Post-exposure Prophylaxis For Hepatitis Research Articles

Non-Vertical Exposures to HIV, HBV and HCV Infection in Children and Adolescents-Risk of Infection, Standards of Care and Postexposure Prophylaxis.

Introduction: in the review, we aimed to present current knowledge about the risk of infection, standards of care, and postexposure prophylaxis (PEP) in pediatric patients after non-vertical exposures to HIV, HBV, and HCV infection. Materials and Methods: the latest available literature and recommendations of Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), European recommendations for the management of HIV and administration of non-occupational PEP, and Polish AIDS Society were reviewed. Results: the majority of cases of non-vertical exposure to blood-borne viruses in the pediatric population consist of sexual exposition and injection with unsterilized sharp objects (usually needlestick injuries). The risk HIV, HBV, and HCV transmission depend on several factors, and each exposure should be evaluated individually with consideration of the patient’s medical history. It is crucial to start antiretroviral therapy within 48 h from exposure. Treatment is continued for 28 days, and a 3-drugs regiment is recommended in the majority of cases. Decisions on hepatitis B and tetanus PEP are based on a history of vaccination. There is no PEP for hepatitis C infection, follow-up testing aims for early identification of disease and consideration of treatment options. Conclusion: all children after the non-vertical exposure to HIV, HBV, and HCV infection should be evaluated by the Infectious Disease specialist as soon as possible after the incident and qualified to post-exposure prophylaxis. Systematic diagnostic and follow-up on children after significant needlestick exposure should be maintained. Children after sexual exposure need a multidisciplinary approach. Response to reported event must be rapid and treatment must be comprehensive.

NURSES’ KNOWLEDGE ON POST EXPOSURE PROPHYLAXIS FOR HEPATITIS B VIRUS INFECTION IN TERTIARY CARE HOSPITAL

Background: Nurses are most vulnerable group for having Hepatitis B Virus (HBV) infection from blood and body fluids. These infections are prevent­able if the nurses have proper knowledge regarding Post Exposure Prophy­laxis (PEP) for hepatitis B virus infections and utilize the PEP services. This study aimed to find out the nurses’ knowledge on PEP for HBV infection. 
 Methods: A descriptive survey design was carried out among 116 random­ly selected nurses working in different wards of tertiary care hospital. Data was collected from July 8th 2018 to 21st July 2018 using pre-tested self-administered questionnaire. Descriptive statistics was used to describe the variables and chi-square test was applied to explore the association between variables. 
 Results: Results of the study revealed that only 22.4% nurses had good, 21.6% had average, and 56.0% had poor knowledge on PEP for HBV. Majority (68.1%) of the nurses knew about the testing of HBsAg serum antigen after exposure. However, few nurses had knowledge on risk per­centage of getting infection (29.3%), contact person for risk assessment (33.6%), constituents of PEP (29.9%), and PEP treatment for unvaccinat­ed/incompletely vaccinated nurse in case of positive (38.8%) and negative (34.5%) sources. Moreover, working unit (p=0.037) and working experi­ence (p=0.027) were the significant variables associated with the level of knowledge on PEP. 
 Conclusions: More than half of nurses’ have poor knowledge on PEP for hepatitis B virus. Hence, there is need of regular in-service education and training for nurses on PEP for HBV to enhance their knowledge and to pre­vent potential infections.

Testing and Clinical Management of Health Care Personnel Potentially Exposed to Hepatitis C Virus - CDC Guidance, United States, 2020.

SummaryExposure to hepatitis viruses is a recognized occupational risk for health care personnel (HCP). This report establishes new CDC guidance that includes recommendations for a testing algorithm and clinical management for HCP with potential occupational exposure to hepatitis C virus (HCV). Baseline testing of the source patient and HCP should be performed as soon as possible (preferably within 48 hours) after the exposure. A source patient refers to any person receiving health care services whose blood or other potentially infectious material is the source of the HCP’s exposure. Two options are recommended for testing the source patient. The first option is to test the source patient with a nucleic acid test (NAT) for HCV RNA. This option is preferred, particularly if the source patient is known or suspected to have recent behaviors that increase risk for HCV acquisition (e.g., injection drug use within the previous 4 months) or if risk cannot be reliably assessed. The second option is to test the source patient for antibodies to hepatitis C virus (anti-HCV), then if positive, test for HCV RNA. For HCP, baseline testing for anti-HCV with reflex to a NAT for HCV RNA if positive should be conducted as soon as possible (preferably within 48 hours) after the exposure and may be simultaneous with source-patient testing. If follow-up testing is recommended based on the source patient’s status (e.g., HCV RNA positive or anti-HCV positive with unavailable HCV RNA or if the HCV infection status is unknown), HCP should be tested with a NAT for HCV RNA at 3–6 weeks postexposure. If HCV RNA is negative at 3–6 weeks postexposure, a final test for anti-HCV at 4–6 months postexposure is recommended. A source patient or HCP found to be positive for HCV RNA should be referred to care. Postexposure prophylaxis of hepatitis C is not recommended for HCP who have occupational exposure to blood and other body fluids. This guidance was developed based on expert opinion (CDC. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Recommend Rep 2001;50[No. RR-11]; Supplementary Figure, https://stacks.cdc.gov/view/cdc/90288) and reflects updated guidance from professional organizations that recommend treatment for acute HCV infection. Health care providers can use this guidance to update their procedures for postexposure testing and clinical management of HCP potentially exposed to hepatitis C virus.

