Two cases of occupational HIV transmission occur despite prompt PEP

Michael Carter
Published: 14 March 2005

Between 1999 and the end of 2002 six definite and 18 possible cases of occupational transmission of HIV have been reported internationally, according to a paper in the March 10th edition of Eurosurveillance Weekly. In two instances, HIV transmission occurred despite the provision of post-exposure prophylaxis.

Investigators from the UK’s Health Protection Agency conducted a literature search to identify cases of definite and possible HIV transmission in healthcare workers worldwide resulting from occupational exposure. The last such review was conducted in 1999. Cases reported until the end of 2002 were included.

Since then six definite and 18 possible cases of occupational transmission of HIV have been reported. These include:

  • France: two possible cases.
  • Germany: two definite and seven possible cases.
  • UK: six possible cases of healthcare workers exposed during work in high prevalence countries.
  • US: two definite cases and two possible cases.
  • Australia: one definite case.
  • Brazil: one definite case.
  • Trinidad and Tobago: one possible case.

In total, 108 definite cases of occupational HIV transmission have now been reported worldwide and 238 possible case. Most of the definite cases, 91% (96/106) occurred after a needle-stick or similar injury.

Two cases of definite occupational HIV transmission since 1999, one in Australia and one in the US occurred despite the provision of post-exposure prophylaxis (PEP). Both individuals initiated PEP within two hours of the injury, however due to the antiretroviral treatment history of the source patient, one of the healthcare workers had to change their PEP regimen. In the other case a volume of blood was accidentally introduced into the site of the needle-stick injury.

Overall, nurses and laboratory workers account for over two-thirds of all definite cases of occupational HIV transmission, and 39% of possible cases.

“To enable the healthcare worker’s occupational exposure to be appropriately managed, a baseline blood sample should be obtained, HIV PEP should be provided in a timely manner, and appropriate follow-up tests should be performed”, write the investigators. They add “healthcare workers should receive training and education on the management and prevention of occupational exposures, including the use of universal precautions, and the correct disposal of sharps.”

The investigators caution that their data are likely to vastly underestimate the true incidence of occupational exposure, relying as they do on established surveillance procedures and case reporting. There is a lack of information on occupational exposure for Africa, South East Asia and South Asia.

Reference

Tomkins S et al. Occupationally acquired HIV: international reports to December 2002. Eurosurveillance Weekly, 10 (10), March 10th, 2005.

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