Hepatitis B vaccination pre & post Exposure
Hepatitis B vaccination pre & post Exposure
As per our discussion for the Epidemiology and Risk Factors of Hepatitis B and understanding the Hepatitis B vaccination Effectiveness and Safety, and we conclude that a Hepatitis infection is the preventable disease even it is affecting people annually either via occupational exposure for health care workers or non-occupational exposure and the person once she is responder to the vaccine protective concentration of anti-HBs (≥10 mIU/mL). a person will be in the safe side and based on the safety of the vaccine so encouragement needs to be applied for vaccinating people to avoid getting Hepatitis be infection and its complications, and we have widely available two types of Single –antigen hepatitis B vaccine and newly a new vaccine was developed which combine both Hepatitis A and hepatitis B vaccine together; All are administered in 3 intramuscular , in the deltoid region.
Pre-exposure: Certain recommendations need to be implemented before exposure to blood or body fluids with the risk of acquiring hepatitis B infection:
- No need to perform pre-vaccination hepatitis B infection tests as a routine except in case health care organization study the cost effective of that procedure in certain high risk team
- The three doses has to be administered to consider the person complete the set that applied for all health care workers and trainee which are anticipated for the blood exposure risk and it is better to finish the three doses before starting contacting patient (offered in schools of medicine , dentistry ,…etc.) as higher risk has been reported during the professional training period
- Post vaccination test has to be performed 1-2 months after the third dose to determine the need for vaccination (non-responders)
- For the non-responders administration of second series of three doses vaccine and retest 1-2 months after the second third dose again
- Persons who have a protective concentration of anti-HBs (<10 mIU/mL) after vaccination receiving 6 doses_ should be tested for HBsAg and anti-HBc to determine infection status.
- The cut off not to be infected but who have anti-HBs <10 mIU/mL (non-responders) should be considered susceptible to HBV infection and should be counseled about precautions to prevent HBV infection and the need to obtain hepatitis B immune globulin (HBIG) post-exposure prophylaxis for any known or likely exposure to HBsAg-positive blood
- Persons determined to be infected (anti-HBc-positive) and positive for HBsAg should be provided counseling regarding how to prevent HBV transmission to others and referred for further evaluation , care, treatment.
- Persons who are HBsAg-positive and who perform exposure-prone procedures should seek a counsel from a review panel comprised of experts with a balanced perspective (e.g., HCPs’ personal physicians and infectious disease doctor) regarding the procedures that they can perform safely. Remember no need to be excluded from work.
Persons who were infected in the past (anti-HBc-positive but negative for HBsAg) require no vaccination or treatment.
Post-exposure: evaluation of the need for post-exposure prophylaxis should be done immediately after any percutaneous, ocular, mucous-membrane or non-intact skin exposure to blood or body fluid in the workplace. Decisions to administer post-exposure prophylaxis should be based on the HBsAg status of the source and the vaccination history and vaccine-response status of the exposed health care provider
- Unvaccinated and Incompletely Vaccinated health care workers and Trainees:
- Persons who have exposure from persons known to be HBsAg-positive should immediately receive 1 dose of hepatitis B immune globulin HBIG preferably within 24 hours (HBIG can be administered to exposed staff up to 7 days but no documented effectiveness if administered after 7 days).
- Administration of hepatitis B vaccine in the deltoid muscle as soon as possible after exposure; plus the HBIG at another injection site.
- Hepatitis B three doses vaccine series should be completed for previously unvaccinated and incompletely vaccinated persons who have the needle stick or other percutaneous exposures, regardless of the HBsAg status of the source and whether the status of the source is known.
Post-vaccination testing of persons who received HBIG for post-exposure prophylaxis should be performed 4–6 months after administration (after anti-HBs from HBIG is no longer detectable).
Vaccinated HCP and Trainees
No need for post-exposure prophylaxis or serologic test for the vaccinated Health care professionals with documented immunity anti-HBs (≥10 mIU/mL).
Non-responder to a 3-dose vaccine series should receive 1 dose of HBIG and a second 3-dose vaccine series if the source is HBsAg-positive or known to be at high risk for carrying hepatitis ( Same as non-vaccinated exposed to HBsAg positive source).
For HBsAg- negative source, non-responding HCP should complete the vaccination series and undergo post-vaccination testing to ensure that they’re response status Post vaccination testing of persons who received HBIG for PEP should be performed after anti-HBs from HBIG is no longer detectable (4–6 months after administration).
Vaccinated HCP with nonresponse to two series of vaccination 6-dose should receive 2 doses of HBIG, 1 month apart if the source is HBsAg-positive or known to be at high risk for carrying hepatitis.
No further vaccination is necessary If the source is known or determined to be HBsAg-negative, for non-responding HCP
Vaccinated HCP with no documentation of post-vaccination response which are exposed to an HBsAg-positive or unknown source should have anti-HBs testing . Those will determine the protective levels of antibody (anti-HBs ≥10 mIU/mL) require no further treatment.
Those with concentrations <10 mIU/mL should receive 1 dose of HBIG, along with a booster dose of hepatitis B vaccine, post-vaccination testing of persons who received HBIG for post-exposure prophylaxis should be performed after anti-HBs from HBIG is no longer detectable (4–6 months after administration).
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