Prevention
- Screening
- The United States Preventive Services Task Force
- Provides a strong recommendation for screening women during their first prenatal visit
- Recommends against screening the general asymptomatic population
- Cites lack of evidence that such screening improves health outcomes and could possibly cause harm from stigmatizing patients in whom screening is being performed
- The American Association for the Study of Liver Diseases
- Recommends screening certain high-risk groups and vaccinating those who are not already immune or infected
- Pregnant women
- Persons born in hyperendemic areas
- Men who have sex with men
- Injection drugs users
- Patients on dialysis
- HIV-infected patients
- Family and household contacts of HBV-infected persons
- Vaccination
- Recombinant hepatitis B vaccine
- Vaccine components and administration
- 2 available vaccines: 10 µg IM (Recombivax-HB) or 20 µg IM (Engerix-B)
- Half dose for children
- 40-µg dose for patients receiving hemodialysis and immunocompromised adults
- Given at 0, 1, and 6 months
- Deltoid, not gluteal, injection
- Recommendations
- Universal vaccination of all children regardless of maternal HBsAg status
- Vaccination of neonates of HBsAg-positive mothers is a critical step toward the eradication of chronic HBV infection.
- Adults in high-risk groups
- Health care workers
- Individuals who have unprotected sex with multiple partners
- Intravenous drug users
- Patients receiving hemodialysis
- Hemophiliac patients
- Household and sexual contacts of HBsAg carriers
- Patients with chronic liver disease
- Duration of protection
- At least 5 years in ~80–90% of immunocompetent vaccine recipients
- At least 10 years in ~60–80% of immunocompetent vaccine recipients
- Booster vaccinations are only indicated for:
- Immunosuppressed individuals who no longer have detectable anti-HBs
- Immunocompetent persons who sustain percutaneous HBsAg-positive inoculations after losing detectable anti-HBs
- Dialysis patients whose anti-HBs antibody levels fall below 10 mIU/mL
- Postexposure prophylaxis
- Hepatitis B immune globulin: 0.06 mL/kg IM
- Immediately after needlestick, followed by a complete course of hepatitis B vaccine to begin within the first week
- Within 14 days of sexual exposure followed by a complete course of hepatitis B vaccine to begin within the first week
- For perinatal exposure of infants born to an HBsAg-positive mother, a single 0.5-mL IM dose should be given immediately after birth in combination with a complete course of 3 injections of hepatitis B vaccine to be started within the first 12 hours of life.
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