Knowledge and Preventive Practices of Hepatitis B Transmission among Dental Students and Interns in a Tertiary Hospital: A Descriptive Cross-sectional Study

Hepatitis B is one of the most common contagious diseases in Nepal and is a signifi- cant public health issue. It is transmitted through contact with contaminated blood or other bodily fluids on broken skin or mucous membranes. Junior doctors and dentists are at particular risk of hepatitis B exposure. This study aims to find the level of knowledge of transmission and prevention of hepatitis B among the dental students. This was a descriptive cross-sectional study conducted among dental students and interns at Kantipur Dental College Teaching Hospital and Research Center, Kathamndu from January 2019 to February 2019 after ethical approval was provided by the Institutional Review Committee. The study included dental students and graduate intern doctors. Convenience sampling was done. Point estimate at 95% Confidence Interval was done along with frequency and proportion of binary data. Out of one hundred forty two students, 68 (48%) of participants had completed a full course of hepatitis B vaccine. Thirty seven (26%) had started but had less than three recommended shots and 37 (26%) had not received any vaccines for hepatitis B prevention. Only 14 (10%) of the study group had checked their hepatitis B titer prior to commencing medical education. There is also a lack of understanding of transmission, prevention and post exposure prophylaxis for hepatitis B infection among them among new health care providers in Nepal. This puts both the practitioners and patients at risk of chronic hepatitis B infection, which is unnecessary given cheap and easy prevention strategies, can virtually eliminate the risk.

Nurses’ Knowledge on Post Exposure Prophylaxis for Hepatitis B Virus Infection in Tertiary Care Hospital

Background: Nurses are most vulnerable group for having Hepatitis B Virus (HBV) infection from blood and body fluids. These infections are prevent­able if the nurses have proper knowledge regarding Post Exposure Prophy­laxis (PEP) for hepatitis B virus infections and utilize the PEP services. This study aimed to find out the nurses’ knowledge on PEP for HBV infection.
 Methods: A descriptive survey design was carried out among 116 random­ly selected nurses working in different wards of tertiary care hospital. Data was collected from July 8th 2018 to 21st July 2018 using pre-tested self-administered questionnaire. Descriptive statistics was used to describe the variables and chi-square test was applied to explore the association between variables.
 Results: Results of the study revealed that only 22.4% nurses had good, 21.6% had average, and 56.0% had poor knowledge on PEP for HBV. Majority (68.1%) of the nurses knew about the testing of HBsAg serum antigen after exposure. However, few nurses had knowledge on risk per­centage of getting infection (29.3%), contact person for risk assessment (33.6%), constituents of PEP (29.9%), and PEP treatment for unvaccinat­ed/incompletely vaccinated nurse in case of positive (38.8%) and negative (34.5%) sources. Moreover, working unit (p=0.037) and working experi­ence (p=0.027) were the significant variables associated with the level of knowledge on PEP.
 Conclusions: More than half of nurses’ have poor knowledge on PEP for hepatitis B virus. Hence, there is need of regular in-service education and training for nurses on PEP for HBV to enhance their knowledge and to pre­vent potential infections.

