Management of possible nonoccupational exposure to hepatitis B virus

HBV: hepatitis B virus; anti-HBc: antibodies to hepatitis B core antigen; anti-HBs: antibodies to hepatitis B surface antigen; HBIG: hepatitis B immune globulin; HBsAg: hepatitis B surface antigen.
* Clinicians should evaluate patients for post-exposure prophylaxis if the patient had a percutaneous (eg, bite or needlestick) or mucosal exposure to blood or infectious secretions (eg, semen or body fluids that contain blood).
¶ Routine hepatitis B vaccination should still be administered to all exposed individuals who engage in high-risk behaviors if they are not immune or are without evidence of prior HBV infection. Refer to the topic that discusses hepatitis B vaccination.
Δ If the exposed patient is uncertain if they completed the hepatitis B vaccine, they should be treated as if they are unvaccinated.
◊ If the HBV status of the source is unknown at the time of exposure and the source is willing to be tested, HBsAg, anti-HBs, anti-HBc should also be obtained. However, decisions regarding initial post-exposure management after a nonoccupational exposure should not be delayed pending the results of serologic testing (of the exposed patient or the source).
§ HBIG and/or hepatitis B vaccine should be administered within 24 hours. If the hepatitis B vaccine and HBIG are given simultaneously, they should be administered at different sites. However, these medications (in particular HBIG) are not always available in the emergency room or primary care setting. If HBIG is delayed, hepatitis B vaccine should be given as soon as possible.
¥ HBIG can still be effective if administered within 7 days of a percutaneous exposure or 14 days of a sexual exposure.
‡ Individuals who have received two courses of the hepatitis B vaccine series are unlikely to respond to additional doses.
† HBIG can be discontinued if serologic testing reveals the source is HBsAg-negative.