Post-Exposure Treatment Summary of Guidelines

A summary of hepatitis B postexposure recommendations has been excerpted from the Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis.

Summary of Hepatitis B Postexposure Guidelines (2001)

Occupational exposures should be considered urgent medical concerns to ensure timely postexposure management and administration of HBIG and hepatitis B vaccine.

General Recommendations for HBV Postexposure Management

Initiation of the hepatitis B vaccine series to any susceptible, unvaccinated person who sustains an occupational blood or body fluid exposure.
Postexposure prophylaxis (PEP) with hepatitis B immune globulin (HBIG) and/or hepatitis B vaccine series should be considered for occupational exposures after evaluation of the hepatitis B surface antigen (HBsAg) status of the source and the vaccination and vaccine-response status of the exposed person.
Neither pregnancy nor lactation should be considered a contraindication to vaccination of women. HBIG is not contraindicated for pregnant or lactating women.
Guidance is provided to clinicians and exposed health care workers for selecting the appropriate HBV PEP.
Employers are required to establish exposure-control plans that include postexposure follow-up for their employees and to comply with incident reporting requirements mandated by the 1992 OSHA bloodborne pathogen standard.
Consult with local experts and/or the National Clinicians' Post-Exposure Prophylaxis Hotline (PEPLine: 1-888-448-4911) for special circumstances.

Specific Recommendations for an HBV Exposure

Provide immediate care to the exposure site
Wash wounds and skin with soap and water.
Flush mucous membranes with water.
Determine risk of exposure
Type of fluid (i.e., blood, body fluids with visible blood, other potentially infectious fluid or tissue, and concentrated virus).
Type of exposure (i.e., percutaneous injury, mucous membrane or nonintact skin exposure, and bites resulting in blood exposure).
Evaluate exposure source
Assess the risk of infection using available information.
Test known sources for HBsAg.
For unknown sources, assess risk of exposure to HBV infection.
Do not test discarded needles or syringes for virus contamination.
Evaluate the exposed person
Assess immune status for HBV infection (i.e., by history of hepatitis B vaccination and vaccine response).
Give HBIG and/or HBV vaccine for exposures posing risk of infection transmission
Perform follow-up testing and provide counseling.
Advise exposed persons to seek medical evaluation for any acute illness during follow-up.
HBV exposures
Perform follow-up anti-HBs testing in persons who receive hepatitis B vaccine.

Test for protective surface antibodies (HBsAb or anti-HBs) 1--2 months after last dose of vaccine.
HBsAb or Anti-HBs response to vaccine cannot be ascertained if HBIG was received in the previous 3--4 months.

Source: Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis (MMWR, June 29, 2001, Vol. 50 (RR11):142)

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