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
    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 (full 3-dose series)
      2. Patient has completed a repeated second full 3-dose series
        1. Hepatitis B Immunoglobulin (HBIG) 0.06 ml/kg TWICE within 24 hours of exposure
        2. Repeat the Hepatitis B Vaccine (complete 3-dose series)
    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 and
        2. Recheck xHBsAg Antibody titers in 1-2 months
  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. 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
  8. Research
    1. Lamivudine (3TC) effective for Hepatitis B prophylaxis

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