systems have reduced the risk of spreading this infection from one patient to another
or to health care personnel during the collection of blood samples or the
administration of parenteral therapy. In the clinical laboratory and the hemodialysis
unit, work areas are disinfected daily. Gloves are worn when handling all blood and
body fluids, as well as HBAg–positive specimens, or when there is potential exposure to
blood (e.g., blood drawing) or to patients’ secretions. Eating is prohibited in the
laboratory and in other areas exposed to secretions, blood, or blood products. Patient
education regarding the nature of the disease, its infectiousness, and prognosis is a
critical factor in preventing transmission and protecting contacts (see
Chart 49-6
).
Active Immunization: HBV
Active immunization is recommended for people who are at high risk for HBV (e.g.,
health care personnel, patients undergoing hemodialysis). In addition, people with
HCV and other chronic liver diseases should receive the vaccine. A yeast-recombinant
hepatitis B vaccine (Recombivax HB) is used to provide active immunity and has shown
rates of protection greater than 90% in healthy people (
Chan, Wong, Qin, et al.,
2016
;
Dan et al., 2015
;
Mandell et al., 2014
). Although antibody levels may become low
or undetectable, immunologic memory may remain intact for at least 5 to 10 years.
Measurable levels of antibodies may not be essential for protection. In general, in
those with normal immune systems, booster doses are not required, and no data
support the use of booster doses of hepatitis B vaccine among immunocompetent
people who have responded to the vaccination series. However, booster doses are
recommended for people who are immunocompromised (
Chan et al., 2016
;
Mandell et
al., 2014
). Additional information is required to determine if booster injections are
9
needed for adults 15 years or more after initial vaccination as well as those at high risk
for HBV infection.
A hepatitis B vaccine prepared from plasma of humans chronically infected with
HBV is used only rarely in patients who are immunodeficient or allergic to recombinant
yeast-derived vaccines.
Both forms of the hepatitis B vaccine are given intramuscularly in three doses; the
second and third doses are given 1 and 6 months, respectively, after the first dose. The
third dose is very important in producing prolonged immunity. Hepatitis B vaccination
should be given to adults in the deltoid muscle. Antibody response may be measured
by anti-HBs levels 1 to 3 months after completion of the basic course of vaccine, but
this testing is not routine and is not currently recommended. People who do not
respond may benefit from one to three additional doses (
Mandell et al., 2014
).
People at high risk, including nurses and other health care personnel exposed to
blood or blood products, should receive active immunization. Health care workers who
have had frequent contact with blood are screened for anti-HBs to determine whether
immunity is already present from previous exposure. The vaccine produces active
