What are the details of post-exposure prophylaxis (PEP) for Hepatitis B (HB)?

From the Guidelines

Post-exposure prophylaxis (PEP) for Hepatitis B involves administering Hepatitis B immune globulin (HBIG) and the Hepatitis B vaccine as soon as possible after exposure, with the goal of preventing infection and reducing morbidity, mortality, and improving quality of life. The most recent and highest quality study, 1, provides guidelines for PEP in nonoccupational exposures to blood or body fluids that contain blood.

• For unvaccinated individuals exposed to an HBsAg-positive source, administering HBIG and initiating the Hepatitis B vaccine series is recommended, with HBIG given within 24 hours of exposure and the vaccine series completed according to the vaccination schedule.
• For previously vaccinated individuals with documented immunity, no PEP is needed.
• For individuals with unknown immunity, testing for anti-HBs antibodies is recommended; if levels are adequate (≥10 mIU/mL), no treatment is needed, but if inadequate, a booster dose of the vaccine is recommended. Key considerations in PEP for Hepatitis B include:
• The timing of PEP, which is critical and should be initiated as soon as possible after exposure, preferably within 24 hours.
• The use of HBIG to provide immediate passive immunity, and the Hepatitis B vaccine to stimulate active immunity for long-term protection.
• The importance of completing the Hepatitis B vaccine series to ensure long-term protection against HBV infection. Overall, the goal of PEP for Hepatitis B is to prevent infection and reduce the risk of chronic disease, liver cancer, and death, thereby improving quality of life and reducing morbidity and mortality.

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 (its value beyond 7 days of exposure is unclear). 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. 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 For persons who refuse Hepatitis B Vaccine, a second dose of Hepatitis B Immune Globulin (Human) should be given 1 month after the first dose All susceptible persons whose sex partners have acute hepatitis B infection should receive a single dose of HBIG (0.06 mL/kg) and should begin the hepatitis B vaccine series if prophylaxis can be started within 14 days of the last sexual contact or if sexual contact with the infected person will continue

The details of post-exposure prophylaxis (PEP) for Hepatitis B (HB) are as follows:

• Hepatitis B Immune Globulin (Human) should be given as soon as possible after exposure, with a dose of 0.06 mL/kg of body weight administered intramuscularly.
• The vaccine series should be initiated as soon as possible after exposure, with the first dose given within 7 days of exposure.
• For persons who refuse Hepatitis B Vaccine, a second dose of Hepatitis B Immune Globulin (Human) should be given 1 month after the first dose.
• Sexual exposure to an HBsAg-positive person requires a single dose of HBIG (0.06 mL/kg) and initiation of the hepatitis B vaccine series within 14 days of the last sexual contact.
• Household exposure to persons with acute HBV infection requires prophylactic treatment with Hepatitis B Immune Globulin (Human) and hepatitis B vaccine for infants <12 months of age 2, 2, 2.

From the Research

Hepatitis B Post-Exposure Prophylaxis (PEP) Details

• The post-exposure prophylaxis (PEP) for Hepatitis B (HB) should be given within 24 hours after exposure of an unprotected person to HBV-positive material 3, 4.
• Active and passive immunoprophylaxis after exposure to HBV is an effective tool against infection with hepatitis B virus in unvaccinated persons 3, 4, 5.
• A hepatitis B vaccination (HepB) series with an initial dose of hepatitis B immune globulin (HBIG) is the recommended prophylaxis for infants born to mothers with chronic hepatitis B virus (HBV) infection and for HBV-exposed persons without known protection 6.
• Administration of HBIG with HepB can delay and reduce responses to HepB in mice, but the initial circulating levels of HBIG could prevent infection despite an impaired response to vaccine 6.
• Post-exposure prophylaxis by anti-hepatitis B immunoglobin injections and/or vaccination should be considered after evaluation of the hepatitis B surface antigen status of the source and of the vaccination and vaccine-response status of the exposed person 5.

Administration and Timing

• PEP should be started as early as possible 3, 4.
• The recommended PEP for HIV consists of two inhibitors of the reverse transcriptase and one inhibitor of the protease, and should be carried out for 28 days 3, 4.
• For Hepatitis B, the PEP should be given within 24 hours after exposure 3, 4.

Special Considerations

• Once acute hepatitis B infection is diagnosed, therapy is not recommended for immunocompetent persons 3, 4, 5.
• At present, PEP against HCV infection is not available, but monotherapy with interferon-alpha can avoid chronification in most patients suffering from acute hepatitis C 3, 4, 5.