Adult/Dialysis Product Information for RECOMBIVAX HB® [Hepatitis B Vaccine (Recombinant)]
High immunogenicity in adults
In healthy adultsa ≥20 years of age after the recommended 3-dose series in clinical trials
Seroprotection ratesb in healthy adults of all ages after the recommended 3-dose series of 10 mcg/1.0 mL administered at 0, 1, and 6 months, as demonstrated in clinical studies [n=1,240–1,873].3
Adapted from West, 1989.3
ACIP=Advisory Committee on Immunization Practices; anti-HBs=antibody to hepatitis B surface antigen.
In clinical studies (n=28–44), RECOMBIVAX HB provided seroprotectiona in 86% of adult predialysis and dialysis patients after the recommended 3-dose series of 40 mcg/1.0 mL at 0, 1, and 6 months3
Adapted from West, 19893
- aSeroprotection is defined by the ACIP as an anti-HBs level ≥10 mlU/mL.4
ACIP=Advisory Committee on Immunization Practices;
anti-HBs=antibody to hepatitis B surface antigen.
Adult & Dialysis Dosing
|Adults ≥20 years of age||10 mcg (1.0 mL)||0, 1, 6 months||3|
|Predialysis and dialysis patients||40 mcg (1.0 mL)a||0, 1, 6 months||3|
|Adults ≥20 years of age||20 mcg (1.0 mL)||0, 1, 6 months||3|
|Adults on hemodialysis||40 mcg (1.0 mL)c||0, 1, 2, 6 months||4-8|
- aRECOMBIVAX HB Dialysis Formulation is available in 1-mL (40 mcg/1.0 mL) single-dose vials.
bEngerix-B is a registered trademark of GlaxoSmithKline.
cFor adults on hemodialysis, Engerix-B, available in 1-mL (20 mcg/1.0 mL) single-dose vials or prefilled syringes, can be given as a single 2-mL dose or as two 1-mL doses.
Indications for RECOMBIVAX HB
RECOMBIVAX HB® [Hepatitis B Vaccine (Recombinant)] is indicated for prevention of infection caused by all known subtypes of hepatitis B virus. RECOMBIVAX HB is approved for use in individuals of all ages. RECOMBIVAX HB Dialysis Formulation is approved for use in adult predialysis and dialysis patients 18 years of age and older.
Do not administer RECOMBIVAX HB to individuals with a history of severe allergic or hypersensitivity reactions (eg, anaphylaxis) after a previous dose of any hepatitis B-containing vaccine or to any component of RECOMBIVAX HB, including yeast.
Do not administer RECOMBIVAX HB® [Hepatitis B Vaccine (Recombinant)] to individuals with a history of severe allergic or hypersensitivity reactions (eg, anaphylaxis) after a previous dose of any hepatitis B-containing vaccine or to any component of RECOMBIVAX HB, including yeast.
The vial stopper and the syringe plunger stopper and tip cap contain dry natural latex rubber, which may cause allergic reactions in latex-sensitive individuals.
Apnea following intramuscular vaccination has been observed in some infants born prematurely. Decisions about when to administer an intramuscular vaccine, including RECOMBIVAX HB, to infants born prematurely should be based on consideration of the individual infant’s medical status and the potential benefits and possible risks of vaccination. For RECOMBIVAX HB, this assessment should include consideration of the mother’s hepatitis B antigen status and high probability of maternal transmission of hepatitis B virus to infants born to mothers who are HBsAg positive if vaccination is delayed.
Hepatitis B vaccination should be delayed until 1 month of age or hospital discharge in infants weighing <2000 g if the mother is documented to be HBsAg negative at the time of the infant’s birth. Infants weighing <2000 g born to HBsAg positive or HBsAg unknown mothers should receive vaccine and hepatitis B immune globulin (HBIG) in accordance with ACIP recommendations if HBsAg status cannot be determined.
Hepatitis B virus has a long incubation period. RECOMBIVAX HB may not prevent hepatitis B infection in individuals who have an unrecognized hepatitis B infection at the time of vaccination.
Vaccination with RECOMBIVAX HB may not protect all individuals.
In healthy infants and children (up to 10 years of age), injection site reactions and systemic adverse reactions were reported following 0.2% and 10.4% of the injections, respectively. The most frequently reported systemic adverse reactions (>1% injections), in decreasing order of frequency, were irritability, fever, diarrhea, fatigue/weakness, diminished appetite, and rhinitis. In a study that compared the 3-dose regimen (5 mcg) with the 2-dose regimen (10 mcg) of RECOMBIVAX HB in adolescents, the overall frequency of adverse reactions was generally similar.
In a group of studies involving healthy adults, injection site reactions and systemic adverse reactions were reported following 17% and 15% of the injections, respectively. The following adverse reactions were reported (≥1% of injections) injection site reactions, fatigue/weakness, headache, fever, malaise, nausea, diarrhea, pharyngitis, and upper respiratory infection.
Additional adverse reactions have been reported with the use of the marketed vaccine. Because these reactions are reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency or establish a causal relationship to a vaccine exposure.
The duration of the protective effect on RECOMBIVAX HB in healthy vaccinees is unknown at present and the need for booster doses is not yet defined.
RECOMBIVAX HB should be administered as soon as possible after being removed from refrigeration.
There are no adequate and well-controlled studies designed to evaluate RECOMBIVAX HB in pregnant women. Available post-approval data do not suggest an increased risk of miscarriage or major birth defects in women who received RECOMBIVAX HB during pregnancy.
Data are not available to assess the effects of RECOMBIVAX HB on the breastfed infant or on milk productions/excretion. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for RECOMBIVAX HB and any potential adverse effects on the breastfed child from RECOMBIVAX HB or from the underlying maternal condition.
The safety and effectiveness of RECOMBIVAX HB Dialysis Formulation in children have not been established.
Clinical studies of RECOMBIVAX HB did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. However, in later studies it has been shown that a diminished antibody response can be expected in persons older than 60 years of age. In addition, the responses to these vaccines may be lower if the vaccine is administered as a buttock injection.
Predialysis and dialysis adult patients respond less well to hepatitis B vaccines than do healthy individuals; however, vaccination of adult patients early in the course of their renal disease produces higher seroconversion rates than vaccination after dialysis has been initiated.
Refer to recommendations of the Advisory Committee on Immunization Practices (ACIP) and to the package insert for hepatitis B immune globulin (HBIG) for management of persons with known or presumed exposure to the hepatitis B virus (eg, neonates born of infected mothers or persons who experienced percutaneous or permucosal exposure to the virus). When recommended, administer RECOMBIVAX HB and HBIG intramuscularly at separate sites (eg, opposite anterolateral thighs for exposed neonates) as soon as possible after exposure.
Before administering RECOMBIVAX HB, please read the Prescribing Information.