PEP Recommendations
If the status of the source person is Hepatitis B Surface Antigen (HBsAg) positive
- An unvaccinated Health Care Worker (HCW) or HCW who is in the process of being vaccinated but has not completed the full series yet, should take 1 dose of HBIG (0.06 mL/kg IM) as soon as possible, preferably within 24 hours followed by hepatitis B vaccination series.
- Vaccinated HCW, who is a known responder, does not require any treatment.
- Vaccinated HCW, who is a known non-responder should take 1 dose of HBIG followed by a complete series of hepatitis B vaccine, OR 2 doses of HBIG should be taken with second dose 1 month after the first dose. For a known non-responder HCW who has already completed the second 3 dose vaccine series, 2 doses of HBIG are
- Vaccinated HCW whose response is unknown should be tested for anti-HBsAg, if response is inadequate (<10 mU/mL), 1 dose of HBIG along with hepatitis B vaccine booster dose should be given. If an adequate response is present, no treatment is required.
If the status of the source person is HBsAg negative
- Unvaccinated HCW should undergo complete series of HBV vaccination.
- Vaccinated HCW who is a known responder does not require any treatment.
- Vaccinated HCW who is a known non-responder does not require any treatment.
- Vaccinated HCW whose response is unknown does not require any treatment.
If the status of the source person is unknown
- Unvaccinated HCW should undergo the complete series of HBV vaccination.
- Vaccinated HCW, who is a known responder, does not require any treatment.
- If the source person is suspected to be of high risk, vaccinated HCW, who is a known non-responder should take 1 dose of HBIG followed by a complete series of hepatitis B vaccination OR 2 doses of HBIG should be taken with second dose 1 month after the first dose. For a known non-responder HCW who has already completed the second 3 dose vaccine series, 2 doses of HBIG are recommended..
- Vaccinated HCW, whose response is unknown, should be tested for anti-HBsAg; if response is adequate no treatment is required. However, if response is inadequate (<10 mU/mL), a hepatitis B vaccine booster dose should be given and the titer should be rechecked in 1-2 months.
Whenever Hepatitis B Immune Globulin (HBIG) or HBV vaccination is indicated, it should be initiated within 24 hours of exposure for maximum effectiveness and no later than 7 days. Both HBIG and HBV vaccination can be administered simultaneous at separate sites of the body.
References
- Little, Falace, Miller, Rhodus. Dental management of the medically compromised patient. 8th ed. St. Louis: Mosby Elsevier; 2008.
- Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR 2001; 50(No. RR-11).