[CIS PIDD] [cis-pidd] Seeking advice for a doctor in Singapore

[Boyce, Thomas G., M.D.]

Kelly,

I asked our HBV expert your question and here is what he said:

Hi Tom:

The only reason that I can think of is that the care provider wished to see if baby has protective level of anti-HBs after the HyperHep B (a form of HBIG) aministered on the day prior.  There are 2 problems with the provider's logic in requesting this test:


1.     I don't know the pharmacokinetics of HBIG in IM versus IV administration.  But, in our clinical practice involving organ transplant recipients with chronic HBV, HBIG is administered IV (not IM) and serum or plasma anti-HBs levels are measured to guide re-dosing of HBIG to prevent reinfection of the allograft with HBV.  I am not aware of clinical need or practice to measure serum or plasma anti-HBs after IM injections of HBIG for postexposure prophylaxis.



2.     Assuming that the 0.5 mL HBIG was administered intramuscularly, one may never see detectable level of anti-HBs in the blood (but doesn't mean that baby is unprotected).  Depending on the ratio of HBIG dose and baby's mass, it may take a few days for the administered IM dose to be absorbed and to reach measurable level in blood.  So testing for anti-HBs on day 1 is probably too early.


JY


Thomas G. Boyce, MD, MPH
Pediatric Infectious Diseases and Immunology
Mayo Clinic
email: boyce.thomas at mayo.edu
phone: 507-255-8464
fax: 507-255-7767


From: Hogan, Kelly [mailto:Kelly.Hogan at grifols.com]
Sent: Thursday, March 13, 2014 11:33 AM
To: CIS-PIDD
Subject: [cis-pidd] Seeking advice for a doctor in Singapore

Dear all,

A question came to us recently about a baby born to a HBsAg-positive mother that was given HyperHep B 0.5 ml day 1 and vaccination on Day 1.  The antibody level was measured 24 hours after administration and the level came back at zero.  Can anyone explain the negative response and what would be the best recommendation for this baby?

Thank you for your advice.
Kelly

Kelly Hogan, Pharm.D.
Medical Affairs Director - Immunology
Grifols Inc.
2410 Lillyvale Ave
Los Angeles, CA  90032
323-227-7484 (office)
949-606-6309 (mobile)


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