Gastroenterology Book

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Hepatitis B Postexposure Prophylaxis

Aka: Hepatitis B Postexposure Prophylaxis, Postexposure Prophylaxis for Hepatitis B
  1. See Also
    1. Hepatitis B
    2. Viral Hepatitis
    3. Sexually Transmitted Disease
    4. Bloodborne Pathogen Exposure
    5. Hepatitis B Prophylaxis in Newborns
    6. HIV Postexposure Prophylaxis
  2. Indications
    1. Perinatal exposure
    2. Percutaneous or permucosal contact
    3. Sexual contact
    4. Household contact
  3. Labs: Monitoring
    1. HBsAg at baseline, 6 weeks, 3 months, 6 months and 12 months
    2. HBsAb at 1-2 months after last dose of Vaccine
  4. Protocol: General
    1. Protocols below intended for healthcare worker exposure
  5. Protocol: Known HBsAg Positive Source OR Unknown source status
    1. Unvaccinated exposed patient
      1. Hepatitis B Immunoglobulin (HBIG) 0.06 ml/kg within 24 hours of exposure and
      2. Hepatitis B Vaccine series
    2. Exposed patient with known response to Vaccine
      1. No treatment
    3. Exposed patient with known failed response to Vaccine (xHBsAg Antibody <10 mIU/ml)
      1. Patient has not yet completed a repeated, second 3-dose series
        1. Hepatitis B Immunoglobulin (HBIG) 0.06 ml/kg within 24 hours of exposure and
        2. Repeat Hepatitis B Vaccine (either one dose or a full 3-dose series)
        3. Recheck immunity 1-2 months after last Hepatitis B dose
      2. Patient has completed a repeated second full 3-dose series (total of at least 6 Vaccine doses)
        1. Hepatitis B Immunoglobulin (HBIG) 0.06 ml/kg TWICE, one month apart
        2. No further Hepatitis BVaccination after 2 full Hepatitis B Series (>=6 doses)
    4. Exposed patient with unknown response to Vaccine
      1. Consider Hepatitis B Immunoglobulin (HBIG) 0.06 ml/kg within 24 hours of exposure
      2. Obtain xHBsAg Antibody levels
        1. Immunity if xHBsAg Antibody 10 mIU/ml or higher
      3. Inadequate xHBsAg Antibody levels (Hepatitis B Surface AntigenAntibody)
        1. Give Hepatitis B Vaccine booster dose OR second full three dose series AND
        2. Recheck HBsAb titers in 1-2 months after last Vaccine dose
  6. Protocol: Known HBsAg Negative Source
    1. Administer Hepatitis B Vaccine Series if unvaccinated
    2. No treatment otherwise needed
  7. Protocol: UnKnown HBsAg Source Status
    1. Treat most unknown exposures as Hepatitis B positive with protocol above
  8. References
    1. Schillie (2013) MMWR Recomm Rep 62(RR-10):1-19 [PubMed]

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