The rate of acute hepatitis B virus (HBV) infection in the United States has decreased, but health care personnel remain at risk for occupationally acquired infections, primarily from exposure to patients with chronic HBV infection. The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) has updated its guidelines on prevention and postexposure management of HBV in health care workers (http://1.usa.gov/1mrRx6l), emphasizing the importance of vaccinating all health care personnel who may be exposed to blood or body fluids.
In 1991, the ACIP recommended that postvaccination serologic testing for antibody to hepatitis B surface antigen (HBsAg) be considered for all health care personnel at risk for needlestick exposures.
In 2011, the ACIP reaffirmed its recommendation that unvaccinated and incompletely vaccinated health care personnel at “reasonably anticipated” risk for blood or body fluid exposure be vaccinated against HBV and that those at high risk receive serologic testing one to two months after completion of the vaccine series.
The new report also provides guidance for all those working, training, or volunteering in health care settings who received (documented) hepatitis B vaccination years before beginning work at a facility. Because vaccine-induced HBsAg weakens over time, the CDC recommends preexposure assessment of HBsAg when workers are taken on, followed by one or more additional doses of vaccine in those whose serum HBsAg level is less than 10 mIU/mL (the minimum value considered to be protective).
The CDC also advises all health care institutions to ensure that personnel receive training in recognizing and reporting exposures; have systems in place to facilitate reporting and postexposure assessment; and provide readily accessible prophylaxis, including hepatitis B immune globulin and hepatitis B vaccine, which should be administered as soon after exposure as possible to exposed personnel who are thought to be susceptible to HBV infection.
No postexposure HBV management is necessary in exposed personnel who have documentation indicating receipt of a complete hepatitis B vaccine series and subsequent HBsAg levels of 10 mIU/mL or greater.—Karen Rosenberg