What is the recommended dosing for post-exposure prophylaxis (PEP) for Hepatitis B (HBV)?

From the Guidelines

For post-exposure prophylaxis (PEP) of Hepatitis B, administer HBIG (0.06 mL/kg or 500 IU for adults) as soon as possible after exposure, ideally within 24 hours, along with the first dose of hepatitis B vaccine, and complete the vaccine series with additional doses at 1 month and 6 months after the first dose, as recommended by the most recent guidelines 1.

Key Considerations

• The effectiveness of HBIG when administered more than 7 days after percutaneous or permucosal exposures is unknown 1.
• For previously vaccinated individuals with documented adequate response, no PEP is needed 1.
• For those with unknown response or inadequate response, give HBIG plus a booster dose of vaccine, or two doses of HBIG one month apart 1.
• Postvaccination testing of persons who received HBIG for postexposure prophylaxis should be performed after anti-HBs from HBIG is no longer detectable (4–6 months after administration) 1.

Dosing and Administration

• HBIG should be administered at a dose of 0.06 mL/kg body weight, with a typical adult dose being 500 IU 1.
• Hepatitis B vaccine should be administered in the deltoid muscle as soon as possible after exposure, with HBIG administered at the same time at a separate anatomic site 1.
• The vaccine series should be completed with additional doses at 1 month and 6 months after the first dose for previously unvaccinated individuals 1.

Special Considerations

• Immunocompromised persons might need annual testing to assess anti-HBs concentrations 1.
• Persons found to have anti-HBs concentrations of <10 mIU/mL after the primary vaccine series should be revaccinated, and administration of all doses in the second series, on an appropriate schedule, followed by anti-HBs testing 1–2 months after the final dose, is usually more practical than serologic testing after one or more doses of vaccine 1.

From the FDA Drug Label

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. 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 A regimen combining Hepatitis B Immune Globulin (Human) with hepatitis B vaccine will provide both short- and long-term protection, will be less costly than the two-dose Hepatitis B Immune Globulin (Human) treatment alone, and is the treatment of choice.

The recommended dosing for post-exposure prophylaxis (PEP) for Hepatitis B (HBV) is:

• 0.06 mL/kg of Hepatitis B Immune Globulin (Human) administered intramuscularly as soon as possible after exposure and within 24 hours, if possible.
• A second dose of Hepatitis B Immune Globulin (Human) may be given 1 month after the first dose if the person refuses the Hepatitis B Vaccine.
• The Hepatitis B Vaccine series should be started in conjunction with Hepatitis B Immune Globulin (Human) for optimal protection 2, 2, 2.

From the Research

Post-Exposure Prophylaxis for Hepatitis B

The recommended dosing for post-exposure prophylaxis (PEP) for Hepatitis B (HBV) involves the use of hepatitis B immune globulin (HBIG) and hepatitis B vaccine.

• HBIG with a minimum titre of 100 IU/ml should be used, with most preparations containing 500 IU/ml 3.
• The use of HBIG post-exposure prophylaxis should be limited to needlestick injury, sexual exposure, and perinatal contact of neonates with HBsAg-positive mothers 3.
• Routine vaccination as an adjunct to HBIG administration is recommended, with the vaccine administered simultaneously with HBIG within 48 hours after exposure, and repeated at 1 and 3 months 4.
• The protective efficacy of combined HBIG and vaccine was compared to HBIG alone in a past study, with results indicating that the combination is efficacious for postexposure immunoprophylaxis of accidental infection 4.
• Recommendations are available to guide HBV prevention activities or practices among healthcare workers, including the use of HBIG alone or HBIG plus the vaccine as postexposure prophylaxis 5.
• HBIG can be used for post-exposure prophylaxis of individuals sustaining accidental needle stick or mucosal exposure to blood known to contain hepatitis B surface antigen (HBsAg), with standard IG containing some anti-HBs as an alternative if HBIG is unavailable 6.

Administration and Efficacy

• Administration of HBIG with hepatitis B vaccine can delay and reduce responses to the vaccine in mice, regardless of the site of administration 7.
• However, the initial circulating levels of HBIG could prevent infection despite an impaired response to the vaccine, supporting the current recommendation of assessing seroprotection after series completion for infants born to HBV carrier mothers 7.
• The impact of HBIG on responses to hepatitis B vaccine during co-administration is being studied, with results indicating that HBIG can reduce anti-HBs levels at the end of the 3-dose series in newborn mice, but not in adult mice when administered at different sites 7.