Bloodborne Pathogens

Bloodborne pathogens:

Lets take a moment and look at the similarities and differences between Hepatitis A (not bloodborne but included here for information and clarification about the virus), Hepatitis B (HBV), Hepatitis C, and Human Immunodeficiency Virus (HIV) .

Hepatitis B*

Hepatitis A*- not bloodborne

Hepatitis C*

Cause:

Hepatitis B virus

Signs and Symptoms :

About 30% of persons have no signs or symptoms. Signs and symptoms are less common in children than in adults.

  • Jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain.

Transmission:

Hepatitis B is spread when the blood from an infected person enters the body of a person who is not infected. It can be spread through sex, by sharing drugs, needles or "works" when "shooting" drugs, through needle sticks or sharps exposure on the job, or from an infected mother to her baby during birth.

 

Long term effects:

Chronic infection occurs in:

  • 90% of infants infected at birth
  • 30% of children infected at age 1-5 years
  • 6% of persons infected after age 5 years.

Death from chronic liver disease occurs in:

  • 12-25% of chronically infected persons.

Persons at risk of infection:

  • Persons with multiple sex partners or diagnosis of a sexually transmitted disease.
  • Men who have sex with men.
  • Sex contacts of infected persons.
  • Injection drug users.
  • Household contacts of chronically infected persons
  • Infants born to infected mothers.
  • Infants/children of immigrants from areas with high rates of HBV infection.
  • Health care and public safety workers.
  • Hemodialysis patients.

Prevention:

  • Hepatitis B vaccine is the best protection.
  • If you are having sex, but not with one steady partner, use latex condoms correctly and every time you have sex. The efficacy of later condoms in preventing infection with Hepatitis B virus is unknown, but their proper use may reduce transmission.
  • Vaccination with hepatitis B immune globulin for infants born to infected mothers.
  • Do not shoot drugs, share drugs or drug "shooting" items or "works".
  • Do not share personal care items that might have blood on them (razors, toothbrushes).
  • Consider the risks if you are thinking about getting a tattoo or body piercing especially if good health practices are not followed. Tattooing and piercing carry risks of needles not being clear (that is, they may be reused from another person after some cleaning). Insist on new, sterile needles for all piercing or tattoos.
  • If you are a health care or public safety worker or work in a school setting where you may come into contact with blood (student wounds, scraped knees, nose bleeds, etc), get vaccinated against hepatitis B, and always follow routine barrier precautions and safely handle needles and other sharps. The school district has vouchers for the vaccine if you are liable to come into contact with blood at work. This can include health room staff, maintenance and janitorial staff, recess staff, kitchen staff, PE staff and some para professionals working in areas with children who are known to act our physically. Contact a nurse for the voucher.

 

 

Statistics and Trends:

  • Number of new infections per year has declined from an average of 260,000 in the 1980s to about 73,000 in 2003.
  • The highest rate of disease occurs in 20-49 year olds.
  • Greatest decline has happened among children and adolescents due to routine hepatitis B vaccination.
  • Estimated 1.25 million chronically infected Americans, of whom 20-30% acquired their infection in childhood.

Cause:

Hepatitis A virus

Signs and Symptoms:

Adults will have signs and symptoms more often than children.

  • Jaundice, fatigue, abdominal pain, loss of appetite, nausea, diarrhea, fever.

Transmission:

Found in the stool (feces) of persons with hepatitis A.

Hepatitis A is usually spread from person to person by putting something in the mouth (even though it may look clean) that has been contaminated with the stool of a person with hepatitis A.

Long term effects:

There is not chronic (long-term) infection. Once you have had hepatitis A you cannot get it again. About 15% of people infected with hepatitis A virus will have prolonged or relapsing symptoms over a 6-9 month period.

 

 

 

 

 

 

 

Persons at risk of infection:

  • Household contacts of infected persons.
  • Sex contacts of infected persons.
  • Persons, especially children, living in areas with increased rates of hepatitis A during the baseline period from 1987-1997.
  • Persons traveling to countries where hepatitis A is common.
  • Men who have sex with men.
  • Injecting and non-injecting drug users.

 

 

Prevention:

  • Hepatitis A vaccine is the best protection.
  • Short term protection against hepatitis A is available from immune globulin (within 2 weeks of contact.)
  • Always wash your hands with soap and water after using the bathroom, changing a diaper, and before preparing and eating food.

Vaccination is available and recommended for some people.

Cause:

Hepatitis C virus

Signs and Symptoms:

80% of the persons with this disease have no symptoms.

  • Jaundice, fatigue, dark urine, abdominal pain, loss of appetite, and nausea.

 

Transmission:

Occurs when blood from an infected person enters he body of a person who is not infected.

