Post-exposure prophylaxis to hepatitis B virus after a nonoccupational exposure

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	HBIG^Δ × 1; initiate HBV vaccine series	Initiate HBV vaccine series
Previously vaccinated^◊, known responder^§	No treatment	No treatment
Previously vaccinated^◊, known nonresponder^§	HBIG^Δ × 1 and initiate revaccination^¥ or HBIG^Δ × 2	No treatment
Previously vaccinated^◊, antibody response unknown^‡	Single vaccine booster dose	No treatment
If still undergoing vaccination	HBIG^Δ × 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.

References:

PEP to prevent HIV infection. Available at: https://www.hivguidelines.org/pep-for-hiv-prevention/. This material was accessed on March 6, 2023 on the HIV Clinical Resource website (www.hivguidelines.org). The HIV Clinical Guidelines Program is a collaborative effort of the New York State Department of Health AIDS Institute and the Johns Hopkins University Division of Infectious Diseases. Copyright © Johns Hopkins University HIV Clinical Guidelines Program 2000-2023.
CDC Guidance for Evaluating Health-Care Personnel for Hepatitis B Virus Protection and for Administering Postexposure Management. MMWR Recomm Rep 2013; 62:1.
Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.

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Post-exposure prophylaxis to hepatitis B virus after a nonoccupational exposure