• Mast EE, Weinbaum CM, Fiore AE, Alter MJ, Bell BP, Finelli L, Rodewald LE, Douglas JM Jr, Janssen RS, Ward JW, Advisory Committee on Immunization Practices (ACIP) Centers for Disease. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults. MMWR Recomm Rep 2006 Dec 8;55(RR-16):1-33; quiz CE1-4. [3 references] PubMed

Note from the Centers for Disease Control and Prevention (CDC) and the National Guideline Clearinghouse (NGC): On September 19, 2008 the CDC released updated guidelines on hepatitis B. For more information see the NGC summary Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection.

This report updates Advisory Committee on Immunization Practices (ACIP) recommendations published previously for hepatitis B vaccination of adults (MMWR 1991;40[RR-13]). The primary changes from previous recommendations are as follows:

• In settings in which a high proportion of persons are likely to be at risk for hepatitis B virus (HBV) infection (e.g., sexually transmitted disease/human immunodeficiency virus –STD/HIV] testing and treatment facilities, drug-abuse treatment and prevention settings, health-care settings targeting services to injection-drug users, health-care settings targeting services to men who have sex with men, and correctional facilities), ACIP recommends universal hepatitis B vaccination for all adults who have not completed the vaccine series.
• In primary care and specialty medical settings, ACIP recommends implementation of standing orders to identify adults recommended for hepatitis B vaccination and administer vaccination as part of routine services. To ensure vaccination of adults at risk for HBV infection who have not completed the vaccine series, ACIP recommends the following implementation strategies:
  • Provide information to all adults regarding the health benefits of hepatitis B vaccination, including risk factors for HBV infection and persons for whom vaccination is recommended.
  • Help all adults assess their need for vaccination by obtaining a history that emphasizes risks for sexual transmission and percutaneous or mucosal exposure to blood.
  • Vaccinate all adults who report risks for HBV infection.
  • Vaccinate all adults requesting protection from HBV infection, without requiring them to acknowledge a specific risk factor.

Recommendations for Hepatitis B Vaccination of Adults

Hepatitis B vaccination is recommended for all unvaccinated adults at risk for HBV infection and for all adults requesting protection from HBV infection (see Box below titled "Adults Recommended to Receive Hepatitis B Vaccination"). Acknowledgment of a specific risk factor should not be a requirement for vaccination.

Box. Adults Recommended to Receive Hepatitis B Vaccination

Providers should select the vaccine schedule they consider necessary to achieve completion of the vaccine series (see Table 2 in the original guideline document and the Box below titled "Hepatitis B vaccine schedules for adults [aged >20 years]").

Box. Hepatitis B Vaccine Schedules for Adults (Aged >20 years)*

Public health programs and primary care providers should adopt strategies appropriate for the practice setting to ensure that all adults at risk for HBV infection are offered hepatitis B vaccine (see Box 6 in the original guideline document and "Description of the Implementation Strategy" field below).

See the following appendices in the original guideline document for further information:

• Appendix A: Immunization management issues
• Appendix B: Postexposure prophylaxis to prevent hepatitis B virus infection
• Appendix C: Identification and management of hepatitis B surface antigen (HBsAg)-positive persons

• Mast EE, Weinbaum CM, Fiore AE, Alter MJ, Bell BP, Finelli L, Rodewald LE, Douglas JM Jr, Janssen RS, Ward JW, Advisory Committee on Immunization Practices (ACIP) Centers for Disease. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: immunization of adults. MMWR Recomm Rep 2006 Dec 8;55(RR-16):1-33; quiz CE1-4. [3 references] PubMed

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