Since 1991, ALL medically stable infants with a birth weight of at least 2,000 g in the U.S. are recommended to receive the first dose of hepatitis B vaccine within 24 hours of birth. The additional 2 doses are given at 1 month and 6 months of age.
Combination vaccines, such as the pentavalent and hexavalent vaccines, include protection against 5 or 6 diseases, including hepatitis B. The first shot is usually given at 6 weeks of age, but in order to protect infants from hepatitis B beginning at birth, a monovalent or single dose of the hepatitis B vaccine is also recommended within 24 hours of birth. The hepatitis B vaccine series can then be completed with the pentavalent or hexavalent vaccine with the recommended schedule.
The hepatitis B vaccine is an injection (or shot) that is generally given in the arm as a three-dose series on a 0, 1, and 6-month schedule. Alternative schedules may be considered, noting that a third dose at 6 months, meeting minimum intervals between doses, is needed for maximum, long-term protection. Completing the hepatitis B vaccine series, preferably beginning at birth, will ensure protection against hepatitis B, hepatitis delta and lower the lifetime risk of liver cancer. Greater than 90% of babies and up to 50% of young children who are not vaccinated and are infected with hepatitis B will have lifelong infection, which makes the birth dose essential to their protection.
There are four, 3-dose vaccine brands approved in the U.S.;
Heplisav-B (Dynavax) is a 2-dose vaccine approved in 2017 and recommended in the U.S. for use in adults age 18 and older. The vaccine is administered as two doses given one month apart. Data released by Dynavax has increased response rates to Heplisav-B compared to some traditional three-dose vaccine brands (Engerix-B, Recombivax HB, and Twinrix) in some populations. This may be a better choice for those with hyporesponsive conditions, like diabetes, or who may have had difficulty responding to the vaccine previously. For assistance accessing this vaccine, you can contact Heplisav-B's Access Navigator at 1-844-375-4728.
In some instances, it may be necessary to vaccinate within a short period of time to ensure protection before travel. There are accelerated schedules to provide the highest level of protection over a short period of time. Individuals who need an accelerated schedule must have a booster dose at 1 year to ensure long-term protection. Note that the 2-dose Heplisav-B vaccine will also ensure maximum protection over a 1-month period without the need for a booster dose at 1 year.
Engerix-B (GlaxoSmithKline) is a 3-dose vaccine that can be given on an accelerated, four-dose schedule, with 3 shots administered within 2 months, and a booster dose at 1 year to provide maximum long-term protection.
Twinrix (GlaxoSmithKline) is a 4-dose vaccine that can be given on an accelerated schedule to provide protection against hepatitis A and B. Three doses are administered within 1 month, followed by a booster shot at 1 year. This is a common choice of vaccine for those traveling on short-notice outside the U.S. It is important to complete the booster dose at 1 year, to ensure long-term protection.
Heplisav-B (Dynavax) is a 2-dose vaccine and is recommended in the U.S. for use in adults aged 18 and older. The vaccine is administered as two doses given one month apart and is complete upon administration of the second dose. No booster dose is needed at 1 year to ensure long-term protection.
The hepatitis B vaccine is an injection (or shot) that is generally given in the arm and as a three-dose series. The World Health Organization (WHO) recommends a 0, 1, and 6-month vaccine schedule, though schedules may vary based on a country’s national immunization program. Completing the hepatitis B vaccine series, preferably beginning at birth, will ensure protection against hepatitis B, hepatitis delta and lower the lifetime risk of liver cancer. Greater than 90% of babies and up to 50% of young children who are not vaccinated and are infected with hepatitis B will have lifelong infection, which makes the birth dose essential to their protection. Please note that the vaccine brand name, manufacturer and associated schedules for adults, children and infants may be unique to different countries, though there is a list of WHO prequalified vaccines.
The World Health Organization recommends all infants receive the first dose of the hepatitis B vaccine within 24 hours of birth (often called the “birth dose”) and to complete the vaccine series with additional shots at 1 month and 6 months of age. Beginning the hepatitis B vaccine at birth will ensure protection against hepatitis B for life.
It is never too late to protect against hepatitis B! Children greater than 1 year of age, and adults, can be vaccinated to protect them for a lifetime against a hepatitis B infection. The vaccine is given at 0, 1 and 6 months. The third dose is needed for complete, long-term protection. If an alternative schedule is considered, ensure that a 4 th booster dose is given at 1 year to provide maximum, long term protection.
