Disease Prevention

In industrialized countries, HBV vaccination is recommended for those who are deemed at risk of acquiring the disease. They include the following:

1. Through occupational exposure.

2. Homosexual/bisexual men.

3. Intravenous drug users.

4. Sexual partners of people with acute or chronic HBV.

5. Family members of people with acute or chronic HBV.

6. Newborn babies whose mothers are infected with HBV. If the mother is HBsAg positive, then hepatitis B-specific immunoglobulin (HBIG) should be given at the same time as the first dose of vaccine.

7. Institutionalized patients and prisoners.

Ideally, HBV vaccine should be administered before exposure to the virus. The routine schedule consists of three doses of the vaccine given at 0, 1, and 6 months. Antibody levels should be checked 8-12 weeks after the last dose. If titers are greater than10 miU/mL, then an adequate response has been achieved. In the United Kingdom, this is considered to provide protection for 5-10 years. In the United States, if an initial adequate response has been achieved, then no further doses of vaccine are considered necessary.

Vaccine administration after exposure varies according to the timing of the incident, the degree of risk involved, and whether the individual has already been partly or fully vaccinated. An accelerated schedule when the third dose is given 2 months after the first dose with a booster 1 year later is used to prevent postnatal transmission. Where risks are greatest, it may be necessary to use a rapid schedule. The doses are given at 0, 7, and 21-28 days after presentation, again with a booster dose at 6-12 months. This schedule is currently only licensed with Engerix B.

HBIG may also be used either alone or in conjunction with vaccine. The exact dose given is age dependent but must be administered by deep intramuscular injection in a different site from the vaccine. In an adult, this is usually into the gluteus muscle.

HBIG is given in conjunction with the first dose of vaccine to individuals who are deemed at high risk of acquiring disease and the incident occurred within 72 hours of presentation. It is also used for neonates born to mothers who are HBeAg-positive.

Between 5 and 10% of adults fail to respond to the routine schedule of vaccine. A further full course of vaccine should be tried before deeming the patients as "nonresponders." Such individuals involved in a high-risk exposure should be given two doses of HBIG administered 1 mo apart. Ideally, the first dose should be given within 48 hours after exposure and no later than 2 weeks after exposure.

Other measures include minimizing the risk of exposure by adopting the safe working practices outlined in Subheading 2. Any potential exposures should be dealt with as soon as possible. In industrialized countries blood, blood products, and organs are routinely screened for HBV.

Intravenous drug users should be encouraged to be vaccinated and to avoid sharing needles or any other drug paraphernalia (see Subheading 6.9.2.).

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