Summary of HBV-Reactivation Prophylaxis AGA 2015 Risk Agent Clinical Situation Action High HBV Reactivation > 10% -B cell depleter: Rituximab, ofatumumab -Anti-HBc(+); -HBsAg (+) or (-) Prophylaxis with Entecavir or Tenofovir, until 12 months after end of B cell depletion, or 6 months for other agents. -Anthracyclines: Doxorubicin, epirubicin -Corticosteroids: Prednisone >/= 10 mg/ day long term, or Prednisone > 20 mg/ day >/= 4 weeks -HBsAg(+) Moderate 1-10% -Cytokine/Integrin inh: etanercept, adalimumab, certolizumab, infliximab, abatacept, ustekinumab, natalizumab, vedolizumab, -Tyrosine kinase inh: imatinib, nilotinib Prophylaxis with Entecavir or Tenofovir, until 6 months after end of therapy. -Corticosteroids: <10 mg/ day prednisone daily or equivalent corticosteroids for duration of >/= 4 weeks; -Anthracyclines: doxorubicin, epirubicin -Corticosteroids: >/= 10 mg prednisone daily or equivalent corticosteroids daily for >/= 4 weeks; -Anti-HBc(+), but -HBsAg(-) Low < 1% -Traditional Immunosuppressors: azathioprine, 6-mercaptopurine, methotrexate -Corticosteroids: Intra-articular, or any systemic dose </= 1 week; No Prophylaxis -Corticosteroids: < 10 mg/ day Prednisone equivalent >/= 4 weeks;

Not tested/ Unknown Source Postexposure Prophylaxis for Occupational Percutaneous or Mucosal Exposure to HBV Status of Exposed HBsAg(+) Source Not tested/ Unknown Source HBsAg(-) Unvaccinated Hepatitis B Hyper-Immune Globulin (HBIG) 0.06 mL/kg or 5mL IM x 1 Vaccinate (0,1,6,12 mo) Vaccinate Vaccine responder No treatment Vaccine non-responder HBIG 0.06 mL/kg or 5 mL IM x 2, 30 d apart Re-vaccinate If “high risk” source, treat as HBsAg(+) (second vaccination series x 3 dose is also reasonable) Vaccinated; unknown response Test anti-HBs titer If > 10 mIU/mL: No treatment If < 10 mIU/mL: HBIG 0.06 mL/kg or 5 mL IM x 1 + Revaccinate x 3 dose and test titer If < 10 mIU/mL: Revaccinate x 3 dose and test titer

Post-Exposure Prophylaxis Non-Occupational Exposure to HBV Vaccination and/or antibody response status of Exposed Person Treatment when Source Person is HBsAg-positive, or Source unknown, or not available for testing HBsAg-negative Unvaccinated/nonimmune HBIG 0.06 mL/Kg or 5 mL IM × 1; initiate HBV vaccine series Initiate HBV vaccine series Previously vaccinated, known responder (anti-HBs > 10 mIU/mL) No treatment Previously vaccinated, known non-responder (anti-HBs < 10 mIU/mL) HBIG 0.06 mL/kg or 5 mL IM × 1 and initiate revaccination, or HBIG × 2, 30 days apart (is also reasonable to re-vaccinate x 3 doses) Previously vaccinated, antibody response unknown Single vaccine booster dose If still undergoing vaccination HBIG 0.06 mL/Kg or 5 mL IM × 1; complete vaccine series Complete vaccine series