In many countries it is standard to provide a “pentavalent vaccine” which protects against 5 diseases, including hepatitis B. Unfortunately, the first dose of the “pentavalent vaccine” is given at 6 weeks, which means babies are not being protected at birth against the hepatitis B virus.
In order to fully protect babies from the hepatitis B virus, newborns must receive the first dose of the hepatitis B vaccine within 24 hours of birth. This should be the hepatitis B “monovalent vaccine,” which means a vaccine that only protects against hepatitis B. Babies can then complete the vaccine series with three doses of the combination “pentavalent” vaccine, beginning at six weeks of age.
It is very important that babies receive the “monovalent” hepatitis B vaccine at birth, (not the “pentavalent vaccine”) in order to protect against a lifelong chronic hepatitis B infection. Infants born to moms who are infected with hepatitis B are at extremely high risk of becoming chronically infected after delivery, unless they receive the first dose of the hepatitis B vaccine within the first 12-24 hours of life.
Infants born to women with hepatitis B must receive accurate doses of hepatitis B vaccine and hepatitis B immune globulin (if recommended and available) to ensure complete protection. In order to protect these infants, medications should be given immediately after birth in the delivery room or within the first 12-24 hours of life*.
* See Testing and Treatment During Pregnancy section for details. Please note that testing of all pregnant women for hepatitis B is a global recommendation.
The World Health Organization (WHO) recommends that infants born to hepatitis B positive mothers receive the first dose of the hepatitis B vaccine within 24 hours of birth, and ideally a dose of hepatitis B immunoglobulin (HBIG). These shots must be followed by the additional vaccine doses given on the recommended schedule. In the U.S., infants should follow a 1 month and 6-month schedule for the additional two doses.
Combination vaccines, such as the pentavalent and hexavalent vaccines, provide protection against 5 or 6 diseases, including hepatitis B. The first shot is usually given at 6 weeks of age, but in order to protect infants from hepatitis B beginning at birth, a monovalent or single dose of the hepatitis B vaccine is also recommended within 24 hours of birth. Their hepatitis B vaccine series can then be completed with the pentavalent or hexavalent vaccine on the recommended schedule.
Where available, the hepatitis B “birth-dose” and HBIG should be administered within 24 hours of birth in order to prevent the transmission of hepatitis B from mother to child. It is very important that the shots be given in opposite limbs, to ensure the highest effectiveness. Please see chart above for more information.
In developing countries, the pentavalent vaccine, a combination 5-in-one vaccine that protects against five diseases, diphtheria, pertussis, tetanus, Hib and hepatitis B, may be given to babies more than 6 weeks of age, and can be given up to 1 year of age. The first dose is given at 6 weeks, and the second and third doses are given at 10 and 14 weeks of age. The pentavalent vaccine may be made available free of charge with the support of GAVI, the vaccine alliance. Check the GAVI country hub to see the resources and immunizations that may be available: http://www.gavi.org/country/
For babies born to mothers with hepatitis B, waiting for the first dose of the pentavalent vaccine is too late and will NOT protect the baby from vertical or horizontal transmission of hepatitis B. Babies born to a mother with hepatitis B have a greater than 90% chance of developing chronic hepatitis B if they are not properly treated at birth.
WHO recommends the hepatitis B vaccine within 24 hours of birth for ALL babies. Plan ahead and inquire about the availability and cost of the monovalent (single), birth dose of the vaccine, as it is not a GAVI provided immunization. This is particularly important to women who are positive for hepatitis B.
If you are unsure of your hepatitis B status, please be sure your doctor tests you for hepatitis B!
For babies NOT receiving the pentavalent vaccine, the first dose of the monovalent hepatitis B vaccine must be given within 24 hours of birth, followed by the remaining 2-3 doses of the hepatitis B vaccine according to schedule.
For babies receiving the pentavalent vaccine, the first, monovalent dose of the hepatitis B vaccine is given within 24 hours of birth, and the second and third doses of the HBV vaccine will be included in dose 1 and dose 2 of the pentavalent vaccine.
Making sure babies get the birth dose hepatitis B vaccine is critical to eliminating hepatitis B. The Center for Global Hepatitis Elimination published a review of strategies to improve implementation of hepatitis B vaccine birth dose worldwide, especially in limited-resource settings. This can be a useful resource to help organizations improve hepatitis B vaccine birth dose completion around the world.
*WHO does not recommend a birth dose of HBIG, which may not be available in all countries. Talk to your doctor if you have questions.
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