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
   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]