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

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)

PositiveProphylaxis recommended
NegativeNo prophylaxis
UnknownNo prophylaxis*
Hepatitis B

Status of the person
exposed

Full immunisation < 5 years agoNo booster

Immunisation incomplete
or > 5 years ago

One booster
No immunisation

Rapid hepatitis B immunisation schedule

* 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.

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, HBVa, HCVb
Creatinine clearance if tenofovir

HIV, HBV, HCV

Day 15
(or sooner if clinically
indicated)

Hbc
ALTd
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

a Hepatitis B virus
b Hepatitis C virus
c Haemoglobin
d Alanine amino transferase

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 itemsCodeQty
LPV 200 mg/r 50 mg, tabletDORALPRF2T5120
AZT 300 mg/3TC 150 mg, tabletDORAYILA3T160
Procedure to be followed in case of accidental exposure to bloodL028AIDG02EF1