CDC Updates Guidance for Bloodborne Pathogens After Mass-Casualty Events
Noting that health authorities in Israel and London have reported hepatitis B-infected tissue and bone fragments were found after suicide bombings and could have infected survivors and rescuers, the Centers for Disease Control and Prevention has issued new guidance for using immunizations and post-exposure prophylaxis for tetanus and bloodborne pathogens (including HBV, hepatitis C, and HIV) in people wounded in bombings or other mass-casualty events, whether explosions or natural disasters. The recommendations were published jointly in CDC's Morbidity and Mortality Weekly Report on Aug. 1 and in the American Medical Association's Disaster Medicine and Public Health Preparedness journal.
CDC said the recommendations represent the consensus of U.S. federal public health officials and reflect the experience and input of public health officials at all levels of government and the acute injury response community. They are available at www.cdc.gov/MMWR/preview/mmwrhtml/rr5706a1.htm and at www.dmphp.org.
Louisa E. Chapman of the Immunization Services Division in CDC's National Center for Immunizations and Respiratory Diseases and her co-authors assessed the infection risk for each hazard and for the most part recommend no action is needed to prevent infections. However, they recommend testing for HCV when an HCV-infected source "is known or thought to be likely on the basis of the setting in which the injury occurred or exposure to blood or biologic material from a bomber or multiple other injured persons is suspected." A decision to perform testing of specific persons might be based on the judgment of the treating physician and the preferences of the individual patient; testing during a follow-up referral might be a more feasible logistical option in the setting of response to a mass-casualty event, they concluded.
The guidance says health care providers should determine appropriate actions in response to evaluation of casualties of bombings or other mass-casualty events, assessing individual exposure risk by categorizing the patient into one of three exposure risk categories and assigning each person to the highest risk category for which he or she qualifies. "When evaluating management choices for casualties of bombings or other mass-casualty events, health-care providers should assume that exposure to blood from other injured persons is likely unless available information on the circumstances of injury suggests otherwise. Blast injuries result occasionally in traumatic implantation of bone or other biologic material that is alien to the wounded person. Testing of such matter is not recommended as a useful adjunct for clinical management of wounded persons. Public health authorities can provide assistance in assessing exposure risk for affected groups of injured persons," it states.