As a blood-borne virus, it is extremely difficult to track exposure to hepatitis B unless you are aware of somebody’s hepatitis B status. Exposure to the virus can occur at work, through sexual intercourse, unsterile tattoo or drug equipment, or even medical procedures with equipment that was not properly sterilized. Precautions – such as vaccination – should always be taken to avoid a possible infection, but timely actions can also be taken to prevent an infection if an exposure does occur.
Post- Exposure Treatment
If you believe you were exposed to hepatitis B, Post-Exposure Prophylaxis (PEP) is the key to preventing the development of a hepatitis B infection. The first step is to seek medical care as soon as possible and let a healthcare professional know that you may have been exposed to hepatitis B. If you do not have a regular doctor or they cannot fit you in for an appointment, you can also visit a hospital’s emergency department or health care center.
Be sure to be honest with the healthcare professional about how you may have been exposed to hepatitis B, as this will help them to determine your exposure risk and the correct actions to take. PEP is typically given in the form of one dose of the hepatitis B vaccine, but in certain circumstances, the healthcare provider will give one dose of the vaccine in addition to a shot of hepatitis B immune globulin (HBIG) to provide additional protection. Even if HBIG is unavailable, you should still receive the a dose of the hepatitis B vaccine
Both vaccinated and unvaccinated individuals can receive PEP. However, recommendations for PEP can differ based upon the exposure and whether or not a person has been fully vaccinated. If the source of exposure is known to be hepatitis B surface antigen-positive (HBsAg), the healthcare provider will take the following steps based upon your vaccination status:
- Source of exposure is known to be HBsAg positive and individual is unvaccinated – HBIG and hepatitis B vaccine are given as soon as possible within a 24 hour window. Complete full vaccine series as recommended after PEP.
- Source of exposure is HBsAg positive and individual is partially vaccinated (less than 3 doses or less than 2 doses of Heplisav-B) – receive HBIG. Complete vaccine series as recommended.
- Source of exposure is HBsAg positive and individual has proof of a completed vaccinate series – one dose of hepatitis B vaccine booster is given.
If the source has an unknown hepatitis B status, the recommendations are as follows:
- Source has unknown HBsAg and individual is unvaccinated – receive first dose of the hepatitis B vaccine as soon as possible within a 24 hour window.
- Source has unknown HBsAg and individual is not fully vaccinated – complete vaccine series.
- Source has unknown HBsAg and individual has proof of completed vaccination – no treatment is needed.
The most important part of PEP is the time between the exposure and treatment. PEP is most effective at preventing hepatitis B if it is given as soon as possible after the exposure. This means that the treatment should be given within 24 hours of exposure.
Pregnancy and PEP
PEP is safe and recommended for both pregnant and breastfeeding mothers who have been exposed to hepatitis B; the vaccine will not harm the baby. For pregnant women who are HBsAg positive, PEP must be administered to the newborn to prevent the baby from developing chronic hepatitis B! In this case, the doctor delivering the newborn should be aware of the mother’s hepatitis B infection so that they can have HBIG and the vaccine on hand during the birth. After the baby is born, one dose of HBIG and the first dose of the hepatitis B vaccine should be given to the newborn within 12 hours of delivery. It’s important to note that HBIG may not be available in all countries. In this case, it is even more important to make sure that babies receive the first dose of the hepatitis B vaccine within 24 hours of birth. The newborn should receive the remainder of the vaccine according to the vaccine schedule.
PEP for Healthcare Workers
It’s important to note that occupational procedures have a different set of guidelines, although the timeline and standard PEP treatment recommendations remain the same. Healthcare institutions should always have infection control guidelines and precautions in place to prevent an exposure, but accidents can still occur. All healthcare workers who are exposed to hepatitis B at work should follow the standard protocol for the post exposure process, as explained by the CDC guidelines. The workplace is also responsible for making sure that all employees have access to PEP and all other post-exposure procedure materials as soon as possible after the exposure.
After the 24 Hour Window and No Access to PEP
If you are unable to receive PEP within the recommended time frame, you should still visit a healthcare provider to receive treatment as soon as possible. The CDC estimates that treatment may be effective at preventing infection if given up to 7 days after the initial exposure, but not enough research has been done to confirm how effective PEP is if given after that timeline. The earlier PEP is received, the more likely it is to be effective.
The World Health Organization also recommends that standard first-aid be applied immediately to all cuts and wounds that may have been exposed to infected blood. The standard first aid includes 1) letting the wound bleed freely and; 2) washing the wound immediately with soap, gel, or hand-cleaning solution. Be sure to treat the wound gently, and to not use harsh solutions or soaps when cleaning the area. WHO also provides instructions on how properly cleanse eyes, the mouth, and unbroken skin after a potential exposure.
If you believe that you were exposed to hepatitis B and never received PEP, you should be tested to know your hepatitis B status. It takes up to 9 weeks for the hepatitis B virus to show in the bloodstream. Therefore, it is important to get tested for the hepatitis B 3 panel blood test (HBsAg, HBcAb, HBsAb) at least 9 weeks after the exposure to determine if you have been infected. If you remain uninfected after that time period and are HBsAb negative, the completion of the hepatitis B vaccine series is strongly recommended.