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Target groups for hepatitis B virus (HBV) vaccination in the United States

Target groups for hepatitis B virus (HBV) vaccination in the United States
Patient groups Comments
Infants (birth to 1 year)
  • The vaccination series should be started as soon as possible after birth, preferably within 12 hours.*
  • For infants born to mothers who are HBsAg positive, HBIG should be administered at the same time as the birth dose HBV vaccine (at a different anatomic site).
  • For infants born to mothers who are HBsAg positive and mothers whose HBsAg status cannot be determined, obtain HBsAg and anti-HBs after completion of HBV vaccination series (usually at age 9 to 12 months). Revaccination may be necessary.
Unvaccinated persons age 1 to 60 years, regardless of risk for HBV infection
  • Catch-up immunization is recommended for persons age <60 years who were not vaccinated for HBV or whose HBV vaccination status is unknown.

Unvaccinated persons age ≥60 years who are at increased risk for acquiring HBV or developing severe HBV infection as well as those who wish to be vaccinated

This includes individuals with:
  • Chronic liver disease
  • HIV infection
  • HCV infection
  • Percutaneous or mucosal risk for HBV exposure (eg, injection drug use, occupational risk, household contact of someone with HBsAg)
  • Sexual risk for HBV (eg, sexual contact with someone who is HBsAg positive, persons who are sexually active and not in mutually monogamous relationships)
  • Planned travel to countries with high (≥8%) or intermediate (2 to 7%) endemic prevalence of HBV infection
  • Risk due to being incarcerated
  • Risk due to working or living in facilities for persons who are developmentally disabled
  • Persons who are predialysis or are undergoing hemodialysis, peritoneal dialysis, or home dialysis
  • Among individuals who are at increased risk for HBV, post-vaccination serologic testing (anti-HBs) is warranted for certain groups (eg, those with HIV, health care and public safety personnel, persons who are predialysis or are undergoing dialysis, and sexual partners of persons who are HBsAg positive).
This table lists target groups for HBV vaccination. More detailed information about groups at increased risk for HBV are presented in UpToDate content that discusses HBV epidemiology, screening, and immunization. For persons who are immunocompromised in all target groups, post-vaccination serology (anti-HBs) is recommended. Revaccination may be necessary. Refer to UpToDate content on HBV vaccination for details.

HBV: hepatitis B virus; HBsAg: hepatitis B surface antigen; HBIG: hepatitis B immune globulin; anti-HBs: antibody to HBsAg; HIV: human immunodeficiency virus; HCV: hepatitis C virus.

* Infants born to mothers who are HBsAg-positive and mothers whose HBsAg status cannot be determined should receive the first dose of HBV and HBIG as soon as possible after birth.
References:
  1. Abara WE, Qaseem A, Schillie S, et al. Hepatitis B vaccination, screening, and linkage to care: Best practice advice from the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med 2017; 167:794.
  2. Schillie S, Vellozzi C, Reingold A, et al. Prevention of hepatitis B virus infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep 2018; 67:1.
  3. Terrault NA, Lok AS, McMahon BJ, et al. Update on prevention, diagnosis, and treatment and of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology 2018; 67:1560.
  4. United States Preventive Services Task Force, Krist AH, Davidson KW, et al. Screening for hepatitis B virus infection in adolescents and adults: US Preventive Services Task Force Recommendation Statement. JAMA 2020; 324:2415.
  5. Weng, MK, Doshani M, Khan MA, et al. Universal hepatitis B vaccination in adults aged 19-59 years: Updated recommendations from the Advisory Committee on Immunization Practices – United States, 2022. MMWR Morb Mortal Wkly Rep 2022; 71:477.
  6. Conners EE, Panagiotakopoulos L, Hofmeister MG, et al. Screening and testing for hepatitis B virus infection: CDC recommendations – United States, 2023. MMWR Recomm Rep 2023; 72:1.
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