Standing Orders for Administering Hepatitis B Vaccine to Adults

Purpose

To reduce morbidity and mortality from hepas B virus (HBV) by vaccinang all adults who meet the criteria

established by the Centers for Disease Control and Prevenon’s Advisory Commiee on Immunizaon Pracces.

Policy

Where allowed by state law, standing orders enable eligible nurses, pharmacists, and other health care professionals

to assess the need for vaccinaon and to vaccinate adults who meet any of the criteria below.

Procedure

1 Assess Adults for Need of Vaccinaon against HBV infecon

1,2,3

according to the following criteria:

•

All adults age 19 through 59 years

•

All adults age 60 or older with risk factors for HBV infecon due to

Sexual exposure risk

• sex partners of hepas B surface angen [HBsAg]-posive people

• sexually acve people not in monogamous relaonships

• people seeking treatment for a sexually-transmied infecon

• men who have sex with men

Percutaneous or mucosal exposure to blood

• current or recent injecon-drug use

• household contacts of HBsAg-posive people

• residents and sta of facilies for developmentally disabled people

• healthcare and public safety workers with risk for exposure to blood or blood-contaminated body uids

• hemodialysis, peritoneal dialysis, home dialysis, and predialysis paents

• paents with diabetes at the discreon of the treang clinician

Other factors

• ancipated travel to countries with high or intermediate endemic hepas B

• people with hepas C infecon

• chronic liver disease (including, but not limited to people with cirrhosis, fay liver disease, alcoholic liver

disease, autoimmune hepas, and an alanine aminotransferase [ALT] or aspartate aminotransferase

[AST] level greater than twice upper limit of normal)

• HIV infecon

• incarceraon

•

Any adult age 60 or older who does not meet the risk-based recommendaons above may be vaccinated.

standing orders for

Administering Hepatitis B Vaccine to Adults

1. In general, people who have documented com-

pleon of a HepB series at any point or who

have a history of previous HBV infecon should

not receive addional HepB vaccine, although

there is no evidence that addional vaccinaon

is harmful.

2. Revaccinaon may be indicated for certain

high-risk adults, including healthcare workers

who are documented non-responders to an

inial HepB series, and certain dialysis paents.

For revaccinaon guidance, see the 2018 ACIP

recommendaons for the prevenon of hepas

B at www.cdc.gov/mmwr/volumes/67/rr/pdfs/

rr6701-H.pdf (pages 23-24).

3. In sengs where the paent populaon has a

high rate of previous HBV infecon, prevacci-

naon tesng, which may be performed at the

same visit when the rst dose of vaccine is

administered, might reduce costs by avoiding

complete vaccinaon of people who are already

immune. However, prevaccinaon tesng is not

required and should not create a barrier to

vaccinaon.

notes

c on t in u ed on t h e n ex t p a ge

FOR PROFESSIONALS www.immunize.org / FOR THE PUBLIC www.vaccineinformation.org

www.immunize.org/catg.d/p3076.pdf

Item #P3076 (10/23/2023)

Scan for PDF

Standing orders for other vaccines are available at www.immunize.org/standing-orders.

note: This standing orders template may be adapted per a pracce’s discreon without

obtaining permission from Immunize.org. As a courtesy, please acknowledge Immunize.org

as its source.

2 Screen for Contraindicaons and Precauons

Contraindicaons

Do not give hepas B vaccine to a person who has experienced a serious systemic or anaphylacc reacon to a

prior dose of the vaccine or to any of its components. For a list of vaccine components, refer to the manufacturer’s

package insert (www.immunize.org/fda) or go to www.cdc.gov/vaccines/pubs/pinkbook/downloads/

appendices/B/excipient-table-2.pdf.

Precauons

Moderate or severe acute illness with or without fever

Pregnancy

Pregnancy tesng is not needed before vaccinaon; however, data on Heplisav-B and PreHevbrio are currently

insucient to reach any conclusions concerning vaccine-associated risks in pregnancy. Thus, providers should

vaccinate pregnant people needing HepB vaccinaon with Engerix-B, Recombivax HB, or Twinrix.

3 Provide Vaccine Informaon Statements

Provide all paents with a copy of the most current federal Vaccine Informaon Statement (VIS). Provide non-

English speaking paents with a copy of the VIS in their nave language, if one is available and desired; these

can be found at www.immunize.org/vis. (For informaon about how to document that the VIS was given, see

secon 6 tled “Document Vaccinaon.”)

4 Prepare to Administer Vaccine

Choose the needle gauge, needle length, and injecon site according to the following chart:

gen der and weight of patie nt nee dle gaug e nee dle leng th inj ecti on s ite

Female or male less than 130 lbs 22–25 ⅝"*–1" Deltoid muscle of arm

Female or male 130–152 lbs 22–25 1" Deltoid muscle of arm

Female 153–200 lbs 22–25 1–1½" Deltoid muscle of arm

Male 153–260 lbs 22–25 1–1½" Deltoid muscle of arm

Female 200+ lbs 22–25 1½" Deltoid muscle of arm

Male 260+ lbs 22–25 1½" Deltoid muscle of arm

Female or male, any weight 22–25 1"*–1½" Anterolateral thigh muscle

5 Administer Hepas B Vaccine according to the criteria and guidance in the tables below:

typ e of vac cine age gro up dos e rou te

Heplisav-B (Dynavax)

18 yrs & older 0.5 mL Intramuscular (IM)

Pediatric formulaon of Engerix-B (GSK)

or Recombivax HB (Merck)

19 yrs & younger 0.5 mL Intramuscular (IM)

Adult formulaon of Engerix-B (GSK) or

Recombivax HB (Merck)

20 yrs & older 1.0 mL Intramuscular (IM)

