hep B post exposure management

Source patients positive for both HBsAg and HBeAg have transmission rates of 40%-60%; those with only HBsAg positivity have reduced transmission rates of 20%-40%. As a result, all health care workers (HCWs) are required to be offered hepatitis B vaccination by their employer. Immune response (ie, hepatitis surface antibody >10 mIU/mL) should be documented 1-2 months after the last vaccine dose. HCWs who do not respond to the first series of injections should be revaccinated.

HCWs with an adequate response to the vaccine (initial hepatitis surface antibody [HBsAb] titer of >10 mIU/mL) are not at risk of contracting the virus and do not require post-exposure prophylaxis even if subsequent antibody titers fall below the threshold for immunity. Post-exposure prophylaxis for exposed nonimmune HCWs (unvaccinated or incomplete response to initial vaccination series) involves immediate simultaneous administration of both hepatitis B immunoglobulin (HBIG) and HBV vaccine (at different sites). The HCW should then receive the remaining 2 series of HBV vaccine according to the routine schedule.

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