Percutaneous or mucocutaneous exposure to discarded needles or other objects or fluids by children put them at risk for infection with blood-borne pathogens (BBP; HIV, hepatitis B [HBV], hepatitis C [HCV]). The purpose of this project was to retrospectively analyze the epidemiology, management and outcome of children seen at SickKids following such exposures in the community in the Greater Toronto area.
Children <19 years of age who had community-based exposure to discarded needles or other objects or fluids that could contain BBP between January 1, 2001 and December 31, 2014 were included. Sexual exposures and hospital inpatient exposures were excluded. All medical charts of children who had an HIV test submitted through the SickKids Microbiology Laboratory were reviewed.
Of 1492 HIV-tested children, 66 were community-based exposures to objects or fluids that could contain BBP. Needlestick injuries accounted for 68.2% of exposures followed by human bites (7.6%), razors (6.1%), used condoms (4.5%) and various other exposures (13.6%). Median age was 6.3 years (1.3-17.3); 44 were male. Most exposures occurred in schools (31.8%), parks (15.2%) and homes (15.2%). The median interval from exposure to medical attention was 2.4 hours (range: 0 hour-31 days). A source person was identified in 11 (16.7%) cases, all but one being family members. Of known source patients, 7 were known to be HIV infected. Antiretroviral medications were given to 21 (31.8%) children, including 5 exposed to body fluids from a known HIV positive source. 15 (71.4%) completed the recommended 4-week course of antiretroviral therapy. Ten (47.6%) developed adverse events, 4 of whom discontinued therapy early. Follow up serology was done in 42 (66.7%) at 6 weeks and 39 (59.1%) at 3-6 months; 16 (25%) had no follow up testing. None of the children with follow-up testing became infected with HIV, HBV or HCV. Of the 48 children who had not been previously vaccinated against HBV, 23 (47.9%) completed a full series of vaccination.
Although no blood-borne infections occurred in this cohort, our findings indicate that public health interventions in schools and other community settings are needed to reduce the risk of exposures that could pose a risk for infection with BBP.
A. Petrich, None
S. Read, None