MSDSs

Bloodborne Pathogens Program

Appendix 4

5. BLOODBORNE DISEASES

There are two bloodborne diseases that merit serious concern for everyone with occupational exposure to human blood or other potentially infectious materials. They are transmitted by two viruses: Hepatitis B Virus (HBV) and the Human Immunodeficiency Virus (HIV).

A number of other pathogens may be transmitted through contact with human blood include non-a/non-b hepatitis, delta hepatitis, syphilis, malaria, babesiosis, brucellosis, leptospirosis, arboviral infections, and cytomegalovirus. By following the universal precautions described in this document you can minimize or prevent the transmission of all bloodborne diseases.

5.1 HEPATITIS B VIRUS (HBV)

Hepatitis is an inflammation of the liver that can be caused by infectious agents, medications, or toxins. Viruses are the most common cause of hepatitis. Of the four hepatitis viruses prevalent in the United States, hepatitis B virus is the major infectious hazard to healthcare workers. It is also the most frequently occurring laboratory infection.

5.1.1 TRANSMISSION OF HEPATITIS B VIRUS

Hepatitis B virus is found in blood, saliva, semen, vaginal secretions, and possibly other body fluids. Blood and blood-derived body fluids contain the highest quantities of virus and are the most likely routes for HBV transmission. The virus is usually found in small quantities in some other fluids such as urine.

Hepatitis B virus is transmitted by

• sexual contact with an infected person
• sharing needles
• contact with infected human materials, either
  - parenterally (direct inoculation through the skin, such as
  from needle sticks)
  - through mucous membranes (such as eyes and mouth)
  - through non-intact skin (such as a cut on a finger)
• infected mother to infant (perinatal)
• contact with recently contaminated surfaces in hemodialysis units
• contact with blood or body fluid spills on environmental surfaces
  (the virus can survive for several days in dried spills)

Hepatitis B virus is not transmitted by

• casual contact
• touching or shaking hands
• eating food prepared by an infected person
• contact with drinking fountains, telephones, or toilets

 

5.1.2 SYMPTOMS OF HEPATITIS B INFECTION

Many persons never have symptoms when they become infected with hepatitis B virus, although they may transmit the disease to others. The symptoms of an acute infection usually are like the flu. They include fatigue, mild fever, muscle and joint aches, nausea, vomiting, loss of appetite, abdominal pain, diarrhea, and jaundice.

Hepatitis B is an unpredictable disease. Some infected persons have no apparent symptoms while others may be incapacitated for weeks or months. Severe cases may be fatal. About 5% to 10% of infected persons become chronic carriers who may spread the disease to others for an indefinite time. This group usually has no symptoms but may develop chronic hepatitis, cirrhosis, or liver cancer.

5.1.3 RISK OF HEPATITIS B INFECTION

According to surveys by the Centers for Disease Control (CDC) in Atlanta, an estimated 8,700 American healthcare workers become infected with hepatitis B each year, resulting in nearly 200 deaths. Healthcare workers are about 20 times more likely to contract the virus than the general public. The table below shows a comparison of hepatitis B infection in the general adult population and in healthcare workers in this country.

5.1.4 HEPATITIS B VACCINE

A vaccine to protect you against hepatitis B infection is available. This vaccine is both safe and effective. It is available to employees without charge if you are at risk of occupational exposure to human blood or other potentially infectious materials.

Three shots of vaccine given in the upper arm will usually provide protection. The most common side effects of vaccination are soreness, swelling, and redness at the vaccination site.

Newer vaccines are not made from blood products. Blood-derived vaccines are processed to inactivate completely HIV and known viral groups. Vaccinated persons do not develop HIV antibodies and may donate blood unless other contraindications are present.

Hepatitis B vaccination is strongly encouraged. You may accept
vaccination at any time following your training. You may decline
vaccination, but if you do, you are required to sign a declination form.

5.2 HUMAN IMMUNODEFICIENCY VIRUS (HIV) AND ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)

Acquired immune deficiency syndrome (AIDS) is caused when the human immunodeficiency virus (HIV) invades the body, damages the immune system, and allows other infectious agents to invade the body and cause disease.

5.2.1 TRANSMISSION OF HIV

HIV is spread through human body fluids, most commonly blood and semen. It has also been transmitted less frequently by vaginal secretions and breast milk. Although it has been isolated from saliva, tears, urine, cerebrospinal fluid, and amniotic fluid, some of these fluids, such as urine, have not been implicated in the transmission of HIV.

HIV is transmitted by

• sexual intercourse with an HIV-infected person
• using HIV-contaminated needles
• contact with infected human materials (see Section 4),
  - parenterally (direct inoculation through the skin or mucous membranes)
  - through mucous membranes (such as eyes and mouth)
  - through non-intact skin (such as a cut on a finger)
• transplants of HIV-infected organs and tissues, such as bone marrow
• transfusions of HIV-infected blood
• mothers to newborn infants (perinatally and breastfeeding)
• semen used for artificial insemination

HIV is not transmitted by

• casual contact with an infected person
• touching or shaking hands
• personal interactions expected of family members such as hugging or kissing on the cheeks or lips
• eating food prepared by an infected person
• sharing food, eating utensils, plates, drinking glasses, or towels
• contact with:

- drinking fountains

- telephones or toilets

- other environmental surfaces

• insects or other animals

HIV is not easy to catch in the workplace. The routes of transmission in the workplace include

• needle sticks or skin punctures from sharp items contaminated with blood or other potentially infectious materials
• extensive contact, splashing, or generation of droplets of blood or other potentially infectious materials into mucous membranes or onto broken skin

 

The virus concentration has been observed to drop 90% to 99% on environmental surfaces within several hours.

5.2.2 SYMPTOMS OF HIV INFECTION

Most persons infected with HIV display no symptoms. Infected persons with advanced HIV infection progress to AIDS. Symptoms may include fungal infections, fatigue, or weight loss. AIDS is diagnosed when a person develops an opportunistic infection. These infections occur when the immune system is severely depressed. Opportunistic infections associated with AIDS include Pneumocystis carinii pneumonia or a rare malignancy called Kaposi's sarcoma.

5.2.3 RISK OF AIDS

The first reports of AIDS in the United States came in 1981. The Centers for Disease Control reported 428,480 cases of Americans with AIDS as of October 1995 and estimate 1 to 1.5 million persons are carriers of the HIV virus.

The extent of HIV infection in general is difficult to assess accurately, and the risk of occupational exposure to HIV cannot be quantified. Infection from HIV represents a small but real hazard to persons handling human blood or other potentially infectious materials as part of their job.

5.2.4 HIV TREATMENT AND VACCINATION

AIDS is managed by treating the HIV infection, providing means of preventing infection, and treating infections or cancers when they occur.

There is currently no vaccine to prevent HIV infection. Prevention is the only way to control transmission of this disease.

[ Up ] [ Foreword ] [ 1.0 OSHA's BBP Standard ] [ 2.0 Occupations with Potential Exposure ] [ 3.0 Exposure Control Plan ] [ 4.0 Potentially Infectious Materials ] [ 5.0 Bloodborne Diseases ] [ 6.0 Recognizing Task and Activities Involving Exposure to Blood ] [ 7.0 Universal Precautions ] [ 8.0 General Personal Protective Practices ] [ 9.0 Personal Protective Equipment ] [ 10.0 Signs, Labels, and Color Coding ] [ 11.0 HIV and HBV Research Laboratories... ] [ 12.0 Emergency Procedures ] [ 13.0 Bibliography ]

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