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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

Roland C. Merchant
Affiliation:
Assistant Professor of Emergency Medicine and Community Health, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, RI
Michelle E. Roland
Affiliation:
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
Rachel L. Chin
Affiliation:
University of California, San Francisco
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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.

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Chapter
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Publisher: Cambridge University Press
Print publication year: 2008

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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.
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  • Blood or Body Fluid Exposure Management and Postexposure Prophylaxis for Hepatitis B and HIV
    • 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
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.057
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Blood or Body Fluid Exposure Management and Postexposure Prophylaxis for Hepatitis B and HIV
    • 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
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.057
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Blood or Body Fluid Exposure Management and Postexposure Prophylaxis for Hepatitis B and HIV
    • 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
  • Book: Emergency Management of Infectious Diseases
  • Online publication: 15 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547454.057
Available formats
×