|Vaccination and/or antibody response status of exposed person*||Treatment when source patient is:|
|HBsAg positive/source unknown or not available for testing||HBsAg negative¶|
|Unvaccinated/nonimmune||HBIGΔ × 1; initiate HBV vaccine series||Initiate HBV vaccine series|
|Previously vaccinated◊, known responder§||No treatment||No treatment|
|Previously vaccinated◊, known nonresponder§||HBIGΔ × 1 and initiate revaccination¥ or HBIGΔ × 2||No treatment|
|Previously vaccinated◊, antibody response unknown‡||Single vaccine booster dose||No treatment|
|If still undergoing vaccination||HBIGΔ × 1; complete series||Complete series|
HBsAg: hepatitis B surface antigen; HBIG: hepatitis B immune globulin; HBV: hepatitis B virus; anti-HBs: antibody to hepatitis B surface antigen; anti-HBc: antibody to hepatitis B core antigen.
* Persons who have previously been infected with HBV are immune to reinfection and do not require post-exposure prophylaxis.
¶ A source is considered HBsAg negative if, at the time of exposure, they are known to have either of the following: anti-HBs ≥10 milli-international units/mL after immunization or resolved HBV (anti-HBs-positive and anti-HBc-positive).
Δ For specific recommendations on dosing and administration of HBIG, refer to the topic that discusses post-exposure prophylaxis after a nonoccupational exposure to HBV and the drug information topic within UpToDate.
◊ Vaccinated with full vaccine series.
§ Based on information available at presentation. Responder is defined as person with previously documented adequate levels of serum antibody to HBsAg (serum anti-HBs ≥10 milli-international units/mL); nonresponder is a person with previously documented inadequate response to vaccination (serum anti-HBs <10 milli-international units/mL). It is recommended that decision-making not be delayed while testing for anti-HBs at presentation.
¥ The option of giving 1 dose of HBIG and reinitiating the vaccine series is preferred for nonresponders who have not completed a second vaccine series. For persons who previously completed a second vaccine series but failed to respond, 2 doses of HBIG are preferred.‡ The need for additional prophylaxis (eg, hepatitis B vaccine and HBIG) depends upon serologic testing performed at the time of the initial evaluation. Refer to the UpToDate topic that discusses post-exposure prophylaxis for HBV.
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