From the Guidelines
Hepatitis B immunoglobulin (HBIG) is indicated for individuals who experience a needlestick injury from an HBsAg-positive source and are either unvaccinated or have an unknown response to previous HBV vaccination. The most recent and highest quality study 1 supports the use of HBIG in conjunction with the hepatitis B vaccine series for postexposure prophylaxis. Key points to consider in the management of such exposures include:
- Administering HBIG as soon as possible after exposure, ideally within 24 hours, but it may still provide some benefit if given within 7 days.
- The recommended dose is 0.06 mL/kg body weight (typically 3-5 mL for adults) administered intramuscularly.
- HBIG should be given in conjunction with the hepatitis B vaccine series (if not previously vaccinated) administered at a different site.
- For individuals with a known response to previous vaccination, the need for HBIG and vaccine booster dose depends on the timing and response to the previous vaccination. This approach is aimed at reducing the risk of developing acute or chronic hepatitis B infection by providing immediate antibodies against HBV through HBIG and stimulating active immunity through the vaccine. The management of occupational exposures to bloodborne pathogens should also include education on safe handling of sharps, immunization, standard precautions, and safe work habits, as outlined in earlier guidelines 1. However, the most recent guideline 1 takes precedence in guiding the specific use of HBIG for postexposure prophylaxis in the context of a needlestick injury from an HBsAg-positive source.
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 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 Exposed Person Source: HBsAg-Positive: 1. Hepatitis B Immune Globulin (Human) x1 immediately
The indication for immunoglobulin (Ig) in a patient with a needlestick injury who is Hepatitis B surface antigen (HbsAg) positive is post-exposure prophylaxis.
- The recommended dose is 0.06 mL/kg of body weight administered intramuscularly as soon as possible after exposure and within 24 hours, if possible.
- The treatment of choice is a regimen combining Hepatitis B Immune Globulin (Human) with hepatitis B vaccine to provide both short- and long-term protection 2.
From the Research
Indication for Immunoglobulin in Needlestick Injury
The indication for immunoglobulin (Ig) in a patient with a needlestick injury who is Hepatitis B surface antigen (HbsAg) positive is as follows:
- Hepatitis B immune globulin (HBIG) is recommended for post-exposure prophylaxis of individuals sustaining accidental needle stick or mucosal exposure to blood known to contain hepatitis B surface antigen (HBsAg) 3, 4, 5, 6.
- If HBIG is unavailable, standard immunoglobulin (IG) containing some anti-HBs may confer benefit 3, 5.
- The use of HBIG is recommended in cases of acute exposure to blood and secretions containing HBsAg, including needlestick injuries 4, 6.
Clinical Situations for HBIG Administration
The following clinical situations are recommended for HBIG administration:
- Acute exposure to blood and secretions containing HBsAg 4, 6
- Sexual contact with HBsAg-positive persons 4
- Household exposure to persons with acute hepatitis B 4
- Perinatal exposure of infants born to HBsAg-positive mothers 4, 6
- Liver transplantation 4, 6
Efficacy of HBIG and IG
Studies have shown that HBIG is more effective than IG in preventing type B hepatitis after needle-stick exposure to HBsAg-positive donors 5.
- HBIG remained significantly superior to IG in preventing type B hepatitis even when the analysis was confined to high-risk subgroups 5.