## **Core Concept**
The management of a needlestick injury (NSI) from a patient who is HBsAg (Hepatitis B surface antigen) and HBeAg (Hepatitis B e-antigen) positive involves understanding the risk of transmission and the appropriate post-exposure prophylaxis (PEP) to prevent Hepatitis B virus (HBV) infection. HBeAg positivity indicates high viral replication and increased infectivity.

## **Why the Correct Answer is Right**
The correct approach for a healthcare worker who has not been immunized against Hepatitis B and experiences a needlestick injury from an HBsAg and HBeAg positive patient includes immediate administration of Hepatitis B Immunoglobulin (HBIG) and the first dose of the Hepatitis B vaccine. This combination provides immediate, temporary protection (HBIG) and starts the process for long-term immunity (vaccine). The HBV vaccine series should be completed according to the recommended schedule. This approach is crucial because it significantly reduces the risk of developing HBV infection after exposure.

## **Why Each Wrong Option is Incorrect**
- **Option A:** This option might suggest HBIG alone or vaccine alone, which is insufficient as standalone measures for immediate and long-term protection.
- **Option B:** This could imply delayed or incomplete management, which would not adequately address the immediate risk of infection.
- **Option C:** Similar to Option A, this might not provide the comprehensive approach of immediate protection with HBIG and initiation of vaccination for long-term immunity.
- **Option D:** This option is not provided for evaluation.

## **Clinical Pearl / High-Yield Fact**
A key point to remember is that for individuals who have not been vaccinated against Hepatitis B and are exposed through a needlestick injury from a Hepatitis B-positive patient, especially one with high infectivity markers like HBeAg positivity, prompt administration of both HBIG and the first dose of Hepatitis B vaccine is critical. This approach can effectively prevent HBV infection if initiated promptly.

## **Correct Answer:** B. HBIG and first dose of vaccine.