After exposure to hepatitis B surface antigen (HBsAg)-positive blood, a healthcare worker who did not respond to the primary hepatitis B vaccine series should receive what?

• A. HBIG plus the hepatitis B vaccine series, with the first dose given as soon as possible after exposure
• B. HBIG alone
• C. The hepatitis B vaccine series only
• D. No treatment is required

Answer: (A)

After exposure to hepatitis B surface antigen–positive blood, a healthcare worker who did not respond to the initial vaccine should receive both the hepatitis B immune globulin (HBIG) and begin or complete the hepatitis B vaccine series, with the first vaccine dose given as soon as possible after exposure. HBIG provides immediate passive protection by supplying antibodies that can neutralize the virus right away, which is crucial during the immediate period after exposure. The vaccine, started now, stimulates the person’s own immune system to produce protective anti-HBs antibodies for lasting immunity. Since this individual did not mount an adequate response to the primary vaccine series, relying on the vaccine alone wouldn't offer immediate protection, while HBIG alone wouldn't establish long-term immunity. The combination covers both the urgent and the longer-term needs, making it the best approach.