Knowledge, Attitude and Practice on post exposure prophylaxis of Hepatitis among Dental undergraduates and Post-Graduates students at Saveetha Dental College and Hospital, Chennai– A Questionnaire Survey

Aim: The aim of this study was to assess under graduates and post graduates knowledge about post-exposure prophylaxis for Hepatitis B virus and to compare the results obtained from both the groups. Material and Methods: A cross-sectional study was conducted in December 2015 using a self-structured questionnaire to collect information from Saveetha Dental College and Hospital, Chennai. Results: Knowledge, attitude and practice of post graduates is more followed by interns, final years and third years. Conclusion: Based on the results of this survey, authors concluded that there is lack of knowledge about HBV post-exposure prophylaxis among undergraduates and post graduates. Participation in such workshops must be made mandatory for all dental health care providers.[4]

Study of sharp injuries and blood splash exposures among healthcare workers in a tertiary hospital in Bangalore

The working environment of healthcare workers (HCW) exposes them to sharp injuries. This communication attempts to examine the injury registers, incidence of sharps injuries and blood splash exposures, and the post-exposure prophylaxis status of employees in a tertiary care hospital. Analysis included records form 54 locations of two units of a tertiary hospital attached to a Medical College. Maintenance of the injury register overall was highly satisfactory in both units. Two hundred and nine injuries were recorded from both units of the hospital. The majority of injuries (60.5%) occurred in the age group of 20-30 years with 70% among females. Waste handlers were at increased risk during waste management procedures. Thirty two percent of sharps injury injuries occurred in wards. Of the ward nursing staff, 25.3% received sharps injuries. Post-exposure prophylaxis for Hepatitis B (primary dose) was given to 25 HCWs; 11 received booster doses. The basic regimen for HIV post-exposure prophylaxis was given to 4 HCWs. Awareness about records maintenance, regular documentation, awareness and training, and implementation of appropriate preventive measures can reduce the incidence of injuries. Key words: Sharps, injury register, Health care workers (HCW),Post exposure prophylaxis (PEP)

Study of sharp injuries and blood splash exposures among healthcare workers in a tertiary hospital in Bangalore

The working environment of healthcare workers (HCW) exposes them to sharp injuries. This communication attempts to examine the injury registers, incidence of sharps injuries and blood splash exposures, and the post-exposure prophylaxis status of employees in a tertiary care hospital. Analysis included records form 54 locations of two units of a tertiary hospital attached to a Medical College. Maintenance of the injury register overall was highly satisfactory in both units. Two hundred and nine injuries were recorded from both units of the hospital. The majority of injuries (60.5%) occurred in the age group of 20-30 years with 70% among females. Waste handlers were at increased risk during waste management procedures. Thirty two percent of sharps injury injuries occurred in wards. Of the ward nursing staff, 25.3% received sharps injuries. Post-exposure prophylaxis for Hepatitis B (primary dose) was given to 25 HCWs; 11 received booster doses. The basic regimen for HIV post-exposure prophylaxis was given to 4 HCWs. Awareness about records maintenance, regular documentation, awareness and training, and implementation of appropriate preventive measures can reduce the incidence of injuries. Key words: Sharps, injury register, Health care workers (HCW),Post exposure prophylaxis (PEP)

Knowledge, attitudes, and practice of medical students regarding occupational risks of hepatitis B virus in college of medicine, aljouf university.

Background:Medical students represent a population that is at high-risk group for acquiring and spreading hepatitis B infection (HBV).Aim:This study was designed to evaluate the knowledge and attitudes among male student regarding occupational risks of HBV infection.Subjects and Methods:During March 2013, a descriptive cross-sectional study was conducted on medical students of AlJouf University College of Medicine. Structured questionnaires of 16 different statements concerning knowledge base of HBV, attitudes as well as practices toward occupational risks of hepatitis B were distributed to 120 students.Results:Response rate of 76.7% (92/120) yielded 92 questionnaires for analysis. Majority of the students surveyed 62.0% (57/92) perceived that they are at high risk of contracting and spreading HBV. The rate of this perception among students who had a history of training on universal precautions was more than that found among those who did not have (70.8% vs. 58.8%; P < 0.01). Most of the students surveyed 63.0% (58/92) considered vaccine is safe and more than half 52.2% (48/92) were vaccinated against HBV. There were a very strong agreement about needlestick 92.4% (85/92) and blood 87.0% (80/92) as efficient modes of HBV transmission. Seventy-two percent of the participants did not have any knowledge about post-exposure prophylaxis for hepatitis B. A significant relationship was found between students who had a history of training on universal precautions and knowledge about post needlestick injury (P < 0.01).Conclusion:Infectious occupational risk of hepatitis B remains a challenge for medical students and the foundations of the medical institutes. Students must complete an infection control training before they start their clinical education.

