Postexposure immunization and prophylaxis of bloodborne pathogens following a traumatic explosive event: preliminary recommendations

Abstract

Background: No definitive guidelines have been established in the United States for postexposure immunization and prophylaxis (PEP) to hepatitis B and C viruses (HBV, HCV) and human immunodeficiency virus (HIV) in the event of a traumatic explosive event.

Methods: The American Medical Association's Center for Public Health Preparedness and Disaster Response assembled a US-Israeli panel of experts, including representatives from disaster medicine, trauma surgery, occupational health, and infectious disease to determine guidelines for adult and pediatric victims following a traumatic explosive event. The panel reviewed the existing Israeli and United Kingdom protocols, previously published Centers for Disease Control and Prevention guidance on occupational and nonoccupational exposures to HBV, HCV, and HIV, before reaching consensus on preliminary guidelines for the United States.

Results: These guidelines recommend an age-appropriate dose and schedule for HBV PEP for individuals presenting from the scene with nonintact skin or mucous membrane exposure, and they also consider HCV and HIV testing in individuals presenting with possible nonintact skin or mucous membrane exposure. The guidelines do not recommend PEP for individuals presenting from the scene with possible superficial skin exposure.

Conclusions: These recommendations offer PEP guidance for bloodborne pathogens and are limited in scope. These recommendations do not address general wound PEP such as tetanus or the need for antibiotics. It is hoped that these guidelines will fill an urgent gap in preparedness until definitive, comprehensive guidelines from the Centers for Disease Control and Prevention are published.