitis B (HepB)


Hepatitis B Virus (HBV)

Transmitted by parenteral or mucosal exposure to HBsAg-positive blood and body fluids Incubation 45-160 days

Vaccine Description

Recombinant hepatitis B vaccine

Doses & Route

Intramuscular.  Hepatitis B vaccine administered by any route or site other than IM in the anterolateral thigh or deltoid muscle should not be counted as valid.

Administration Schedule

Dose               Recommended age             Minimal Interval

1…………………..Birth………………………………*Monovalent HepB vaccine only

2…………………..1-2 months…………………..4 weeks from dose 1

3…………………..6-18 months…………………At least 8 weeks after 2nd dose and at least 16 weeks after 1st dose and infants must be at least 24 weeks of age

  • All children and adolescents < 19 years and not previously vaccinated with hepatitis B series based on shared clinical decision making should be vaccinated at the earliest opportunity.
  • It is permissible to administer 4 doses of hepatitis B vaccine (e.g., when combination vaccines are given after the birth dose).
  • Adolescents and adults (≥ 18 years) may receive a 2- dose series of Hep B (Heplisav-B) at least 4 weeks apart.
  • Adolescents and adults (≥ 18 years) may receive a 3- dose series of Hep B (PreHevbrio) on a 0-, 1- and 6-month schedule.
  • Adults aged ≥ 20 years at risk for hepatitis B infection or lack a risk factor but want protection should receive 1 mL x 3 doses typically given at 0, 2 & 6 months.


  • Anaphylactic reaction following a prior dose of HepB.
  • Persons with hypersensitivity to yeast, yeast products or any vaccine component.
  • Defer vaccination in persons with moderate or severe acute illness until illness subsides.
  • Prefilled syringes might contain natural rubber latex, which might cause allergic reactions in persons who are latex-sensitive.
  • The safety and effectiveness of Heplisav-B and PreHevbrio have not been established in adults on hemodialysis.
  • Data are not available to assess the effects of Heplisav-B and PreHevbrio on breastfed infants or on maternal milk production and excretion.
  • Data on Heplisav-B and PreHevbrio are currently insufficient to inform vaccine-associated risks in pregnancy. Thus, providers should vaccinate pregnant persons needing HepB vaccination with Engerix-B, Recombivax HB, or Twinrix.

Special Instructions

Infants born to hepatitis B positive (HBsAg) women must receive hepatitis B vaccine and hepatitis B immune globulin (HBIG) within 12 hours of birth regardless of birth weight.

Perinatal HepB Website: https://dph.georgia.gov/epidemiology/viral-hepatitis/hepatitis-b/perinatal-hepatitis-b 

Intervention & Recommended Age

  • 1st dose – Birth (within 12 hours)
  • HBIG – Birth (within 12 hours)
  • 2nd dose – 1-2 months
  • 3rd dose – 6 months
  • PVT* – 9-18 months

*PVT: Post vaccination Test-includes Hepatitis B Surface Antigen/ HBsAg (infection) and Hepatitis B Surface Antibody/Anti-HBs (antibody protection) Protocol available in the Georgia Immunization Program Manual.

For infants weighing less than 2000 grams at birth:

  • If the mother is HBsAg negative, the 1st dose should be given at birth or at next doctor’s visit.
  • If the mother is HBsAg positive or her status is unknown, the infant should receive the 1st dose within 12 hours of birth regardless of birth weight, dose #2 at age 1 month, dose #3 at 2-4 months, and dose #4 at age 6 The infant should be tested at 9-12 months of age for infection and antibody. If the mother is HBsAg positive, the infant should also receive HBIG at birth within 12 hours of birth.

Special Populations

  • Chronic liver disease
  • Hepatitis C virus infection
  • Percutaneous or mucosal risk of exposure to blood
  • Adults younger than age 60 years with diabetes mellitus or 60 years or older with diabetes mellitus based on individual clinical decision
  • Adults in pre-dialysis care or receiving hemodialysis or peritoneal dialysis
  • Current or recent injection drug use
  • Health care and public safety workers at risk for exposure to blood-contaminated body fluids
  • Sexual exposure risk; persons seeking evaluation or treatment for a STI; and men who have sex with men
  • Adults receiving care in settings where a high proportion of adults have risk for hepatitis B infection such as STD treatment center, drug abuse treatment and prevention services, hemodialysis and end-stage renal disease programs, institutions for developmentally disabled persons, health care settings targeting services to injection drug users or MSM, HIV testing and treatment facilities, and correctional facilities
  • Travel to countries with high or intermediate hepatitis B endemicity