Immunoglobulins for preventing hepatitis A

Hepatitis A (infectious hepatitis) is a common epidemic disease. Immunoglobulins for passive immunisation are used as prevention. To assess the beneficial and harmful effects of the pre- and post-exposure prophylaxis with immunoglobulins for preventing hepatitis A. We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, The Chinese Biomedical Database, and Science Citation Index Expanded for trials until October 2008. In addition, we read through reference lists of the identified publications and handsearched three journals. Randomised clinical trials on immunoglobulin prophylaxis for preventing hepatitis A, irrespective of blinding, publication status, or language. Data were extracted by two authors and verified by a third author. Results were presented as relative risks (RR) with 95% confidence intervals (CI). The primary outcome was occurrence of hepatitis A (infectious hepatitis). We included 13 trials with 567,476 participants randomised to pre- or post-exposure prophylaxis. The trials had high risk of bias. The trials were heterogeneous in terms of study setting, participants, interventions, and outcome measures. Our meta-analysis with six randomised trials showed that immunoglobulins, when used for pre-exposure prophylaxis, significantly reduced the number of adult patients with hepatitis A at 6 to 12 months (1020/286503 versus 761/134529; RR 0.53; 95% CI 0.40 to 0.70; random-effects model) in comparison with no intervention or inactive control. Four trials showed a similar effect in children aged 3 to 17 at 6 to 12 months follow-up (917/210822 versus 677/78960; RR 0.45; 95% CI 0.34 to 0.59). Comparing different doses of immunoglobulins, higher dosage was generally more effective than lower dosage (1.5 ml better than 0.75 ml and 0.75 ml better than 0.1 ml) in preventing hepatitis A. No significant systemic adverse events were reported. One trial showed that immunoglobulin was more effective than placebo for post-exposure prophylaxis. It appeared that there was no significant difference between immunoglobulins and inactivated hepatitis A vaccine in seroconversion to hepatitis A vaccine antibodies at four weeks (RR 1.16; 95% CI 0.98 to 1.38), but immunoglobulins were significantly less effective than vaccine regarding antibody levels at 8, 12, or 24 weeks. Immunoglobulins seem to be effective for pre-exposure and post-exposure prophylaxis of hepatitis A. However, caution is warranted for the positive findings due to the limited number of trials, year of conductance, and risk of bias. Conductance of rigorous trials will be justifiable.

Hepatitis B vaccine

Hepatitis B is one of the most important infectious diseases in the world. More than 300 million people are infected worldwide. Six thousand people die per year in the United States as a result of Hepatitis B infection. The incidence of infection in the United States has decreased in the last ten years, in part because of effective immunoprophylaxis. The two licenced vaccines, RecombivaxHB ® and Engerix-B ®, used in combination with Hepatitis B immune globulin (HBIG) are effective in preventing transmission of Hepatitis B infection in most cases. The vaccine can be used with or without HBIG for prophylaxis, depending on the type of exposure and prior vaccination record. Preexposure and postexposure prophylaxis for Hepatitis B is effective, safe, and cost effective.

Immune response to hepatitis B vaccine in pregnant women receiving post-exposure prophylaxis

Hepatitis B immunoglobulin and vaccine were given as post-exposure prophylaxis to 73 women after an outbreak of hepatitis B due to in vitro fertilization treatment. The immunization schedule consisted of 5 ml of hepatitis B immunoglobulin (125 IU/ml) at months 0 and 1 and recombinant hepatitis B vaccine (10 μg of HBvaxDNA) at months 0, 1, 2 and 6. The safety and immunogenicity of hepatitis B vaccine were studied in 16 women who became pregnant after in vitro fertilization; 57 non-pregnant women receiving the same treatment served as controls. Blood samples were drawn at 0, 1, 2, 6 and 7 months. One patient had a clinical abortion 2 days after initial immunization; other side effects of vaccination were not found in vaccinees or in their offspring. All vaccinees exhibited antibodies against hepatitis B surface antigen after vaccination but relatively low peak geometric mean titers of 258 IU/l and 684 IU/l were attained in pregnant and non-pregnant women, respectively. There were no significant differences in seroconversion rates and geometric mean titers between the two groups although the immune response to hepatitis B vaccine was slower and lower in pregnant women at all times. Our results suggest that when post-exposure prophylaxis for hepatitis B infection is indicated, passive active immunization can be started safely during pregnancy. The relative weak response to the vaccine calls for monitoring of the anti-HBs 1 month after the initial series of vaccinations.

Management guidelines for health care workers exposed to blood and body fluids

The purpose of this article is to propose specific management guidelines for the immediate emergency department and subsequent occupational health treatment of health care workers (HCWs) following accidental exposures to blood or body fluids. These guidelines are based on a collective review of the literature and the recommendations of the Advisory Committee on Immunization Practices (ACIP) and authorities expert in this knowledge domain. Guidelines are needed to assure appropriate treatment and coordinated efforts by ED and occupational health providers. Although numerous infections can potentially be transmitted by exposure to blood and body fluids, these guidelines are intended only for evaluation and postexposure prophylaxis of hepatitis B, hepatitis C, and infection with HIV.

