Name: Haseebul haq

Roll#:965

Final year BDS

Assignment of OMFS

Topic: Post exposure prophylaxis for HBV HCV and HIV.

Post exposure prophylaxis (PEP) is a treatment that may prevent human

immunodeficiency virus (HIV) infection and is available to anyone likely to
have been exposed to HIV within the previous 72 hours. It is a
combination of anti-HIV drugs that must be taken exactly as prescribed at
very specific times over a four-week period.
PEP will reduce the risk of HIV infection following an exposure to infected
blood or bodily fluids. In the case of occupational exposure in a workplace
(e.g. needlestick injury in a clinic), PEP has been used for a number of
years and has been effective in most

Table 1 - The HBV Panel - Interpretation

Test Results Interpretation

HBsAg Negative The patient is susceptible to an
anti-HBcAg Negative HBV infection and has not been
anti-HBsAg Negative exposed previously to the virus
The patient has not been
vaccinated

HBsAg Negative The patient is immune to HBV as a

anti-HBcAg Positive result of having been infected
anti-HBsAg Positive previously (indicated by the
presence of anti-HBc antibodies
which would not occur if the patient
had been vaccinated)

HBsAg Negative The patient is immune because of

anti-HBcAg Negative vaccination against HBV
anti-HBsAg Positive

HBsAg Positive The patient has an acute HBV

anti-HBcAg Positive infection. Any anti-HBsAg
anti-HBcAg IgM Positive antibodies that have been made are
anti-HBsAg Negative complexed with the large amount of
the antigen and are thus
undetectable

HBsAg Positive The patient has a chronic HBV

anti-HBcAg Positive infection. The IgM anti-HBc has
anti-HBcAg IgM Negative waned
anti-HBsAg Negative

HBsAg Negative The patient may be in the recovery

anti-HBcAg Positive phase of an acute HBV infection.
 anti-HBsAg Negative This patient could be infected and
thus a carrier of HBV. The inability
to detect HBsAg may result from it
being complexed with anti-HBsAg
antibodies in the "window" phase
Other possible interpretations
are that the patient is distantly
immune to HBV but the test was
too insensitive to detect anti-
HBsAg. There may also have
been a false positive for anti-
HBcAg and the patient is
actually uninfected.

Treatment
Supportive care is the major treatment. Anti-HBV immune globulin is effective soon after exposure .It can also be given neonatally to
of HBsAg-positive mothers. Ideally, the immune globulin should be administered within 24 hours of birth or exposure and is probabl
effective after one week from exposure.
There are three FDA-approved drugs for treating hepatitis B.
 Interferon-alpha 2b (Intron A - Schering-Plough) is a protein that mimics the cell’s natural defenses against viral infection.
 Hepsera (Adefovir Dipivoxil – Gilead Sciences) is a nucleotide analog that inhibits HBV DNA polymerase (reverse transcrip
is indicated for the treatment of chronic hepatitis B in adults with evidence of active viral replication and either evidence of p
elevations in serum aminotransferases (ALT or AST) or histologically active disease.
 Lamivudine (Epivir HBV - Glaxo SmithKlein). This is 3TC which is a reverse transcriptase inhibitor that is also approved for
HIV infections. As with all reverse transcriptase inhibitors, the appearance of resistant mutants is a problem. Hepsera can b
patients with Epivir-resistant mutant virus.

Vaccination
This is the best preventative strategy. The current vaccines are subunit vaccines made in yeast
contains the S gene (that codes for HBsAg). The HBV vaccines go under the names of Recomb
addition, there is an approved vaccine against both HAV and HBV (Twinrix – Glaxo). Another fo
contains vaccines against diphtheria, tetanus, pertussis (whooping cough), polio and HBV.

POST-EXPOSURE PROPHYLAXIS

• Two types of products are available for prophylaxis against HBV infection:

> Hepatitis B vaccine, which provides long- term protection against HBV infection, is recommended
for pre-exposure and post- exposure prophylaxis.

HBIG, provides temporary protection (i.e., three to six months) and is only indicated in certain post-
exposure settings.
POST-EXPOSURE PROPHYLAXIS

• No protective antibody response has been identified following HCV infection.

In the absence of PEP for HCV, recommendations for postexposure management are intended to
achieve early identification of chronic disease and, if present, referral for evaluation of treatment
options.

NEEDLE STICK INJURY

THE ACCIDENTAL PUNCTURE OF THE SKIN BY A NEEDLE DURING A MEDICAL INTERVENTION

Accidental contact with blood occurs especially in

the following situations:

> During re-capping

> During surgery, especially during wound closure

> During biopsy

> When an uncapped needle has ended up in bed

linen, surgery clothing etc When taking an unsheathed used needle to the waste container

> During the cleaning up and transporting of waste material

>When using more complex collection & injection techniques

INFECTIONS TRANSMITTED
• The major blood-borne pathogens of concern associated with needle stick injury are:

hepatitis B virus (HBV) 6-30%

hepatitis C virus (HCV) = 2% human immunodeficiency virus (HIV). 0.3%

However, other infectious agents also have the potential for transmission through needle stick
injury. These include:

hepatitis D virus (HDV or delta agent, which is activated in the presence of HBV) hepatitis G virus (GB
virus or GBV-C)

cytomegalovirus (CMV)

Epstein Barr Virus (EBV) West Nile Virus (WNV)

malarial parasites

PREVENTION

Employee training.

Use devices with safety

features to isolate

sharps.

Safe recapping system.

Do not recap needles or scalpels & dispose them through effective disposal system.
Plan for safe handling and disposal of sharps before using them.

MANAGEMENT

[Link] the incident immediately.

2 Wash the area immediately under running water or use an eye-washing bottle as appropriate.

[Link] the wound bleed for three to four minutes whilst continuing to wash the area. Dry area with
paper towel.

[Link] the wound with a water-impermeable sticking plaster and consider double gloving any hand
injury if continuing to work.

[Link] source patient should be identified and arrangements made for a blood sample to be
obtained, with informed consent. This should be tested for the presence of the blood borne viruses
hepatitis B, hepatitis C and HIV.

[Link] should be made for blood samples to be taken from the staff member (victim) with
informed consent. One sample is marked "for storage" and is retained in the relevant laboratory.
The other is analyzed to determine the staff members hepatitis B antibody level.

• Further assessment, treatment and follow up of the staff member are performed in accordance
with current best practice. Arrangements should be in place for speedy assessment and treatment.

Counseling, reassurance and information may be required and arrangements for accessing this
should be in place as appropriate.

Appropriate records must be kept.