Postexposure prophylaxis pep understanding hivaids. After exposure to hepatitis b virus hbv, appropriate and timely prophylaxis can prevent hbv infection and subsequent development of chronic infection or liver disease. Recommendations on the management and postexposure. Postexposure prophylaxis hbv division of viral hepatitis. Daily emtricitabinetenofovir df truvada is safe and effective for significantly reducing the risk of hiv infection in sexually active individuals including adolescents and people who inject drugs pwid when used consistently. Hepatitis exposure management clinician consultation center. Send by email view as pdf send by post postexposure prophylaxis pep is treatment that can be used after possible exposure to the hepatitis b virus through sex, drug injecting equipment or injury such as needle stick injury. This report contains cdc guidance that augments the 2011 recommendations of the advisory committee on immunization practices acip for evaluating hepatitis b protection among healthcare personnel hcp and administering post exposure prophylaxis. Patients can be exposed through sexual contact or through exposure. Health care personnel are at risk for occupational exposure to bloodborne pathogens pathogenic microorganisms that are present in human blood and can cause disease in humans. However, the period during which pep is most efficacious is often said to be within 72 hours of exposure. These infections acquired through the occupational route are largely preventable through strict infection prevention and control ipc, universal precautions, use of safe devices, proper waste disposal, immunization against hepatitis b virus, and prompt management of exposures including the use of post exposure prophylaxis for hiv. If no, outside of window of effectiveness, no pep required for this exposure.
Hepatitis b postexposure prophylaxis bc centre for disease. Prompt assessment and management of potential hepatitis b and c exposures from needlesticks, splashes, sexual exposure, and human bites is paramount. Postexposure hiv prophylaxis symptoms, diagnosis and. The mainstay of postexposure prophylaxis pep is hepatitis b vaccine, but, in certain circumstances, hepatitis b immune. Postexposure prophylaxis pep all nonimmune people who are exposed to hepatitis a virus hav and have not been vaccinated should receive pep. These pathogens include, but are not limited to, hepatitis b virus hbv and human immunodeficiency virus hiv. Post exposure prophylaxis pep must be initiated as soon as possible, ideally within 2 hours, and preferably within 24 hours of exposure. Laboratory bpl for postexposure use to prevent hepatitis b infection. All susceptible persons whose sex partners have acute hepatitis b infection should receive a single dose of hbig 0. Alberta guidelines for post exposure management and prophylaxis. Apr 18, 2020 shortterm treatment started as soon as possible after highrisk exposure to an infectious agent, such as hiv, hepatitis b virus hbv, or hepatitis c virus hcv. Jan 27, 2015 although immunization remains the mainstay of disease prevention, hivpositive individuals mount poorer antibody responses to hepatitis b vaccine than healthy donors 17, 18. While each exposure case is unique, there are standard strategies that help you determine who should receive hepatitis b prophylaxis and how to evaluate and monitor hepatitis c exposures. Human hepatitis b immunoglobulin specific for hepatitis b post.
Persons with chronic hbv infection are at increased risk for cirrhosis and liver cancer and require medical care. If the employee does not have documented proof of completing the 3 dose hepatitis b. Hepatitis b immune globulin hbig is indicated in the case of sexual assault, or if one of the individuals is known to be hbsag positive or tests positive within 48 hours of exposure. Has the dose changed for serum immune globulin for hepatitis a post exposure prophylaxis. Prevention of hepatitis b virus infection in the united. Guidelines for the prevention, care and treatment of persons. Prevention of hepatitis b and c transmission in healthcare settings 95. This guideline is for individuals over 16 years of age, for children younger than this please. Patients can be exposed through sexual contact or through exposure to infected blood or bloodcontaminated body fluids.
