CDC Recommendations for Managing Exposures

Centers for Disease Control and Prevention recommendations for managing occupational exposures to HIV, hepatitis B virus, and hepatitis C virus include the following steps:¹

Provide immediate care to the exposure site.

• Wash wounds and skin with soap and water.

• Flush mucous membranes with water.

Determine risk associated with exposure by:

• type of fluid (e.g., blood, visibly bloody fluid, other potentially infectious fluid or tissue, and concentrated virus);

• type of exposure (i.e., percutaneous injury, mucous membrane or nonintact skin exposure, and bites resulting in blood exposure).

Evaluate exposure source.

• Assess the risk of infection using available information.

• Test known sources for HBsAg, anti-HCV, and HIV antibody (consider using rapid testing).

• For unknown sources, assess risk of exposure to HBV, HCV, or HIV infection.

• Do not test discarded needles or syringes for virus contamination.

Evaluate the exposed person.

• Assess immune status for HBV infection (i.e., by history of hepatitis B vaccination and vaccine response).

Give post-exposure prophylaxis (PEP) for exposures posing risk of infection transmission.

• HBV. PEP with hepatitis B immune globulin (HBIG) and/or hepatitis B vaccine series should be considered for occupational exposures after evaluation of the hepatitis B surface antigen status of the source and the vaccination and vaccine-response status of the exposed person.

• HCV. PEP not recommended.

• HIV. These steps are advised:

— Initiate PEP as soon as possible, preferably within hours of exposure.

— Offer pregnancy testing to all women of childbearing age not known to be pregnant.

— Seek expert consultation if viral resistance is suspected.

— Administer PEP for four weeks if tolerated.

Perform follow-up testing and provide counseling.

• Advise exposed persons to seek medical evaluation for any acute illness occurring during follow-up.

HBV exposures

• Perform follow-up anti-HBs testing in persons who receive hepatitis B vaccine.

— Test for anti-HBs one to two months after last dose of vaccine.

— Anti-HBs response to vaccine cannot be ascertained if HBIG was received in the previous three to four months.

HCV exposures

• Perform baseline and follow-up testing for anti-HCV and alanine amino-transferase (ALT) four months to six months after exposures.

• Perform HCV RNA at four weeks to six weeks if earlier diagnosis of HCV infection desired.

• Confirm repeatedly reactive anti-HCV enzyme immunoassays (EIAs) with supplemental tests.

HIV exposures

• Perform HIV-antibody testing for at least six months postexposure (e.g., at baseline, six weeks, three months, and six months).

• Perform HIV antibody testing if illness compatible with an acute retroviral syndrome occurs.

• Advise exposed persons to use precautions to prevent secondary transmission during the follow-up period.

• Evaluate exposed persons taking PEP within 72 hours after exposure and monitor for drug toxicity for at least two weeks.

Reference

1. Centers for Disease Control and Prevention. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for post-exposure prophylaxis. MMWR 2001; 50(RR11):1-42.

---