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Background
- The majority of persons (e.g. source patients) chronically infected with hepatitis B and C (65% to 75%) are not aware of their infection [1]
Clinical Features
- Frequently from needlestick injuries or other occupational exposures to bodily fluids
Differential Diagnosis
Evaluation
- In many systems, a standardized baseline lab panel is sent in the ED and then followed up at employee health the next day
- Frequently, the only actionable lab on the day of exposure is a rapid HIV test from the source patient (for consideration of PEP)
Source-patient labs
- Rapid HIV, hepatitis panel, RPR?
- Hepatitis B and C infectivity of source patient
- HBs-Ag (active infection)
- HBc-Ab IgM (window period)
- HepC-Ab, plus or minus viral load
Exposed-patient labs
- Most require NO laboratory testing
- If giving HIV PEP:
- Rapid HIV
- CBC, C7, LFTs, pregnancy test
Management
HIV
Hepatitis B
- Not normally indicated, assuming patient has had full course of Hepatitis B vaccination (as all healthcare workers should have)
Hepatitis C
- No prophylaxis regimen has any benefit
Disposition
- Outpatient management with employee health follow-up
See Also
References