Hepatitis B

[Bad_day]

Dear Doctor,

Thank you for your work on this site. I am male, 31yrs. On a recent visit to Kenya I had protected vaginal intercourse with a local woman. When I withdrew (without ejaculation)I noticed the condom had slipped off inside her. I checked it was in place 5 seconds previous so the exposure was brief. Common sense tells me it probobly slipped off AS I withdrew bt im not sure. Still there would have been some exposure to secretions.
I panicked and brought her for a hiv test which came back negative, I forgot however to have her checked for Hep B.

On my return home I panicked and went to get PEP in the form of vaccine and HBIG. I recieved the first shot of vaccine and 0.5ml of HBIG 36 hours after the exposure.

(Note: I recieved 2 shots of the Hep vaccine 2 years ago, but recently tests showed I had not developed immunity. ie HBsAb 2.8 mlu/L)

I have no way of contacting this woman now to ask her status.

My questions:

1. How effective is this PEP treatment? Also I believe the dose of HBIG was about 10 times too low, is this right? If so, what is the effectiveness of the vaccine alone as PEP?

2. This woman had a baby five years ago. Is it common practice to vaccinate pregnant women against Hep B?

3. All considered, what are the chances I contracted the virus?

4. Do I need testing and if so when?

Thank you so much

Mike

[H. Hunter Handsfield, M.D.]

Obviously the risk was very low for HIV, HBV, and probably for any other STD.  Clearly you had protected sex; even if the condom slipped just before you withdrew, that contact most likely was too brief to confer any measurable risk.

1) In this circumstance, I would not have recommended HBIG, and I'm not even sure vaccination was warranted. (But every sexually active person ought to be protected against HBV, so it's OK to go ahead -- but not so much because of this particular event.)

2) HBV immunization is widespread in much of Africa, but quite spotty, depending on setting (urban, rural), social class, and other aspects.  But I have no knowledge of the situation in Kenya and cannot predict whether or not your partner might have been immunized.

3, 4) As I said above, the risk seems very low. Feel free to get tested--but work out the details with the provider who provided HBIG and vaccine. Special blood tests will be required to measure the possibilty you were infected versus just showing up positive because of the vaccine.

Good luck--  HHH, MD

[H. Hunter Handsfield, M.D.]

I forgot to say that I don't remember the dose of HBIG off the top of my head, but most likely you can rely on the knowledge of the provider who administered it.

Also, I meant to say that you probably were substantially if not totally protected against HBV from your past immunization.  The research suggests that protection is not entirely dependent on achieving the desired antibody levels; having received 2 doses of the vaccine, the odds are good you were protected.

[Bad_day]

Thank you very much doctor. I feel better now, I thought the risk would have been much greater.
I will follow up with my provider as suggested.

[Bad_day]

Dr,

Ive just read your additional comments, and now I feel even better.

Note to all: Im so glad I got those Hep B shots back then.

Thanks