Public Health Department Policy & Procedure Manual Example


Hepatitis B Virus Post-Exposure Management



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Hepatitis B Virus Post-Exposure Management

  1. Source of exposure is known to be HbsAg positive and the exposed person has not completed vaccination:


    1. Hepatitis B vaccination should be initiated.

    2. A single dose of HBIG (0.06 ml/kg) should be administered as soon as possible after the exposure and within 24 hours, if possible.

    3. A and B can be administered simultaneously in separate sites.

    4. Complete Hepatitis B vaccination as scheduled.

  1. Source of exposure is known to be HbsAg positive and the exposed person has been vaccinated against Hepatitis B:

    1. The exposed person’s immunity to Hepatitis B should be tested unless an adequate level was found upon testing in the last 24 months.

    2. If the immunity is adequate, no treatment is necessary.

    3. If the immunity is inadequate, a booster dose of Hepatitis B vaccine should be administered.

    4. If the exposed person is known to have not responded to the primary series of Hepatitis B vaccine, he or she should receive either a single dose of HBIG and a dose of Hepatitis B vaccine as soon as possible after exposure, or two doses of HBIG (0.06 ml/kg), one as soon as possible after exposure and the second one month later. The latter treatment is preferred for persons who have not responded to at least four doses of Hepatitis B vaccine.

  2. Source of exposure is known to be HbsAg negative and the exposed person has not been vaccinated or has not completed the vaccine series:

    1. If the exposed person has had no Hepatitis B vaccinations, the series should be started within 7 days of exposure and completed as usual.
    2. If the exposed person has started the series, vaccination should be completed as scheduled.


  3. Source of exposure is unknown or unavailable for testing and exposed person has not been vaccinated or has not completed the vaccine series:

    1. Follow A and B in #3 above.

    2. If source is known to be high risk, follow A-D in #1 above.

  4. Source of exposure is unknown or unavailable for testing and the exposed person has been vaccinated and immunity status is known:

    1. If exposed person is known to have had adequate response, no treatment is necessary.

    2. If exposed person is known not to have responded to the vaccine, follow D in #2 above.

  5. Source of exposure is unknown or unavailable for testing and the exposed person’s immunity status in unknown:

    1. The exposed person’s immunity to Hepatitis B should be tested.

    2. If the exposed person is immune, no treatment is necessary.

    3. If the exposed person has inadequate immunity to Hepatitis B, a standard booster of the vaccine should be administered.

NOTE: Adequate antibody level is >10 mlU/ml.

Hepatitis C Virus Post-Exposure Management


  1. For the source, perform testing for anti-HCV.

  2. For the person exposed to an HCV-positive source:

    • perform baseline testing for anti-HCV and ALT activity; and

    • perform follow-up testing (e.g., at 4-6 months) for anti-HCV and ALT activity (if earlier diagnosis of HCV infection is desired, testing for HCV RNA may be performed at 4-6 weeks).

Human Immunodeficiency Virus (HIV) Post-Exposure Management

For any exposure to a source individual who has AIDS, who is found to be positive for HIV infection, or who refuses testing, the exposed person should be counseled by his/her health care provider regarding the risk of infection. The exposed person should be evaluated clinically and serologically for evidence of HIV infection as soon as possible after the exposure.
The exposed person should be advised to report and seek medical attention for any acute febrile illness that occurs within 2 weeks after exposure. Such an illness, particularly one characterized by fever, rash, or lymphadenopathy, may be indicative of recent HIV infection.
Following the initial test at the time of exposure, sero-negative exposed persons should be retested 6 weeks, 12 weeks, and 6 months after exposure to determine whether transmission has occurred. During this follow-up period, exposed persons should follow precautions recommended for preventing transmission of HIV to others. This includes refraining from blood donation and using appropriate protection during sexual intercourse. The health department director will be responsible for reminding the employee of the timeline for testing.
If the source individual is available for testing, consents to a test, and is sero-negative, follow-up testing of the exposed person is not necessary.
If the source individual cannot be identified, decisions regarding appropriate follow-up should be individualized. Serologic testing will be made available to all exposed persons who may be concerned they have been infected with HIV through significant exposure.

If the source individual is identified but refuses to be tested, the exposed person should be tested at the time of exposure and retested 6 weeks, 12 weeks, and 6 months after exposure. In some circumstances HIV testing can be completed without the source person’s consent. When a health care professional or other affected person* is significantly exposed while performing his/her duties** testing may occur without consent if all of the following apply:


  • Affected person was using universal precautions, (exception is if using universal precautions would have endangered the life of the individual);

  • A physician certifies in writing that a significant exposure occurred;

  • The affected person submits to a test;

  • Except in situations listed below, a test is performed on blood drawn for another purpose:

  • The individual, if capable, has been given the opportunity to consent and refused;

  • The individual is informed that their blood will be tested for HIV; and

  • Results are disclosed only to the affected individual.

*Other affected Persons include:



    • EMT

    • First responder

    • Fire fighter

    • Peace officer

    • Correctional officer

    • State patrol officer

    • Jailer/keeper of a jail

    • Person who is employed at a secured facility

** Exposed under the following circumstances:



  • Providing care or services

  • Searching or arresting an individual

  • Controlling or transferring an individual in custody

  • Handling or processing specimens

NOTE: If blood of the source individual is unavailable for testing, the affected person may request the District Attorney to apply to the circuit court to order the individual to submit to a test and have results disclosed to the affected person. A hearing must be set within 20 days of the request. If probable cause is found that the affected person was significantly exposed, the court must order the source individual to submit to testing. The health care provider ordering the test may only disclose the results to the affected person and his/her health care provider. If the affected individual knows the identity of the source person, he or she cannot disclose the test results to anyone else [Wisconsin Statute 252.15(2)7].





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