POST 00773E : INTERVAL INJURY-PROTECTION
Follow-up on Post 00764E
9 April 2005
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In response to Vladimir Petrovic's request, this posting contains two
contributions. The first is from (mailto:[email protected]) from the
United States and the second from David Hipgrave
(mailto:[email protected]) of UNICEF/Indonesia.
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With regard to bloodborne pathogens (non-tetanus, non-rabies, etc), in the
US, we use the document - the "US Public Health Service's Guidelines for
Management of Occupational Exposures to HBV, HCV, and HIV" available at the
following URL :
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm
Granted, this is for occupational post-exposure management, but same holds
true for any percutaneous injury or blood/body fluid exposure to a
potentially infectious material, as we assume that all blood is exposed
with all pathogens under standard precautions. Especially in a community
situation where source testing is likely not an option prior to medical
care of the exposed person (e.g., waste hauler, community member, etc.).
Amber Hogan, MPH
Global Safety Advocacy
BD (Becton, Dickinson and Company)
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For tetanus it obviously depends on whether the person has ever had a
course of TT vaccine. There are clear guidelines on this already, but if
never vaccinated, then the person needs TIg as well as vaccine, and
depending on the wound etc. etc. the later they present the more likely
they will have a problem.
For hepatitis B, one example of post-exposure prophylaxis is in infants
exposed at birth. The question of the exact timing of dose-1 of HepB
vaccine in infants exposed to HBV at birth and the comparative protective
efficacy (PE) of the vaccine after administration at different times after
birth has not been formally assessed in the scientific literature, and most
studies of the PE of the birth-dose HepB vaccine have involved the
additional use of HBV-specific Immunoglobulin. However, there is general
agreement amongst the few studies including a delayed vaccine-only
schedule. Infants in three reports from Taiwan (Lee SD, Lo KJ et al.,
1986), Lee, 1989 in (Andre FE and Zuckerman AJ, 1994), (Goudeau A, Lo KJ et
al., 1983), and in Indonesia (Ruff TA, Gertig DM et al., 1995) received
vaccine alone after 7 days.
In each of these 4 studies the PE was 50 - 57%. The only exception to this
was a PE of 75% amongst another group of Taiwanese infants of HBeAg + women
first vaccinated in their second week of life (Lo KJ, Tsai YT et al.,
1985). With only the latter exception, the PE achieved with dose-1 beyond
one week of age is well below the 70 Â 95% found for vaccine-only regimens
commencing in the first week of life (Mast E, Mahoney FJ and Kane M,
2004), (Poovorawan Y, Sanpavat S et al., 1992), (Xu ZY, Liu CB et al.,
1985), (Wong VC, Ip HM et al., 1984). Accordingly, it appears that delaying
dose-1 beyond 1 week of age reduces its PE against perinatally acquired
infection by 13 Â 45%.
It is dangerous to extrapolate from infants to adults with an exposure, as
although the likelihood of an effective immune response to HepB vaccine is
greatest in infancy and decreases with age, the risk of chronic infection
is also highest then, and diminishes to
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