June 29, 2001 / 50(RR11);1-42
/
Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis
HepatitisB Vaccination

Any person who performs tasks involving contact with blood, lood-contaminated ody fluids, other body fluids, or sharps should be vaccinated against hepatitisB[2][21] . Prevaccination serologic screening for previous infection is not indicated for persons being vaccinated because of occupational risk, unless the hospital or health-care organi-zation considers screening cost-effective.

HepatitisB vaccine should always be administered by the intramuscular route in the deltoid muscle with a needle 1-1.5 inches long. HepatitisB vaccine can be administered at the same time as other vaccines with no interference with antibody response to the other vaccines [164] . If the vaccination series is interrupted after the first dose, the second dose should be administered as soon as possible. The second and third doses should be separated by an interval of at least 2 months. If only the third dose is delayed, it should be administered when convenient. HCP who have contact with patients or blood and are at ongoing risk for percutaneous injuries should be tested 1-2 months after completion of the 3-dose vaccination series for anti-HBs [21] . Persons who do not re-spond to the primary vaccine series (i.e., anti HBs <10 mIU/mL) should complete a sec-ond 3 dose vaccine series or be evaluated to determine if they are HBsAg-positive. Revaccinated persons should be retested at the completion of the second vaccine series. Persons who do not respond to an initial 3-dose vaccine series have 30%-50% chance of responding to a second 3-dose series [165] . Persons who prove to be HBsAg-positive should be counseled regarding how to prevent HBV transmission to others and regard-ing the need for medical evaluation [12][163][166] . Nonresponders to vaccination who are HBsAg negative should be considered susceptible to HBV infection and should be coun seled regarding precautions to prevent HBV infection and the need to obtain HBIG pro-phylaxis for any known or probable parenteral exposure to HBsAg-positive blood. Booster doses of hepatitisB vaccine are not necessary, and periodic serologic testing to monitor antibody concentrations after completion of the vaccine series is not recom-mended. Any blood or body fluid exposure sustained by an unvaccinated, susceptible person should lead to the initiation of the hepatitisB vaccine series.

December 26, 1997 / 46(RR-18);1-42
/

Immunization of Health-Care Workers: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC)

Prevaccination serologic screening for prior infection is not indicated for persons being vaccinated because of occupational risk. Postvaccination testing for antibody to hepatitis B surface antigen (anti-HBs) response is indicated for HCWs who have blood or patient contact and are at ongoing risk for injuries with sharp instruments or needlesticks (e.g., physicians, nurses, dentists, phlebotomists, medical technicians and students of these professions). Knowledge of antibody response aids in determining appropriate postexposure prophylaxis.