Hepatitis B secondary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Hepatitis B Immunoglobulin (HBIG) is a form of passive immunization when given shortly before or soon after exposure to hepatitis B virus. It is also administered in combination with HBV vaccines to the newborns of HBsAg positive mothers.[1][2]

Secondary Prevention

Hepatitis B Immunoglobulin

HBIG provides passively acquired anti-HBs and temporary protection (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.[1][2]

HBIG is similar to conventional IG preparations except that it is prepared from plasma preselected for a high titre of anti-HBs (>100 000 IU/ml 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:[1]

  • HBIG protects by passive immunization if given shortly before or soon after exposure to HBV.
  • The protection is immediate, but it lasts only 3 to 6 months.
  • HBIG is not recommended as pre-exposure prophylaxis because of high cost, limited availability, and short-term effectiveness. HBIG is generally not affordable in developing countries.
  • HBIG should be given to adults within 48 hours of HBV exposure.
  • Maternal-neonatal transmission of HBV and the subsequent development of chronic hepatitis B in infected children is reduced drastically when HBIG is given to the newborn babies of HBV carrier mothers in conjunction with the first dose of the HB vaccine.


Postexposure prophylaxis algorythm Adapted from World Health Organization[3]

Summary of Recommendations for Counseling and Prevention of Transmission of Hepatitis B from Individuals with Chronic HBV Infection: AASLD Practice Guidelines [4]

Class I
"1. Newborns of HBV-infected mothers should receive HBIG and hepatitis B vaccine at delivery and complete the recommended vaccination series."
Class IIb
"2. 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."
Class III
"3. Carriers should be counseled regarding prevention of transmission of HBV."
Class III
"4. Sexual and household contacts of carriers who are negative for HBV seromarkers should receive hepatitis B vaccination."
Class III
"5. 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.
  • 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.
  • Follow-up testing of vaccine responders is recommended annually for chronic hemodialysis patients."
Class III
"6. Abstinence or only limited use of alcohol is recommended in hepatitis B carriers."

References

  1. 1.0 1.1 1.2 World Health Organization, Guidelines for the Prevention, Care, and Treatment of persons with chronic Hepatitis B Infection. (March 2015). http://apps.who.int/iris/bitstream/10665/154590/1/9789241549059_eng.pdf Accessed on October 4th, 2016
  2. 2.0 2.1 Centers for Disease Control and Prevention. Prevention and Control of Infections with Hepatitis Viruses in Correctional Settings http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5201a1.htm Accessed on October 4th 2016
  3. "WHO". 
  4. AASLD guidelines for treatment of chronic hepatitis B. Hepatology (2016)http://onlinelibrary.wiley.com/doi/10.1002/hep.28156/full Accessed on October 10th, 2016

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