Hepatitis B Virus (HBV)
Transmitted by parenteral or mucosal exposure to HBsAg-positive blood and body fluids Incubation 45-160 days
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.
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.
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.
- 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