A healthcare worker sustains a deep needlestick injury from a patient with known hepatitis B infection (HBsAg positive). The worker's anti-HBs titre is 5 mIU/mL. According to WHO and CDC guidelines, what is the recommended post-exposure prophylaxis?
- A Hepatitis B vaccine booster dose alone
- B Both hepatitis B immunoglobulin (HBIG) and hepatitis B vaccine (first dose) given at separate sites ✓
- C Hepatitis B immunoglobulin (HBIG) alone
- D No intervention needed as the titre is above the protective threshold
Correct answer: B. Both hepatitis B immunoglobulin (HBIG) and hepatitis B vaccine (first dose) given at separate sites
Explanation
An anti-HBs titre below 10 mIU/mL is considered non-protective. For a non-immune individual with significant exposure to an HBsAg-positive source, both passive immunization with HBIG (for immediate neutralizing antibodies) and active immunization with hepatitis C vaccine (for long-term protection) are recommended, administered at separate anatomical sites. HBIG alone would provide only short-term passive protection without inducing active immunity.
Reference: CDC Pink Book: Epidemiology and Prevention of Vaccine-Preventable Diseases, 14th ed.
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Written and medically reviewed by the StethoPrep medical team.