Checklist before Hep B vaccination

• type: inactivated biosynthetic surface antigen, HBsAg
  
  
• minimum age: within a few hours of birth
  
  
• primary course: day 1, 1 month & 6 months (3 doses) OR rapid dose schedule: day 1, 1 month, 2 months, & 12 months (4 doses)
  
  
• booster interval: 5years
  • boosters are also recommended after exposure to the virus

Cautions/notes:

• postpone vaccination in febrile illness
• a blood test for antibodies should be carried out after the final dose of the course to confirm protection
• non-responders may be anti-HBc positive (see above HepB vaccine section for associations with poor response)
• high risk groups - see 'indications' subsection

Notes (2):

• because of the continued presence of infection in other family members, a single booster dose of hepatitis B vaccine, given with the pre-school booster for other childhood immunisations, is advised for the children born to hepatitis B infected-mothers. This will also provide the opportunity to check whether the child was properly followed up in infancy
• in patients with renal failure:
  • role of immunological memory in patients with chronic renal failure on renal dialysis does not appear to have been studied, and protection may persist only as long as anti-HBs levels remain above 10mIU/ml
    • antibody levels should, therefore, be monitored annually and if they fall below 10mIU/ml, a booster dose of vaccine should be given to patients who have previously responded to the vaccine
  • booster doses should also be offered to any haemodialysis patients who are intending to visit countries with a high endemicity of hepatitis B and who have previously responded to the vaccine, particularly if they are to receive haemodialysis and have not received a booster in the last 12 months

Ref:

1. BNF 14.4
2. DH. Immunisation against Infectious Disease - The Green Book (May 2007)