Hepatitis A and B combined vaccine#

Information about the combined hepatitis A and B vaccine, who should consider it, the standard and accelerated schedules, what to do if you do not develop antibodies, and how TeleTest can help.

The hepatitis A and B combined vaccine is an injected vaccine that protects against two different viruses that infect the liver. It is given as a series of doses over several months and is one of the most commonly used pre-travel and pre-exposure vaccines in Canada.

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What it protects against#

The vaccine combines two separate vaccines into one product:

  • Hepatitis A - a virus spread through contaminated food or water, common in many parts of the world. Most adult infections cause weeks of nausea, fatigue, jaundice (yellowing of the skin and eyes), and time off work; a small number become serious.
  • Hepatitis B - a virus spread through blood, body fluids, and sexual contact. Many people clear the infection, but some (especially those infected as children) develop chronic liver disease, which can progress to liver scarring (cirrhosis) and liver cancer over decades.

Both vaccines have been used for decades and are very effective.

Who should consider it#

The combined vaccine is appropriate when you need protection from either or both viruses. Common reasons include:

  • Travel to countries where hepatitis A or B is common (much of Asia, Africa, parts of Central and South America, and Eastern Europe)
  • Healthcare workers and others with occupational exposure to blood or body fluids
  • Household contacts or sexual partners of someone with chronic hepatitis B
  • Men who have sex with men, people with multiple sexual partners, or those exposed to body fluids of partners whose status is unknown
  • People who inject drugs or share equipment for any reason
  • People with chronic liver disease (including chronic hepatitis C, alcohol-related liver disease, or fatty liver disease), where a new infection would be more dangerous
  • People starting on medications that suppress the immune system or affect the liver
  • Anyone who was not vaccinated for hepatitis B in childhood and would like to be protected

People who already had hepatitis B vaccination in childhood can still receive the combined vaccine - it adds hepatitis A coverage and gives extra protection against hepatitis B.

How TeleTest helps#

  • What we do. We review your reasons for vaccination, check whether you've had any previous doses or post-vaccination bloodwork, and write the prescription for the combined hepatitis A and B vaccine. We can arrange the appropriate schedule (standard or accelerated) based on your travel timeline or exposure. We also order the post-vaccination antibody check if it is recommended (for healthcare workers or other high-exposure groups).
  • What we do not do. We do not administer injectable vaccines on site. You take the prescription to a pharmacy that administers vaccines (in provinces where this is allowed), a public health unit, a travel-medicine clinic, or your family doctor. We do not manage acute hepatitis B exposures (for example, a needlestick injury) - those require an in-person visit to urgent care or an emergency department within hours.

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Common questions#

What is the standard schedule?#

The standard schedule is three injections in the upper arm: at month 0 (first dose), month 1 (second dose, one month after the first), and month 6 (third dose, six months after the first). Full protection develops about two to four weeks after the third dose.

What is the accelerated schedule?#

If you don't have six months before travel or potential exposure, an accelerated four-dose schedule is available for adults: doses at day 0, day 7, and day 21-30, with a final booster at 12 months. This produces good early protection in time for travel. The booster at 12 months is important for long-term immunity.

Can I start the series if I've already had hepatitis B vaccination?#

Yes. The combined vaccine is safe even if you have already had a course of hepatitis B vaccine. It will provide hepatitis A protection (which you may not have had) and additional hepatitis B protection. If you have full and documented hepatitis A and hepatitis B vaccination already, you usually don't need the combined product.

What are the side effects?#

Common side effects are pain, redness, or swelling at the injection site, tiredness, mild fever, and headache. These usually settle in 1-2 days. Serious allergic reactions (anaphylaxis) are rare but possible. People who have had a severe allergic reaction to a previous dose, or to a known vaccine component (including yeast), should not receive the same product without an allergist's input.

Should I check antibody levels after the series?#

For most healthy adults, routine post-vaccination antibody testing is not recommended - protection is excellent and the test isn't needed. Antibody testing is recommended for healthcare workers, people with chronic kidney disease on dialysis, people with weakened immune systems, and household or sexual contacts of someone with chronic hepatitis B. Testing is done 1-2 months after the final dose.

My antibody test came back showing no hepatitis B antibodies. What do I do?#

A small number of people do not develop a measurable antibody response (a protective level is generally considered 10 mIU/mL or higher of anti-HBs). The usual steps are:

  1. A single booster dose of a hepatitis B-containing vaccine
  2. Repeat antibody testing 1-2 months after the booster
  3. If still no detectable antibodies, a full repeat hepatitis B series (three doses at 0, 1, and 6 months)
  4. Repeat antibody testing 1-2 months after the final dose

About 5% of healthy adults are "non-responders" after two full series. Further doses are not helpful.

What if I'm still not immune after two full hepatitis B series?#

You are considered a non-responder. This is uncommon but recognized. Practical points:

  • Additional doses beyond two full series are not helpful in most cases.
  • Your clinician may order additional tests (HBsAg and anti-HBc) to make sure you don't already have hepatitis B that is just not producing antibodies in a typical pattern.
  • If those tests are negative, you remain susceptible to hepatitis B if exposed.
  • In a future high-risk exposure (for example, a needlestick or unprotected contact with someone who has hepatitis B), you would need hepatitis B immune globulin (HBIG) as soon as possible, ideally within 24 hours, to provide short-term protection.
  • Keep a record of your "non-responder" status with your other health information so it can be acted on quickly if needed.
Is it safe in pregnancy or breastfeeding?#

Yes. The combined hepatitis A and B vaccine is not a live vaccine and is considered safe in pregnancy and while breastfeeding. It is given when the benefit (for example, travel or exposure risk) outweighs the small theoretical risks.

Can children get this vaccine?#

A separate paediatric formulation is available and is sometimes used. Most children in Canada are already vaccinated against hepatitis B as part of the routine childhood schedule, so the most common reason for the combined vaccine in children is travel to a country where hepatitis A is common.

How long does protection last?#

Protection is long-lasting for both hepatitis A and hepatitis B after a complete series, often life-long for most healthy adults. Routine boosters are not currently recommended for the general population.

I missed a dose - do I need to start over?#

No. If a dose is delayed, you do not need to restart the series. The next dose is given as soon as it can be arranged. The interval between doses can be longer than recommended without losing protection.

Can I get it at the same time as other vaccines?#

Yes. The combined hepatitis A and B vaccine can be given at the same visit as most other vaccines, including travel vaccines, the influenza shot, and COVID vaccines.

Cost and coverage#

The combined hepatitis A and B vaccine is not part of the publicly funded adult immunization schedule in most provinces (some childhood doses are publicly funded). Out-of-pocket cost is typically in the range of about $70-$100 per dose, so the standard three-dose adult series is usually $210-$300 in total, plus the administration fee at the pharmacy or clinic. Pricing varies between pharmacies.

Many private and workplace plans cover travel vaccines partially or in full. Travel-insurance plans and credit-card travel benefits sometimes reimburse as well. Keep your receipts.

Some groups can access the vaccine free of charge through public health programs - for example, healthcare workers (through their employer), household contacts of people with chronic hepatitis B, men who have sex with men, and people who inject drugs. Eligibility varies by province.

TeleTest charges a consultation fee for the review and prescription; a receipt is available for reimbursement.

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Last reviewed: Spring 2026. Reviewed by Dr. Mohan Pandit, Chief Medical Officer at TeleTest. We review this page periodically as medical guidelines, lab practices, and provincial programs evolve. This page is for general information, not personal medical advice. If you've noticed information that may be out of date or have suggestions, please contact us - we appreciate the help keeping these resources accurate.

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