Appendix B

Postexposure Prophylaxis to Prevent Hepatitis B Virus Infection

This appendix provides guidelines for management of persons with nonoccupational exposure to hepatitis B virus (HBV) through a discrete, identifiable exposure to blood or body fluids (Table). Guidelines for postexposure prophylaxis of occupational exposures have been published separately (1) and are intended for use in settings in which postvaccination testing is recommended for certain employees (see Appendix A, Postvaccination Testing for Serologic Response) and in which programs are available to implement testing and follow-up algorithms. Recommendations for management of infants born to hepatitis B surface antigen (HBsAg)--positive mothers also have been published separately (2).

HBsAg-Positive Exposure Source

• Persons who have written documentation of a complete hepatitis B vaccine series and who did not receive postvaccination testing should receive a single vaccine booster dose.
• Persons who are in the process of being vaccinated but who have not completed the vaccine series should receive the appropriate dose of hepatitis B immune globulin (HBIG) and should complete the vaccine series.
• Unvaccinated persons should receive both HBIG and hepatitis B vaccine as soon as possible after exposure (preferably within 24 hours). Hepatitis B vaccine may be administered simultaneously with HBIG in a separate injection site. The hepatitis B vaccine series should be completed in accordance with the age-appropriate vaccine dose and schedule (see Table 2 and Box 5).

Exposure Source with Unknown HBsAg Status

• Persons with written documentation of a complete hepatitis B vaccine series require no further treatment.
• Persons who are not fully vaccinated should complete the vaccine series.
• Unvaccinated persons should receive the hepatitis B vaccine series with the first dose administered as soon as possible after exposure, preferably within 24 hours. The vaccine series should be completed in accordance with the age-appropriate dose and schedule (see Table 2 and Box 5).

References

1. CDC. 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).
2. CDC. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP). Part 1: immunization of infants, children, and adolescents. MMWR 2005;54(No. RR-16).

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Date last reviewed: 11/21/2006