Re-examining Hepatitis B Postexposure Prophylaxis Following Pediatric Community-acquired Needle-stick Injury in an Era of a National Immunization Registry. Issue 1 (January 2022)

• Record Type: Journal Article
• Authors: Ewe, Krist Y.H.; Blyth, Christopher C.; McLeod, Charlie; Borland, Meredith L.; Bowen, Asha C.; Yeoh, Daniel K.; Campbell, Anita J.
• Is Part Of: Pediatric infectious disease journal. Volume 41:Issue 1(2022)
• Publication Date: 2022-01
• Subjects: Hepatitis B -- needle-stick -- postexposure prophylaxis -- pediatric -- immunization; Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000003350
• Languages: English
• ISSNs: 0891-3668

Abstract

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. Abstract : Supplemental Digital Content is available in the text.