Acute Exposure to Blood Containing HBsAg15 Table 1 summarizes prophylaxis for percutaneous (needlestick or bite), ocular, or mucous-membrane exposure to blood according to the source of exposure and vaccination status of the exposed person. For greatest effectiveness, passive prophylaxis with Hepatitis B Immune Globulin (Human) should be given as soon as possible after exposure (its value beyond 7 days of exposure is unclear). If Hepatitis B Immune Globulin (Human) is indicated (see Table 1), an injection of 0.06 mL/kg of body weight should be administered intramuscularly (see PRECAUTIONS) as soon as possible after exposure and within 24 hours, if possible. Consult Hepatitis B Vaccine package insert for dosage information regarding that product. Table 1 : (adapted from 20) Recommendations for Hepatitis B Prophylaxis Following Percutaneous or Permucosal Exposure
Exposed Person Source Unvaccinated Vaccinated HBsAg-Positive
- Hepatitis B Immune Globulin (Human) X 1 immediately*
- Initiate HB Vaccine Series†
- Test exposed person for anti-HBs.
- If inadequate antibody,‡ Hepatitis B Immune Globulin (Human) (X1) immediately plus HB Vaccine booster dose, or 2 doses of HBIG,* one as soon as possible after exposure and the second 1 month later.
Known Source (High Risk)
- Initiate HB Vaccine Series
- Test source for HBsAg. If positive, Hepatitis B Immune Globulin (Human) X 1
- Test Source for HBsAg only if exposed is vaccine nonresponder; if source is HBsAg-positive, give Hepatitis B Immune Globulin (Human) X 1 immediately plus HB Vaccine booster dose, or 2 doses of HBIG*, one as soon as possible after exposure and the second 1 month later.
Low Risk HBsAg-Positive Initiate HB Vaccine series Nothing required. Unknown Source Initiate HB Vaccine series within 7 days of exposure Nothing required. * Hepatitis B Immune Globulin (Human), dose 0.06 mL / kg IM.
† HB Vaccine dose 20 μg IM for adults; 10 μg IM for infants or children under 10 years of age. First dose within 1 week; second and third doses, 1 and 6 months later.
‡ Less than 10 sample ratio units (SRU) by radioimmunoassay (RIA), negative by enzyme immunoassay (EIA). For persons who refuse Hepatitis B Vaccine, a second dose of Hepatitis B Immune Globulin (Human) should be given 1 month after the first dose. Prophylaxis of Infants Born to HBsAg and HBeAg Positive Mothers Efficacy of prophylactic Hepatitis B Immune Globulin (Human) in infants at risk depends on administering Hepatitis B Immune Globulin (Human) on the day of birth. It is therefore vital that HBsAg-positive mothers be identified before delivery. Hepatitis B Immune Globulin (Human) (0.5 mL) should be administered intramuscularly (IM) to the newborn infant after physiologic stabilization of the infant and preferably within 12 hours of birth. Hepatitis B Immune Globulin (Human) efficacy decreases markedly if treatment is delayed beyond 48 hours. Hepatitis B Vaccine should be administered IM in three doses of 0.5 mL of vaccine (10 μg) each. The first dose should be given within 7 days of birth and may be given concurrently with Hepatitis B Immune Globulin (Human) but at a separate site. The second and third doses of vaccine should be given 1 month and 6 months, respectively, after the first. If administration of the first dose of Hepatitis B Vaccine is delayed for as long as 3 months, then a 0.5 mL dose of Hepatitis B Immune Globulin (Human) should be repeated at 3 months. If Hepatitis B Vaccine is refused, the 0.5 mL dose of Hepatitis B Immune Globulin (Human) should be repeated at 3 and 6 months. Hepatitis B Immune Globulin (Human) administered at birth should not interfere with oral polio and diphtheria-tetanuspertussis vaccines administered at 2 months of age.15 Sexual Exposure to an HBsAg-positive Person All susceptible persons whose sex partners have acute hepatitis B infection should receive a single dose of HBIG (0.06 mL/kg) and should begin the hepatitis B vaccine series if prophylaxis can be started within 14 days of the last sexual contact or if sexual contact with the infected person will continue (see Table 2 below). Administering the vaccine with HBIG may improve the efficacy of postexposure treatment. The vaccine has the added advantage of conferring long-lasting protection.8 Table 2 : (adapted from 21) Recommendations for Postexposure Prophylaxis for Sexual Exposure to Hepatitis B
HBIG* Vaccine Dose Recommended timing Dose Recommended timing 0.06 mL/kg IM† Single dose within 14 days of last sexual contact 1.0 mL IM† First dose at time of HBIG* treatment¶ * HBIG = Hepatitis B Immune Globulin (Human)
† IM = intramuscularly
¶ The first dose can be administered the same time as the HBIG dose but at a different site; subsequent doses should be administered as recommended for specific vaccine. Household Exposure to Persons with Acute HBV Infection Prophylactic treatment with a 0.5 mL dose of Hepatitis B Immune Globulin (Human) and hepatitis B vaccine is indicated for infants < 12 months of age who have been exposed to a primary care-giver who has acute hepatitis B. Prophylaxis for other household contacts of persons with acute HBV infection is not indicated unless they have had identifiable blood exposure to the index patient, such as by sharing toothbrushes or razors. Such exposures should be treated like sexual exposures. If the index patient becomes an HBV carrier, all household contacts should receive hepatitis B vaccine.8 Hepatitis B Immune Globulin (Human) may be administered at the same time (but at a different site), or up to 1 month preceding Hepatitis B Vaccination without impairing the active immune response from Hepatitis B Vaccination.16 Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Administer intramuscularly. Do not inject intravenously. Hepatitis B Immune Globulin (Human) — BayHep B® (hepatitis b immune globulin (human)) is supplied with a syringe and an attached UltraSafe® Needle Guard for your protection and convenience. Please follow instructions below for proper use of syringe and UltraSafe® Needle Guard. Directions for Syringe Usage
- Remove the prefilled syringe from the package. Lift syringe by barrel, not by plunger.
- Twist the plunger rod clockwise until the threads are seated.
- With the rubber needle shield secured on the syringe tip, push the plunger rod forward a few millimeters to break any friction seal between the rubber stopper and the glass syringe barrel.
- Remove the needle shield and expel air bubbles. [Do not remove the rubber needle shield to prepare the product for administration until immediately prior to the anticipated injection time.]
- Proceed with hypodermic needle puncture.
- Aspirate prior to injection to confirm that the needle is not in a vein or artery.
- Inject the medication.
- Keeping your hands behind the needle, grasp the guard with free hand and slide forward toward needle until it is completely covered and guard clicks into place. If audible click is not heard, guard may not be completely activated. (See Diagrams A and B)
- Place entire prefilled glass syringe with guard activated into an approved sharps container for proper disposal. (See Diagram C)
A number of factors beyond our control could reduce the efficacy of this product or even result in an ill effect following its use. These include improper storage and handling of the product after it leaves our hands, diagnosis, dosage, method of administration and biological differences in individual patients. Because of these factors, it is important that this product be stored properly and that the directions be followed carefully during use.