- Hepatitis B
- For Healthcare Personnel
Table 3: Postexposure management of healthcare personnel after occupational percutaneous and mucosal exposure to blood and body fluids, by healthcare personnel HepB vaccination and response status
| Healthcare personnel status | Postexposure testing | Postexposure prophylaxis | Postvaccination serologic testing† |
||
| Source patient (HBsAg) |
HCP testing (anti-HBs) |
HBIG* | Vaccination | ||
| Documented responder§ after complete series |
No action needed | ||||
| Documented nonresponder¶ after 2 complete series |
Positive/unknown | Not indicated | HBIG x2 separated by 1 month |
— | No |
| Negative | No action needed | ||||
| Response unknown after complete series |
Positive/unknown | <10mIU/mL** | HBIG x1 | Initiate revaccination |
Yes |
| Negative | <10mIU/mL | None | |||
| Any result | >10mIU/mL | No action needed | |||
| Unvaccinated/incompletely vaccinated or vaccine refusers |
Positive/unknown | —** | HBIG x1 | Complete vaccination |
Yes |
| Negative | — | None | Complete vaccination |
Yes | |
Abbreviations: HCP = health-care personnel; HBsAg = hepatitis B surface antigen; anti-HBs = antibody to hepatitis B surface antigen; HBIG = hepatitis B immune globulin.
* HBIG should be administered intramuscularly as soon as possible after exposure when indicated. The effectiveness of HBIG when administered >7 days after percutaneous, mucosal, or nonintact skin exposures is unknown. HBIG dosage is 0.06 mL/kg.
† Should be performed 1–2 months after the last dose of the HepB vaccine series (and 6 months after administration of HBIG to avoid detection of passively administered anti-HBs) using a quantitative method that allows detection of the protective concentration of anti-HBs (>10 mIU/mL).
§ A responder is defined as a person with anti-HBs >10 mIU/mL after 1 or more complete series of HepB vaccine.
¶ A nonresponder is defined as a person with anti-HBs <10 mIU/mL after 2 complete series of HepB vaccine.
** HCP who have anti-HBs <10mIU/mL, or who are unvaccinated or incompletely vaccinated, and sustain an exposure to a source patient who is HBsAg-positive or has unknown HBsAg status, should undergo baseline testing for HBV infection as soon as possible after exposure, and follow-up testing approximately 6 months later. Initial baseline tests consist of total anti-HBc; testing at approximately 6 months consists of HBsAg and total anti-HBc.
Source: This table from Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR 2018;67(RR-1): 18 www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6701-H.pdf