From the Guidelines
A comprehensive post-exposure prophylaxis (PEP) policy for Hepatitis B should include immediate risk assessment followed by prompt intervention, with administration of Hepatitis B immune globulin (HBIG) and initiation of the Hepatitis B vaccine series as soon as possible, ideally within 24 hours, as recommended by the most recent guidelines 1. The policy should consider the exposure type and the individual's hepatitis B vaccination status.
- For individuals exposed to an HBsAg-positive source, administer HBIG and initiate the Hepatitis B vaccine series 1.
- For individuals exposed to a source with unknown HBsAg status, initiate the Hepatitis B vaccine series 1.
- For previously vaccinated individuals with documented adequate response, no treatment is necessary 1.
- For those with unknown response or inadequate response, administer one dose of HBIG and a booster dose of vaccine 1. The standard vaccine schedule consists of three doses: initial dose, followed by doses at 1 month and 6 months (0,1,6 schedule) 1. Post-vaccination serologic testing should be conducted 1-2 months after completing the series to confirm immunity, particularly in healthcare workers and immunocompromised patients, with testing for anti-HBs and HBsAg, and interpretation of results based on assay cutoff values 1. This approach is effective because HBIG provides immediate passive immunity while the vaccine stimulates active immunity for long-term protection, preventing viral replication in the liver and subsequent chronic infection, which is particularly important as HBV can remain viable on environmental surfaces for at least 7 days and has a high risk of transmission through percutaneous or mucosal exposure to infected blood or body fluids 1.
From the Research
Policy for Post-Exposure Prophylaxis for Hepatitis B
The following policy is based on the available evidence and guidelines for post-exposure prophylaxis (PEP) for hepatitis B:
- Indications for PEP: PEP is recommended for individuals who have been exposed to hepatitis B virus (HBV) through percutaneous or mucocutaneous exposure, unprotected sexual exposure, or mother-to-infant transmission 2.
- Administration of PEP: Hepatitis B immune globulin (HBIG) and hepatitis B vaccine should be administered as soon as possible after exposure, ideally within 24 hours 3, 2.
- Dosage and Schedule: The recommended dosage and schedule for HBIG and hepatitis B vaccine vary depending on the individual's age, weight, and immune status. Generally, a single dose of HBIG (0.06 mL/kg) is administered, followed by a series of hepatitis B vaccine doses (0,1, and 6 months) 4, 5.
- Assessment of Immunity: Individuals who have been exposed to HBV should have their immunity assessed through serologic testing, including hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs) testing 3, 6.
- Follow-up Testing: Follow-up testing should be performed at 6 weeks, 3 months, and 6 months after exposure to monitor for seroconversion and determine the need for additional doses of vaccine or HBIG 3.
- Special Considerations: Individuals who are immunosuppressed or have a history of non-response to hepatitis B vaccine may require additional doses of HBIG or alternative prophylaxis strategies 2, 5.
- Vaccine Selection: Recombinant hepatitis B vaccine (e.g., Engerix B) is a suitable alternative to plasma-derived vaccines and has been shown to be effective in preventing HBV infection 5.
Key Considerations
- PEP should be given as soon as possible after exposure to minimize the risk of HBV infection 3, 2.
- HBIG and hepatitis B vaccine should be administered at different sites to minimize interference with the immune response 4.
- Individuals who have been exposed to HBV should be monitored for signs and symptoms of infection and receive follow-up testing to determine the effectiveness of PEP 3, 6.