1. 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;

2. 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

3. 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