How can Hepatitis B (HBV) transmission be prevented?

Hepatitis B Transmission Prevention

Hepatitis B transmission is prevented through a comprehensive vaccination strategy targeting all contacts of infected individuals, combined with specific behavioral precautions including barrier protection during sex, proper handling of blood-contaminated materials, and immediate post-exposure prophylaxis with both HBIG and vaccine for newborns of infected mothers.

Primary Prevention Through Vaccination

Universal Vaccination Strategy

• All sexual and household contacts of HBV carriers must be tested for HBsAg and anti-HBs, then vaccinated if seronegative 1, 2
• Universal hepatitis B vaccination of all unvaccinated adults is recommended in high-risk settings including STD clinics, drug treatment facilities, correctional facilities, and healthcare settings serving injection drug users or men who have sex with men 1
• Vaccination achieves seroprotection (anti-HBs ≥10 mIU/mL) in over 95% of vaccinees 3
• The vaccine series should be completed at 0,1, and 6 months 4

Post-Vaccination Testing for High-Risk Groups

• Healthcare workers should be tested 1-2 months after completing vaccination 1, 2, 4
• Infants of HBsAg-positive mothers require testing 9-15 months after vaccination 2, 4
• Dialysis patients need annual testing 1, 2
• Sexual partners of HBV carriers should be tested after vaccination to confirm protective antibody levels 4

Perinatal Transmission Prevention

Immediate Newborn Management

• Newborns of HBsAg-positive mothers must receive both HBIG (0.06 mL/kg) and hepatitis B vaccine immediately at delivery, preferably within 24 hours 1, 2, 5
• This combination is 85-95% effective in preventing perinatal transmission and development of chronic carrier state 1, 5
• Infants must complete the full vaccination series 1, 2
• Follow-up testing at 9-15 months is mandatory to confirm protection 1, 2

Important Caveat

• Efficacy may be lower (though still substantial) for mothers with very high HBV DNA levels (>8 log10 IU/mL) 2
• These high-risk cases may require additional monitoring and potentially antiviral therapy during pregnancy

Sexual Transmission Prevention

For Steady Partners

• Test partners for HBV markers and vaccinate if seronegative 1, 2
• Vaccination of sexual partners has been proven effective in preventing sexual transmission 1
• Partners should use barrier protection (condoms) until vaccination series is complete and protective antibody levels are confirmed 1, 2

For Casual or Non-Vaccinated Partners

• Barrier protection methods must be employed consistently 1, 2
• Condoms should be used during all sexual contact until partner completes vaccination and achieves protective antibody levels 2

Post-Exposure Management

• For sexual exposure to a person with acute hepatitis B, a single dose of HBIG is 75% effective if given within 2 weeks of last sexual exposure 5
• Combining HBIG with vaccine series provides both immediate and long-term protection 5

Household and Environmental Precautions

Blood and Body Fluid Management

• Cover all open cuts and scratches immediately 1, 2
• Clean blood spills with bleach solution or detergent 1, 2
• HBV can survive on environmental surfaces for at least 1 week, making proper cleaning critical 1
• Properly dispose of all blood-contaminated materials 2

Personal Items

• Never share toothbrushes, razors, or any items that might have blood contact 2
• Do not share needles or drug paraphernalia 1

Infant Household Exposure

• Infants less than 12 months old with household exposure to persons with acute HBV infection require both HBIG and hepatitis B vaccine 5
• This is because infants have closer contact with caregivers and higher risk of becoming chronic carriers 5

Occupational Transmission Prevention

Healthcare Workers

• All healthcare workers should be vaccinated and have documented protective antibody levels 1
• HBeAg-positive healthcare workers should not perform invasive procedures without expert review panel guidance and patient notification 1
• For accidental needlestick or mucous membrane exposure to HBsAg-positive blood, a two-dose HBIG regimen (one immediately, one at 1 month) is approximately 75% effective 5
• Combining HBIG with vaccine series is superior to HBIG alone and provides long-term protection 5

What Does NOT Transmit HBV (Common Pitfalls to Avoid)

Safe Activities

• Breastfeeding does not transmit HBV 2
• Kissing, hugging, coughing, or casual touching do not spread HBV 2
• Sharing food, utensils, or drinking glasses is safe 2
• Children with HBV can participate in all activities including contact sports 2
• Children should not be excluded from daycare or school 2

Critical Point

• These reassurances are important for reducing unnecessary social isolation while maintaining appropriate precautions for actual transmission routes (blood, sexual contact, perinatal)

Additional Preventive Measures

For HBV Carriers

• Never donate blood, plasma, organs, tissue, or semen 2
• Inform all healthcare and dental providers of HBsAg-positive status 2
• Limit alcohol consumption to <20 g/day for women, <30 g/day for men to reduce liver disease progression 2
• Consider hepatitis A vaccination if anti-HAV negative, as coinfection increases mortality risk 5.6- to 29-fold 4

Monitoring Infectivity

• Carriers with high HBV DNA levels are more infectious 1, 2
• Regular monitoring of viral load helps assess transmission risk and need for antiviral therapy

Post-Exposure Prophylaxis Algorithm

For Any Exposure to HBsAg-Positive Blood or Body Fluids:

1. Immediately administer HBIG (0.06 mL/kg) and first dose of hepatitis B vaccine, preferably within 24 hours 4, 5
2. Complete the full vaccine series at 0,1, and 6 months 4
3. Test for anti-HBs 1-2 months after final dose 4
4. If anti-HBs <10 mIU/mL, revaccinate with complete 3-dose series 4

Timing is Critical

• HBIG and vaccine are most effective when given as soon as possible after exposure 4, 5
• Efficacy decreases significantly if delayed beyond 24-48 hours for perinatal exposure or 2 weeks for sexual exposure 5