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HBV vaccine recommended for all unvaccinated at-risk HCWs
CDC recommends that all health care workers who are unvaccinated or incompletely vaccinated receive hepatitis B vaccination if they have an anticipated risk for blood or body fluid exposure, according to a report in MMWR.
It also recommends that vaccinated health care workers (HCWs) receive post-vaccination serologic testing 1 to 2 months after receiving the final dose. If completely vaccinated HCWs have HBV antibody levels of 10 mIU/mL or more, they are considered immune. If completely vaccinated HCWs have antibody levels of less than 10 mIU/mL, they should receive an additional dose of hepatitis B vaccine and be retested in 1 to 2 months.
“Although acute HBV infections have declined substantially since HepB vaccination was introduced in the United States, a risk for occupational exposure to HBV persists, largely from persons with chronic HBV infection,” the authors wrote. “Pre-exposure assessment of current or past [antibody] results upon hire or matriculation, followed by one or more additional doses of HepB vaccine … if necessary, helps to ensure that HCWs will be protected if they have an exposure to HBV-containing blood or body fluids.”
If HCWs are exposed to HBV, initial post-exposure management includes washing wounds and skin sites exposed with soap and water. Procedures should be implemented to test known sources of the infection, then referring the patient appropriate management and reporting the infection to state or local health authorities. If the exposure source is unknown, the exposed HCWs should be managed as though the source is positive for HBV.
Exposed personnel who are unvaccinated, incompletely vaccinated or have no documentation of vaccination should receive one dose of hepatitis B immune globulin and one dose of vaccine as soon as possible after exposure from a source patient who has confirmed HBV. They should then complete the vaccine series and be tested for antibody levels. If the source patient is negative for HBV, the exposed personnel should complete the vaccine schedule with antibody testing.
If vaccinated personnel are exposed, they have antibody levels of less than 10 mIU/mL and the source patient has confirmed or unknown HBV status, the exposed personnel should receive one dose of hepatitis B immune globulin and be revaccinated after the exposure. No post-exposure HBV management is necessary if the HCW has antibody levels of 10 mIU/mL or more at the time of exposure or if the HCW has completed the vaccine series and has documented subsequent antibodies of 10 mIU/mL or more.