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  • Print publication year: 2008
  • Online publication date: December 2009

56 - Blood or Body Fluid Exposure Management and Postexposure Prophylaxis for Hepatitis B and HIV

from Part III - Special Populations
    • By Roland C. Merchant, Assistant Professor of Emergency Medicine and Community Health, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, RI, Michelle E. Roland, Associate Professor of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, Positive Health Program at San Francisco General Hospital, Chief, Office of AIDS, California Department of Public Health, Sacramento, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Publisher: Cambridge University Press
  • DOI: https://doi.org/10.1017/CBO9780511547454.057
  • pp 373-380

Summary

INTRODUCTION

Because the efficacy of prophylactic therapy may be highly time-dependent, the acute care management of occupational or other blood and body fluid exposures must include rapid determination of the need for prophylaxis, testing, and treatment. Attention to wound care principles and referral for social, medical, or advocacy services remain important in all cases.

EXPOSURE EPIDEMIOLOGY AND TRANSMISSION RISK

There were an estimated 78,123 visits to United States emergency departments (EDs) annually during 1998–2000 for work-related exposures to blood or body fluids. More than 90,000 females of all ages present annually for medical care after sexual assault. The frequency of ED visits for other populations and for other types of blood or body fluid exposures is not well known.

Hepatitis B

The Centers for Disease Control and Prevention (CDC) estimates that 5.6% of 20- to 59-year-olds in the United States have been infected with hepatitis B, though the prevalence and incidence has decreased over the past 20 years (see Chapter 13, Viral Hepatitis). This reduction is likely due to widespread use of the hepatitis B vaccination, universal precautions in health care settings, and educational campaigns to increase condom usage and reduce injection-needle sharing.

Although it is found in other body fluids (e.g., bile, breast milk, cerebrospinal fluid, saliva, semen, and sweat), hepatitis B is primarily transmitted through contact with blood.

PEP RESOURCES
PEPline: The National Clinicians' Post-Exposure Prophylaxis Hotline. Phone: 1-888-448-4911. Available at: http://www.ucsf.edu/hivcntr/Hotlines/PEPline.html.
National and State PEP Guidelines Websites:
CDC:
Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States. Available at: http://www.cdc. gov/mmwr/PDF/rr/rr5402.pdf.
Sexually transmitted diseases treatment guidelines (2002). Available at: http://www.cdc.gov/std/treatment/rr5106.pdf.
Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis (2001). Available at: http://www.cdc.gov/mmwr/PDF/rr/rr5011.pdf.
Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis (2005). Available at: http://www.cdc.gov/mmwr/PDF/rr/rr5409.pdf.
California:
Offering HIV post-exposure prophylaxis (PEP) following non-occupational exposures: recommendations for health care providers in the state of California. Available at: http://www.dhs.ca.gov/ps/ooa/Reports/PDF/OfferingPEPFollowingNonOccupExp0604.pdf.
Massachusetts:
Clinical advisory – HIV prophylaxis for non- occupational exposures. Available at: http://www.mass.gov/dph/aids/guidelines/ca_exposure_nonwork.htm.
New York:
HIV post-exposure prophylaxis following non-occupational exposure including sexual assault. Available at: http://www.hivguidelines.org/public_html/npep/npep.pdf.
HIV post-exposure prophylaxis for children beyond the perinatal period. Available at: http://www.hivguidelines. org/public_html/p-pep/p-pep.pdf.
HIV prophylaxis following occupational exposure. Available at: http://www.hivguidelines.org/public_html/oe/oe.pdf.
Rhode Island:
Nonoccupational HIV post-exposure prophylaxis guidelines for Rhode Island healthcare practitioners. Available at: http://www.brown.edu/Departments/BRUNAP/resources.html.
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