Occupational Infections

Question 1

SIDAW

Answer 1

Surveillance of infectious diseases at work
Closed in 2015
75% cases due to diarrhoea

Question 2

ACDP

Answer 2

Advisory Committee on Dangerous Pathogens

Question 3

Public Health Control of Diseases Act 1984

Answer 3

Must report notifiable infectious diseases to PH England
30 communicable diseases
Includes HepB, HepC, TB. NOT HIV

Question 4

Hepatitis B Clinical Features (DNA)

Answer 4

Incubation 2-6 months
Acute sx - malaise, fatigue, jaundice, vomiting
30% are asymptomatic
Most patients clear infection spontaneously, 2-10% develop chronic carriage

Question 5

Anti-HBc +

HBsAg +

Answer 5

Current infection or infectious carrier

Question 6

Anti-HBc +
HBsAg +
HBeAg +

Answer 6

Current infection or infectious carrier with particularly high infectivity

Question 7

Anti-HBc +

HBsAg -

Answer 7

Previous infection with natural immunity and non-infectious

Question 8

Treatment of HBV

Answer 8

Interferon alpha, leading to reversal of the carrier state in 40%
Untreated 20-25% of chronic cases infected as adults will get chronic liver disease

Question 9

Immunization of Hep B

Answer 9

Increases level of anti-HBs (surface antibody)
>100IU/L then booster every 5 years
<10IU/L indicates no immunity

Question 10

Anti-HBc

Answer 10

Core antibody

Question 11

HBsAg

Answer 11

Surface antigen

If NEGATIVE can do EPP

Question 12

HBeAg

Answer 12

e antigen

Question 13

anti-HBs

Answer 13

Surface antibody

Question 14

Workers cannot do EPP if

Answer 14

HEP B - Have HBsAg and HBeAg

HEP C - Positive HCV RNA

Question 15

Acute infection Hep C (RNA)

Answer 15

Incubation 6-9 weeks
Mostly asymptomatic. 50% become carriers
At risk of Chronic liver disease and Hep cancer

Question 16

Anti-HCV

Answer 16

HCV antibodies - detectable 3 months after infection

Shows individual was infected but not if active or previous infection

Question 17

Hep C treatment

Answer 17

Combination antiviral therapy successful in clearing HCV in 50% of cases.
Pegylated interferon-alpha weekly with ribavirin
There is no vaccine or PEP for HCV.

Question 18

HIV Reporting

Answer 18

It is not a PD - can claim as an injury if at work
It is not notificable
It IS reportable to HSE under RIDDOR

Question 19

HCW doing EPP with HIV

Answer 19

Can perform EPP if on retroviral therapy and have plasma viral load <200 copies/ml
Need 2 tests 3 months apart
Must remain under OH team

Question 20

AIDS

Answer 20

Associated with CD4 <200

Then get pneumocystis, toxoplasma, cryptosporidia

Question 21

HIV Infectivity

Answer 21

Measured by HIV RNA

Question 22

PEP in HIV

Answer 22

AZT (Zidovudine) is effective in reducing seroconversion following injury
Tx- Truvada and raltegovir
Should be given within 2 hours but can be up to 72 hours

Question 23

TB Vaccination

Answer 23

Offered to all Non-immune HCWs

Routine BCG of children aged 11-13 has stopped. Now for at risk, selective vaccination.

Question 24

Pre-employment for HCW - TB

Answer 24

1. Unexplained cough 3 weeks or more in past year
2. Unexplained weight loss, night sweats, fever
3. Previous tx for TB or family had tx for TB
4. Been to a TB country last 12 months?

Check for BCG Scar. May need CR and IGRA

Question 25

IGRA

Answer 25

Interferon gamma result. If + indicates latent TB | If negative offer vaccination

Question 26

Hepatits C and EPP

Answer 26

Cannot work if anti-HCV positive AND HCV RNA positive | If HCV RNA negative after 12 months and HEP C antibody positive, then can return to EPP

Question 27

Rubella

Answer 27

HCW should have immune status checked as risk of transmitting to pregnant ladies.

Question 28

Varicella

Answer 28

Non immune HCW should not be in contact with pregnant women, immunocompromised, cancer, transplant and leukaemia patients.

Question 29

MSRA

Answer 29

Tx- chlorhexidine mouthwash 5 days, topical mupirocin for 3 days

Question 30

Salmonella Typhi

Answer 30

Not to return to work until 6 negative stool samples

Question 31

Shigella

Answer 31

3 negative stool samples

Question 32

Streptococcus suis

Answer 32

Rare infection of pig farmers, abattoir workers, butchers | PD B9

Question 33

Giardia Intestinalis

Answer 33

Protozoan found in normal stools | Outbreaks in sewage workers

Question 34

Hepatitis A

Answer 34

Small cluster in nurseries and hospitals | Also risk in sewage workers and farm workers

Question 35

Legionnaires

Answer 35

From contaminated condensates from ACs | Pontiac Fever is a mild form of this

Question 36

Hep B and EPP

Answer 36

If positive for HBsAg need to be tested for HBeAg If HBeAg + cannot do EPP If HBsAg negative, need to check HBV DNA If HBV DNA>10^3 then can't do EPP