Hepatitis B vaccination and immune globulin administration in patients presenting to the emergency department following sexual assault

Abstract

Objective: Sexual assault is unfortunately common in patients seen in the emergency department (ED). Following sexual assault, patients are at risk for several transmissible infections, including hepatitis B virus (HBV). HBV screening, HBV vaccination, and treatment with hepatitis B immune globulin (HBIG) is recommended in select scenarios by the Centers for Disease Control and Prevention (CDC). However, there is a paucity of evidence on the compliance with these recommendations in the ED.

Methods: This was a multi-center, retrospective cohort study utilizing the Emergency Medicine Pharmacotherapy Research NETwork (EMPHARM-NET). Patients aged 18 or older were included if they had an ED visit with an ICD-10 diagnosis code corresponding to sexual assault from January 1st, 2021 to January 1st, 2023. The primary endpoint was percent concordance with CDC recommendations for receipt of HBV vaccine and HBIG in the ED.

Results: A total of 1010 patients were included across ten EDs. Of the 633 patients (62.7 %) with no/unknown vaccine history, only 37 (5.8 %) received a dose of the HBV vaccine in the ED consistent with CDC recommendations. There were zero assailant(s) known to be HBV positive, but eight patients (0.8 %) received HBIG while in the ED. HBV serology testing was also performed in 63.6 % of patients but there was low compliance to CDC recommendations based upon serology testing results.

Conclusions: Opportunities exist to improve HBV vaccination rates and HBIG administration in accordance with CDC guidelines for patients presenting to the ED following sexual assault.

Keywords: Emergency department; Hepatitis B; Hepatitis B immune globulin; Hepatitis B vaccine; Sexual assault.