Background

Concern regarding the management of occupational exposure to human immunodeficiency virus (HIV) was heightened when it was realized that HIV is transmitted through bodily fluids. Despite this concern, the risk of hepatitis is actually a greater occupational threat.^[1]

Pathophysiology

The major pathogens of concern in occupational body fluid exposure are HIV, hepatitis A, hepatitis B, and hepatitis C.^{[1, 2, 3, 4, 5]}These pathogens are viruses that require percutaneous or mucosal introduction for infectivity. The major target organs are the immune system (HIV) and the liver (hepatitis). A lesser theoretical concern is tetanus, which attacks the central nervous system.

Epidemiology

The rate of occupational transmission from the blood of an HIV-positive source is believed to be 0.3% for a percutaneous exposure and 0.09% for a mucous membrane (nose, eye, mouth) exposure.^{[6, 7]}For an exposure to intact skin, there is no risk of transmission if removed in timely fashion via washing. The rate of transmission from a hepatitis B–positive source to a nonimmunized host is 6%-24% and 1%-.8% (range, 0%-7%) for exposure to hepatitis C.^[3]Hepatitis B infectivity depends on the hepatitis B e antigen (HBeAg) status of the source. If HBeAg-positive, the rate of transmission can be up to 30% but, when negative, is 1%-6%.

Clinical Presentation

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Author

Megan A Stobart-Gallagher, DO Assistant Professor of Emergency Medicine, Sidney Kimmel Medical College of Thomas Jefferson University; Associate Program Director, Emergency Medicine Residency, Thomas Jefferson University Hospital

Megan A Stobart-Gallagher, DO is a member of the following medical societies: American College of Emergency Physicians, American College of Osteopathic Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eric L Weiss, MD, DTM&H Medical Director, Office of Service Continuity and Disaster Planning, Fellowship Director, Stanford University Medical Center Disaster Medicine Fellowship, Chairman, SUMC and LPCH Bioterrorism and Emergency Preparedness Task Force, Clinical Associate Professor, Department of Surgery (Emergency Medicine), Stanford University Medical Center

Eric L Weiss, MD, DTM&H is a member of the following medical societies: American College of Emergency Physicians, American College of Occupational and Environmental Medicine, American Medical Association, American Society of Tropical Medicine and Hygiene, Physicians for Social Responsibility, Southeastern Surgical Congress, Southern Oncology Association of Practices, Southern Clinical Neurological Society, Wilderness Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician / Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Prisma Health Richland Hospital

Jeter (Jay) Pritchard Taylor, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Columbia Medical Society, Society for Academic Emergency Medicine, South Carolina College of Emergency Physicians, South Carolina Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Employed contractor - Chief Editor for Medscape.

Additional Contributors

Robert E Suter, DO, MHA Professor, Division of Emergency Medicine, University of Texas at Southwestern Medical School

Robert E Suter, DO, MHA is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

William G Gossman, MD, FAAEM Associate Clinical Professor of Emergency Medicine, Creighton University School of Medicine; Chairman, Department of Emergency Medicine, Creighton University Medical Center

William G Gossman, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine

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Brenda Cosens, RN Branch Director, Encompass Home Health

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Mariclaire Cloutier Freelance editor, Medscape Drugs & Diseases

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