The alcohol, smoking and substance involvement screening test assist. Two types of products are available for prophylaxis against hbv infection. Introduction prophylactic treatment to prevent hepatitis b hb infection after exposure to hepatitis b virus hbv should be considered in several situations. Hepatitis b infection is not a contraindication to prep. In certain circumstances, hepatitis b immune globulin hbig is recommended in addition to vaccine for added protection see postexposure prophylaxis and perinatal exposure sections below. See separate hepatitis b immune globulin hbig oregon. Some settings also will have a lower prevalence of hbv infection in the patient population served than in other settings, which will influence the risk for hcp exposure to hepatitis b surface antigen hbsag positive blood and body fluids. The guidelines recommended providing a two or threedrug post exposure prophylaxis regimen following risk assessment of the exposure.
Occupational exposure to blood faqs infection control. Alberta guidelines for postexposure management and. Pre exposure prophylaxis consists of administration of a 3 dose series of hepatitis b vaccine given over a 6month period. Public health service recommendations for the management of healthcare personnel hcp who have occupational exposure to blood and other body fluids that might contain hepatitis. Appropriate screening, postexposure prophylaxis and vaccination are the keys to prevention. Postexposure prophylaxis to prevent hepatitis b virus infection this appendix provides guidelines for management of persons with nonoccupational exposure to hepatitis b virus hbv through a discrete, identifiable exposure to blood or body fluids table. Hepatitis b vaccination is the best method to prevent disease.
Hcv, and hiv and recommendations for post exposure prophylaxis, 2001. Postexposure prophylaxis to prevent hepatitis b virus infection. Form shows data local health departments collect to report acute hepatitis b cases to washington state department of. This risk of becoming infected drops to 24% if such infants are provided appropriate post exposure prophylaxis at birthi. The purpose of occupational postexposure prophylaxis opep is to. Recommendations for hbv postexposure management include initiation of the hepatitis b vaccine series to any susceptible, unvaccinated person who sustains an occupational blood or body fluid exposure. Should infants aged 6 to 12 months receive hepatitis a vaccine when hepatitis a protection is required. Infants at high risk for hepatitis b bc centre for. The following information applies to immune competent individuals. What should be used for hepatitis a post exposure prophylaxis, by age and underlying medical conditions. After exposure to hepatitis b virus hbv, appropriate and timely prophylaxis can prevent hbv infection and subsequent development of chronic infection or liver. Exposures to hbv, hcv, and hiv and recommendations for postexposure prophylaxis.
Hbig immunoglobulin is not available for the treatment of any type of chronic hepatitis b. Guidelines for postexposure prophylaxis of occupational exposures have. Nc hepatitis b public health program manualpostexposure prophylaxis. Postexposure treatment for hepatitis b hepatitis b postexposure treatment if an uninfected, unvaccinated person or anyone who does not know their hepatitis b status is exposed to the hepatitis b virus through contact with infected blood, a timely postexposure prophylaxis. Post exposure prophylaxis pep means taking hiv medicines very soon after a possible exposure to hiv to prevent becoming infected with hiv. Patients who are potentially exposed to hiv, hepatitis b virus hbv, and hepatitis c virus hcv through a nonoccupational exposure or injury are at risk for acquiring infection. Serologic testing comprises testing for hepatitis b surface antigen hbsag, antibody to hbsag, and antibody to hepatitis b core antigen. Hepatitis b virus hbv is transmitted via blood or sexual contact. Post exposure prophylaxis and occupational health recommendations. Postexposure prophylaxis hepatitis b queensland health. These infections acquired through the occupational route are largely preventable through strict infection prevention and control ipc, universal precautions, use of safe devices, proper waste disposal, immunization against hepatitis b virus, and prompt management of exposures including the use of post exposure prophylaxis. Perinatal hepatitis b post exposure prophylaxis recommendations guidelines for labor and delivery hospitals. If the employee does not have documented proof of completing the 3 dose hepatitis b vaccination series they should be considered as incompletely vaccinated and. Document created by simcoe muskoka district health unit.
