guayoman
Forum Elite
Topics: 44
Posts: 273
|
23 yo nurse has needle-stick injury while drawing blood from a pt with acute HBV infex. She is HBsAg (+). 5 years ago received vaccination and had docummented response to the vaccine. Best next step in management?
a. HBIG
b.Vaccine against HBV
c.Both a and b
d. Test for anti-HBsAg
e. Reassurance
___________________
Confidence does not come from simply reading the content, but from doing things with it. Confidence is born in the flash of insight, in the ability to face something new and figure it out.
Kaplan usmle edge newsletter
|
| AAAAA
Forum Fanatic
Topics: 156
Posts: 1,991
|
e Reassurance
___________________
seeking study partner in USMLE, Canadian MCC OSCE examination
|
| AAAAA
Forum Fanatic
Topics: 156
Posts: 1,991
|
Optimal use of immunizing agents such as Hepatitis B vaccination safeguards the health of workers and protects patients from becoming infected through exposure to infected workers (Table_1) (1-15). Consistent immunization programs could substantially reduce both the number of susceptible HCWs in hospitals and health departments and the attendant risks for transmission of vaccine-preventable diseases to other workers and patients (16).
___________________
seeking study partner in USMLE, Canadian MCC OSCE examination
|
| AAAAA
Forum Fanatic
Topics: 156
Posts: 1,991
|
Postvaccination testing for antibody to hepatitis B surface antigen (anti-HBs) response is indicated for HCWs who have blood or patient contact and are at ongoing risk for injuries with sharp instruments or needlesticks (e.g., physicians, nurses, dentists, phlebotomists, medical technicians and students of these professions). Knowledge of antibody response aids in determining appropriate postexposure prophylaxis.
___________________
seeking study partner in USMLE, Canadian MCC OSCE examination
|
| AAAAA
Forum Fanatic
Topics: 156
Posts: 1,991
|
Vaccine-induced antibodies to HBV decline gradually over time, and less than or equal to 60% of persons who initially respond to vaccination will lose detectable antibodies over 12 years (28; CDC, unpublished data). Studies among adults have demonstrated that, despite declining serum levels of antibody, vaccine-induced immunity continues to prevent clinical disease or detectable viremic HBV infection (29). Therefore, booster doses are not considered necessary (1). Periodic serologic testing to monitor antibody concentrations after completion of the three-dose series is not recommended. The possible need for booster doses will be assessed as additional data become available
___________________
seeking study partner in USMLE, Canadian MCC OSCE examination
|
| AAAAA
Forum Fanatic
Topics: 156
Posts: 1,991
|
Booster doses are not considered necessary for hepatitis B exposure despite the vaccine-induced antibodies to HBV gradually decline over time in 12 years to 60% of the initial level.
But this nurse has documented response so no booster dose is necessary ! (CDC guidelines)
___________________
seeking study partner in USMLE, Canadian MCC OSCE examination
|
| AAAAA
Forum Fanatic
Topics: 156
Posts: 1,991
|
I am an RN at a health care facility where we are exposed to blood and body fluids on a daily basis. We have provided hepatitis B vaccine to our employees for 10 years. We started performing titers 1-2 months after the last dose of vaccine only within the last 4 years. (Our employee health manual gives previously vaccinated employees the option of requesting a titer.) Several employees who had been vaccinated more than 4 years ago requested titers. Some of these titers returned too low (<10mIU/ml). How should we treat these employees as we don't know if they responded to the initial vaccine series?
Postvaccination serologic testing of health care workers for anti-HBs is only recommended 1 to 2 months after completion of the primary series. Responders (anti-HBs level >10 mIU/ml) are protected against hepatitis B. Periodic anti-HBs testing and booster doses of vaccine are not recommended.
Because your employees were not tested 1-2 months after completing the primary series, it is not known if they had previously responded to hepatitis B vaccination. The preferred approach to managing these persons is to base interventions on the results of serologic testing performed at the time of percutaneous or permucosal exposure to blood or body fluids. The Advisory Committee on Immunization Practices and the Hospital Infection Control Practices Advisory Committee have published guidelines for the management of HCWs after percutaneous or permucosal exposures. These guidelines include postexposure anti-HBs testing of those who were vaccinated but not tested for response after the primary series. To obtain a copy of the CDC guidelines "Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis," visit www.cdc.gov/mmwr/PDF/rr/rr5011.pdf (4/04)
___________________
seeking study partner in USMLE, Canadian MCC OSCE examination
|
| AAAAA
Forum Fanatic
Topics: 156
Posts: 1,991
|
Who should get the Hepatitis B vacinne and the HBIG Hepatitis B Immunoglobulin?
