[Can prevention of hepatitis B following exposure to hepatitis virus be improved by immediate administration of HB immune serum?].

Sixty-five medical personnel thought to be exposed to hepatitis-B-surface antigen (HBs) positive material by accidental needle stick were treated with 4 ml hepatitis B-immunoglobulin (SRK, Swiss Red Cross). The prophylaxis was started as soon as possible, mostly within an hour or two. 56 patients were followed up with clinical and serological tests at monthly intervals for 9 months. In individuals exposed to HBs-antigen negative material, signs of HBV-infection could be detected only in one. In 36 cases potentially infectious material proved to be HBs-Ag positive. Six of the medical personnel (16.7%) had signs of hepatitis B-virus infection. One individual (2.8%) developed clinical hepatitis type B. Three (8.3%) converted to active hepatitis B markers (anti-HBs and/or anti-HBc) without clinical symptoms. Two of four who already had anti-HBs before exposure developed antibodies to HBc afresh at three- and six-month intervals. These serological conversions and the one case of clinical hepatitis developed despite the fact that HB-Ig was given in nearly all cases within one hour of exposure. The incubation period was 5-8 months. It is concluded that even rapid prophylaxis with HB-Ig after needle stick exposure does not afford 100% protection. It is urged that any passive prophylaxis with HB-Ig in exposed personnel should be complemented by active hepatitis B immunization.