Prevention of hepatitis B virus (HBV) infection in health-care workers after accidental exposure: A comparison of two prophylactic schedules

Abstract

The efficacy of hepatitis B (HB) vaccine alone or combined with hepatitis B immunoglobulin (HBIg) in preventing hepatitis B virus (HBV) infection was studied in a controlled trial. Recombinant HB vaccine (Engerix-B, 20 micrograms) was given to 40 susceptible health-care workers within three days of exposure (Group B). In another group of 37 medical professionals a single dose of HBIg (0.06 mg/kg) was administered intramuscularly within three days of exposure, followed immediately by the first dose of vaccine (20 micrograms dose) (Group A). In both groups the next doses of recombinant vaccine were administered one, two and six months later. One month after the fourth dose of vaccine the percentage of incidence of antibody to hepatitis B virus surface antigen (anti-HBs) was 94.6% in group A and 95% in group B with geometric mean titer of antibodies of 340 and 380 mIU/ml, respectively. A control group consisted of 34 persons who did not receive any specific immunoprophylaxis (Group C). All subjects were followed for at least ten months. The protective value of immunization, both active alone and combined passive and active, was clearly effective since none of the recipients developed acute symptomatic HBV infection compared with two (6%) of 34 not immunized persons (Fisher's exact test p = 0.01). Thus, in the absence of evidence of lesser efficacy for the use of HB vaccine alone after exposure to HBsAg-positive blood, this schedule would seem to be the treatment of choice in adult persons.

British HIV Association guidelines for immunization of HIV‐infected adults 2008

“…Hepatitis-B-specific immunoglobulin (HBIg) can protect from infection or attenuate disease if given immediately after exposure to HBV, when it is usually combined with the HBV vaccine [75]. Among HIV-negative people, only 1% develop disease and 2% have evidence of infection if prophylaxis is given within 7 days of exposure [76].…”

“…HBIg affords protec-tion for 3-6 months [1]. A rapid vaccination course started within 7 days of exposure appears to be as effective as vaccination plus HBIg in healthy persons [75]. There are no data on the efficacy of post-exposure prophylaxis by either strategy in HIV-infected persons.…”

Manual accidents, biological risk control, and quality indicators at a children's hospital in north-east Italy

“…Monitoring of immunosuppressive therapy, and blood and platelet transfusions are often necessary for many months, especially during a pediatric bone marrow transplant in a patient with graft versus host disease. 36 – 39 …”

Registration of Blood Exposure Accidents in the Netherlands by a Nationally Operating Call Center

“…6,16,17 HBV vaccination was advised a total of 188 times, and administration of HBIg was advised only 41 times. This is in accordance with our other studies, in which a reduction in HBIg administration was calculated after the introduction of the new Dutch national guidelines.…”