A 28-year-old mother has delivered a full-term healthy newborn baby. Mother has tested positive for hepatitis HBe antigen and HBs antigen two weeks before delivery.
Which one of the following would you recommend for managing the newborn?
Correct Answer D:
Neonates whose mothers are HBsAg-positive should be given 1 dose of HBIG 0.5mL IM within 12 h of birth. Recombinant hepatitis B virus vaccine should be given IM in a series of 3 doses. (Note: Doses vary among proprietary vaccines.) The 1st dose is given concurrently with HBIG but at a different site. The 2nd dose is given at 1 to 2 mo, and the 3rd dose is given at 6 mo after the first.
A woman who is positive for hepatitis B surface antigen (HBsAg), but negative for hepatitis B antigen (HBeAg), delivers at term.
What would be the best management for this woman's infant?
The recommendation for infants with HBsAg-negative mother is to give the hepatitis B vaccine between 0 to 2 months, then again between 1 to 4 months, and finally a third time between 6 to 18 months.
The recommendation for infants with HBsAg-positive mother is to give the Hepatitis B immune globulin and vaccination within 12 hours of birth, then the vaccine between 1 to 2 months and again at 6 months.
A pregnant patient is positive for hepatitis B surface antigen (HbsAg).
Which one of the following would be most appropriate for her infant?
Correct Answer A:
Infants born to hepatitis B-positive mothers should receive both immune globulin and hepatitis B vaccine. They should receive the entire series of the vaccine, with testing for seroconversion only after completion of the vaccination series; the recommended age for testing is 9-12 months of age.
A female medical student at 10 weeks’ gestation is starting an intravenous line in a patient who is a chronic active hepatitis B carrier. After placing the line, the student inadvertently sticks herself with the bloody needle. The student has never been immunized against hepatitis B and is susceptible.
Which of the following is the best choice in managing her situation?
In a susceptible patient, even pregnant, the standard therapy is to give the hepatitis B immune globulin to cover the needle stick exposure, followed by the vaccination. This vaccination is not a live vaccine, so it is not contraindicated in pregnancy.
A. Hepatitis-specific immune globulin and vaccinations are required.
B. Immune globulin to cover the immediate exposure is also needed.
C. Hepatitis vaccine is required as well.
E. The risk of infection is high and can be prevented by the recommended therapy. Observation is not the standard care.
A patient in the first trimester of pregnancy has just learned that her husband has acute hepatitis B. She feels well, and her screening test for hepatitis B surface antigen (HBsAg) was negative last month. She has not been immunized against hepatitis B.
Which one of the following would be the most appropriate management of this patient?
Correct Answer E: Hepatitis B immune globulin (HBIG) should be administered as soon as possible to patients with known exposure to hepatitis B. Hepatitis B vaccine is a killed-virus vaccine and can be used safely in pregnancy, with no need to wait until after organogenesis. This patient has been exposed to sexual transmission for at least 6 weeks, given that the incubation period is at least that long, so it is too late to use condoms to prevent infection. The patient is unlikely to be previously immune to hepatitis B, given that she has no history of hepatitis B infection, immunization, or carriage. Because the patient's HBsAg is negative, she is not the source of her husband's infection. Full treatment for this patient has an efficacy of only 75%, so follow-up testing is still needed.
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