Postexposure management of common blood-borne pathogens
| Pathogen and source individual | Exposed individual | Postexposure prophylactic regimen | Initial and follow-up evaluation |
|---|---|---|---|
| Hepatitis B virus (HBV): HBV-infected patient with positive HBsAg | Unvaccinated or nonresponder to the first 3-dose vaccine seriesa | A single dose of HBIG, 0.06 mL/kg IM, followed by HBV vaccine series given at 0, 1–2 months, and 6 monthsc injected at different site than HBIG; give HBIG within 24 hours but no later than 7 days after exposure | Source individual: HbsAg if status is unknown Exposed individual: Baseline HbsAg, anti-HBs, anti-HBc HbsAg and anti-HBc at 6 months No work or school restriction for exposed individuals, including healthcare providers |
| Currently receiving first 3-dose vaccine series | A single dose of HBIG 0.06 mL/kg IM, followed by completion of 3-dose vaccine series | ||
| Previous HBV infection or vaccinated with adequate responseb | Not required | ||
| Hepatitis C virus (HCV): HCV-infected patient with positive anti-HCV and HCV RNA | Hepatitis C seronegative | None is available | Source individual: Anti-HCV, HCV RNA if status is unknown Exposed individual: Anti-HCV, HCV RNA, and ALT at baseline HCV RNA and ALT at 4 weeks Anti-HCV, HCV RNA, and ALT at 12 weeks Anti-HCV and ALT at 24 weeks No work or school restriction for exposed individuals, including healthcare providers |
| Human immunodeficiency virus (HIV): HIV-infected patient | HIV seronegative | Tenofovir-emtricitabine 300/200 mg once daily plus raltegravir 400 mg orally twice daily | Source individual: Anti-HIV1/HIV2 if status is unknown Exposed individual: Anti-HIV1/HIV2 at baseline, 6 weeks, and 16 weeks postexposure Complete blood count, urea, creatinine, liver function tests, serum glucose (if on PIs), and creatine phosphokinase (if on raltegravir) at baseline, 2 weeks, and 4 weeks after initiating ARV drugs No work or school restriction for exposed individuals, including healthcare providers |
↵a Serum level of anti-HBs < 10 mIU/mL.
↵b Serum level of anti-HBs > 10 mIU/mL.
↵c Day 0 is the day when the first dose of vaccine was given.
ALT = alanine aminotransferase; anti-HBc = antibody against hepatitis B core antigen; anti-HBs = antibody against hepatitis B surface antigen; anti-HCV = antibody against hepatitis C virus; anti-HIV1/HIV2 = antibodies against human immunodeficiency virus1 and 2; ARV = antiretroviral; HBIG = hepatitis B immune globulin; HBsAg = hepatitis B surface antigen; IM = intramuscularly; PI = protease inhibitor