An example of a highrisk occupational exposure is exposure to an infectious agent as the result of a needlestick injury in a health care setting. Nurses knowledge on post exposure prophylaxis for hepatitis b. Hbig is used after exposure to give rapid protection until hepatitis b vaccine, which should. Hepatitis b immune globulin hbig is indicated in the case of sexual assault, or if one of the individuals is known to be. If there are concerns about acute hiv or a recent exposure. Guidelines for post exposure prophylaxis pep for hiv. Hepatitis b screening recommendations for prenatal care.
Pepline is available 24 hours a day, 7 days a week, at 18884484911. Hepatitis b and healthcare personnel immunization action coalition. Preexposure prophylaxis preexposure prophylaxis for the. Current guidelines for postexposure prophylaxis pep are almost exclusively generated in the developed world, where hiv is far less prevalent than in the southern african region. Hepatitis a post exposure prophylaxis october 20 i public health ontario public health ontario is a crown corporation dedicated to protecting and promoting the health of all ontarians and reducing inequities in health. Post exposure prophylaxis pep for hepatitis b virus hbv cdc. Nurses are most vulnerable group for having hepatitis b virus hbv infection from blood and body fluids. Consensus document on postexposure prophylaxis against. The purpose of postexposure prophylaxis pep is to reduce the risk of infection. Postexposure hiv prophylaxis investigations bmj best. This guidance is for public health, workplace health and safety and other health professionals involved in the management of. Postexposure prophylaxis hbv division of viral hepatitis cdc.
Postexposure prophylaxis to prevent hepatitis b virus. Prophylaxis of needlestick injury or mucosal contact to hbv, hcv and hiv. Jan 02, 2020 after exposure to hepatitis b virus hbv, appropriate and timely prophylaxis can prevent hbv infection and subsequent development of chronic infection or liver disease. Jun 26, 2017 prompt assessment and management of potential hepatitis b and c exposures from needlesticks, splashes, sexual exposure, and human bites is paramount. Individuals who have been prescribed post exposure prophylaxis pep. You may reuse this information excluding logos free of charge in any format or medium, under. Postexposure prophylactic effect of hepatitis b virus hbv.
How should a fully vaccinated employee with an unknown anti. Postexposure estimated risk of hiv transmission following. Document vaccine administration and provide the hepatitis b vaccine information statement o to obtain a vis. Perinatal exposure hbig plus hbv vaccine at the time of birth 90% effective sexual. Pep quick guide for occupational exposures clinician. This resource provides updated provincial guidelines for post exposure management and prophylaxis for human immunodeficiency virus hiv, hepatitis b hbv, hepatitis c hcv and sexually transmitted infections stis. Recommendations for postexposure prophylaxis for contacts of patients positive for hbsag are as follows. Postexposure prophylaxis pep with hepatitis b immune globulin hbig andor hepatitis b. Public health management of hepatitis a questions and. The california department of public health cdph recommends that. Most exposures have only a low risk of hiv transmission even in the absence of pep.
The purpose of these guidelines is to provide health care providers in the united states with updated guidelines to the 2005 u. You must start it within 72 hours after you were exposed to hiv, or it wont work. Postexposure prophylactic effect of hepatitis b virus hbvactive antiretroviral therapy against hbv infection. Both passiveactive pep with hbig and hepatitis b vaccination and active pep with. Postexposure treatment for hepatitis b hepatitis b postexposure treatment if an uninfected, unvaccinated person or anyone who does not know their hepatitis b status is exposed to the hepatitis b virus through contact with infected blood, a timely postexposure prophylaxis pep can prevent an infection and subsequent development of a chronic infection or liver disease. Pep, we explored the possibility of using nas in pep following hbv exposure, if preexposure prophylaxis. Hepatitis a vaccine andor immune globulin ig is recommended for all. Postexposure prophylaxis to prevent hepatitis b virus infection this appendix provides guidelines for management of persons with nonoccupational exposure to hepatitis b virus hbv through a discrete, identifiable exposure. Apr 24, 2020 shortterm treatment started as soon as possible after highrisk occupational exposure to an infectious agent, such as hiv, hepatitis b virus hbv, or hepatitis c virus hcv. Hiv, hepatitis b, hepatitis c and sexually transmitted infections ministry of health, government of alberta.
