What are the post-exposure prophylaxis (PEP) treatments for hepatitis B (HBV) and hepatitis C (HCV)?

Post-Exposure Prophylaxis for Hepatitis B and C

Yes, effective post-exposure prophylaxis exists for hepatitis B using hepatitis B immune globulin (HBIG) and hepatitis B vaccine, but no post-exposure prophylaxis is available for hepatitis C. 1

Hepatitis B Post-Exposure Prophylaxis

Immediate Management (Within 24 Hours)

For unvaccinated persons or vaccine non-responders exposed to HBsAg-positive blood, administer both HBIG (0.06 mL/kg body weight) and hepatitis B vaccine simultaneously at separate anatomic sites as soon as possible, preferably within 24 hours. 1 This combined passive-active prophylaxis is 85-95% effective in preventing HBV transmission. 2

• The effectiveness of prophylaxis diminishes significantly with delayed administration, though efficacy may extend up to 7 days post-exposure for needlestick injuries. 1
• Recent evidence suggests HBIG administered between 24 hours and 7 days post-exposure may still be effective, though earlier is always better. 3

Exposure-Specific Protocols

For HBsAg-positive source exposures: 1

• Unvaccinated persons: HBIG + complete vaccine series (first dose immediately)
• Incompletely vaccinated persons: HBIG + complete remaining vaccine doses
• Fully vaccinated with documented response: No treatment needed
• Fully vaccinated without documented response: Single vaccine booster dose
• Known vaccine non-responders: HBIG + vaccine booster, or two doses of HBIG (immediately and at 1 month)

For unknown source exposures: 1

• Unvaccinated persons should receive the hepatitis B vaccine series initiated within 24 hours
• Vaccine non-responders should complete the series
• Fully vaccinated persons require no treatment

For sexual exposure to HBsAg-positive persons: 2

• Single dose of HBIG (0.06 mL/kg) within 14 days of last sexual contact
• Initiate hepatitis B vaccine series simultaneously

For perinatal exposure (infants born to HBsAg-positive mothers): 2

• HBIG 0.5 mL intramuscularly within 12 hours of birth (efficacy decreases markedly after 48 hours)
• Hepatitis B vaccine 0.5 mL (10 μg) within 7 days of birth at separate site
• Complete vaccine series at 1 month and 6 months
• This regimen is 85-95% effective in preventing chronic carrier state 2

Critical Timing Considerations

The major determinant of PEP effectiveness is early administration—ideally within 24 hours, with diminishing efficacy thereafter. 1 The maximum effective interval is unlikely to exceed 7 days for needlestick and perinatal exposures. 1

Hepatitis C Post-Exposure Management

No post-exposure prophylaxis is recommended or available for hepatitis C. 1 This is a critical distinction from hepatitis B management.

Recommended Follow-Up for HCV Exposure

Instead of prophylaxis, implement surveillance and early treatment if infection occurs: 1

• Perform baseline anti-HCV and ALT testing at time of exposure
• Perform HCV RNA testing at 4-6 weeks if earlier diagnosis desired 1
• Perform follow-up anti-HCV and ALT testing at 4-6 months 1
• Confirm repeatedly reactive anti-HCV enzyme immunoassays with supplemental tests 1

If acute hepatitis C develops (detectable HCV RNA with elevated transaminases), initiate interferon monotherapy as early as possible after symptom appearance. 4 The earlier treatment begins, the more effective it is at preventing chronification. 5, 4

Key Differences in Transmission Risk

• HCV transmission after needlestick from positive source averages only 1.8% (range 0-7%), compared to 23-62% for HBV. 1
• HCV is not transmitted efficiently through occupational exposures and requires large amounts of blood or repeated direct percutaneous exposures. 1

Common Pitfalls to Avoid

• Do not delay HBIG administration for hepatitis B exposures while waiting for source testing—start prophylaxis immediately if high suspicion exists. 1
• Do not confuse HBV and HCV protocols—there is no immunoglobulin or vaccine for hepatitis C. 1
• Do not test discarded needles or syringes for virus contamination—focus on source patient testing. 1
• Do not administer HBIG intravenously—it must be given intramuscularly. 2
• Do not assume all vaccinated persons are protected—verify vaccination response status, especially for healthcare personnel and immunocompromised individuals. 1