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Immunization Dialogue Indian Pediatrics 1999;36: 1273 |
Postexposure Prophylaxis in Hepatitis B Infection |
| Nonseroconversion is a documented phenomenon after HBV vaccination. So what do you recommend when a person, who is immunized adequately, get exposed to HBV? For the same reason, do you recommend routine testing for anti HBs antibodies, especially in high risk groups, for example, health care personnel? Ramesh Agarwal, Reply The opportunity to offer quickly post-exposure immunoprophylaxis against HB virus infection arises mostly, if not solely, in health care workers. At the present time all health care workers should be immunized with HB vaccine, but as they are already adults, a small proportion would have been low or non-responders. If antibody test had been done one would know the immune status, but it is not common to test everyone post immunization. Every Institution must have a policy and procedures for reporting and responding to all instances of percutaneous and mucosal exposure to blood or body fluids of other persons, directly or indirectly (such as needle stick injury). When exposed (as when the index patient is HbsAg positive), the staff should be immediately tested for Anti HBs (surface antibody). If adequate level is found, there is no need for further treatment. If inadequate, hepatitis immune globulin must be given immediately, followed by initiation of revacciantion. I do not recommend that all health care workers should have antibody level tested after HB immunization. As institutional policies are made, perhaps staff working on oncology and nephrology (especially dialysis areas) depart-ments may be singled out for routine antibody testing; but this must come as the institutional policy. All IAP members working in hospitals must ensure that the message (for specific institutional policies) is heard by administrators and acted upon. If this is done, Dr. Agarwal's question would have contributed some thing positive. T. Jacob John, Chairman, |
