Dialysis BBV

Question 1

BBV dialysis machines

Answer 1

Equipment:

Separate machine for confirmed and high risk cases of HBV.

NO NEED for separate machine for HIV/HCV.

Question 2

BBV surveillance dialysis

Answer 2

Before starting:
HBsAg for all
HCV IgG for all. HCV RNA for high risk.
HIV screening for all.

If unknown status, use separate machine in a side room and do not reuse machine until status known.

Repeat testing:
HbSAg every 6 months if Ab> 100 IU/mL
Every 3 months for non responders
HCV every 3 months
HIV routine surveillance NOT needed

If a new BBV is detected, TEST ALL PATIENTS IN THE UNIT

Question 3

HBV patient dialysis

Answer 3

Side room and separate machine
Staff dialysing them should not dialyse other patients at same time.

Question 4

HBV vaccine in HD

Answer 4

Engerix B for all HD patients including isolated core Ab (risk of reactivation)

0,1,2,6

Adequate responder if titre > 100 - 8 weeks after schedule

If between 10-100, booster dose
If <10, repeat schedule
If second time <10 - non responder

Question 5

BBV risk stratification HD traveller

Answer 5

Low risk - same as usual

Medium risk - HCV, HBsAg every 2 weeks for 3 months. HIV if any additional risk factor. If initial screen Meg, segregation not needed.

High risk - HCV, HBsAg every 2 weeks for 3 months. HIV if additional risk. Segregation and isolation with separate machine.