Post-Exposure Prophylaxis for Hepatitis B and C

Hepatitis B Post-Exposure Prophylaxis

The Centers for Disease Control and Prevention recommends that for unvaccinated persons or vaccine non-responders exposed to HBsAg-positive blood, administer both HBIG (0.06 mL/kg body weight) and hepatitis B vaccine simultaneously at separate anatomic sites as soon as possible, preferably within 24 hours 4, 5
The effectiveness of prophylaxis diminishes significantly with delayed administration, though efficacy may extend up to 7 days post-exposure for needlestick injuries 6, 5
For HBsAg-positive source exposures, incompletely vaccinated persons should receive HBIG + complete remaining vaccine doses 1
For HBsAg-positive source exposures, fully vaccinated without documented response should receive a single vaccine booster dose 3
For unknown source exposures, unvaccinated persons should receive the hepatitis B vaccine series initiated within 24 hours 3
For sexual exposure to HBsAg-positive persons, a single dose of HBIG (0.06 mL/kg) should be administered within 14 days of last sexual contact 3
For perinatal exposure, infants born to HBsAg-positive mothers should receive HBIG 0.5 mL intramuscularly within 12 hours of birth and hepatitis B vaccine 0.5 mL within 7 days of birth 3

The Centers for Disease Control and Prevention recommends that no post-exposure prophylaxis is available for hepatitis C 1, 2, 3, 7
For HCV exposure, baseline anti-HCV and ALT testing should be performed at the time of exposure, and HCV RNA testing at 4-6 weeks if earlier diagnosis is desired 1, 2, 3
For HCV exposure, follow-up anti-HCV and ALT testing should be performed at 4-6 months 1, 2, 3
HCV transmission after needlestick from a positive source averages only 1.8% (range 0-7%), compared to 23-62% for HBV 6, 8

The Centers for Disease Control and Prevention recommends that HBIG administration for hepatitis B exposures should not be delayed while waiting for source testing—start prophylaxis immediately if high suspicion exists 4, 5
There is no immunoglobulin or vaccine for hepatitis C, and protocols should not be confused with HBV 1, 2, 3
Source patient testing should be focused on, rather than testing discarded needles or syringes for virus contamination 1, 2, 3
Vaccination response status should be verified, especially for healthcare personnel and immunocompromised individuals 4