Hepatitis B vaccine now recommended for adults ages 19 through 59 years

The Advisory Committee on Immunization Practices has changed its guidance to encourage clinicians to offer the vaccine to adult patients, rather than target those with risk factors or wait for it to be requested.

The CDC is newly recommending that all adults ages 19 through 59 years receive the hepatitis B vaccine.

The agency's Advisory Committee on Immunization Practices (ACIP) now recommends hepatitis B vaccination for all adults ages 19 to 59 years and those ages 60 years and older with risk factors for hepatitis B. Adults ages 60 years and older without known risk factors may also be vaccinated. The ACIP previously recommended hepatitis B vaccination of children, adults with risk factors for infection, and all patients who request vaccination.

“The new language for adults aged ≥60 years without known risk factors is intended to prompt all providers to offer HepB vaccination to patients in that cohort, rather than wait for a patient to request vaccination, thus shifting the responsibility of initiating the consideration of HepB vaccination from the patient to the provider,” said the recommendations, which became CDC policy upon their publication in the April 1 MMWR.

The ACIP's new recommendations were based on an assessment of the evidence, including an economic analysis and a systematic literature review, which concluded that universal hepatitis B vaccination of adults ages 59 years and younger provides advantages over the previous risk factor-based recommendations.

The committee noted that about half of acute hepatitis B cases in 2019 were diagnosed in patients ages 30 to 49 years and that cases are on the rise among adults ages 40 years and older. Less than a third of U.S. adults reported being vaccinated against hepatitis B in 2018. “The past decade demonstrated that the long-standing, risk-based hepatitis B vaccination strategy among adults was falling short,” the recommendations noted.

Hepatitis B incidence is markedly lower among older adults, the ACIP said, supporting the ongoing recommendation to target those with risk factors in that age range. The CDC continues to recommend hepatitis B vaccination for all infants and unvaccinated children under the age of 19 years. “Fully implementing existing and new recommendations can reduce the burden of hepatitis B, while also moving toward elimination of the virus in the United States,” the ACIP recommendations said.