Hepatitis B Postexposure Prophylaxis

1. See Also
   1. Hepatitis B
   2. Viral Hepatitis
   3. Sexually Transmitted Disease
   4. Bloodborne Pathogen Exposure
   5. Hepatitis B Prophylaxis in Newborns
2. Indications
   1. Perinatal exposure
   2. Percutaneous or permucosal contact
   3. Sexual contact
   4. Household contact
3. Protocol: General
   1. Protocols below intended for healthcare worker exposure
4. Protocol: Known HBsAg Positive Source
   1. Unvaccinated exposed patient
      1. Hepatitis B Immunoglobulin (HBIG) 0.06 ml/kg and
      2. Hepatitis B Vaccine
   2. Exposed patient with known response to Vaccine
      1. No treatment
   3. Exposed patient with known failed response to Vaccine
      1. Patient has not yet completed second 3-dose series
         1. Hepatitis B Immunoglobulin (HBIG) 0.06 ml/kg and
         2. Hepatitis B Vaccine (complete second 3-dose series)
      2. Patient has completed two prior 3-dose series
         1. Hepatitis B Immunoglobulin (HBIG) 0.06 ml/kg
         2. Second Hepatitis B Immunoglobulin dose
   4. Exposed patient with unknown response to Vaccine
      1. Test for Antibody to HBsAg
      2. Adequate Antibody (HBsAg Positive): No treatment
      3. Inadequate Antibody (HBsAg Negative)
         1. Hepatitis B Immunoglobulin (HBIG) 0.06 ml/kg and
         2. Hepatitis B Vaccine booster dose
5. Protocol: Known HBsAg Negative Source
   1. Administer Hepatitis B Vaccine Series if unvaccinated
   2. No treatment otherwise needed
6. Protocol: UnKnown HBsAg Source Status
   1. Unvaccinated exposed patient
      1. Hepatitis B Vaccine Series
   2. Exposed patient with known response to Vaccine
      1. No treatment
   3. Exposed patient with known failed response to Vaccine
      1. Treat source as HBsAg positive if high risk
   4. Exposed patient with unknown response to Vaccine
      1. Test for Antibody to HBsAg
      2. Adequate Antibody (HBsAg Positive): No treatment
      3. Inadequate Antibody (HBsAg Negative)
         1. Hepatitis B Vaccine initial and booster dose
         2. Recheck titer in 1 to 2 months
7. Research
   1. Lamivudine (3TC) effective for Hepatitis B prophylaxis