Hepatitis B vaccine is available both as single-antigen formulations and as multiantigen formulations in fixed combination with other vaccines (Mast et al., 2005). The two single-antigen vaccines are Recombivax HB® (Merck & Co., Inc., Whitehouse Station, NJ) and Engerix-B® (GlaxoSmithKline Biologicals, Rixensart, Belgium). Of the three licensed combination vaccines, Twinrix® (GlaxoSmithKline Biologicals, Rixensart, Belgium) is used for vaccination of adults, and Comvax® (Merck & Co., Inc., Whitehouse Station, NJ) and Pediarix® (GlaxoSmithKline Biologicals, Rixensart, Belgium) are used for vaccination of infants and young children. Twinrix contains recombinant HBsAg and inactivated hepatitis A virus. Comvax contains recombinant HBsAg and Haemophilus influenzae type b (Hib) polyribosylribitol phosphate conjugated to Neisseria meningitidis outer-membrane protein complex. Pediarix contains recombinant HBsAg, diphtheria and tetanus toxoids and acellular pertussis adsorbed (DTaP), and inactivated poliovirus.

The hepatitis B vaccine is administered in a three-dose series: two priming doses administered 1 month apart and a third dose administered 6 months after the second (Mast and Ward, 2008). Alternative schedules have been used successfully. Administration of the three-dose series results in protective concentrations of anti-HBs in more than 95% of healthy infants, children, and adolescents and in more than 90% of healthy adults aged 40 years old and younger. Immunogenicity drops below 90% in adults over the age of 40 years. The hepatitis B vaccine has a pre-exposure efficacy of 80–100% and a postexposure efficacy of 70–95%, depending on whether hepatitis B immune globulin (HBIG) is given with the vaccine. The duration of immunity appears to be long-lasting, and booster doses of the vaccine are not routinely recommended (Mast and Ward, 2008).

HBIG is derived from plasma and is used prophylactically to prevent infection with the hepatitis B virus (HBV). It provides passively acquired antibody to hepatitis B surface antigen (anti-HBsAg) and temporary protection (3–6 months). HBIG is typically used as an adjunct to hepatitis B vaccine for postexposure immunoprophylaxis to prevent HBV infection (Mast et al., 2005). HBIG administered alone is the primary means of protection after an HBV exposure for people who do not respond to hepatitis B vaccination. It is also used after liver transplantation for end-stage hepatitis B to prevent recurrence of the disease in the transplanted liver.

Current Vaccination Recommendations, Requirements, and Rates

The Advisory Committee on Immunization Practices (ACIP) provides advice and guidance to the US Department of Health and Human Services and the US Centers for Disease Control and Prevention (CDC) on the control of vaccine-preventable diseases. It develops written recommendations

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