Vaccine Information: ENGERIX-B

ENGERIX-B- hepatitis b virus subtype adw2 hbsag surface protein antigen injection, suspension
GlaxoSmithKline Biologicals SA

1 INDICATIONS AND USAGE

ENGERIX-B is indicated for immunization against infection caused by all known subtypes of hepatitis B virus.

2 DOSAGE AND ADMINISTRATION

For intramuscular administration. See Section 2.2 for subcutaneous administration in persons at risk of hemorrhage.

2.1 Preparation for Administration

Shake well before use. With thorough agitation, ENGERIX-B is a homogeneous, turbid white suspension. Do not administer if it appears otherwise. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. If either of these conditions exists, the vaccine should not be administered.

For the prefilled syringes, attach a sterile needle and administer intramuscularly.

For the vials, use a sterile needle and sterile syringe to withdraw the vaccine dose and administer intramuscularly. Changing needles between drawing vaccine from a vial and injecting it into a recipient is not necessary unless the needle has been damaged or contaminated. Use a separate sterile needle and syringe for each individual.

2.2 Administration

ENGERIX-B should be administered by intramuscular injection. The preferred administration site is the anterolateral aspect of the thigh for infants younger than 1 year and the deltoid muscle in older children (whose deltoid is large enough for an intramuscular injection) and adults. ENGERIX-B should not be administered in the gluteal region; such injections may result in suboptimal response.

ENGERIX-B may be administered subcutaneously to persons at risk of hemorrhage (e.g., hemophiliacs). However, hepatitis B vaccines administered subcutaneously are known to result in a lower antibody response. Additionally, when other aluminum-adsorbed vaccines have been administered subcutaneously, an increased incidence of local reactions including subcutaneous nodules has been observed. Therefore, subcutaneous administration should be used only in persons who are at risk of hemorrhage with intramuscular injections.

Do not administer this product intravenously or intradermally.

2.3 Recommended Dose and Schedule

Persons from Birth through 19 Years

Primary immunization for infants (born of hepatitis B surface antigen [HBsAg]-negative or HBsAg-positive mothers), children (birth through 10 years), and adolescents (aged 11 through 19 years) consists of a series of 3 doses (0.5 mL each) given on a 0-, 1-, and 6-month schedule.

Persons Aged 20 Years and Older

Primary immunization for persons aged 20 years and older consists of a series of 3 doses (1 mL each) given on a 0-, 1-, and 6-month schedule.

Adults on Hemodialysis

Primary immunization consists of a series of 4 doses (2-mL each) given as a single 2-mL dose or two 1-mL doses on a 0-, 1-, 2-, and 6-month schedule. In hemodialysis patients, antibody response is lower than in healthy persons and protection may persist only as long as antibody levels remain above 10 mIU/mL. Therefore, the need for booster doses should be assessed by annual antibody testing. A 2-mL booster dose (as a single 2-mL dose or two 1-mL doses) should be given when antibody levels decline below 10 mIU/mL.1 [See Clinical Studies (14.2).]

Table 1. Recommended Dosage and Administration Schedules

Group

Dosea

Schedules

Infants born of:

HBsAg-negative mothers

0.5 mL

0, 1, 6 months

HBsAg-positive mothersb

0.5 mL

0, 1, 6 months

Children:

Birth through 10 years

0.5 mL

0, 1, 6 months

Adolescents:

Aged 11 through 19 years

0.5 mL

0, 1, 6 months

Adults:

Aged 20 years and older

1 mL

0, 1, 6 months

Adults on hemodialysis

2 mLc

0, 1, 2, 6 months

HBsAg = Hepatitis B surface antigen.

a 0.5 mL (10 mcg); 1 mL (20 mcg).

b Infants born to HBsAg-positive mothers should receive vaccine and hepatitis B immune globulin (HBIG) within 12 hours after birth [see Dosage and Administration (2.6)].

c Given as a single 2-mL dose or as two 1-mL doses.

2.4 Alternate Dosing Schedules

There are alternate dosing and administration schedules which may be used for specific populations (e.g., neonates born of hepatitis B-infected mothers, persons who have or might have been recently exposed to the virus, and travelers to high-risk areas) (Table 2). For some of these alternate schedules, an additional dose at 12 months is recommended for prolonged maintenance of protective titers.

Table 2. Alternate Dosage and Administration Schedules

Group

Dosea

Schedules

Infants born of:

HBsAg-positive mothersb

0.5 mL

0, 1, 2, 12 months

Children:

Birth through 10 years

0.5 mL

0, 1, 2, 12 months

Aged 5 through 10 years

0.5 mL

0, 12, 24 monthsc

Adolescents:

Aged 11 through 16 years

0.5 mL

0, 12, 24 monthsc

Aged 11 through 19 years

1 mL

0, 1, 6 months

Aged 11 through 19 years

1 mL

0, 1, 2, 12 months

Adults:

Aged 20 years and older

1 mL

0, 1, 2, 12 months

HBsAg = Hepatitis B surface antigen.

a 0.5 mL (10 mcg); 1 mL (20 mcg).

b Infants born to HBsAg-positive mothers should receive vaccine and hepatitis B immune globulin (HBIG) within 12 hours after birth [see Dosage and Administration (2.6)].

c For children and adolescents for whom an extended administration schedule is acceptable based on risk of exposure.

2.5 Booster Vaccinations

Whenever administration of a booster dose is appropriate, the dose of ENGERIX-B is 0.5 mL for children aged 10 years and younger and 1 mL for persons aged 11 years and older. Studies have demonstrated a substantial increase in antibody titers after booster vaccination with ENGERIX-B. See Section 2.3 for information on booster vaccination for adults on hemodialysis.

2.6 Known or Presumed Exposure to Hepatitis B Virus

Persons with known or presumed exposure to the hepatitis B virus (e.g., neonates born of infected mothers, persons who experienced percutaneous or permucosal exposure to the virus) should be given hepatitis B immune globulin (HBIG) in addition to ENGERIX-B in accordance with Advisory Committee on Immunization Practices recommendations and with the package insert for HBIG. ENGERIX-B can be given on either dosing schedule (0, 1, and 6 months or 0, 1, 2, and 12 months).

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