Hepatitis C can be spread through sex, by sharing drugs, needles or "works" when "shooting" drugs, through needle sticks or sharps exposures on the job, or from an infected mother to her baby during birth.

 

 

Long term effects:

  • Chronic infection: 55%-85% of infected persons
  • Chronic liver disease: 70% of chronically infected persons
  • Deaths from chronic liver disease: 1%-5% of infected persons may die
  • Leading indication for liver transplant.

 

 

 

Prevention:

  • There is no vaccine to prevent hepatitis C.
    * Do not shoot drugs, share drugs or drug "shooting" items or "works".
  • Do not share personal care items that might have blood on them (razors, toothbrushes.)
  • If you are a health care, public safety worker or work in a school setting where you may come into contact with blood (student wounds, scraped knees, nose bleeds, etc), always follow routine barrier precautions and safely handle needles and other sharps; get vaccinated against hepatitis B.
  • Consider the risks if you are thinking about getting a tattoo or body piercing especially if good health practices are not followed. Tattooing and piercing carry risks of needles not being clear (that is, they may be reused from another person after some cleaning). Insist on new, sterile needles for all piercing or tattoos.
  • Hepatitis C can be spread by sex, but this is rare. If you are having sex with more than one steady partner, use latex condoms correctly and every time to prevent the spread of sexually transmitted diseases. You should also get vaccinated against hepatitis B.
  • If you are Hepatitis C positive, do not donate blood, organs, or tissue.

Statistics and trends:

  • Number of new infections per year has declined from an average of 240,000 in the 1980s to about 30,000 in 2003. Most infections are due to illegal injection drug use.
  • Transfusion-associated cases occurred prior to blood donor screening; now occurs in less than one per 2 million transfused units of blood.
  • Estimated 3.9 million (1.8%) Americans have been infected with Hepatitis C virus, of whom 2.7 million are chronically infected.
  • The risk of perinatal Hepatitis C transmission is about 4%.
  • If co-infected with HIV the risk for perinatal infection is about 19%.

More information on Hepatitis B can be obtained by clicking here or by visiting the cdc.gov web site.

More information is available on Hepatitis A by clicking here or by visiting the cdc.gov web site.

More information on Hepatitis C can be obtained by clicking here or by visiting the cdc.gov web site.

*Information obtained from the cdc.gov web site October 25, 2005


Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS)-

The following information are excerpts from the HIV Infection and AIDS: An Overview published by the National Institutes of Health, U.S. Department of Health and Human Services dated March 2005. A complete copy of the NIAID handout may be obtained by logging into www.niaid.nih.gov/fact sheets/hivinf.htm.

AIDS (acquired immunodeficiency syndrome) was first reported in the United states in 1981 and has since become a major worldwide epidemic. AIDS is caused by HIV (human immunodeficiency virus). By killing or damaging cells of the body's immune system, HIV progressively destroys the body's ability to fight infections and certain cancers. People diagnosed with AIDS may get life -threatening diseases called opportunistic infections, which are caused by microbes such as viruses or bacteria that usually do not make health people sick.More than 900,000 cases of AIDS have been reported in the United States since 1981. As many as 950,000 Americans may be infected with HIV, one-quarter of whom are unaware of their infection. The epidemic is growing most rapidly among heterosexual women, heterosexual and gay teenagers, and heterosexual and gay minority populations and is a leading killer of African-American males ages 25-44.

People with sexually transmitted infection may be more susceptible to getting HIV infection during sex with infected partners.

Transmission:

  • HIV is spread most commonly by having unprotected sex with an infected partner.
  • HIV can infect anyone who practices risky behaviors such as sharing drug needles, syringes, has sexual contact with an infected person without using a condom, having sexual contact with someone whose HIV status is unknown.
  • The HIV virus is contained in body fluids of an infected person. These include blood, semen and breast milk.
  • HIV is also spread through contact with infected blood (although today, blood is screened and heat treated, reducing the risk of getting HIV from such transfusions is extremely small.)
  • Women can transmit HIV to their babies during pregnancy or birth, or through breast milk if infected with the virus. Drugs taken during pregnancy and delivery by C-section have significantly reduced the chances the that baby will get infected with HIV.
  • Although researchers have found HIV in the saliva of infected people, there is no evidence that the virus is spread by contact with saliva especially through kissing.The lining of the mouth, however, can be infected by HIV and instances of HIV transmission through oral intercourse have been reported.
  • Studies of families of HIV-infected people have shown clearly that HIV is not spread through casual contact such as the sharing of food utensils, towels and bedding, swimming pools, telephones, or toilet seats.
  • HIV is not spread by biting insects such as mosquitoes or bedbugs. People with sexually transmitted infection may be more susceptible to getting HIV infection during sex with infected partners.