Answer :
A person who is a "known non-responder" to hepatitis B vaccine has a percutaneous exposure to HbsAg positive blood. According to the ACIP recommendations, I have the option to give hepatitis B immune globulin (HBIG) x 2 or HBIG x 1 and initiate revaccination. How do I decide which to do?
If the person is a true "non-responder" (i.e., failed to produce adequate anti-HBs after two full vaccine series), it seems illogical to give a third hepatitis B vaccine series. The two-dose HBIG regimen would be the better choice. The first dose of HBIG (0.06ml/kg) should be given as soon as possible after exposure and the second dose (same dosage) given one month later. If the person has failed only one hepatitis B vaccine series, the second option (HBIG x 1 and initiate revaccination) should be used. Post-vaccination testing with anti-HBs should be done 1-2 months after the second series of vaccine. (3/99)
___________________
seeking study partner in USMLE, Canadian MCC OSCE examination
|
| AAAAA
Forum Fanatic
Topics: 156
Posts: 1,991
|
I'm a nurse who received the hepatitis B vaccine series over 10 years ago and had a positive follow-up titer. At present, my titer is negative. What should I do now?
Nothing. Current data show that vaccine-induced anti-HBs levels may decline over time; however, immune memory (anamnestic anti-HBs response) remains intact indefinitely following immunization. Persons with declining antibody levels are still protected against clinical illness and chronic disease. For health care workers with normal immune status who have demonstrated an anti-HBs response following vaccination, booster doses of vaccine are not recommended nor is periodic anti-HBs testing. (7/00
___________________
seeking study partner in USMLE, Canadian MCC OSCE examination
|
| AAAAA
Forum Fanatic
Topics: 156
Posts: 1,991
|
Even 10 years out (in this queestion the nurse is 5 years out), despite the titer is negative (<10 mIU/ml), the body' immune memory cells can be recalled to fight off the Hepatitis B viris HBV.
Even someone has no immunity to HBV, 85%-90% of non-responders (never have been vaccinated) can clear the HBV !
Only 10-15% of patients exposed to HBV will go on to become chronic carriers !!
___________________
seeking study partner in USMLE, Canadian MCC OSCE examination
|
| AAAAA
Forum Fanatic
Topics: 156
Posts: 1,991
|
Nothing should be done !
___________________
seeking study partner in USMLE, Canadian MCC OSCE examination
|
| guayoman
Forum Elite
Topics: 44
Posts: 273
|
Great explanation. So, to have a vaccine response docummented, you need to be retested a month later to see if you raised your level of antibodies anti-HBsAg to >10mIU/ml. If that happens, you don't need revaccination in the case of needle-stick.
Non-docummented responders, need titers. May use vaccine, HBIG, or both depending on te case.
Non-responders need 2 HBIG doses.
___________________
Confidence does not come from simply reading the content, but from doing things with it. Confidence is born in the flash of insight, in the ability to face something new and figure it out.
Kaplan usmle edge newsletter
|
| AAAAA
Forum Fanatic
Topics: 156
Posts: 1,991
|
Some papers reported only 5% of acute infection of HBV among adults will go on to become chronic HBV carriers. So this nurse has documented positive titer and immunized against HBV, no hepatitis B or HBIG are warranted !
But in neonates, 90% or higher who are exposed to HBV will go on to become chronic carrier of HBV !
___________________
seeking study partner in USMLE, Canadian MCC OSCE examination
|
| Jinx
Forum Elite
Topics: 17
Posts: 316
|
slightly confused here
She is HBsAg (+). --doesnt that mean she has disease??
wont immunised status have only Anti-HBs(antibody)????
___________________
Life is a journey--enjoy the drive!!
|
| guayoman
Forum Elite
Topics: 44
Posts: 273
|
I guess that HBsAg means she was infected. BUT, since she has immunity....IT DON'T MATTER. Like AAAAA said, if she has docummented reaction to vaccine (that means that 1 month after vaccination...titers of Ab where taken and proven to be above a certain number) then you can have unprotected sex with infected needles and will not require vaccine or HBIG.
___________________
Confidence does not come from simply reading the content, but from doing things with it. Confidence is born in the flash of insight, in the ability to face something new and figure it out.
Kaplan usmle edge newsletter
|
|
| |
| | | | | | | | | | | | | | | |
Similar forum topics