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Old 08-11-2012
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Syringe Hepatitis B Needle Stick Injury

If a normal person is exposed to hepatitis B ie. needle stick injury, what is the most appropriate next step?

serology to look for whether the person is HBsAb +ve ??

OR

give the person HBIG and HBV vaccine ???
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serology to look for whether the person is HBsAb +ve
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Well also would depend on immunization status.

I think if immunized, you wouldn't do anything.
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if the person is not immunized,
i think u need to send labs for serology and give HBV vaccine and HBiG straightway. dont wait for the lab results!
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hey guys don't mind , But I need the most accurate answer.......

anyone who is 100% sure shud tell me.....

bcoz if this comes in exam , I don't want to have 2 options in mind ,just need the one which is best and correct......

so now tell whether do serology OR give HBIG and HBV vaccine ?????
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Normally CDC does not recommend checking the Hep B immune status in general population.
However, in this case you should do it because the person has been exposed to a potential Hep B infection and you need to know the status due to following reasons:

1. If the person is HBsAb+ then he/she is already immunized and there is no need to give anything.
2.
If the person is HBsAb- then you need to give both HBIG and HBV vaccine
3. If the person is HBsAg+ then it is an active infection so again don't need anything.

The situation is different in a newborn with active infection in the mother since you don't need to check the newborn's Hepatitis status. So, you need to give both HBIG and HBV vaccine to the newborn.

There is another scenario when you find that the titer of the HBsAb is low (but > 10). According to CDC you don't need to give either HBIG or HBV vaccine but I (?think) read in UW that you do give a booster of Hep B vaccine.

Another rare scenario when there is a non-responder to Hep B vaccination the only option is to give HBIG.

Quote:
Who should receive postvaccination testing?

Testing for immunity is advised only for persons whose subsequent clinical management depends on knowledge of their immune status, including
  • Infants born to HBsAg-positive mothers
  • Health care workers and public safety workers at high risk for continued percutaneous or mucosal exposure to blood or body fluids
  • Chronic hemodialysis patients, HIV-infected persons, and other immunocompromised persons (e.g., hematopoietic stem-cell transplant recipients or persons receiving chemotherapy)
  • Sex partners of persons with chronic HBV infection
Quote:
After primary immunization with hepatitis B vaccine, anti-HBs levels decline rapidly within the first year and more slowly thereafter. Among young adults who respond to a primary vaccine series with antibody concentrations of >10 mIU/mL, 17%–50% have low or undetectable concentrations of anti-HBs (reflecting anti-HBs loss) 10–15 years after vaccination. In the absence of exposure to HBV, the persistence of detectable anti-HBs after vaccination depends on the concentration of postvaccination antibodies. Even when anti-HBs concentrations decline to <10 mIU/mL, nearly all vaccinated persons remain protected against HBV infection. The mechanism for continued vaccine-induced protection is thought to be the preservation of immune memory through selective expansion and differentiation of clones of antigen-specific B and T lymphocytes. Persistence of vaccine-induced immune memory among persons who responded to a primary adult vaccine series 4–23 years previously but then had anti-HBs concentrations of <10 mIU/mL has been demonstrated by an anamnestic increase in anti-HBs concentrations in 74%–100% of these persons 2–4 weeks after administration of an additional vaccine dose and by antigen-specific B and T cell proliferation. Although direct measurement of immune memory is not yet possible, these data indicate that a high proportion of vaccines retain immune memory and would have an anti-HBs response upon exposure to HBV.
http://www.cdc.gov/mmwr/PDF/rr/rr5516.pdf

Last edited by Novobiocin; 08-11-2012 at 05:02 PM.
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thanx a lot...I think now I need to copy it down........
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HBsAg-positive mothers and their infants
• Administer single-antigen hepatitis B vaccine and hepatitis B immune globulin (HBIG) to all infants born to HBsAg-positive mothers <12 hours after birth.

Mothers with unknown HBsAg status and their infants
• Administer single-antigen hepatitis B vaccine (without HBIG) to all infants born to mothers with unknown HBsAg status <12 hours after birth.
• Alert infant’s pediatric health-care provider if an infant is discharged before the mother’s HBsAg test result is available; if the mother is determined to be HBsAg positive, HBIG should be administered to the infant as soon as possible, but no later than age 7 days.