Early symptoms of HIV infection:

Many people will not have any symptoms when they first become infected with HIV. They may have a flu-like illness within a month or two after exposure to the virus which may include: fever, headache, tiredness, enlarged lymph nodes easily felt in the neck, and groin. These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. More persistent or severe symptoms may not appear for 10 years or more after HIV first enters the body in adults, or within 2 years in children born with HIV infection. As the immune system worsens, a variety of complications start to take over. For many people, the first signs of infection are large lymph nodes or "swollen glands" that may be enlarged for more than 3 months. Other symptoms often experienced months to years before the onset of AIDS include: lack of energy, weight loss, frequent fevers and sweats, persistent or frequent yeast infections, persistent skin rashes or flaky skin, pelvic inflammatory diseases in women that does not respond to treatment, or short-term memory loss. Children may grow slowly or be sick a lot.

What is AIDS?

The term AIDS applies to the most advanced stages of HIV infection. In people with AIDS, certain opportunistic infections are often severe and fatal because the immune system is so ravaged by HIV that the body cannot fight off certain bacteria, viruses, fungi, parasites, and other microbes.

Diagnosis:

HIV can usually be diagnosed by testing your blood for the presence of antibodies (disease-fighting proteins) to HIV. HIV antibodies generally do not reach noticeable levels in the blood for 1 to 3 months following infection. If you have been exposed to the virus, you should get an HIV test as soon as you are likely to develop antibodies to the virus-within 6 weeks to 12 months after possible exposure to the virus. (The Center for Disease Control notes that the Food and Drug Administration has approved rapid testing measures which includes use of blood and oral fluids.)

Treatment:

The Food and Drug Administration has approved a number of drugs for treating HIV infection.

  • The first class of drugs is used to treat HIV infection, called nucleoside reverse transcriptase inhibitors, interrupts an early stage of the virus making copies of itself.
  • The second class of drugs used to treat HIV infection are called protease inhibitors, which interrupt the virus from making copies of itself at a later step in its life cycle.
  • A third new class of drugs, known as fusion inhibitors, works by interfering with HIV-1's ability to enter into cells by blocking the merging of the virus with the cell membranes.

Because HIV can become resistant to any of these drugs, health care providers must use a combination treatment to effectively suppress the virus. When three or more drugs are used in combination, it is referred to as a highly active antiretroviral therapy (HAART). Researchers have credited this type of therapy as being a major factor in significantly reducing the number of deaths from AIDS in this country. While it is not a cure for AIDS, it has greatly improved the health of many people with AIDS and it reduces the amount of virus circulating in the blood to nearly undetectable levels. Even with this treatment though, HIV remains present in hiding places, such as the lymph nodes, brain, testes, and retina of the eye in people who have been treated. At this point in time, AIDS is not curable, but people are living longer with treatment.

Prevention:

Because no vaccine for HIV is available, the only way to prevent infection by the virus is to avoid behaviors that put you at risk of infection, such as sharing needles and having unprotected sex.

The Center for Disease Control and Prevention (CDC) also recommends:

When providing assistance to another person, use Universal Precautions as an approach to infection control. According to this concept of universal precautions, all human blood and certain human body fluids are treated as if known to be infectious for Human Immunodeficiency Virus, Hepatitis B Virus, and other bloodborne pathogens. When rendering care, staff should use personal protective equipment such as gloves and CPR barriers; wash hands before and after applying gloves or immediately after any part of the body had contact with blood or other body fluids; use approved disinfectants for soiled surfaces and provide proper cleaning techniques; and dispose of any sharps/needles in approved properly labeled containers; cuts, sores, or other breaks on both the care giver's and the patient's exposed skin should be covered with bandages; .

Surveillance Rates: Center for Disease Control and Prevention reported AIDS cases, cumulative through 2005 -- United States (Numbers do not include U.S. dependencies, possessions, and associated nations.)

Total: 925,452

Washington State HIV/AIDS surveillance report 6/30/2007: 16,342 HIV/AIDS cases reported. 9,774 presumed living.

King County HIV/AIDS surveillance report 6/30/2007: 10,461 HIV/AIDS cases reported. 6,188 presumed living.

Human Immunodeficiency Virus Type 2

In 1986, a second type of HIV, called HIV-2, was isolated from AIDS patients in West Africa, where it may have been present decades earlier.

HIV-1 and HIV-2 have the same modes of transmission and are associated with similar opportunistic infections and AIDS. In persons infected with HIV-2 immunodeficiency seems to develop more slowly and to be milder. People infected with HIV-2 are less infectious early in the course of infection and as the disease advances, HIV-2 infectiousness seems to increase; however the duration of this increased infectiousness is shorter than in HIV -1. The two differ in geographic patterns of infection as well. The United States has fewer reported cases of HIV-2, as it is predominately found in Africa.

More information about HIV-2 is available on the cdc.gov web site