Postexposure Prophylaxis following Occupational Exposure to Hepatitis B Virus

Authors: Emily Darby, MD David H. Spach, MD

Last updated: July 6, 2013

A 47-year-old hospital custodial worker presents to the employee health clinic with a needlestick injury. Approximately 24 hours ago, as she was changing the linens on a patient's bed, she felt a sharp pain in her index finger and noted a syringe with a needle under one of the sheets. The syringe and needle had been used 4 hours previously during a central venous catheter line placement on a patient with known chronic active hepatitis B virus (HBV) infection (positive HBsAg and positive HBeAg). This source patient had recently tested negative for hepatitis C virus (HCV) and HIV. When asked about the delay in reporting the exposure, she said that she was concerned about getting fired for not wearing gloves. A review of her medical records indicates that she had no evidence of prior infection or immunity to hepatitis B, but she declined hepatitis B vaccination when she was hired for reasons that were not specified.

Which of the answers below is TRUE regarding this healthcare worker and her occupational exposure to hepatitis B virus (HBV)?

A The fact that she was not vaccinated for hepatitis B is unusual, because greater than 90% of healthcare workers complete the hepatitis B immunization series.
B Without receipt of postexposure prophylaxis for HBV infection, her risk of becoming infected with HBV is greater than 5%.
C She should receive the first dose of the hepatitis B vaccine series now, but should not receive hepatitis B immune globulin (HBIG).
D Her HBV exposure is too remote (24 hours ago) to recommend postexposure prophylaxis for hepatitis B.