Human bites: bloodborne pathogen risk and postexposure follow-up algorithm

Area of Science:

• Occupational Health
• Infectious Diseases
• Public Health

Background:

• Human bites pose a risk of bloodborne pathogen (BP) transmission.
• Current guidelines may lead to unnecessary testing and follow-up.
• BP transmission via human bites is documented as rare.

Purpose of the Study:

• To propose a selective algorithm for post-bite follow-up.
• To ensure Occupational Safety and Health Administration (OSHA) compliance while minimizing unnecessary procedures.
• To reduce patient harm and healthcare waste.

Main Methods:

• Review of institutional records (1993-2011) for bite-related BP transmission.
• Analysis of transmission routes for Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and Human Immunodeficiency Virus (HIV).
• Development of a risk-based algorithm for post-exposure management.

Main Results:

• No bite-related BP transmissions were identified in the reviewed records.
• HBV transmission is possible via mucosal exposure to blood and rarely, saliva.
• HCV and HIV transmission require "visible blood" exposure; risk from saliva is negligible unless bloody.

Conclusions:

• All human bite cases require Hepatitis B follow-up for both biter and bitee.
• HCV and HIV testing for biters is recommended only after bites involving bloody saliva.
• Bitees require HCV-HIV testing due to potential reverse exposure to the bitee's blood.