CPS

Question 1

Factors affecting risk assessment of transmission from exposure to needle stick injury?

Answer 1

1) Source:
- High risk source or not (known or unknown)
2) Device
- Size: larger bore, hollow?
- Blood: visible blood?
3) Injury:
- Penetration: depth/extent

Question 2

Needle stick injury, risk of transmission of:

1) Hep B
2) Hep C
3) HIV

Answer 2

1) Hep B: 4-20%
2) Hep C: 3-10%
3) HIV - 0.2-0.5%

Question 3

Needle Stick Injury: how to manage for HBV if:

- If known to be immune or known to be infected

Answer 3

No action required

Question 4

Needle stick injury: how to manage for HBV if:

• In unimmunized/partially immunized children

Answer 4

Test Ab (anti-HBsAg) and HBsAg immediately, then await results if available in 48h

• If both negative, give PEP with anti-HBV Ig and HBV vaccine
• If Ab-positive, complete HBV vaccine series according to schedule
• If HepBs-Ag positive (patient has HepB) – ref to ID, don’t need to vaccinate

Question 5

Needle stick injury: how to manage for HBV if:

- fully immunized children

Answer 5

• Test for Ab-HBsAg, if results not available in 48h, give one dose of HBV vaccine
• If Ab- positive, no further action is required
• If Ab-negative, test for HBsAg
  * If HB-sAg negative, give HBIG and HBV vaccine
  * If HB-sAg positive – they have Hep B – ref to ID

Question 6

Needle stick injury: when to recommend PEP?

Answer 6

Only if high risk: source likely to have HIV, or needle/syringe with visible blood, or blood injected

For low risk: discuss but do not recommend.

Question 7

Needle stick injury: timing from injury –> PEP

Answer 7

1h to 4h from injury (ideally)
Not indicated if its been >72h

(if parents undecided- start immediately anyway, can DC)

Question 8

Needle stick injury: which ARTs recommended for PEP, how long?

Answer 8

Young children:
- Zidovudine+ Lamivudine + lopinavir/ritonavir

Children 12+
- emtricitabine plus tenofovir plus raltegravir or dolutegravir. (tolerated better)

28 days

Question 9

Needle stick injury: appropriate follow up?

Answer 9

• Second HBV vaccine: 4 weeks
• Test anti-HIV Ab: 4-6 weeks
• Test anti-HIV Ab and anti-HCV Ab: 3 months
• Test anti-HIV, anti-HCV, anti-HbsAg Ab: 6 months
• 3rd dose of HepB vaccine: 6 months (if only 2 previous doses given)
• Test anti-HBsAg level 1-2 months after 3rd dose of vaccine if it was negative at 6 months
• Some may need a 4th dose of hep B vaccine before titers are sufficient for immunity