immunoglobulins

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Hepatitis B

Human hepatitis B immunoglobulin

Hepatitis B immunoglobulin (HBIG) is given as a prophylactic measure to people at increased risk of exposure to hepatitis B.

Hepatitis B is caused by a virus that attacks the liver and causes it to become inflamed. It is estimated worldwide there are 800 million people infected with the virus and a further 300 million are carriers. People may have no symptoms at all but can still pass on the virus to others. Symptoms can include: itchy skin, weight loss, a short, mild flu-like illness, jaundice (yellow skin and eyes), loss of appetite, nausea, vomiting and diarrhoea. It is possible to have contracted hepatitis B and not have symptoms for many years until it develops into long-term disease.

Hepatitis B can be passed on in the following ways: during sex with an infected partner, from an infected mother to her newborn baby during delivery, by users of injected drugs who can infect others through sharing needles, and through a blood transfusion in a country where blood is not tested for the hepatitis B virus. All blood in the UK is screened for hepatitis B. If you have had other types of hepatitis, you can still get hepatitis B. People who have had hepatitis B but haven't recovered fully can remain infectious all their lives.

Hepatitis B can cause long term infection that leads to liver disease such as cirrhosis or cancer which can be fatal.  1.5% develop liver cirrhosis and 0.1% develop liver cancer. Hepatitis B is particularly likely to cause long term infection in babies and children. It is not known how many people are infected in the UK, but in some cities up to 1 in 100 women who visit antenatal clinics have been found to carry hepatitis B. Babies born to carrier mothers should begin with their vaccination as soon as possible after delivery (max. 24 hours). 

Some healthcare workers inadvertently prick themselves with a used needle (‘needle-stick injury’) and are at risk of hepatitis B infection.  Healthcare workers are usually vaccinated now to prevent this happening.

Specific hepatitis B immunoglobulin (HBIG) is available for passive protection and is normally used in combination with hepatitis B vaccine to confer immediate cover (passive immunity) and long-lasting protection (active immunity) after exposure – post-exposure prophylaxis.

Whenever immediate protection is required, immunisation with the vaccine should be combined with the simultaneous administration of HBIG at a different injection site. It has been shown that passive immunisation with HBIG does not suppress an active immune response. A single dose of HBIG is sufficient for healthy individuals. If infection has already occurred at the time of immunisation, virus multiplication may not be inhibited completely, but severe illness and, most importantly, the development of the carrier state may be prevented.

Groups requiring post-exposure prophylaxis:

1.    Babies born to mothers, who are HBeAg* positive carriers, who are HBsAg** positive without e markers, or who have had acute hepatitis during pregnancy.

2.    Persons who are accidentally inoculated, or who contaminate the eye and mouth or fresh cuts or abrasions of the skin with blood from a known HBsAg** positive person.

3.    Sexual partners of individuals suffering from acute hepatitis B, and who are seen within one week of onset of jaundice.

 

*HBeAg stands for hepatitis B "e" antigen. This antigen is a protein from the hepatitis B virus that circulates in infected blood when the virus is actively replicating.

**HBsAg stands for hepatitis B surface antigen. When a healthcare provider orders blood tests to determine if someone is infected with the hepatitis B virus, one thing he is looking for is HBsAg in the blood. If it is found, along with other specific antibodies, it means the person has a hepatitis B infection.

Vaccination Program for Neonates

Baby should receive

There is no contraindication to breast-feeding of a carrier mother when the baby begins immunisation at birth.

Hepatitis B vaccine

HBIG single dose

Mother is HBsAg positive and HBeAg positive

Yes

Yes

Mother is HBsAg positive without e markers (or where they have not been determined)

Yes

Yes

Mother has acute hepatitis B during pregnancy

Yes

Yes

Mother is HBsAg positive and anti-HBe positive

Yes

No

 

Useful documentation available from the electronic Medicines Compendium (eMC).

PDF Hepatitis B (Patient Information Leaflet)

Patient information leaflets