Individuals at risk for HBV due to vertical transmission (ie, mother to child transmission) |
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Individuals at risk due to horizontal transmission (ie, percutaneous or mucosal exposure to blood or body fluids contaminated with blood)Δ |
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Other individuals |
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Refer to UpToDate content on screening and diagnosis of HBV, HBV immunization, and HBV and pregnancy for more detailed information on screening and vaccination.
HBV: hepatitis B virus; HBsAg: hepatitis B surface antigen; US: United States; HIV: human immunodeficiency virus; HCV: hepatitis C virus; anti-HBs: hepatitis B surface antibody; anti-HBc: hepatitis B core antibodies; HBIG: hepatitis B immune globulin.
* If HBsAg-positive persons are found in first-generation immigrants of a family, subsequent generations should be tested.
¶ To reduce the risk of perinatal transmission, infants born to HBsAg-positive mothers should receive HBIG and hepatitis B vaccine as soon as possible and within 12 hours of birth and then complete the hepatitis B series. Post-vaccination serology should be obtained at 9 to 12 months. Refer to the UpToDate topic that discusses HBV immunization in infants.
Δ In unvaccinated individuals with ongoing HBV risk through percutaneous or mucosal exposure, hepatitis B vaccine should be initiated at the time of screening; the need for subsequent doses will depend upon the results. Post-vaccination serology should be performed to ensure immunity. For at-risk persons who do not complete the vaccine series, repeat testing should be performed periodically (eg, every 1 to 2 years).
◊ The presence of HBV coinfection informs the choice of antiretroviral regimen. In addition, patients with HIV who are not immune should be vaccinated regardless of age or risk factors, since HBV infection has an accelerated course in coinfected patients.
§ Patients with chronic HBV are at risk for HBV reactivation with direct-acting antiviral therapy for hepatitis C. Refer to the UpToDate topic that provides an overview of the management of hepatitis C infection.
¥ Susceptible persons include those who have never been infected with HBV (ie, HBsAg-negative, total anti-HBc-negative, and anti-HBs-negative) and either did not complete a HepB vaccine series per the Advisory Committee on Immunization Practices recommendations or who are known to be vaccine nonresponders.
‡ For most patients who remain without risk factors for acquiring HBV, repeat screening is not warranted. However, screening prior to blood, plasma, organ, tissue, or semen donation is routinely performed, regardless of the person's prior history. In addition, screening is warranted prior to initiating immunosuppressive therapy (eg, corticosteroids, biologics, cancer chemotherapy, anti-rejection therapies) since persons with HBV are at risk for HBV reactivation. Refer to the UpToDate topic on HBV reactivation.Do you want to add Medilib to your home screen?