Pre exposure prophylaxis prep for the prevention of hiv in men who have sex with men msm, injecting drug users idus, and heterosexually active adults at high risk for acquiring hiv are also summarized. Occupational postexposure prophylaxis opep definition. While each exposure case is unique, there are standard strategies that help you determine who should receive hepatitis b prophylaxis and how to evaluate and monitor hepatitis. Hepatitis a post exposure prophylaxis making a decision did the person have close contact1 with a confirmed hepatitis a case. Occupational postexposure prophylaxis opep shortterm treatment started as soon as possible after highrisk occupational exposure to an infectious agent, such as hiv, hepatitis b virus hbv, or hepatitis c virus hcv. We have developed recommendations for assessing the risk of transmission in different types of exposure situations in which post exposure prophylaxis should be recommended, special. Within the health sector, pep should be provided as part of a comprehensive universal precautions package that reduces staff exposure to infectious. Initiate hepatitis b vaccine series as indicated by age and history.
Post exposure prophylaxis by anti hepatitis b immunoglobin injections andor vaccination should be considered after evaluation of the hepatitis b surface antigen status of the source and of the vaccination and vaccineresponse status of the exposed person. Public health service guidelines for the management of occupational exposures to hbv, hcv, and hiv and recommendations for postexposure prophylaxis. Moreover, as the course of hepatitis b immunization involves injections at 0, 1, and 6 months, a coordinated effort and period of time are required. The classic scheme for selecting the most appropriate postexposure prophylaxis is reminded. Hiv, hepatitis b, hepatitis c and sexually transmitted infections ministry of health, government of alberta march 2019 for more information about this document, contact. These ccc postexposure prophylaxis pep recommendations will help you with urgent decisionmaking for occupational exposures to hiv and hepatitis b and c. Public health management of hepatitis a questions and answers. For people who need to prevent hiv after a single highrisk potential hiv exposure, such as condomless anal sex or a sexual assault, there is another option, post exposure prophylaxis, or pep. Hepatitis b is a serious liver infection caused by the hepatitis b virus hbv and is spread through exposure to infected blood or body fluids. For the moment, there are 2 reference documents that are commonly used. The mainstay of postexposure prophylaxis pep is hepatitis b vaccine, but, in certain circumstances, hepatitis b immune globulin is recommended in addition.
Recommendations on the postexposure management and. This resource provides updated provincial guidelines for post exposure management and prophylaxis for human immunodeficiency virus hiv, hepatitis b hbv, hepatitis c hcv and sexually transmitted. Hepatitis b reporting guideline washington state department. An example of a highrisk occupational exposure is exposure. Consultation can be obtained from occupational health or employee health services, local experts, or the cccs pepline. Department of health and human services nonoccupational postexposure prophylaxis npep recommendation1 on the use of antiretroviral npep and other aspects of case management for persons with isolated exposure. This guidance refers primarily to the issue of hiv post exposure prophylaxis. The mainstay of postexposure prophylaxis pep is hepatitis b vaccine, but, in certain circumstances, hepatitis b immune globulin is recommended in addition to vaccine for. Further supporting documents are also available via the new guidelines website at. Postexposure prophylaxis pep shortterm treatment started as soon as possible after highrisk exposure to an infectious agent, such as hiv, hepatitis b virus hbv, or hepatitis c virus hcv. Hepatitis b and c prophylaxis preexposure prophylaxis postexposure prophylaxis. Post exposure prophylaxis pep is shortterm antiretroviral treatment to reduce the likelihood of hiv infection after potential exposure, either occupationally or through sexual intercourse. Health care professionals caring for exposed health care workers can call the national clinicians postexposure prophylaxis hotline pepline for advice on managing occupational exposures to hiv and hepatitis b and c viruses.
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