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POST 00773E : INTERVAL INJURY-PROTECTION Follow-up on Post 00764E 9 April 2005 _____________________________________ In response to Vladimir Petrovic's request, this posting contains two contributions. The first is from (mailto:Amber_Hogan@bd.com) from the United States and the second from David Hipgrave (mailto:dhipgrave@unicef.org) of UNICEF/Indonesia. _____________________________________ 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) ------------------------------------------------------- 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 ­ 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 ­ 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 You will find instructions to subscribe, a direct access to archives, links to reference documents and other features. ______________________________________________________________________________ To UNSUBSCRIBE, send a message to : mailto:LISTSERV@listes.ulaval.ca Leave the subject area BLANK In the message body, write unsubscribe TECHNET21E ______________________________________________________________________________ The World Health Organization and UNICEF support TechNet21. The TechNet21 e-Forum is a communication/information tool for generation of ideas on how to improve immunization services. It is moderated by Claude Letarte and is hosted in cooperation with the Centre de coopération internationale en santé et développement, Québec, Canada (http://www.ccisd.org) ______________________________________________________________________________


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