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Human Bite Algorithm

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25 views

Human Bite Algorithm

Uploaded by

Ali Qureshi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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EMI Guidelines - Appendix 6 Algorithm for human bite exposure (updated May 2016)

-35-
Management of BBV risk following human bite breaching skin – or ‘fight bite’ (closed fist injury-

toolkit
see appendix 18) There is no risk of BBV transmission if the skin is not breached. Complete BBV patient management form (appendix 1)

Oral antibiotic (Augmentin if not penicillin allergic) + wound irrigation (If ‘fight bite’ – refer for washout) + tetanus prophylaxis (appendix 15)

No risk of HCV/HIV NO Was biter (source) bleeding from mouth prior to bite? YES
transmission. No Consider risk to biter if bitten person’s blood gets in biter’s mouth
Follow-up
further follow-up required for HBV,
required for HCV or HCV and HIV
HIV. HBV follow-up Assess BBV risk of source (Section 3.3). If source known, test for BBVs or confirm previous results (with consent).
as per HBV PEP table If source unknown or does not consent, is it likely that they are from a high risk group e.g. PWID/MSM/CSW/endemic
(appendix 8) as it is country (Section 3.1)?
theoretically possible
that HBV can be
transmitted through a To date there have only been a handful of reports of BBV transmission from human bites and few of these were
deep tissue bloodless convincing. All cases involved deep bites where there was blood in the mouth of the biter, and where the biter had high
bite. Manage as per viral loads. Thus the absolute risk is not known - deemed to be possible but extremely rare.
table and patient will
need HBsAg (but not
HIV/HCV) level at 6
weeks and 3 months if Assess BBV status of recipient (HBV vaccination, previous BBV tests, baseline bloods (Section 3.4 and appendix 9))
not HBV immune. Clinical management of recipient based on risk assessment (Section 4)

HBV HIV HCV


See Hepatitis B PEP table HIV PEP should only be prescribed where all the following criteria are met: There is currently no
(Appendix 8). PEP available for HCV,
1. It is within 72 hours of the injury but if seroconversion
2. There was deep tissue injury occurs, early treatment
3. The biter was, with complete certainty, bleeding from their mouth prior to the bite is highly effective
4. The biter is known to be HIV positive and is either not on ART or not virologically suppressed on ART. Where (appendix 14)
the biter is on ART with an undetectable viral load for >/= 6 months, PEP is NOT indicated.
If all 4 criteria are met, HIV PEP is indicated. Follow the management steps for HIV PEP prescription as
outlined in the management checklist on the patient management form (appendix 1), and in appendix 7 (HIV
PEP). Outside of this, HIV PEP should not be prescribed without discussion with an ID/HIV specialist, where it
may be considered in rare extreme cases.
toolkit

Information and Follow-up


Level of risk, precautions, follow-up for further testing (appendix 9), vaccination, PEP. Give information leaflets (appendices 28 & 31)

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