Appendix 46. Accidental exposure to blood (AEB) during a vaccination campaign

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    46.1 First aid

    In case of a needle stick or a cut with blood-contaminated materials (percutaneous exposure):
    – let the wound bleed;
    – clean the wound and the surrounding skin immediately with soap and water, and then rinse;
    – disinfect with polyvidone iodine 10% for 5 minutes.

    46.2 Evaluating the risk of transmission

    The average seroconversion rate with percutaneous exposure is 0.3% for HIV and 10-30% for hepatitis B.
    The actual transmission risk depends on the amount of infected blood transmitted and the source patient’s viral load. Wearing gloves probably reduces the risk greatly.
    During vaccination campaigns, the most common accidents are needle stick injuries with a needle used for IM or SC injection. The risk is considered “intermediate”.
    For an AEB with materials used more than 72 hours previously, the risk of infection is extremely low for HIV, but remains significant for hepatitis B.

    46.3 Decision to treat

    A medical focal person is responsible for analysing the risk, providing psychological support to the person exposed and choosing a course of action.
    The risk analysis should be done quickly so that prophylaxis, if necessary, can be started as soon as possible. The analysis should be painstaking in order to clearly determine whether or not antiretroviral prophylaxis is indicated.
    The type of exposure, the source patient’s serological status and the status of the person exposed (for HBV) should be taken into account when deciding what to do.

     

    Post-AEB prophylaxis in an intermediate exposure context:

     

    HIV

    Status of source
    patient
    (test or clinical
    history)

    Positive Prophylaxis recommended
    Negative No prophylaxis
    Unknown No prophylaxis (a) Citation a. The risk-benefit trade-off is not in favour of starting prophylaxis, except in specific situations that should be evaluated after consultation with a specialist.
    Hepatitis B

    Status of the person
    exposed

    Full immunisation < 5 years ago No booster

    Immunisation incomplete
    or > 5 years ago

    One booster
    No immunisation

    Rapid hepatitis B immunisation schedule

    Antiretroviral prophylaxis should ideally begin within 4 hours of the AEB, and within 72 hours at the latest. The total duration of treatment is 4 weeks.

    46.4 Reporting the AEB and monitoring the person exposed

    Confidentiality is a must, even in emergency or difficult situations.

     

    After local first aid, the accident must be reported to the medical officer, whether post-AEB prophylaxis is prescribed or not.
    An individual AEB reporting form (with the name of the person exposed) is used to describe the AEB and its management. This confidential form must be completed by the doctor.
    Medical follow-up is compulsory, whether post-AEB prophylaxis is prescribed or not.

     

    Clinical monitoring
    – Look for possible signs of seroconversion.
    – Monitor for tolerance to the prophylactic treatment, if prescribed; look for and manage adverse effects, provide support to encourage good treatment adherence.
    – Provide support for the person exposed: reassure (exposure can be a source of worry) and encourage adherence.

     

    Laboratory monitoring
    – Perform antibody testing for HIV, HBV and HCV within 8 days of the AEB. If positive, the accident was not the cause of the seroconversion; if at least one of the tests is positive, refer for specialised follow-up.
    – If HIV-negative, HBV-negative and HCV-negative, follow this schedule:

     

     

    People receiving
    AEB prophylaxis

    People not receiving
    AEB prophylaxis

    Between Day 0 and Day 8

    HIV, HBV (b) Citation b. Hepatitis B virus , HCV (c) Citation c. Hepatitis C virus
    Creatinine clearance if tenofovir

    HIV, HBV, HCV

    Day 15
    (or sooner if clinically
    indicated)

    Hb (d) Citation d. Haemoglobin
    ALT (e) Citation e. Alanine amino transferase
    Creatinine clearance if tenofovir

     

    Month 1
    (or sooner if clinically
    indicated)

    HIV
    Hb
    ALT
    Creatinine clearance if tenofovir

    HIV
    Month 3

    HIV, HBV, HCV
    ALT

    HIV, HBV, HCV
    ALT

    Month 6

    HIV, HBV, HCV
    ALT

    HIV, HBV, HCV
    ALT

    46.5 AEB kit

    AEB kits contain a complete antiretroviral treatment (28 days) for one person.
    The kit below contains a triple therapy regimen (zidovudine/lamivudine + lopinavir/ritonavir), but kit contents may vary depending on the national recommendations.

     

    KMEDMPEP01- List of items Code Qty
    LPV 200 mg/r 50 mg, tablet DORALPRF2T5 120
    AZT 300 mg/3TC 150 mg, tablet DORAYILA3T1 60
    Procedure to be followed in case of accidental exposure to blood L028AIDG02EF 1

     

    • (a)The risk-benefit trade-off is not in favour of starting prophylaxis, except in specific situations that should be evaluated after consultation with a specialist.
    • (b)Hepatitis B virus
    • (c)Hepatitis C virus
    • (d)Haemoglobin
    • (e)Alanine amino transferase