From the Guidelines
Healthcare workers should be vaccinated against hepatitis B virus (HBV) as the primary prevention strategy, with the standard HBV vaccination series consisting of three doses of recombinant HBV vaccine administered at 0,1, and 6 months, and post-vaccination serologic testing 1-2 months after completing the series to confirm immunity (anti-HBs ≥10 mIU/mL). The most recent and highest quality study, 1, published in 2018, provides guidelines for the prevention of hepatitis B virus infection in the United States, including recommendations for healthcare personnel.
Key Recommendations
- The standard HBV vaccination series consists of three doses of recombinant HBV vaccine (such as Engerix-B or Recombivax HB) administered at 0,1, and 6 months.
- For adults, each dose is typically 1.0 mL (20 μg) given intramuscularly in the deltoid muscle.
- Healthcare workers should undergo post-vaccination serologic testing 1-2 months after completing the series to confirm immunity (anti-HBs ≥10 mIU/mL).
- Those who do not develop adequate antibody levels may require additional doses.
- Beyond vaccination, healthcare workers should practice standard precautions including proper hand hygiene, use of personal protective equipment (gloves, masks, eye protection) when exposure to blood or body fluids is anticipated, and proper handling and disposal of sharps.
- Following needlestick injury or other potential HBV exposure, unvaccinated workers should receive both HBV vaccine and hepatitis B immune globulin (HBIG) as post-exposure prophylaxis, as recommended by 1 in 2021.
Importance of Prevention
These measures are critical because HBV is highly infectious and can survive on environmental surfaces for at least 7 days, with healthcare workers at particular risk due to occupational exposure to blood and body fluids. The guidelines from 1 and other studies, such as 1 and 1, emphasize the importance of vaccination and standard precautions in preventing HBV transmission among healthcare workers.
Additional Considerations
In addition to vaccination, healthcare workers should be aware of the risks of HBV transmission and take precautions to minimize exposure, including proper handling and disposal of sharps, and use of personal protective equipment, as recommended by 1 in 2007 and 1 in 2003. By following these guidelines and taking a proactive approach to prevention, healthcare workers can reduce their risk of HBV infection and protect themselves and their patients from this serious disease.
From the FDA Drug Label
For greatest effectiveness, passive prophylaxis with Hepatitis B Immune Globulin (Human) should be given as soon as possible after exposure Acute Exposure to Blood Containing HBsAg Table 1 summarizes prophylaxis for percutaneous (needlestick or bite), ocular, or mucous-membrane exposure to blood according to the source of exposure and vaccination status of the exposed person If Hepatitis B Immune Globulin (Human) is indicated (see Table 1), an injection of 0. 06 mL/kg of body weight should be administered intramuscularly (see PRECAUTIONS) as soon as possible after exposure and within 24 hours, if possible.
Healthcare workers are at risk of hepatitis B due to potential exposure to blood containing HBsAg through needlestick injuries or other percutaneous exposures.
- The recommended prophylaxis for healthcare workers exposed to blood containing HBsAg includes:
- Immediate administration of Hepatitis B Immune Globulin (Human)
- Initiation of the hepatitis B vaccine series
- The effectiveness of prophylaxis depends on the timing of administration, with the greatest effectiveness achieved when administered as soon as possible after exposure. 2
From the Research
Risk of Hepatitis B in Healthcare Workers
- Healthcare workers are at a high risk of occupationally acquiring hepatitis B virus (HBV) due to their continuous contact with blood or body fluids 3, 4, 5, 6.
- The risk is greater in highly endemic areas where the prevalence of infection is higher in the general population 3.
- HBV is the most transmissible infection among healthcare workers and is preventable by vaccination 4, 5.
Recommendations for Preventing Hepatitis B
- The use of hepatitis B vaccine as a preexposure prophylaxis is recommended to prevent HBV infection among healthcare workers 3, 4, 5, 6.
- Postexposure prophylaxis, including the use of hepatitis B immunoglobulin alone or hepatitis B immunoglobulin plus the vaccine, is also recommended for healthcare workers who have been exposed to HBV 3, 4.
- Regular screening and vaccination of healthcare workers, as well as regular provision of training and logistics, are necessary to prevent occupational exposure to HBV 7.
Barriers to Prevention
- Low uptake of preexposure prophylaxis has been observed in resource-poor settings where the disease is highly endemic 3.
- Many barriers, including lack of awareness, risk assessment, and low priority given by health management, have been identified as impacting the successful use of HBV preventive measures 3, 4.
- Poor practice of standard precautions among healthcare workers is also a major concern, leading to high occupational exposure to HBV 7.