Immunoprophylaxis of viral hepatitis.

Because safe, effective treatment for established viral hepatitis is not available, physicians need to be acquainted with recent advances in prophylaxis. Immune globulin (Gamastan, Gammar) is used for both preexposure and postexposure prophylaxis of hepatitis A, and side effects are rare. Two vaccines (Heptavax-B, Recombivax HB) are licensed for hepatitis B, one is a plasma-derived vaccine, the other a yeast-recombinant vaccine. Indirectly, these also control hepatitis D (delta agent), which needs hepatitis B virus to develop.

Prevalence of hepatitis B markers in patients and staff in a hospital for the mentally handicapped

Patients and staff at a hospital for the mentally handicapped were screened for markers of infection with hepatitis B virus. Of 436 patients, 14 (3·2%) were carriers of hepatitis B surface antigen (HBsAg), of whom four were carriers of hepatitis B e antigen (HBeAg) and were considered to be ‘infectious’. One-quarter of the patients had markers of hepatitis B infection. Males were four times more likely to have markers than females; and 13 of the 14 carriers of HBsAg were male. Patients with Down's Syndrome (DS) were six times more likely to be HBsAg positive, but were not more likely to have markers of infection than other patients. Phenytoin therapy did not predispose to carriage of HBsAg. Of 439 staff members, 26 (5·9%) had markers of hepatitis B infection. It was not considered that staff were at increased risk of infection with hepatits B virus at the hospital, and that post-exposure prophylaxis for hepatitis B should continue. It is suggested that patients with DS who are not immune to hepatitis B should be offered immunization.

Postexposure prophylaxis of hepatitis B: Centers for Disease Control, Department of Health and Human Services: Atlanta, GA. Ann Intern Med 1984; 101:351–354

Postexposure prophylaxis of hepatitis B: Centers for Disease Control, Department of Health and Human Services: Atlanta, GA. Ann Intern Med 1984; 101:351–354

Leads from the MMWR. Postexposure prophylaxis of hepatitis B

Leads from the MMWR. Postexposure prophylaxis of hepatitis B

Passive immunization for hepatitis B

Numerous studies have been conducted to assess the effectiveness of gamma globulin in preventing type B hepatitis. These investigations have evaluated the effectivenesses of standard immunoglobulin (IG) and hepatitis B immunoglobulin (HBIG) in pre-exposure and postexposure settings. The current data suggest that HBIG and standard IG containing some antibody to hepatitis B surface antigen may be effective for pre- and postexposure prophylaxis of hepatitis B. It is recommended that HBIG be used for the postexposure prophylaxis of individuals sustaining accidental needle-stick or mucosal exposure to blood known to contain hepatitis B surface antigen. If HBIG is unavailable, then standard IG may be beneficial. While pre-exposure prophylaxis with gamma globulin may be effective, there are appropriate environmental control methods available that may significantly reduce the transmission of hepatitis B, and these should be fully implemented.

PASSIVE IMMUNIZATION AGAINST HEPATITIS B: A REVIEW OF RECENT STUDIES AND COMMENT ON CURRENT ASPECTS OF CONTROL

Several independent studies suggest that both hepatitis B immune globulin (HBIG) made from plasma pools containing high titers of anti-HBs and standard immunoglobulin (IG) containing some anti-HBs may be effective for pre- and post-exposure prophylaxis of hepatitis B. Based on a synthesis of current data, it seems reasonable to recommend HBIG for the post-exposure prophylaxis of individuals sustaining accidental needle stick or mucosal exposure to blood known to contain hepatitis B surface antigen (HBsAg). If HBIG is unavailable there is also reason to expect that administration of standard IG which contains some anti-HBs may confer benefit. Although available data regarding prophylaxis of infants born to mothers with HBsAg positive hepatitis at time of delivery are insufficient to warrant firm recommendations on globulin administration, a temporary set of guidelines supporting use of either HBIG or standard IG containing some anti-HBs seems warranted in view of the serious implications for induction of the HBsAg chronic carrier state in infancy. Because appropriate environmental control measures may significantly reduce the transmission of hepatitis B in certain endemic settings such as hemodialysis units or homes for the mentally retarded, IG prophylaxis in these surroundings cannot be routinely recommended. Since current data show no evidence for superiority of HBIG over standard IG in these settings, and because there is some evidence that use of lower anti-HBs titer globulins may provide for acquisition of passive-active immunity, it seems reasonable to suggest that if IG is to be used for pre-exposure prophylaxis, the material to be used should be standard IG containing some anti-HBs.