Ask the Experts: Hepatitis B

For the general public, only one HepB series is routinely recommended in a lifetime, with specific exceptions described below.

As of April 2022, CDC recommends HepB vaccination of the following:

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• Routine HepB vaccination of all infants, beginning with a birth dose.
• Routine HepB vaccination of all children and adults through age 59 years.
• Vaccination of all adults age 60 years and older with risk factors for hepatitis B:
  • People at risk for infection by sexual exposure
    • Sex partners of people testing positive for HBsAg
    • Sexually active people who are not in a long-term, mutually monogamous relationship (e.g., those with more than one sex partner during the previous 6 months)
    • People seeking evaluation or treatment for a sexually transmitted infection
    • Men who have sex with men
  • People at risk for infection by percutaneous or mucosal exposure to blood
    • People with current or recent injection drug use
    • Household contacts of people testing positive for HBsAg
    • Residents and staff members of facilities for people with developmental disabilities
    • Health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids
    • People on maintenance dialysis, including in-center or home hemodialysis and peritoneal dialysis, and people who are predialysis
    • People with diabetes, at the discretion of the treating clinician
  • Others
    • International travelers to countries with high or intermediate levels of endemic HBV infection (HBsAg prevalence of 2% or higher)
    • People with hepatitis C virus infection
    • People with chronic liver disease (including, but not limited to, people with cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and an alanine aminotransferase or aspartate aminotransferase level greater than twice the upper limit of normal)
    • People with HIV infection
    • People who are incarcerated
• Adults age 60 or older years without known risk factors for hepatitis B infection may receive HepB.

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People with documentation of complete vaccination or documentation of previous HBV infection generally do not need to be vaccinated; however, there is no evidence that administration of additional doses of HepB to someone who is already immune or infected is harmful. Serologic testing is not required before vaccination and should not pose a barrier to access to vaccination. If testing is done, it may be done at the same visit when the first dose of vaccine is administered.

Revaccination is recommended only for individuals for whom post-vaccination serologic testing (PVST) is recommended and evidence of nonresponse is found. Annual serologic testing of people undergoing dialysis is recommended, with booster doses administered when detectable antibodies drop below 10 mIU/mL. Annual testing and revaccination may be indicated for other immunocompromised people. See CDC 2018 ACIP recommendations for a detailed discussion of these issues: www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6701-H.pdf (pages 21-24).

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