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Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor
It is defined as a “ reasonably anticipated skin, eye, mucus membrane or parenteral contact with blood or other potentially infectious materials that may result from the performance of employee's duties.
Testing of Exposure
Testing to determine HBV, HCV, HIV infection status of an exposure source should be performed as soon as possible after obtaining the required consent.
Management of potential Hepatitis B Virus Exposure
If the exposed person has taken Hepatitis B vaccination , Check Anti HBs titre.
If the Anti HBs titre is below the protection level (anti Hbs <10mIU/ml) or if the patient is nonimmune take HBIG * 1 and initiate revaccination.
If Hepatitis B Immunoglobulin is indicated it should be given as soon as possible within 24 hrs, After 7 days, the effectiveness is unknown.
Recommended Postexposure Prophylaxis for Percutaneous and Mucous Membrane Exposure to HBV | |||
Vaccination & Antibody Response status of Exposed Workers | Treatment | ||
Source is HbsAg Positive | Source is HbsAg negative | Source is unkown | |
Unvaccinated/non immune | HBIG* + Vaccine | Initiate Vaccine | Initiate Vaccine |
Previously vaccinated known responder # | No treatment | No treatment | No treatment |
Previously vaccinated non responder | HBIG* + Vaccine | No treatment | If known high risk-source, treat as if source were HbsAg Positive. |
Previously vaccinated antibody response unknown | Test exposed persons for anti-Hbs
| No treatment | Test exposed persons for anti-Hbs
|
* : Dose of HBIG is 0.06 ml/kg IM.
# : Responder is a person with adequate levels of serum antibody to HBsAg (i.e. antiHBs >10mIU/ml).
Management of potential Hepatitis C Virus Exposure
Source patient should be checked for Anti HCV.
Exposed patient should be tested for anti HCV and alanine aminotransferase at baseline and follow up at 4 -6 months.
Immunoglobulins and antivirals are not recommended.
Medical personnel may not take any precautions to prevent secondary transmission during follow up period, but may not donate blood.
Management of potential Human Immunodeficiency Virus Exposusdre
The health care workers baseline HIV status should be checked.
If the source patient is HIV Negative no further follow up is required.
Exposure Type | HIV Positive Class 1 | HIV Class 2 |
Recommended HIV PEP for Mucous Membrane Exposures & Non Intact Skin Exposures | ||
Small Volume | Consider basic 2 drug PEP | Recommend basic 2 drug PEP |
Large Volume | Recommend basic 2 drug PEP | Recommended expanded three drug regimen |
Recommended HIV PEP for Percutaneous Injuries | ||
Less severe | Recommend basic 2 drug PEP | Recommended expanded three drug regimen |
More severe | Recommended expanded three drug regimen | Recommended expanded three drug regimen |
Class 1 : Asymptomatic HIV infection or known low viral load (<1500 RNA copies /ml)
Class II : Symptomatic HIV infection, acquired immunodeficiency syndrome, acute seroconversion or known high viral load.
In case if the source,is known but HIV status cannot be determined (eg :deceased paerson, inadequate sample) generally no PEP is warranted, however consider basic 2 drug PEP for source with HIV risk factors.
In case if the source,is unknown, generally no PEP is warranted, however consider basic 2 drug PEP in settings where exposure to HIV infected persons is likely.
PEP Regimen for HIV
Basic 2 drug regimen
Zidovudine (300mg BD or 200 mg TID) + Lamivudine (150mg BD)
or
Zidovudine (300mg BD or 200 mg TID) + Emtricitabine (200 mg OD)
or
Lamivudine (150mg BD) + Tenofovir (300mg OD)
or
Tenofovir (300mg OD)+ Emtricitabine ( 200 mg OD)
Expanded HIV PEP Regimen
Basic two drug regimen plus one of the following:
Lopinavir/ ritronavir combination 400/100 mg twice daily with food is preferred.
Alternatively atazanvir/fosamprenavir may be considered along with +/- ritonavir.
Updated on 2/1/2015
Reference
Tintinalli
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emmedonline
Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor