A healthcare worker sustains a needlestick injury from a patient known to be HBsAg positive. The worker completed the three-dose hepatitis B vaccination series 5 years ago and has a documented anti-HBs level of 8 mIU/mL at the time of injury. What is the most appropriate post-exposure prophylaxis?

• A No intervention needed; prior vaccination provides adequate protection
• B Single booster dose of hepatitis B vaccine
• C Hepatitis B immunoglobulin (HBIG) alone
• D Hepatitis B immunoglobulin (HBIG) and a booster dose of hepatitis B vaccine ✓

Explanation

A vaccinated individual with anti-HBs below 10 mIU/mL (non-responder or waned immunity) who sustains exposure to HBsAg positive blood requires both HBIG for immediate passive immunity and a booster dose of hepatitis B vaccine to stimulate active immunity. Anti-HBs of 8 mIU/mL is below the protective threshold of 10 mIU/mL. Option A is incorrect because the antibody level is non-protective. Option B alone is insufficient for immediate post-exposure protection. Option C without a vaccine booster fails to stimulate active immunity.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.