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Healthcare Worker Evaluation

There are five possibilities for post-exposure prophylaxis following exposure to hepatitis B that needs to be considered during evaluation of an exposed person; a specific post-exposure prophylaxis plan exists for each scenario, as outlined here.

  1. Completed hepatitis B vaccination withresponse
  2. Evidence of a prior infection with hepatitisB
  3. Hepatitis B vaccination has been completed but the hepatitis B anti-HBs titer (surface antibody concentration) is < 10mIU/mL
  4. Hepatitis B vaccination has been completed but serologic testing for a response has not been done or serologic testing was doneand the response is notknown
  5. The affected person has not been vaccinated or thevaccination series has not beencompleted

For the first and second situations, there is no need for post-exposure prophylaxis.13

For the third situation, if the source patient is positive for hepatitis B or the source patient’s hepatitis B status is not/cannot be known, the affected healthcare worker should be given two doses of hepatitis B immunoglobulin, the second one month after the first.13

For the fourth situation, if the anti-HBs titer is ≥10 mIU/mL, post- exposure prophylaxis is not needed. If the anti-HBs titer is <10 mIU/mL, the management will depend on the hepatitis B status of the source. If the source is positive or the status of the source cannot be determined, administer one dose of hepatitis B immunoglobulin and the first dose of hepatitis B vaccine, at the same time. The remaining two doses of hepatitis B vaccine can be given as per the recommended schedule.13

For the fifth situation, if the source patient is positive for hepatitis B or the source patient’s hepatitis B status is not/cannot be known, the affected healthcare worker should be given one dose of hepatitis B immunoglobulin and the first dose of the hepatitis B vaccine series, at the same time. If the source patient is hepatitis B negative, the healthcare worker should receive the three-dose hepatitis B vaccine series and then be checked for response.13

The immune globulin and the first dose of the hepatitis B vaccine can be given at the same time but at different injection sites. The hepatitis B immune globulin should be give within 24 hours after the exposure and it must be given within 7 days of the exposure.13 The second and third doses of the hepatitis B vaccine are given 1 month and 6 months after the initial dose even if the source patient is subsequently known not to be infected. Testing for hepatitis B infection should be done six months after the exposure. During this six-month period the affected healthcare professional should not donate blood, organs, plasma, semen, or tissue, but the healthcare worker can perform normal duties.13 The need for tetanus vaccination should also be considered.