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

Routine vaccination	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 unvaccinated persons age <60 years and persons age <60 years whose HBV vaccination status is unknown.
Target groups at increased risk for HBV infection
Unvaccinated persons age ≥60 years and at increased risk for HBV infection:^¶
Chronic liver disease, including: Cirrhosis Fatty liver disease Alcoholic liver disease Autoimmune hepatitis ALT or AST level greater than twice upper limit of normal	Concurrent chronic HBV infection may increase the risk of progressive liver disease.
HCV infection	Persons with HCV are at risk for reactivation of HBV with antiviral therapy and more severe liver disease if superinfected with HBV.
HIV infection	Postvaccination serologic testing (measurement of anti-HBs) is recommended. Revaccination may be necessary.
Percutaneous or mucosal risk for exposure, including: Current or recent injection drug use Household contacts or needle contacts of persons who are HBsAg positive Residents and staff of facilities for persons who are developmentally disabled Health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids Persons who are predialysis or are undergoing hemodialysis, peritoneal dialysis, or home dialysis Persons with diabetes mellitus at the discretion of the treating clinician	Postvaccination serologic testing (measurement of anti-HBs) is recommended for: Health care and public safety personnel Persons who are predialysis or are undergoing dialysis Revaccination may be necessary.
Persons who are incarcerated
Sexual exposure risk, including: Sexual partners of persons who are HBsAg positive Persons who are sexually active and not in mutually monogamous relationships Persons seeking evaluation or treatment for an STI Men who have sex with men	Postvaccination serologic testing (measurement of anti-HBs) is recommended for sexual partners of persons who are HBsAg positive. Revaccination may be necessary.
Travel in countries with high (≥8%) or intermediate (2 to 7%) endemic prevalence of HBV infection	Refer to UpToDate content on immunizations for travel and epidemiology of HBV.

This table lists target groups for HBV vaccination. For persons who are immunocompromised in all target groups, postvaccination serology (anti-HBs) is recommended. Revaccination may be necessary. Refer to UpToDate content on HBV vaccination for details.

Prevaccination serology generally is not required, but may be warranted for persons who:

Are household, sexual, or needle contacts of persons who are HBsAg positive
Have ever injected drugs
Are incarcerated
Are infected with HIV or HCV
Are predialysis or are undergoing hemodialysis, peritoneal dialysis, or home dialysis
Have chronic liver disease
Belong to multiple risk groups
Should be screened for HBV independent of HBV vaccination, including persons:
- Born in countries with HBsAg prevalence ≥2%
- Who were born in the United States, were not vaccinated against HBV as infants, and whose parents were born in countries with HBsAg prevalence ≥8%
- Who need immunosuppressive therapy
- Who are blood, tissue, plasma, organ, or semen donors

Refer to UpToDate content on epidemiology of HBV and screening and diagnosis of HBV for details.

Prevaccination serology should not be a barrier to HBV vaccination. The first dose of HBV vaccine generally should be administered after collection of blood for serologic testing.

HBV: hepatitis B virus; HBsAg: hepatitis B surface antigen; HBIG: hepatitis B immune globulin; anti-HBs: antibody to HBsAg; HCV: hepatitis C virus: ALT: alanine aminotransferase; AST: aspartate transaminase; HIV: human immunodeficiency virus; STI: sexually transmitted infection.

* 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.

¶ Persons ≥60 years of age who do not meet risk-based recommendations may receive HBV vaccination.

Data from:

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.
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.
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.
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.
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.

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