Decision on further management based on HBsAg status of source patienta

HBsAg(+)

HBsAg(–)

Exposure source unknownh or HBsAg measurement not feasible

History of HBVb or ongoing infection (HBsAg[+] in exposed person)

No need for additional specific prophylaxis

No need for additional specific prophylaxis

No need for additional specific prophylaxis

Unvaccinated

1 dose of HBIGc + start hepatitis B vaccine seriesd

Start hepatitis B vaccine seriesd

Start hepatitis B vaccine seriesd

Consider HBIG if source considered at high risk (eg, drug use history, sexual contacts with multiple partners)

Vaccinated with response to vaccination evaluated 1-2 months after scheduled vaccination

Insufficient serologic responsef

1 dose of HBIGc + restart hepatitis B vaccine seriesd

No need for additional specific prophylaxisg

Administer booster dose of vaccine

Consider HBIG if high risk

Multiple vaccinations with confirmed lack of response to vaccination

2 doses of HBIG at 1-month interval

No need for additional specific prophylaxis

No need for additional specific prophylaxis

If clinical and epidemiologic data indicate high risk of HBV infection, follow guidelines for exposure to HBsAg(+) blood

Vaccinated without evaluation of response to vaccination 1-2 months after scheduled vaccination; in such cases measure anti-HBs as part of qualification for prophylaxis

Anti-HBs <10 mIU/mL

Booster dose + 1 dose of HBIG

No need for additional specific prophylaxis

Administer booster dose of vaccine; consider HBIG if high risk

Recommendations presented in this table are graded as strong recommendations based on low quality of evidence.Evidence 2Strong recommendation (benefits clearly outweigh downsides; right action for all or almost all patients). Low Quality of Evidence (low confidence that we know true effects of the intervention). Quality of Evidence lowered due to the observational nature of data. Schillie S, Vellozzi C, Reingold A, Harris A, Haber P, Ward JW, Nelson NP. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2018 Jan 12;67(1):1-31. doi: 10.15585/mmwr.rr6701a1. PMID: 29939980; PMCID: PMC5837403.

a Measure HBsAg in patients whose blood or body fluids were the source of infection.

b Individuals who have recovered from an earlier HBV infection acquire sustained immunity and require no postexposure prophylaxis.

c IM or IV, depending on the preparation (dosage as per manufacturer’s prescribing information), as soon as possible after exposure, preferably within 12 hours. HBIG should be administered simultaneously with the first dose of hepatitis B vaccine (IM preparations should be injected in separate sites).

d As soon as possible (preferably within 12-24 hours). Safe in pregnant and breastfeeding women. Vaccination schedule: month 0, 1, then month 6; or month 0, 1, and 2, then month 12.

e Serum anti-HBs levels ≥10 mIU/mL in individuals tested within 1-2 months of completion of a primary (scheduled, preexposure) vaccination series.

f Serum anti-HBs levels <10 mIU/mL in individuals tested within 1-2 months of completion of a primary (scheduled, preexposure) vaccination series, without a repeated vaccination dose.

g A repeated scheduled vaccination should be administered 1-2 months following the last dose. Serologic response should be evaluated.