Hepatitis B and Healthcare Personnel - immunize.org

1 Hepatitis B and Healthcare Personnel CDC answers frequently asked questions about Q&A. how to protect Healthcare Personnel The Immunization Action Coalition could contract Hepatitis B virus (HBV) infec- risk of occupational percutaneous or mucosal thanks experts at the Centers for Disease tion during pregnancy, which might result in exposure to blood or body fluids ( , HCP. severe disease for the newborn. Women who with direct patient contact, HCP who have the Control and Prevention for answering breastfeed their babies can be vaccinated as risk of needlestick or sharps injury, labora- the following questions. well. Receipt of Hepatitis B vaccine is not a tory workers who draw, test or handle blood reason to discontinue breastfeeding. specimens) should have postvaccination Hepatitis B Vaccination testing for antibody to Hepatitis B surface Is there a recommendation for routine booster antigen (anti-HBs).

2 Postvaccination testing Which people who work in Healthcare set- doses of Hepatitis B vaccine? should be done 1 2 months after the third tings need Hepatitis B vaccine? No. HCP who have documentation of receiv- dose of vaccine. Postvaccination testing for The Occupational Safety and Health Admin- ing a 3-dose series of Hepatitis B vaccine and persons at low risk for mucosal or percutane- istration (OSHA) requires that Hepatitis B who subsequently tested positive for anti- ous exposure to blood or body fluids ( , vaccine be offered to Healthcare Personnel HBs (defined as anti-HBs of 10 mIU/mL) public safety workers and HCP without direct (HCP) who have a reasonable expectation of are considered to be immune to Hepatitis B. patient contact) likely is not cost-effective. being exposed to blood or body fluids on the Immunocompetent persons who also have Those who do not undergo postvaccination job.

3 This requirement does not include per- followed the protocol, have long-term pro- testing should be counseled to seek immedi- sonnel who would not be expected to have tection against HBV and do not need further ate testing if exposed. occupational risk ( , general office workers). testing or vaccine doses. Some immuno- deficient persons, including those on hemo- What should be done if HCP postvaccination At what anatomic site should Hepatitis B anti-HBs test is negative (less than 10 mIU/mL). dialysis, may need periodic booster doses of vaccine be administered to adults? What needle 1 2 months after the third dose of vaccine? Hepatitis B vaccine, as described in the 2006. size should be used? adult Hepatitis B vaccine ACIP recommenda- Repeat the 3-dose series and test for anti-HBs For adults, administer Hepatitis B vaccine intra- tions (MMWR 2006;55[RR-16]:26 29). 1 2 months after the last dose of the vaccine.

4 Muscularly (IM) in the deltoid muscle. A 22- If the test is still negative after a second vac- to 25-gauge, 1 1 -inch needle should be used. In December 2013, CDC released a new cine series, HCP should be tested for HBsAg The gluteus muscle should not be used as a document titled CDC Guidance for Evaluating and total anti-HBc to determine their HBV. site for administering Hepatitis B vaccine. For Health-Care Personnel for Hepatitis B Virus infection status. HCP who test negative for optimal protection, it is crucial that the vac- Protection and for Administering Postexposure HBsAg and total anti-HBc should be consid- cine be administered IM, not subcutaneously. Management (MMWR 2013;62[RR-10]) avail- ered vaccine non-responders and susceptible able at to HBV infection. They should be counseled If a person who works in a Healthcare setting Does the content of this document update had one dose only of Hepatitis B vaccine about precautions to prevent HBV infection and ACIP recommendations on Healthcare person- the need to obtain Hepatitis B immune globu- 1 year ago, should the series be restarted?

5 Nel vaccination and Hepatitis B? lin (HBIG) prophylaxis for any known or likely No. The Hepatitis B vaccine series should not The new guidance published by CDC does not exposure to HBsAg-positive blood or blood be restarted when doses are delayed; rather, constitute new recommendations of ACIP. or body fluids from a person whose HBsAg the series should be continued from where it The CDC guidance was created based on the status is unknown. stopped. The person should receive the sec- opinions of an expert panel convened by CDC. ond dose of vaccine now and the third dose HCP found to be HBsAg negative but total According to the document, the guidance anti-HBc positive were infected in the past and at least 8 weeks later. There needs to be at from CDC augments the 2011 recommenda- least 8 weeks between the second and third require no vaccination or treatment. tions of the ACIP document titled Immu- doses and at least 16 weeks between the first nization of Health-Care Personnel published If the HBsAg and total anti-HBc tests are pos- and the third doses of vaccine.

