Twinrix Combination Hepatitis A and B Vaccine

Indications, Dosing, and Potential Side Effects

The Twinrix vaccine combines the hepatitis A and hepatitis B vaccine into one syringe.

Learn more about this vaccine, including who should be vaccinated, dosing, and potential side effects based on information from the Centers for Disease Control and Prevention and US Food and Drug Administration.

Vaccine administration
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What Is the Twinrix Vaccine? 

The Twinrix vaccine is a combination vaccine for hepatitis A and B. 

How Twinrix Is Administered

It's administered as an intramuscular injection — which means it's given as a shot into the muscle. 

Who Should Be Vaccinated With Hepatitis A?

  • Any person who desires protection from hepatitis A
  • Men who have sex with men 
  • People who use injection or non-injection illegal drugs
  • People traveling to areas with a high or intermediate occurrence of hepatitis A 
  • People with chronic liver disease
  • People who receive clotting factor concentrates
  • People working with HAV-infected primates or with HAV in a research laboratory
  • People who will have close personal contact with an international adoptee during the first 60 days after arriving in the US from a country with a high or intermediate occurrence of hepatitis A

Who Should Be Vaccinated With Hepatitis B?

  • Any person who desires protection from hepatitis B
  • Sexually active people who are not in a long-term, mutually monogamous relationship — like a person with more than 1 sex partner during the last six months
  • Men who have sex with men
  • People seeking testing or therapy for a sexually transmitted infection — like HIV
  • Recent or current injection drug users
  • Healthcare and public safety workers who are potentially exposed to blood or other infectious body fluids
  • People with diabetes who are younger than age 60 years and consider after age 60 
  • People with end-stage kidney disease, including people undergoing hemodialysis, people with HIV, and people with chronic liver disease
  • Household contacts and sex partners of people who have hepatitis B
  • Clients and staff members of institutions and daycare facilities for persons with developmental disabilities
  • International travelers to countries with a high or intermediate prevalence of chronic HBV infection
  • All adults in sexually transmitted infection treatment facilities like HIV testing and treatment facilities,
  • All adults in facilities providing drug abuse treatment and prevention services or providing services to injection drug users
  • All adults in healthcare settings providing services to men who have sex with men
  • All adults in correctional facilities
  • All adults working in end-stage kidney disease facilities for patients on chronic hemodialysis


Twinrix can be given in a series of three doses at:

  • The first dose on day 0
  • Another dose 1 month later
  • The third dose 5 months after that
  • It can also be administered in an accelerated series of 4 doses at:
  • The first dose on day 0
  • The second dose on day 7,
  • The third dose on day 21 to 30
  • The fourth dose at 12 months 

Potential Side Effects

  • Soreness or redness at the injection site
  • Headache
  • Fatigue

Who Should Not Get the Vaccine?

The Twinrix vaccine is contraindicated in people with:

  • Known hypersensitivity to neomycin
  • Known hypersensitivity to yeast
  • A person who has had a severe allergic reaction after a prior dose of any hepatitis A or hepatitis B vaccine

Special Note

Depending on immune system strength, Twinrix may not elicit an antibody response. Talk with your healthcare provider for more information about alternative dosing for those people with weak immune systems.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

By Mark Cichocki, RN
Mark Cichocki, RN, is an HIV/AIDS nurse educator at the University of Michigan Health System for more than 20 years.