Book contents
- Frontmatter
- Contents
- Preface
- Contributors
- Part I Systems
- Part II Pediatrics
- Part III Special Populations
- 50 Bites
- 51 Infections in Oncology Patients
- 52 Ectoparasites
- 53 Fever in Pregnancy
- 54 Fever in the Returning Traveler
- 55 Infectious Complications of Injection Drug Use
- 56 Blood or Body Fluid Exposure Management and Postexposure Prophylaxis for Hepatitis B and HIV
- 57 Postoperative Infections
- 58 Postpartum and Postabortion Infections
- 59 The Febrile Post-Transplant Patient
- 60 Rabies
- 61 Septic Shock
- 62 Sickle Cell Disease
- 63 Tetanus
- Part IV Current Topics
- Part V Overview of Antibiotics
- Part VI Microbiology/Laboratory Tests
- Part VII Infection Control Precautions
- Index
- References
56 - Blood or Body Fluid Exposure Management and Postexposure Prophylaxis for Hepatitis B and HIV
from Part III - Special Populations
Published online by Cambridge University Press: 15 December 2009
Edited by
Book contents
- Frontmatter
- Contents
- Preface
- Contributors
- Part I Systems
- Part II Pediatrics
- Part III Special Populations
- 50 Bites
- 51 Infections in Oncology Patients
- 52 Ectoparasites
- 53 Fever in Pregnancy
- 54 Fever in the Returning Traveler
- 55 Infectious Complications of Injection Drug Use
- 56 Blood or Body Fluid Exposure Management and Postexposure Prophylaxis for Hepatitis B and HIV
- 57 Postoperative Infections
- 58 Postpartum and Postabortion Infections
- 59 The Febrile Post-Transplant Patient
- 60 Rabies
- 61 Septic Shock
- 62 Sickle Cell Disease
- 63 Tetanus
- Part IV Current Topics
- Part V Overview of Antibiotics
- Part VI Microbiology/Laboratory Tests
- Part VII Infection Control Precautions
- Index
- References
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.
- Type
- Chapter
- Information
- Emergency Management of Infectious Diseases , pp. 373 - 380Publisher: Cambridge University PressPrint publication year: 2008
References
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.
, , , et al. A new strategy for estimating risks of transfusion-transmitted viral infections based on rates of detection of recently infected donors. Transfusion 2005 Feb;45(2):254–64.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention (CDC). HIV/AIDS surveillance report, 2004. Vol. 16. Atlanta, GA: Centers for Disease Control and Prevention, 2005.
, . Potential work-related exposures to bloodborne pathogens by industry and occupation in the United States [abstract M2-B1301]. Paper presented at National HIV Prevention Conference, Atlanta, GA, 2005.Google Scholar
, . Hepatitis B virus infection–natural history and clinical consequences. N Engl J Med 2004 Mar 11;350(11):1118–29.CrossRefGoogle ScholarPubMed
, . Estimated HIV prevalence in the United States at the end of 2003 [Abstract T1-B1101]. Paper presented at 2005 National HIV Prevention Conference, Atlanta, GA, 2005.Google Scholar
, . Seroprevalence of six infectious diseases among adults in the United States by race/ethnicity: data from the third national health and nutrition examination survey, 1988–94. Adv Data 2005 Mar 9;352:1–9.
, , , et al. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) part 1: immunization of infants, children, and adolescents. MMWR Recomm Rep 2005 Dec 23;54(RR-16):1–31.Google ScholarPubMed
, , , et al. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 2005 Sep 30;54(RR-9):1–17.Google ScholarPubMed
, , , et al. Misdiagnosis of HIV infection by HIV-1 plasma viral load testing: a case series. Ann Intern Med 1999 Jan 5;130(1):37–9.CrossRefGoogle ScholarPubMed
, , , et al. HIV RNA testing in the context of nonoccupational postexposure prophylaxis. J Infect Dis 2004 Aug 1;190(3):598–604.CrossRefGoogle ScholarPubMed
, , , et al. Seroconversion following nonoccupational postexposure prophylaxis against HIV. Clin Infect Dis 2005 Nov 15;41(10):1507–13.CrossRefGoogle Scholar
Sexually transmitted diseases treatment guidelines 2002. Centers for Disease Control and Prevention. MMWR Recomm Rep 2002 May 10;51(RR-6):1–78.
, , , et al. Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: recommendations from the U.S. Department of Health and Human Services. MMWR Recomm Rep 2005 Jan 21;54(RR-2):1–20.Google ScholarPubMed
Updated U.S. Public Health Service Guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 2001 Jun 29;50(RR-11):1–52.