Hepatitis B Vaccine Schedule for Adults

Hepatitis B is a vaccine-preventable viral disease that involves inflammation of the liver. 

The hepatitis B virus (HBV) usually leads to a short-term infection known as acute hepatitis B. If their infection is left untreated, some people develop chronic hepatitis B. Chronic hepatitis B is a serious, permanent condition that can cause organ damage, cirrhosis (scarring of the liver), liver cancer, liver failure, and even death. 

According to the Centers for Disease Control and Prevention (CDC), all people should be vaccinated against hepatitis B starting at birth. Adults who are at risk of developing hepatitis B should also receive the vaccine, which is highly effective in preventing infection.

Read on to learn more about the hepatitis B vaccine (HepB) for adults, including who should receive it, the details of the dosage schedule, side effects, and more.

Who Should Receive the Hepatitis B Vaccine?

Vaccination is the most reliable way to prevent getting hepatitis B or developing serious related medical complications. 

The CDC’s Advisory Committee on Immunization Practices (ACIP) recommends that people in all age groups get the hepatitis B vaccine, including:

• All infants within 24 hours after birth
• Children and teens who have not previously been vaccinated against hepatitis B
• Adults ages 19 to 59 
• Adults ages 60 and older with at least one risk factor for hepatitis B

Adults over 60 who are not at risk of developing hepatitis B can also receive the HepB vaccine if they choose.

Hepatitis B spreads through direct contact with bodily fluids, such as semen or blood. Examples include:

• Sharing needles or other sharp instruments, such as tattooing or piercing instruments
• Unprotected sex (also referred to as condomless sex)
• Sharing medical equipment, such as a glucose monitor
• Sharing personal items, such as razors or nail clippers
• Contact with the open sores or blood of someone who has hepatitis B
• Birth (from birthing parent to baby)

While anyone can get hepatitis B, certain people are more at risk. Risk factors for HBV include:

• Having a sexual partner with hepatitis B
• Living with someone who has hepatitis B
• Having more than one sexual partner within the last six months
• A history of sexually transmitted infections (STIs)
• Being born in, living in, or traveling to regions where hepatitis B is common
• If male, having sex with other men
• Injection drug use
• Diabetes
• Chronic liver disease
• Being infected with human immunodeficiency virus (HIV)
• Kidney dialysis
• Having had an organ transplant or blood transfusion before the 1980s
• Being incarcerated
• Being a sexual assault survivor
• Working in a health care setting
• Working in a prison
• Working in a care facility for people with dementia or developmental disabilities

It’s especially important for adults in high-risk groups to get the hepatitis B vaccine. Adults in any age group who haven’t previously gotten the hepatitis B vaccine, or who did not complete all of their doses, should also get vaccinated.

Hepatitis B Vaccine Schedule for Adults

The Food and Drug Administration (FDA) has approved the following vaccines for the prevention of hepatitis B: 

• Engerix-B 
• Heplisav-B
• PreHevbrio
• Recombivax HB

Engerix-B and Recombivax HB are approved for use in people of all ages, including infants. Heplisav-B and PreHevbrio are available only for adults ages 18 and older. 

All four HepB vaccines are recombinant vaccines. Recombinant vaccines are produced by inserting a small portion of DNA from a virus into a yeast cell. The yeast then produces a protein seen on the virus. When you receive the vaccine, your immune system learns to react to this protein and fight the virus.

The hepatitis B vaccine schedule for adults varies based on the person’s condition and the selected vaccine. Adults typically get the HepB vaccine in a two-, three-, or four-dose series. If you missed a dose, you can get the next one in the series without repeating the previous one.

Two-Dose Vaccine Series

Adults ages 18 and over can get a two-dose series of Heplisav-B for full protection against HBV. Heplisav-B is delivered as an intramuscular injection—a shot, usually in the upper arm—in two 0.5-milliliter doses, one month apart. 

If you missed a dose of a different HepB vaccine, it can also be replaced by Heplisav-B.

Three-Dose Vaccine Series

For people age 18 and older, Engerix-B, PreHevbrio, Recombivax HB are all available in a three-dose series given across six months. The second dose is given one month after the first, and the third dose is given at six months. The standard schedule for Twinrix is also three doses and follows the same timing.

Four-Dose Vaccine Series

People who are currently receiving hemodialysis (kidney dialysis) may need additional protection against hepatitis B. Adults on hemodialysis should get a four-dose series of Engerix-B across six months. These can be delivered in individual 2-milliliter doses or two 1-milliliter doses. After the first dose, they are given in one month, two months, and six months.

The Twinrix four-dose series is considered an accelerated schedule and is recommended for certain travelers. After the first dose, the next doses are given at 1 week, 3 weeks, and 1 year.

Hepatitis B Vaccine Side Effects

Most people only experience mild, short-term side effects from the hepatitis B vaccine. Common side effects include:

• Headache
• Fever
• Pain, redness, or swelling at the site of injection

Severe allergic reactions to the hepatitis B vaccine are very rare. If you have symptoms of an allergic reaction shortly after getting the HepB vaccine—such as difficulty breathing, facial swelling, or hives—seek medical help immediately.

The hepatitis B vaccine is safe and effective for most people. However, there are certain people who should not get the HepB vaccine, including:

• People who are moderately or severely ill at the time of vaccination
• People who have had a severe allergic reaction to yeast
• People who have had a severe allergic reaction to a hepatitis B vaccine in the past

Summary

The hepatitis B vaccine is a safe, effective way to prevent hepatitis B and related complications. Engerix-B, Recombivax HB, PreHevbrio, and Heplisav-B have all been approved by the FDA to prevent hepatitis B.

Adults at risk for contracting hepatitis B (such as people having sex or living with someone who has hepatitis B, intravenous drug users, healthcare workers, people who are undergoing kidney dialysis, and people with certain medical conditions) should get the HepB vaccine.

Adults who haven’t already been vaccinated against hepatitis B should also receive the vaccine. 

Heplisav-B is delivered in a two-dose series in one month. It is available to adults 18 and over. Engerix-B, PreHevbrio, and Recombivax HB are administered to adults in a three-dose series across six months. Adults who are on hemodialysis can receive extra protection against HepB with a four-dose series of Engerix-B or Recombivax-HB across six months.

A Word From Verywell

Hepatitis B can sometimes lead to serious medical consequences, including liver failure. Getting the hepatitis B vaccine is an effective, safe way to protect yourself from liver inflammation and potential complications.