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Date of preparation: March 2018

Twinrix dosage and administration


A dose of 1.0ml of Twinrix Adult (720 ELISA Units HA/20 µg HBsAg) is recommended for adults and adolescents 16 years of age and above. 1

The dose of 0.5ml (360 ELISA Units HA/10µg HBsAg) Twinrix Paediatric is recommended for infants, children and adolescents from 1 year up to and including 15 years of age. 2

Primary vaccination schedule

The standard primary course of vaccination with Twinrix Adult and Twinrix Paediatric consists of 3 doses, the first administered at the elected date, the second 1 month later and the third 6 months after the first dose. 12

In exceptional circumstances in adults, when travel is anticipated within 1 month or more after initiating the vaccination course, but where insufficient time is available to allow the standard 0, 1, 6 month schedule to be completed, a schedule of 3 intramuscular injections given at 0, 7 and 21 days may be used. When this schedule is applied, a fourth dose is recommended 12 months after the first dose. 1

The recommended schedule should be adhered to. Once initiated, the primary course of vaccination should be completed with the same vaccine. 12

Booster dose

Long-term antibody persistence data following vaccination with Twinrix Adult is available up to 15 years after vaccination 1and 10 years with Twinrix Paediatric. 2The anti-HBs and anti-HAV antibody titres observed following a primary vaccination course with the combined vaccine are in the range of what is seen following vaccination with the monovalent vaccines. The kinetics of antibody decline are also similar. General guidelines for booster vaccination can therefore be drawn from experience with the monovalent vaccines. 12

Hepatitis B  

The need for a booster dose of hepatitis B vaccine in healthy individuals who have received a full primary vaccination course has not been established; however some official vaccination programmes currently include a recommendation for a booster dose of hepatitis B vaccine and these should be respected. 12

For some categories of subjects or patients exposed to HBV (e.g. haemodialysis or immunocompromised patients) a precautionary attitude should be considered to ensure a protective antibody level >10IU/l. 1

Hepatitis A  

It is not yet fully established whether immunocompetent individuals who have responded to hepatitis A vaccination will require booster doses as protection in the absence of detectable antibodies may be ensured by vaccine-induced HAV immunological memory. Guidelines for boosting are based on the assumption that antibodies are required for protection; anti-HAV antibodies have been predicted to persist for at least 10 years with Twinrix Adult and Twinrix Paediatric. 12

In situations where a booster dose of both hepatitis A and hepatitis B are desired, Twinrix Adult and Twinrix Paediatric can be given. Alternatively, subjects primed with Twinrix Adult may be administered a booster dose of either of the monovalent vaccines. 12

Method of administration

Twinrix Adult and Twinrix Paediatric is for intramuscular injection, preferably in the deltoid region; in the case of infants, Twinrix Paediatric can be given in the anterolateral thigh. 1 2

Since intradermal injection or intramuscular administration into the gluteal muscle could lead to a suboptimal response to the vaccine, these routes should be avoided. However, exceptionally, Twinrix can be administered subcutaneously to subjects with thrombocytopenia or bleeding disorders since bleeding may occur following an intramuscular administration to these subjects. 12


  1. Twinrix Adult Summary of Product Characteristics, GlaxoSmithKline.
  2. Twinrix Paediatric Summary of Product Characteristics, GlaxoSmithKline.

Twinrix is a registered trademark of the GlaxoSmithKline Group of Companies