Hepatitis B Virus (HBV)

HCP who perform tasks involving contact with blood or OPIM should be vaccinated against the HBV and should be tested for anti-HBs (antibody to hepatitis B surface antigen) 1 to 2 months after completion of the 3-dose HepB vaccine series.5 HCP who did not respond to the vaccination (i.e., anti-HBs <10 mIU/mL) should complete a second 3-dose regimen.5 One to 2 months after completion of the second series, the person should be retested for anti-HBs.

Persons who do not respond to an initial 3-dose HepB vaccine series have a 30% to 50% chance of responding to a second 3-dose series. Nonresponders who are HBsAg-negative should be considered susceptible to HBV infection and counseled regarding precautions to prevent HBV infection and the need to obtain hepatitis B immune globulin (HBIG) prophylaxis for any known or probable exposure to HBsAg-positive blood or OPIM (Table 1).5

Table 1. Recommended PEP following exposure to the HBV.5
Exposed person
(vaccination status)
Postexposure prophylaxis
Source person
(HBsAg positive)
Source person
(HBsAg negative)
Source person
(status unknown)
Unvaccinated
or
Incompletely vaccinated
or
Vaccine refusers
HBIG x 1
and
HepB vaccine series
HepB vaccine seriesHBIG x 1
and
HepB vaccine series
Previously vaccinated

Documented
responder after
≥3 doses
No treatmentNo treatmentNo treatment
Previously vaccinated

Documented nonresponder after 6 doses
HBIG x 2 separated by
1 month
No treatmentHBIG x 2 separated by
1 month
Previously vaccinated

Antibody response unknown after 3 doses
Test exposed person for anti-HBs:
if <10 mIU/mL

HBIG x 1
and
initiate HepB revaccination
No treatmentTest exposed person for anti-HBs:
if <10 mIU/mL

HBIG x 1
and
initiate HepB revaccination
Test exposed person for anti-HBs:
if ≥10 mIU/mL

No treatment
Test exposed person for anti-HBs:
if ≥10 mIU/mL

No treatment

The need for PEP should be evaluated immediately after HCP experience any percutaneous, ocular, mucous-membrane or nonintact skin exposure to blood and OPIM. HBV PEP should be initiated as soon as possible (preferably within 24 hours) after exposure.5 The HBIG and the first dose of the HepB vaccine can be administered simultaneously at separate sites (HepB vaccine should always be administered in the deltoid muscle).

Expert counseling is recommended for susceptible HCP exposed to the HBV, especially in cases of known or suspected pregnancy, breastfeeding, or serious medical illnesses. Additional information should be provided on any special precautions to prevent secondary transmission of the HBV during the follow-up period, current information on how to modify sexual practices and strategies to prevent pregnancy, and on donating blood, plasma, organs, tissue, or semen.4

No modifications of patient-care responsibilities are necessary based solely on an exposure to HBV-positive blood or OPIM.4 If an exposed person becomes acutely infected with the HBV, the person should be evaluated according to published recommendations for infected healthcare providers. Those who are chronically infected with the HBV should ensure adherence to the principles of Standard and Transmission-based Precautions and all other recommendations.6,7