All mothers and their infants

• Administer a dose of single-antigen hepatitis B vaccine to all infants weighing >2,000 g.
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HBsAg-Positive Exposure Source
  • Persons who have written documentation of a complete hepatitis B vaccine series and who did not receive postvaccination testing should receive a single vaccine booster dose.
  • Persons who are in the process of being vaccinated but who have not completed the vaccine series should receive the appropriate dose of hepatitis B immune globulin (HBIG) and should complete the vaccine series.
  • Unvaccinated persons should receive both HBIG and hepatitis B vaccine as soon as possible after exposure (preferably within 24 hours). Hepatitis B vaccine may be administered simultaneously with HBIG in a separate injection site. The hepatitis B vaccine series should be completed in accordance with the age-appropriate vaccine dose and schedule .

Exposure Source with Unknown HBsAg Status
  • Persons with written documentation of a complete hepatitis B vaccine series require no further treatment.
  • Persons who are not fully vaccinated should complete the vaccine series.
  • Unvaccinated persons should receive the hepatitis B vaccine series with the first dose administered as soon as possible after exposure, preferably within 24 hours. The vaccine series should be completed in accordance with the age-appropriate dose and schedule.

Ref
CDC
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a3.htm
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Old 09-07-2012
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Quote:
Originally Posted by Novobiocin View Post
Normally CDC does not recommend checking the Hep B immune status in general population.
However, in this case you should do it because the person has been exposed to a potential Hep B infection and you need to know the status due to following reasons:

1. If the person is HBsAb+ then he/she is already immunized and there is no need to give anything.
2.
If the person is HBsAb- then you need to give both HBIG and HBV vaccine
3. If the person is HBsAg+ then it is an active infection so again don't need anything.

The situation is different in a newborn with active infection in the mother since you don't need to check the newborn's Hepatitis status. So, you need to give both HBIG and HBV vaccine to the newborn.

There is another scenario when you find that the titer of the HBsAb is low (but > 10). According to CDC you don't need to give either HBIG or HBV vaccine but I (?think) read in UW that you do give a booster of Hep B vaccine.

Another rare scenario when there is a non-responder to Hep B vaccination the only option is to give HBIG.


If a patient is HBsAg+, in this case he/she has active infection, so do we proceed to give either inteferon or lamivudine OR we check AST and ALT??

if during this time AST and ALT is normal should we wait? like the management for chronic hepatitis C??
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Quote:
Originally Posted by chienpolska View Post
If a patient is HBsAg+, in this case he/she has active infection, so do we proceed to give either inteferon or lamivudine OR we check AST and ALT??

if during this time AST and ALT is normal should we wait? like the management for chronic hepatitis C??
Only Hepatitis C gets treated (interferon etc) for which there is no PEP or vaccination.
No other Hepatitis gets treated (no effective treatment), the only option is vaccination/ PEP.
Hep A & E are self limiting.
Source MTB 2 Page 21
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Quote:
Originally Posted by Novobiocin View Post
Only Hepatitis C gets treated (interferon etc) for which there is no PEP or vaccination.
No other Hepatitis gets treated (no effective treatment), the only option is vaccination/ PEP.
Hep A is self limiting.
but i read from UW and it says that chronic hepatitis B with persistently elevated ALT, positive HBsAg, HBeAg, HBV DNA should be treated with inteferon or lamivudine
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Quote:
Originally Posted by chienpolska View Post
but i read from UW and it says that chronic hepatitis B with persistently elevated ALT, positive HBsAg, HBeAg, HBV DNA should be treated with inteferon or lamivudine
That's correct. I am talking about acute hepatitis infections.
10% of Hep B progress to chronic Hepatitis B which is treated with as above.
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Old 12-27-2012
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Quick follow up:

For regular, unvaccinated people with acute hepatitis b -

Do they need both hbig and hep b vaccine?
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Old 12-27-2012
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Also, why give vaccine if already infected? You don't give the chicken pox vaccine to someone who has chicken pix, so why here?
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