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Section IconHepatitis B (HBV)
Overview
Patients should have other Post-exposure prophylaxis (PEP) for other sexually transmitted infections (e.g., HIV, STI) that is beyond the scope of this tool
Patients who receive PEP should undergo repeat HBV in six months
Isolated anti-HBc - could be window period, should have HBV DNA tested
  • If unable to confirm HBV DNA within 7 days, should treat as HBV positive
Questions to ask/consider
Type of Exposure
  • Mucosal exposure of blood or infectious secretions (e.g., semen)
    • Tears, saliva, and breast milk are considered low risk
    • Unprotected sexual exposure
  • Percutaneous exposure of bodily fluid - bite, needlestick
Patient previously vaccinated
Patient vaccination response (positive titers, unknown titers, known nonresponder)
Source available for testing
Source HBV status (e.g. HBsAg neg, HBsAg pos, anti-HBc isolated)
Guidelines
Patient fully vaccinated with known response, prior recovery from HBV, or chronic HBV
  • No need for post-exposure prophylaxis
Patient fully vaccinated but unknown response
  • Source HBsAg neg: no vaccination, but draw titers
  • Source HBsAg pos or unknown: HBV vaccine booster and draw titers
    • If low titers, they should complete a second vaccination series
      • No further vaccination if already received two series
Patient fully vaccinated but known nonresponder
  • Source HBsAg neg - vaccination and repeat series if only single series
  • Source HBsAg pos or unknown: HBIG (Hepatitis B immunoglobulin) and vaccination if only single series
    • Repeat HBIG in 1 mo if the patient has received two series and still nonresponder
Patient incompletely vaccinated or unvaccinated (source available for testing)
  • Source HBsAg neg: HBV vaccination, the patient should follow up in one month for repeat labs and continuation of the HBV series
  • Source HBsAg pos: HBV vaccination, add HBIG at different anatomical site if within exposure window (<7d percutaneous / <14d sexual), the patient should follow up in one month for repeat labs and continuation of the HBV series
References
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