Hepatitis B 

Vaccination against hepatitis B (Engerix-B - GlaxoSmithKline; Recombivax HB - Merck) is now a routine pediatric immunization in the US. It is recommended for previously unvacci- nated travelers going to highly or moderately endemic areas  if they plan to stay for a long time, return fre- quently, live among the local population, receive medical or dental care, or undergo cosmetic needle punctures for tattoos or body-piercing. Risk areas include all of Africa and Asia, the Middle East, Southern Europe, the Southern and Western Pacific Islands, tropical South America and the Caribbean. People who might have unprotected sexual contact with new partners should be immunized against hepatitis B whether traveling or not.

Primary immunization usually consists of 3 doses given IM at 0, 1 and 6 months. An accelerated schedule of 3 doses given at 0, 1 and 2 months, followed by a fourth at 12 months, is approved for Engerix-B  in the US. Accelerated schedules given at 0, 7 and 21 days plus a fourth dose 12 months after the first or 0, 7 and 14 days plus a fourth dose 6 months after the first can be used if necessary. A 2-dose schedule of Recombivax at 0 and 4-6 months is approved in the US for adolescents 11-15 years old. An interrupted hepatitis B vaccination series does not need to be restarted. A 3-dose series started with one vaccine may be completed with the other.