PreHevbrio (VBI Vaccines)

18 yrs & older 1.0 mL Intramuscular (IM)

Standing Orders for Administering Hepatitis B Vaccine to Adults (continued) page 2 of 4

Alternave needle lengths may be used for IM injecons if

the skin is stretched ght, the subcutaneous ssue is not

bunched, and the injecon is made at a 90° angle to the skin

as follows: a) a 5/8” needle for paents weighing less than

130 lbs (<60 kg) or b) a 1” needle for administraon in the

thigh muscle for adults of any weight.

c on t in u ed on t h e n ex t p a ge

www.immunize.org/catg.d/p3076.pdf / Item #P3076 (10/23/2023)

Schedules for vaccinaon

his tory of prev ious

vaccination

for patients whose brand of vaccine is known, continue with the same brand as shown

below. if previous brand is not known or is not available, complete series with a total

of 3 doses of vaccine. use the 3-dose schedule dosing intervals except when adminis-

tering 2 doses of heplisav-b (given 4 weeks apart as a complete 2-dose series).

sch edul e for a dmin istr at ion of

hep lisav-b

1,2

sch edul e for a dmin istr at ion of e nger ix-b ,

recom bivax h b, o r pr ehevbrio

1,2

None or unknown Give a 2-dose series at 0 and 1 month. Give a 3-dose series at 0, 1, and 6 mos.

1 dose

Give dose #2 at least 4 wks aer dose #1 to

complete the series.

Give dose #2 at least 4 wks aer #1; then, give

dose #3 at least 8 wks aer dose #2 and at least

16 wks aer dose #1.

2 doses

Give dose #3 at least 8 wks aer dose #2 and at

least 16 wks aer dose #1.

not es

Informaon on serologic tesng

•

CDC recommends screening all adults age 18 years or older at least one me for hepas B using a triple panel

serologic test, regardless of vaccinaon status. Periodic tesng of suscepble individuals at increased risk of

infecon is also recommended. Vaccinaon should proceed and should not be deferred if a screening test is

unavailable or is declined when the opportunity to vaccinate is present. Ideally, serologic tesng may be per-

formed at the same visit as vaccinaon, with the rst dose of vaccine administered aer the blood draw. If the

paent is found to be HBsAg-posive, appropriate medical follow-up should be provided; if the paent is

HBsAg-posive or shows evidence of immunity to HBV (qualitavely reported as “posive” or quaned at least

10 IU/mL), no further doses of hepas B vaccine are indicated. See 2023 CDC screening recommendaons for

details at www.cdc.gov/mmwr/volumes/72/rr/pdfs/rr7201a1-H.pdf.

•

Certa

in people need tesng for immunity (an-HBs) 1–2 months following vaccinaon. Check 2018 ACIP

recommendaons for details at www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6701-H.pdf (page 25).

6 Document Vaccinaon

Document each paent’s vaccine administraon informaon and follow up in the following places:

Medical record: Document the date the vaccine was administered, the manufacturer and lot number, the vaccinaon

site and route, and the name and tle of the person administering the vaccine. You must also document, in the

paent’s medical record or oce log, the publicaon date of the VIS and the date it was given to the paent.

Note that medical records/charts should be documented and retained in accordance with applicable state laws

and regulaons. If vaccine was not administered, record the reason(s) for non-receipt of the vaccine (e.g., medical

contraindicaon, paent refusal); discuss the need for vaccine with the paent at the next visit.

Personal immunizaon record card: Record the date of vaccinaon and the name/locaon of the administering

clinic.

Immunizaon Informaon System (IIS) or “registry”: Report the vaccinaon to the appropriate state/local IIS,

if available.

Standing Orders for Administering Hepatitis B Vaccine to Adults (continued) page 3 of 4

1. For paents receiving

hemodialysis or with other immunocompro-

mising condions, use one of the following alternave dosing

schedules: (a) Recombivax HB: series of 3 doses (1 mL each) of

40 mcg/mL at 0, 1, and 6 mos, OR (b) Engerix-B: series of 4 doses

(2 mL each) as a single 2-mL dose or as two 1-mL doses on a 0-, 1-,

2-, 6-month schedule. The safety and eecveness of Heplisav-B

and PreHevbrio have not been established in adults on hemodialysis.

2. The hepas B vaccine series does not need to be restarted,

regardless of the me that has elapsed between doses.

c on t in u ed on t h e n ex t p a ge

www.immunize.org/catg.d/p3076.pdf / Item #P3076 (10/23/2023)

7 Be Prepared to Manage Medical Emergencies

Be prepared for management of a medical emergency related to the administraon of vaccine by having a

wrien emergency medical protocol available, as well as equipment and medicaons. For Immunize.org’s “Medical

Management of Vaccine Reacons in Adult Paents,” go to www.immunize.org/catg.d/p3082.pdf. To prevent

syncope, vaccinate paents while they are seated or lying down and consider observing them for 15 minutes aer

receipt of the vaccine.

8 Report All Adverse Events to VAERS

Report all adverse events following the administraon of hepas B vaccine to the federal Vaccine Adverse

Event Reporng System (VAERS). To submit a VAERS report online (preferred) or to download a writable PDF

form, go to hp://vaers.hhs.gov/reportevent.html. Further assistance is available at (800) 822-7967.

Standing Orders Authorizaon

Standing Orders for Administering Hepatitis B Vaccine to Adults (continued) page 4 of 4

www.immunize.org/catg.d/p3076.pdf / Item #P3076 (10/23/2023)

This policy and procedure shall remain in effect for all patients of the

NAME OF PRACTICE OR CLINIC

effective

DATE

until rescinded or until

DATE

Medical Director

PRINT NAME

SIGNATURE

DATE