18.10   Post-exposure prophylaxis

18.10.1            Specific hepatitis B immunoglobulin (HBIG) is available for passive protection and is normally used in combination with hepatitis B vaccine to confer passive/active immunity after exposure.  Guidance is given in ‘Exposure to hepatitis B virus; guidance on post exposure prophylaxis’.  PHLS Hepatitis Subcommittee.  CDR Review 1992:2;R97-R101.  A summary of this guidance is given in the following table.

18.10.2            Whenever immediate protection is required, immunisation with the vaccine should be combined with simultaneous administration of hepatitis B immunoglobulin (HBIG) at a different site.  It has been shown that passive immunisation with HBIG does not suppress an active immune response.  A single dose of HBIG (usually 500iu for adults; 200iu for the newborn) is sufficient for healthy individuals.  If infection has already occurred at the time of immunisation, virus multiplication may not be inhibited completely, but severe illness and, most importantly, the development of the carrier state may be prevented.

18.10.3   Immunoglobulin should be administered as soon as possible after exposure.  In babies born to hepatitis B carrier mothers it should be given not later than 48 hours after birth (but see 18.11.1) and in other types of exposure it should preferably be given with 48 hours and certainly no later than a week after exposure.

18.10.4   There is no evidence associating the administration of HBIG with acquisition of HIV infection.  Not only does the processing of the plasma from which it is prepared render it safe, but the screening of blood donations is now routine practice.

18.11     Groups requiring post-exposure prophylaxis

18.11.1   Babies born to mothers who are HBeAg positive carriers, who are HBsAg positive without e markers (or where e marker status has not been determined), or who have had acute hepatitis during pregnancy.

Active/passive immunisation is recommended (see 18.4.4).  All babies of HBsAg positive mothers are e-antigen positive, HBsAg positive without e markers (or where e-marker status has not been determined) or had acute hepatitis during pregnancy will require HBIG.  The first dose of vaccine should be given at birth or as soon as possible thereafter.  HBIG should be given at a contralateral site at the same time; arrangements for the supply of HBIG should be made well in advance.  If administration of HBIG is delayed for more than 48 hours, advice should be sought from a local Consultant in Communicable Disease Control, CPHM (CD & EH), a Consultant in Medical Microbiology/Consultant Virologist or from the PHLS Communicable Disease Surveillance Centre or SCIEH.

18.11.2   Persons who are accidentally inoculated, or who contaminate the eye or mouth or fresh cuts or abrasions of the skin, with blood from a known HBsAg positive person.  Individuals who sustain such accidents should wash the affected area well with soap and warm water and seek medical advice.  Advice about prophylaxis after such accidents should be obtained by telephone from the nearest Public Health Laboratory or from the CPHM on call for the local Health Board in Scotland.  Advice following accidental exposure may also be obtained from the Hospital Control of Infection Officer or the Occupational Health Services.

Health care workers who have already been successfully immunised should be given a booster dose of vaccine unless they are known to have adequate protective levels of antibody.

18.11.3  Sexual partners (and in some circumstances a family contact judged to be at high risk) of individuals suffering from acute hepatitis B, and who are seen within one week of onset of jaundice in the contact.

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