Exposure to hepatitis B virus

• Product for post-exposure treatment: hepatitis B specific Immunoglobulin (HBIG).
• Risk assessment: must be performed by the clinician with responsibility for the patient.
• Prescription for HBIG: must be signed by clinician with responsibility for the patient.
• HBIG risk assessment and prescription forms (bottom of page)
  
  • Neonatal exposure to hepatitis B
  • Sexual exposure to hepatitis B
  • Needle stick/sharp/splash exposure to hepatitis B

Please note that HBIG and vaccine are administered by the intramuscular route. However, the route of injection is different (subcutaneous) in case of bleeding disorders.

HBIG stock and issuing centre: pharmacy at Southampton General Hospital.

Please note: HBIG is issued only when UHS Pharmacy receives both prescription and risk assessment forms (required for HBIG returns to the Department of Health).

Deliver or fax (023 8120 6792) prescription and risk assessment forms to the main dispensary at Southampton General Hospital. If faxed, the original prescription will need to be received by pharmacy within 72 hours.

Out-of-hours, contact the on-call pharmacist through switchboard (023 8077 7222).

General information about HBV infection

Hepatitis B is caused by infection with the hepatitis B virus (HBV). The incubation period from the time of exposure to onset of symptoms is six weeks to six months (average 2.5 months). HBV is found in highest concentrations in blood and in lower concentrations in other body fluids (for example, semen, vaginal secretions, and wound exudates).

HBV infection can be self-limited or chronic. In adults, only approximately half of newly acquired HBV infections are symptomatic, and approximately 1% of reported cases result in acute liver failure and death. Risk for chronic infection is inversely related to age at infection: approximately 90% of infected infants and 30% of infected children aged less than five years become chronically infected, compared with 2% to 6% of adults. Among persons with chronic HBV infection, the risk for premature death from cirrhosis or hepatocellular carcinoma is 15% to 25%. HBV is efficiently transmitted by percutaneous or mucous membrane exposure to infectious blood or body fluids that contain blood.

The most important risk factors associated with HBV infection are:

• Birth to an infected mother.
• Unprotected sex with an infected partner (risk increases in case of multiple sex partners, men who have sex with other men and history of other sexually transmitted diseases).
• Illegal intravenous drug use.

UK national strategy to eliminate transmission of HBV infection includes:

• Prevention of perinatal infection through routine screening of all pregnant women for HBsAg and immunoprophylaxis of the infants born to HBsAg-positive mothers and to mothers with unknown HBsAg status.
• Vaccination of previously unvaccinated adults at increased risk for infection.