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HBV Needlestick Immune Nurse — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementHBV Needlestick Immune NurseORE Part 1

A dental nurse sustains a percutaneous needlestick injury while treating a 40-year-old man known to be HBsAg positive and HBeAg positive. The nurse completed a primary hepatitis B vaccination course and had an anti-HBs concentration of 112 mIU/mL measured 1 month after completing that course, 2 years ago. She has not received a hepatitis B booster dose. What is the most appropriate immediate hepatitis B post-exposure management?

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Correct answer: C — Give a hepatitis B vaccine booster dose without hepatitis B immunoglobulin.

The correct answer is C. A needlestick from a known HBsAg-positive patient is a significant exposure. This nurse had a documented adequate vaccine response, with anti-HBs 112 mIU/mL measured 1 month after her primary course. UKHSA advises that fully vaccinated individuals exposed to a known HBsAg-positive source receive a hepatitis B vaccine booster, without HBIG, unless they received a booster within the preceding year. HBIG plus vaccine is indicated for documented non-responders, defined by anti-HBs below 10 mIU/mL after a completed course, not for this nurse. A new full vaccine course is unnecessary. Prophylaxis should not be delayed for repeat anti-HBs testing, and prior hepatitis B vaccination does not remove the need for the indicated post-exposure booster. The incident should also undergo standard occupational-health assessment for HIV and HCV exposure.

Reference: UK Health Security Agency. Hepatitis B immunoglobulin (issued November 2023), section: Post-exposure for individuals who have been vaccinated. Updated 16 July 2026. https://www.gov.uk/government/publications/immunoglobulin-when-to-use/hepatitis-b-immunoglobulin-issued-march-2021