6 November 25, 2011 ( itive, HCP should receive appropriate coun- pdf/ ), for evaluating Hepatitis B seling for preventing transmission to others Is it safe for HCP to be vaccinated during as well as referral for ongoing care to a pregnancy? protection among Healthcare Personnel and administering postexposure prophylaxis. specialist experienced in the medical manage- Yes. Many years of experience with Hepatitis ment of chronic HBV infection. HCP should B vaccines indicate no apparent risk for adverse not be excluded from work. events to a developing fetus. Current Hepatitis Post-vaccination Anti-HBs Testing B vaccines contain noninfectious Hepatitis B Which HCP need serologic testing after receiv- continued on the next page . surface antigen (HBsAg) and pose no risk to ing 3 doses of Hepatitis B vaccine? the fetus. If not vaccinated, a pregnant woman All HCP, including trainees, who have a high Technical content reviewed by the Centers for Disease Control and Prevention Saint Paul, Minnesota 651- 647- 9009 Item #P2109 (11/17).

7 Hepatitis B and Healthcare Personnel (continued) page 2 of 5. How often should I test HCP after they've We test all our new employees for immunity be administered and anti-HBs postvaccination received the Hepatitis B vaccine series to make to Hepatitis B. Some of our new employees testing should be performed 1 2 months sure they're protected? have documentation of completing Hepatitis after the third dose of vaccine. There is no For immunocompetent HCP, periodic testing B vaccination as children or adolescents harm in receiving extra doses of vaccine. Care or periodic boosting is not needed. Post- but now test negative for anti-HBs (that is, should always be taken to document vaccine vaccination testing (anti-HBs) should be done antibody level less than 10 mIU/mL). How lot, date, manufacturer, route, and vaccine 1 2 months after the third dose of the hepa- should we manage these employees?

8 Dosages. Postvaccination testing results titis B vaccine series. If adequate anti-HBs (at CDC published guidance for this situation in should also be documented, including the least 10 mIU/mL) is present, nothing more December 2013. For persons vaccinated in the date testing was performed. All Healthcare needs to be done. This information should be past who were not tested for a response fol- settings should develop policies or guidelines made available to the individual and recorded lowing the completed vaccination series and to assure valid Hepatitis B immunization and in the his or her health record. If postvacci- who now test negative for anti-HBs, it is rec- anti-HBs testing when indicated. nation testing is less than 10 mIU/mL, the ommended to administer 1 booster dose An employee thinks she had 3 doses of Hepatitis 3-dose vaccine series should be repeated and of Hepatitis B vaccine, then test for anti-HBs B vaccine in the past but has no documenta- anti-HBs testing should be completed 1 2 1 2 months later.

9 Those who test positive tion of receiving those doses. We obtained an months after the last dose of the second series. for anti-HBs after the single booster dose anti-HBs titer and the result was greater than are considered to be immune and no further 10 mIU/mL. With this lab result, can't we Does CDC now recommend routine pre- testing or vaccination is needed. Those who exposure anti-HBs testing for all HCP who assume she is immune? test negative for anti-HBs after the booster . were previously vaccinated but not tested? dose should receive 2 additional doses to No. A positive anti-HBs indicates that the In general, no, but the type of testing (pre- complete a second 3-dose series. Anti-HBs vaccinated person is immune at the time the exposure or postexposure) depends on the testing should be repeated 1 2 months after person was tested but does not assure that setting. An expert panel convened by CDC completion of the second vaccination series.

10 The person has long-term immunity. Long-term acknowledged that the risk for HBV infection An algorithm (Figure 1) adapted from the CDC immunity has been demonstrated only for for vaccinated HCP can vary widely by setting guidance document is provided on page 3. people attaining an adequate anti-HBs result and profession (see reference at the end of of at least 10 mIU/mL after completing a this answer). The risk might be low enough in At our facility we do routine pre-employment full Hepatitis B vaccination series. The most certain settings that assessment of anti-HBs anti-HBs testing regardless of whether the direct way to deal with this is to vaccinate the status and appropriate follow-up can be done employee has documentation of a Hepatitis B employee with a 3-dose series of Hepatitis B. at the time of exposure to potentially infec- vaccination series and consider those with vaccine; test for anti-HBs in 1 2 months and tious blood or body fluids.