hepatic and biliary disorders
Hepatitis B, Acute
Prevention of Acute Hepatitis B
Patients should be advised to avoid high-risk behavior (eg, sharing needles to inject drugs, having multiple sex partners). Blood and other body fluids (eg, saliva, semen) are considered infectious. Spills should be cleaned up using dilute bleach. Barrier protection is recommended, but isolation of patients is of no value. Posttransfusion infection is minimized by avoiding unnecessary transfusions and screening all donors for hepatitis B and C. Screening has decreased the incidence of posttransfusion hepatitis B and hepatitis C, which are now extremely rare in the US. (See also Hepatitis B (HepB) Vaccine .) Hepatitis B (HepB) Vaccine in endemic areas has dramatically reduced local prevalence. Preexposure immunization has long been recommended for people at high risk. However, selective vaccination of high-risk groups in the US and other nonendemic areas has not substantially decreased the incidence of HBV infection; thus, vaccination is now recommended for all US residents≤18 years old beginning at birth (seeCenters for Disease Control and Prevention [CDC]: Child and Adolescent Immunization Schedule by Age). Universal worldwide vaccination is desirable but is too expensive to be feasible. Adults at high risk of HBV infection should be screened and vaccinated if they are not already immune or infected (see also the CDC'sAdult Immunization Schedule). These high-risk groups include Men who have sex with men People with a sexually transmitted infection People who have had>1 sex partner during the previous 6 months Health care and public safety workers potentially exposed to blood or other infectious body fluids People who currently or have recently injected illicit drugs People who have diabetes and are<60 years old (or≥60 years if their risk of acquiring HBV is considered increased) People with end-stage renal disease who receive dialysis, HIV infection, or chronic liver disease, or hepatitis C Household contacts and sex partners of people who are HBsAg-positive Clients and staff members of institutions and nonresidential day care facilities for people with developmental disabilities People in correctional facilities or facilities providing services to injection-drug users International travelers to regions with high or intermediate HBV endemicity Hepatitis B postexposure immunoprophylaxis combines vaccination withhepatitis B immune globulin(HBIG), a product with high titers of anti-HBs. Efficacy of postexposure HBIG is about 75%. For infants born to HBsAg-positive mothers, an initial dose of vaccine plus 0.5 mL of HBIG is given IM in the thigh immediately after birth. For anyone having sexual contact with an HBsAg-positive person or percutaneous or mucous membrane exposure to HBsAg-positive blood, 0.06 mL/kg of HBIG is given IM within days, along with vaccine. Any previously vaccinated patient sustaining a percutaneous HBsAg-positive exposure is tested for anti-HBs; if titers are<10 mIU/mL, a booster dose of vaccine is given. 