A 25-year-old medical volunteer comes to the occupational health office after accidentally pricking his finger while disposing of sharps from a procedure on a 36-year-old patient. The patient had been admitted to the hospital for anorexia, abdominal pain, and jaundice. Laboratory results on the source patient 's blood are as follows: The volunteer admits that he is not vaccinated against hepatitis B. Which of the following is the most appropriate next step in his management?

Question

A 25-year-old medical volunteer comes to the occupational health office after accidentally pricking his finger while disposing of sharps from a procedure on a 36-year-old patient.  The patient had been admitted to the hospital for anorexia, abdominal pain, and jaundice.  Laboratory results on the source patient 's blood are as follows:  The volunteer admits that he is not vaccinated against hepatitis B.  Which of the following is the most appropriate next step in his management?

Quizplus · Accepted Answer

11ec25c8_d453_7a13_bc81_b9e8feb70909_MD0003_00 This patient's test results (positive HBsAg and positive HBeAg) are consistent with acute hepatitis B (HB). Positive hepatitis Be antigen indicates a higher risk of transmission. Healthcare workers (HCWs) exposed to blood (ocular, percutaneous, or mucous membrane) from a suspected or known HB patient should be considered for post-exposure prophylaxis. HCWs with previous HB vaccination and known antibody response usually require no post-exposure prophylaxis. However, many clinicians recommend HB booster vaccine in these patients. HCWs without previous HB vaccination or adequate antibody response to the vaccine should receive the complete HB vaccine series as soon as possible (Choice D). The first dose of the vaccine is preferred within 12 hours, with the next 2 doses according to the standard schedule. Unvaccinated HCWs exposed to an HBsAg-positive source patient (as in this case) should also receive the HB immune globulin as soon as possible, preferably within 24 hours. (Choices B, C, and E) This unvaccinated HCW should receive both the HB vaccine and immune globulin with follow-up serological testing for viral hepatitis. Educational objective: Active hepatitis B (HB) infection typically presents with positive HB surface antigen, positive Be antigen, and absent surface antibody. Health care workers exposed to blood from HB patients (ocular, mucous membrane, or skin) should receive post-exposure prophylaxis. Unvaccinated individuals should receive both the HB vaccine and HB immune globulin as soon as possible. References: Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. (http://www.ncbi.nlm.nih.gov/pubmed/11442229)

A 25-Year-Old Medical Volunteer Comes to the Occupational Health Office