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Developing an evidence-based guideline for the management of exposure to hepatitis B at a Victorian tertiary hospital.

AbstractOBJECTIVE:
To develop a guideline for the management of potential exposures to hepatitis B virus (HBV) at The Alfred Hospital, based on results of clinical audit, database analysis and literature review.
METHODS:
i) Retrospective record review of all histories of patients who received HBV immunoglobulin (HBIG) at The Alfred between 1/1/2007 and 30/9/2011. ii) Analysis of HBV serological results of men who have sex with men (MSM) on Victorian NPEP Service (VNPEPS) database between 10/8/2005 and 31/12/2011. iii) Literature review to determine risks of HBV transmission and best practice for prevention of HBV transmission.
RESULTS:
A total of 48 patients were potentially exposed to HBV and given HBIG, with sexual exposure the most common indication (n=20). The source was reported to be HBsAg positive in one case only. Of the MSM on the VNPEPS database, 63% were immune to HBV, and only 0.5% of patients tested had evidence of chronic HBV infection. The recommendations for use of HBIG in The Australian Immunisation Guidelines are ambiguous and differ from other international guidelines.
CONCLUSION:
This audit at a tertiary referral hospital identified problems with the management of those potentially exposed to HBV. In those non-immune patients exposed to HBV, the combination of HBIG plus vaccination provides the best protection against infection. The risk of transmission of HBV is highly variable; rates of chronic HBV in PWID and MSM in Australia are low and do not warrant use of HBIG unless the source is known to be HBsAg positive.
AuthorsAnna B Pierce, Jude Armishaw, Stacey Aitchison
JournalAustralian and New Zealand journal of public health (Aust N Z J Public Health) Vol. 37 Issue 5 Pg. 411-5 (Oct 2013) ISSN: 1753-6405 [Electronic] Australia
PMID24090322 (Publication Type: Journal Article)
Copyright© 2013 The Authors. ANZJPH © 2013 Public Health Association of Australia.
Chemical References
  • Hepatitis B Surface Antigens
  • Hepatitis B Vaccines
  • Immunoglobulins
Topics
  • Australia
  • Evidence-Based Medicine
  • Female
  • Guidelines as Topic
  • Hepatitis B (diagnosis, prevention & control, transmission)
  • Hepatitis B Surface Antigens (blood)
  • Hepatitis B Vaccines (administration & dosage)
  • Hepatitis B virus
  • Humans
  • Immunoglobulins (administration & dosage)
  • Male
  • Medical Audit
  • Retrospective Studies
  • Tertiary Care Centers

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