To The Editors:
A new problem has recently occurred in our cities. Some people, usually children, have needle sticks from syringes used by intravenous drug users and discarded in a public place.1-8 Hepatitis B virus (HBV), hepatitis C virus and HIV-1 are transmitted by parenteral exposure to contaminated blood9:
A 4-year-old boy was admitted in the hospital because of acute hepatitis B virus infection, with HBV surface antigen and IgM surface antibody tests positive. By history the only risk factor was an antecedent injury from a needle discarded by a neighbor known to be infected with HBV and HIV-1. His parents did not consider the incident important and he did not receive immunoprophylaxis. His mother and father are HBV surface antigen- and core antibody-negative. HIV-1 antibodies were not detected in the child. This boy became a chronic carrier of HBV surface antigen for more than 2 years without response to treatment with interferon.
Hepatitis B virus infection from occupational needle sticks has been documented in health care workers.10, 11 The transmission risk is between 6 and 30%, depending on the absence or presence of HBV e antigen.12 If the health care worker is completely vaccinated, there is probably no risk.13
HBV is very infectious, because of the high concentration in blood (109 to 1013/ml)10 the resistance of the virus to external conditions10, 14 and the small inoculum needed for transmission.1, 10
Needles and syringes are discarded by intravenous drug users, who have an high prevalence of HBV infection. In Barcelona the rate of HBV carriers varies between 6.4 and 17%.15 In several studies HBV surface antigen has been demonstrated in syringes discarded in the street and collected in Florence, Italy1 and Barcelona, Spain,3, 16 and HBV DNA in New Haven, CT,17 and Barcelona.3
Our case confirms that the risk of HBV infection exists in the case of an accidental needle stick from a hypodermic needle and syringe discarded by an intravenous drug user in a public place. Postexposure immunoprophylaxis against HBV with vaccine and hyperimmune gamma-globulin in the management of such an accidental exposure should be considered if the child has not already had a complete hepatitis B vaccination.
Óscar García-Algar, M.D.
Oriol Vall, M.D.
Department of Pediatrics; Hospital del Mar; Barcelona, Spain
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