Hepatitis B secondary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Secondary Prevention

HBIG

HBIG provides passively acquired anti-HBs and temporary protection (i.e., 3--6 months) when administered in standard doses. HBIG is typically used as an adjunct to hepatitis B vaccine for postexposure immunoprophylaxis to prevent HBV infection. HBIG administered alone is the primary means of protection after an HBV exposure for nonresponders to hepatitis B vaccination.

HBIG is prepared from the plasma of donors with high concentrations of anti-HBs. The plasma is screened to eliminate donors who are positive for HBsAg, antibodies to HIV and hepatitis C virus (HCV), and HCV RNA. In addition, proper manufacturing techniques for HBIG inactivate viruses (e.g., HBV, HCV, and HIV) from the final product. No evidence exists that HBV, HCV, or HIV ever has been transmitted by HBIG commercially available in the United States. HBIG that is commercially available in the United States does not contain thimerosal.

Recommendations for Counseling and Prevention of Transmission of Hepatitis B from Individuals with Chronic HBV Infection: AASLD Practice Guidelines 2009

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1. Carriers should be counseled regarding prevention of transmission of HBV. (III) 2. Sexual and household contacts of carriers who are negative for HBV seromarkers should receive hepatitis B vaccination. (III) 3. Newborns of HBV-infected mothers should receive HBIG and hepatitis B vaccine at delivery and complete the recommended vaccination series. (I) 4. Persons who remain at risk for HBV infection such as infants of HBsAg-positive mothers, health care workers, dialysis patients, and sexual partners of carriers should be tested for response to vaccination. (III) Postvaccination testing should be performed at 9 to 15 months of age in infants of carrier mothers and 1-2 months after the last dose in other persons. (III) Follow-up testing of vaccine responders is recommended annually for chronic hemodialysis patients. (III) 5. Abstinence or only limited use of alcohol is recommended in hepatitis B carriers. (III) 6. Persons who are positive only for anti-HBc and who are from a low endemic area with no risk factors for HBV should be given the full series of hepatitis B vaccine. (II-2)

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