Hepatitis B - Vaccination of Adults

Hepatitis B vaccine has been successfully integrated into the childhood vaccination schedule, contributing to a 96% decline in the incidence of acute Hepatitis B in children and adolescents. Currently, approximately 95% of new HBV infections occur among adults, and unvaccinated adults with behavioral risk factors or who are household contacts or sex partners of HBV-infected persons remain at risk.

An estimated 80%–95% of sexually transmitted diseases (STDs) are diagnosed in medical settings other than STD clinics. Therefore, primary care and specialty medical care providers should provide Hepatitis B vaccination whenever indicated or requested as part of regular preventive care.

In primary care and specialty medical settings, including physician’s offices, family planning clinics, community health centers, liver disease clinics, and travel clinics, the Advisory Committee on Immunization Practices (ACIP) recommends that providers implement standing orders to identify adults recommended for Hepatitis B vaccination and administer vaccination as part of routine services.

Guidelines and Recommendations

Hepatitis B Vaccination Recommendations for Adults

Implementation Guidelines

• Provide information to all adults regarding the benefits of Hepatitis B vaccination
• Assess the need for vaccination by obtaining a history that emphasizes risks for sexual or bloodborne transmission of HBV
• Vaccinate all adults who report risk factors for HBV infection
• Vaccinate anyone seeking protection from Hepatitis B; identification of a specific risk factor is not required
• Identify, counsel, and vaccinate susceptible household, sex, and needle-sharing contacts of Hepatitis B surface antigen (HBsAg)-positive persons
• Assess patients’ needs for other recommended vaccines
• Vaccinate all adults receiving services in the following settings:
  • STD clinics
  • HIV/AIDS counseling, testing and treatment facilities
  • Health care settings targeting services to men who have sex with men
  • Drug abuse prevention and treatment facilities

Immunization Schedules and Dosages

Adult Immunization Schedule

Recommended doses of Hepatitis B vaccines (by age group and vaccine type)

Standing Orders

Use of Standing Orders Programs to Increase Adult Vaccination Rates: Recommendations of the Advisory Committee on Immunization Practices
MMWR 2000;49(RR-1):15–26

Standing Orders for Administering Hepatitis B Vaccine to Adults [PDF – 1 page]

Vaccine Funding, Billing, and Reimbursement

Coding Guidelines for Vaccine Preventable Hepatitis [PDF – 2 pages]
Brochure from the American Medical Association that provides CPT and ICD coding guidelines for Hepatitis A and Hepatitis B in high-risk populations

Merck Vaccine Reimbursement Support Center
Service to assist physicians in filing for reimbursement for Merck vaccines and their administration

Merck Vaccine Patient Assistance Program
Provides vaccines free of charge to eligible adults, primarily the uninsured

Specific Sites and Tools

Adults Only Vaccination: A Step-by-Step Guide (2004)
Guide from the Immunization Action Coalition to help integrate immunization services into health care settings new to vaccination

Related Pages

Travelers’ Health

Vaccines and Immunizations