📋 HISTORY
🔹 Occupational exposure — needle-stick injury
🔹 Source patient: known HBsAg positive
🔹 Exposed person: healthcare worker (nurse)
🔹 Previous vaccination: Full 3-dose HBV vaccine series completed
🔹 Post-vaccination antibody status: Unknown
――――――――――――――
🩺 EXAMINATION
🔹 Needle-stick wound noted
🔹 Exposure site assessment
🔹 No current signs of acute hepatitis
🔹 Risk stratification required based on immune status
――――――――――――――
🔬 INVESTIGATION
🔹 Anti-HBs antibody titer — key to determine immune status
🔹 Source patient HBsAg status already known (positive)
🔹 Baseline LFTs of exposed healthcare worker
🔹 HBsAg, Anti-HBc, Anti-HBs of exposed nurse (baseline serology)
――――――――――――――
❓ QUESTION
What is the most appropriate next step?
🔹 Occupational exposure — needle-stick injury
🔹 Source patient: known HBsAg positive
🔹 Exposed person: healthcare worker (nurse)
🔹 Previous vaccination: Full 3-dose HBV vaccine series completed
🔹 Post-vaccination antibody status: Unknown
――――――――――――――
🩺 EXAMINATION
🔹 Needle-stick wound noted
🔹 Exposure site assessment
🔹 No current signs of acute hepatitis
🔹 Risk stratification required based on immune status
――――――――――――――
🔬 INVESTIGATION
🔹 Anti-HBs antibody titer — key to determine immune status
🔹 Source patient HBsAg status already known (positive)
🔹 Baseline LFTs of exposed healthcare worker
🔹 HBsAg, Anti-HBc, Anti-HBs of exposed nurse (baseline serology)
――――――――――――――
❓ QUESTION
What is the most appropriate next step?
🅐 Administer HBIG only
🅑 Administer Hepatitis B vaccine booster only
🅒 Check Anti-HBs antibody titer
🅓 No action is required
❌ WHY OTHERS ARE WRONG
🅐 Administer HBIG only
HBIG is indicated only when the exposed person is a non-responder or has inadequate antibody titers. Giving it without checking antibody status first is premature.
🅑 Administer Hepatitis B vaccine booster only
A booster is unnecessary if the nurse already has protective Anti-HBs levels. Antibody status must be checked before deciding on a booster.
🅓 No action is required
Exposure to a known HBsAg-positive source always requires risk assessment. Ignoring it could miss a non-immune individual at risk of infection.
🅐 Administer HBIG only
HBIG is indicated only when the exposed person is a non-responder or has inadequate antibody titers. Giving it without checking antibody status first is premature.
🅑 Administer Hepatitis B vaccine booster only
A booster is unnecessary if the nurse already has protective Anti-HBs levels. Antibody status must be checked before deciding on a booster.
🅓 No action is required
Exposure to a known HBsAg-positive source always requires risk assessment. Ignoring it could miss a non-immune individual at risk of infection.
❓ FAQ: Needle-Stick Injury (Hepatitis B Positive Source)
1. What is the first step after a needle-stick injury?
Immediately wash the wound with soap and water; do not squeeze or scrub the site.
2. What determines further management?
The vaccination status and antibody response (Anti-HBs titer) of the exposed person.
3. What Anti-HBs level is considered protective?
A titer of ≥10 mIU/mL is considered protective immunity.
4. What if the exposed person is unvaccinated?
Give both HBIG and start the Hepatitis B vaccine series immediately.
5. What if the exposed person is a known non-responder?
Administer HBIG and consider a second full vaccine series or a second dose of HBIG.
6. What if Anti-HBs titer is adequate (≥10 mIU/mL)?
No further treatment is needed; the person is already immune.
7. What if Anti-HBs titer is inadequate or unknown and result is delayed?
Give a vaccine booster dose and HBIG, then check titer.
8. Is the source patient's HBsAg status important?
Yes, it determines the level of risk and guides whether prophylaxis is needed.
9. What follow-up testing is required?
Repeat LFTs and HBV serology (HBsAg, Anti-HBc) at 6 weeks and 6 months.
10. Can Hepatitis B be transmitted via needle-stick injury?
Yes, HBV is highly transmissible via percutaneous exposure, more so than HIV or HCV.
1. What is the first step after a needle-stick injury?
Immediately wash the wound with soap and water; do not squeeze or scrub the site.
2. What determines further management?
The vaccination status and antibody response (Anti-HBs titer) of the exposed person.
3. What Anti-HBs level is considered protective?
A titer of ≥10 mIU/mL is considered protective immunity.
4. What if the exposed person is unvaccinated?
Give both HBIG and start the Hepatitis B vaccine series immediately.
5. What if the exposed person is a known non-responder?
Administer HBIG and consider a second full vaccine series or a second dose of HBIG.
6. What if Anti-HBs titer is adequate (≥10 mIU/mL)?
No further treatment is needed; the person is already immune.
7. What if Anti-HBs titer is inadequate or unknown and result is delayed?
Give a vaccine booster dose and HBIG, then check titer.
8. Is the source patient's HBsAg status important?
Yes, it determines the level of risk and guides whether prophylaxis is needed.
9. What follow-up testing is required?
Repeat LFTs and HBV serology (HBsAg, Anti-HBc) at 6 weeks and 6 months.
10. Can Hepatitis B be transmitted via needle-stick injury?
Yes, HBV is highly transmissible via percutaneous exposure, more so than HIV or HCV.
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