From the Guidelines
Vaccination is the primary recommended prevention strategy for hepatitis B in healthcare workers, as it provides long-lasting immunity and prevents infection after exposure to the virus. All healthcare personnel should receive a complete hepatitis B vaccine series, which consists of three doses given at 0,1, and 6 months. The recombinant vaccines (Engerix-B or Recombivax HB) are most commonly used, with adult dosing of either 20 μg/mL (Engerix-B) or 10 μg/mL (Recombivax HB) per injection 1.
Key Recommendations
- Following vaccination, healthcare workers should undergo post-vaccination serologic testing 1-2 months after completing the series to confirm immunity (anti-HBs ≥10 mIU/mL) 1.
- Those who do not develop adequate antibody levels may require additional doses.
- For immediate protection after a needlestick injury or other exposure, unvaccinated workers should receive both hepatitis B immune globulin (HBIG) and begin the vaccine series within 24 hours of exposure 1.
- Healthcare workers who are at risk of HBV infection should be tested and vaccinated, and those who are found to be susceptible should receive vaccine 1.
Rationale
The vaccine provides long-lasting immunity by stimulating the production of protective antibodies, preventing infection even after exposure to the virus. Hepatitis B virus is highly infectious through blood and body fluids, with healthcare workers at particular risk due to occupational exposure 1.
Additional Considerations
- Hospitals, clinics, and offices should implement programs to ensure that health care professionals are immunized appropriately and that annual immunization coverage assessments are performed 1.
- All health care professionals and people who work in any health care setting should be included in immunization programs 1.
From the FDA Drug Label
Considering the serious consequences of infection, immunization should be considered for all persons at potential risk of exposure to the hepatitis B virus. The Advisory Committee on Immunization Practices (ACIP) recommends vaccination of all persons from birth to age 18. The Committee on Infectious Diseases of the American Academy of Pediatrics (AAP) has also endorsed universal infant immunization as part of a comprehensive strategy for the control of hepatitis B infection.
The recommended prevention strategy for hepatitis B in health workers is vaccination. Health workers are at risk of exposure to hepatitis B virus, and vaccination is the most effective way to prevent infection. The ACIP and AAP recommend vaccination of all persons from birth to age 18, and health workers should be included in this recommendation.
- Key points:
- Vaccination is recommended for all health workers
- Vaccination should be considered for all persons at potential risk of exposure to the hepatitis B virus
- The ACIP and AAP recommend vaccination of all persons from birth to age 18 2
From the Research
Risk of Hepatitis B in Health Workers
- Health care workers (HCWs) are at a high risk of occupationally acquiring hepatitis B virus (HBV) due to their direct contact with blood or body fluids 3.
- The risk of HCWs in highly endemic areas is greater due to the greater prevalence of infection in the general population 3.
Prevention Strategies
- The use of the hepatitis B vaccine as a preexposure prophylaxis is recommended to prevent HBV infection among HCWs [(3,4)].
- Postexposure prophylaxis with hepatitis B immunoglobulin (HBIG) alone or HBIG plus the vaccine is also recommended for HCWs who have been exposed to HBV [(3,5)].
- Active vaccination after HBV exposure can start immediately, and postvaccination testing for hepatitis B antibody can show positive seroconversion in most cases 6.
Postexposure Prophylaxis Management
- HBIG can be administered within 24 hours after HBV exposure, but it may still be effective when administered between 24 hours and 7 days postexposure 6.
- The management of operating room personnel who have had occupational exposure to blood and other body fluids that might contain HBV includes starting hepatitis B vaccine series in any susceptible unvaccinated personnel 5.