Hepatitis B Vaccination Schedule
- Babies and Children up to 12 have 3 injections of 10mg
of HBs Antibodies over 3 months On Day 1, Day 30 and Day 60 with a final injection at 1 year
- Adult Vaccination involves 3 injections of 20mg
HBs Antibodies over 6 months On Day 1, 30 and 180, with a final injection of 20mg at 1 year
- The accelerated course for adults at high risk is 3 20mg
injections over 21 days On Day 1, 7, 21, boosted at 1 year
The vaccine should be given into the deltoid (shoulder) region or anterior thigh in babies. It is less effective if given into the buttock.
The vaccination is generally good for at least 10 years and it is quite possible that a course may give lifelong immunity, but Hepatitis B immunity blood tests for Antibody titres should always be done 2 months after the 3 injection course, as some 10% fail to gain immunity or have poor levels and need repeat courses.
An immunity score (titre) above 100 mIU/ml is regarded as adequate. Around 10-15% of adults and children fail to respond to three doses of vaccine or respond poorly.
Poor responders with titres of 10 to 100 mIU/ml need a booster and very poor responders with a titre below 10 mIU/ml need a repeat course.
Those over 40 years old, are overweight or who smoke/drink alcohol are more likely to fail.
Patients who are immunosuppressed or on renal dialysis may also respond less well and require larger or more doses of vaccine.
Failure to gain antibody after 2 complete courses should not be seen as necessarily meaning no immunity, as immunity is largely cell-mediated rather than by antibody.
Post-exposure prophylaxis (PEP) involves giving HBV immunoglobulin within 48 hours.
Of a thousand people vaccinated and having no boosters 3 became infected after 10-15 years. 5 years is chosen due to safety, health staff are not suddenly “at risk” after 5 years. However it is understood in the US that a nurse dies every day from poor vaccination coverage mainly from infections caught before the vaccine was invented, further it is understood that 1 in 17 workers at risk contracted HBV before HBV vaccination became mandatory.