Overview of HBV prophylaxis after a possible nonoccupational exposure for persons 13 years of age and older

anti-HBc: hepatitis B core antibody; anti-HBs: hepatitis B surface antibody; HBIG: hepatitis B immunoglobulin; HBsAG: hepatitis B surface antigen; HBV: hepatitis B virus; nPEP: nonoccupational post-exposure prophylaxis.

* On rare occasion laboratory testing may reveal the exposed patient or source is isolated anti-HBc positive (HBsAg and anti-HBs negative). Refer to the topic on post-exposure prophylaxis for information on management of this population.

¶ If a patient did not respond to the conventional HBV series (eg, Engerix-B or Recombivax HB), we prefer to administer a higher potency vaccine (eg, Heplisav) if possible.

Δ If the exposed patient received two vaccine series using the conventional HBV vaccine, it is unlikely they will respond to a third series of the conventional vaccine. However, it is reasonable to administer a third series with a higher potency HBV vaccine, although the efficiacy of this approach has not been established.

◊ A second dose of HBIG should be administered one month later if the exposed patient was a nonresponder to two hepatitis B vaccine series.

§ If the source is unknown but felt to be at high risk for HBV (eg, person who uses injection drugs; person who engages in high-risk sexual behaviors), the decision to administer HBIG should be made using a shared decision-making approach with the patient, weighing the risk of acquiring HBV versus risk of HBIG (eg, allergic reaction, injection site reaction, headache, myalgias).