Re-examining Hepatitis B Postexposure Prophylaxis Following Pediatric Community-acquired Needle-stick Injury in an Era of a National Immunization Registry

Ewe, KYH; Blyth, CC; McLeod, C; Borland, ML; Bowen, AC; Yeoh, DK; Campbell, AJ

Author(s): Ewe, KYH; Blyth, CC; McLeod, C; Borland, ML; Bowen, AC; Yeoh, DK; Campbell, AJ;
Details: Publication Year 2022-01-01,Volume 41,Issue #1,Page 80-84
Journal Title: Pediatric Infectious Disease Journal
Publication Type: Research article
Abstract: BACKGROUND: Long-term hepatitis B immunity has been demonstrated following the completion of the primary vaccination series in childhood. Some guidelines recommend a hepatitis B surface antibody (anti-HBs) directed approach following community-acquired needle-stick injury (CANSI) to inform hepatitis B postexposure prophylaxis (PEP) management. We assessed the utility of anti-HBs testing post-CANSI, as well as the costing of, and adherence to PEP at a pediatric hospital. METHODS: Children presenting to an Australian tertiary pediatric hospital post-CANSI (2014-2019) were identified retrospectively using medical and laboratory records. Immunization status was obtained from the Australian Immunisation Registry. RESULTS: Fifty-six children with CANSI were identified. Of those with immunization records, all had completed hepatitis B vaccinations (n = 52). At presentation, 44% (n = 23) had anti-HBs <10 IU/L, which was more likely in older (>/=6 years, 68%) versus younger children (OR 4.59, P < 0.02). HBIG and hepatitis B vaccine adherence was 65% (15/23) and 78% (18/23), respectively. All children (n = 14) with anti-HBs >/=4 weeks postvaccination +/-HBIG, demonstrated an anamnestic response. No hepatitis B infections were detected. Using completed immunizations versus anti-HBs levels as a marker of immunity to direct PEP resulted in a projected cost savings of AUD$ 4234. CONCLUSION: Anti-HBs levels <10 IU/L, despite previous vaccinations, were frequent in children post-CANSI, with many demonstrating an anamnestic response. Adherence to postexposure HBIG and hepatitis B vaccine was suboptimal using an anti-HBs directed approach. These data support re-evaluating PEP in an era of the national immunization registry; completion of hepatitis B vaccinations as a marker of immunity provides a practical approach, ensuring optimized care for pediatric CANSI.
Keywords: Adolescent; Australia; Child; Child, Preschool; Female; Hepatitis B/*prevention & control; Hepatitis B Antibodies/immunology; Hepatitis B Vaccines/administration & dosage; Hepatitis B virus/immunology; Humans; Infant; Male; Needlestick Injuries/*complications/virology; Post-Exposure Prophylaxis/standards/*statistics & numerical data; *Registries; Tertiary Care Centers/statistics & numerical data; Vaccination/*statistics & numerical data
Department(s): Infectious Diseases
PubMed ID: 34862347
Publisher's Version: https://doi.org/10.1097/INF.0000000000003350
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-10-24 04:10:00

Last Modified: 2024-10-24 04:10:44