Hepatitis B Vaccination of Adults

An adult receiving a vaccination

The Advisory Committee on Immunization Practices (ACIP) recommends vaccination of adults at risk for HBV infection, including universal vaccination of adults in settings in which a high proportion have risk factors for HBV infection and vaccination of adults requesting protection from HBV without acknowledgment of a specific risk factor.

Adults recommended to receive HepB vaccine:

  • Persons at risk for infection by sexual exposure
    • Sex partners of hepatitis B surface antigen (HBsAg)–positive persons
    • Sexually active persons who are not in a long-term, mutually monogamous relationship (e.g., persons with more than one sex partner during the previous 6 months)
    • Persons seeking evaluation or treatment for a sexually transmitted infection
    • Men who have sex with men
  • Persons at risk for infection by percutaneous or mucosal exposure to blood
    • Current or recent injection-drug users
    • Household contacts of HBsAg-positive persons
    • Residents and staff of facilities for developmentally disabled persons
    • Health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids
    • Hemodialysis patients and predialysis, peritoneal dialysis, and home dialysis patients
    • Persons with diabetes aged 19–59 years; persons with diabetes aged ≥60 years at the discretion of the treating clinician
  • Others
    • International travelers to countries with high or intermediate levels of endemic hepatitis B virus (HBV) infection (HBsAg prevalence of ≥2%)
    • Persons with hepatitis C virus infection
    • Persons with chronic liver disease (including, but not limited to, persons with cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, or an alanine aminotransferase [ALT] or aspartate aminotransferase [AST] level greater than twice the upper limit of normal)
    • Persons with HIV infection
    • Incarcerated persons
    • All other persons seeking protection from HBV infection

Implementation Guidelines

To ensure vaccination of persons at risk for HBV infection, health care providers should:

  • In settings in which a high proportion of persons have risk factors for HBV infection (e.g., health care settings targeting services to injection-drug users, correctional facilities, institutions and nonresidential day care facilities for developmentally disabled persons), all adults should be assumed to be at risk for HBV infection and should be offered HepB vaccination if they have not previously completed vaccination.
  • Healthcare providers should implement standing orders to administer HepB vaccine as part of routine services to adults who have not completed the vaccine series and make HepB vaccination a standard component of evaluation and treatment for STIs and HIV/AIDS.
  • When feasible, HepB vaccination should be offered in outreach and other settings in which services are provided to persons at risk for HBV infection (e.g., needle-exchange programs, HIV testing sites, HIV prevention programs, and homeless shelters).
  • In medical settings, healthcare providers should implement standing orders to identify adults recommended for HepB vaccination and administer vaccination as part of routine services.