Vaccination after needlestick injury

[emmavix]

Hi

I'm in England & my 3-year old daughter recently found a hypodermic needle (without a syringe attached) at an outdoor museum & pricked her finger on it. At hospital, they were very worried that she wasn't vaccinated & spent 4 hours trying to find someone to convince us to give her a full set of vaccinations. We agreed to accept tetanus & Hepatitis B vaccinations and then later declined tetanus as it was only available with diptheria & pertussis.

She had the 1st Hep B vaccination but I now wonder whether she really needs further ones. I have been told that there is an infinitely small chance of her having caught anything & we don't even know if the needle had been used. It had no signs of anything on it & was an intra-muscular needle. If it was infected with Hepatitis B (which had somehow managed to survive outside the human body for how ever many hours the needle had been there for), wouldn't one vaccination offer as much protection as a course of them?

Any help greatly appreciated.

Vix

[carriebft]

Hepatitis B can be infectious up to 1 week outside the body (some say 10 days), according to some resources I have read (I will try and pull them up). One vaccine will not offer complete protection to someone her age who has had no previous doses.

the cdc says:

Unvaccinated persons should receive the hepatitis B vaccine series with the first dose administered as soon as possible after exposure, preferably within 24 hours. The vaccine series should be completed in accordance with the age-appropriate dose and schedule

more here with some study backup (they mention 2 doses of hbig being 75% effective)

For inadvertent percutaneous exposure, only regimens including HBIG and/or immune globulin (IG) have been studied. A regimen of two doses of HBIG, one given after exposure and one a month later, is about 75% effective in preventing hepatitis B in this setting (A6, A7). For sexual exposure to a person with acute hepatitis B, a single dose of HBIG is 75% effective if administered within 2 weeks of last sexual exposure (A8). The efficacy of IG for postexposure prophylaxis is uncertain; IG no longer has a role in postexposure prophylaxis of hepatitis B because of the availability of HBIG and the wider use of hepatitis B vaccine.

http://www.ochealthinfo.com/epi/hepatitisB.htm


Given the importance of the 24 hour time frame, I would get dose 1 and then perhaps get results on the needle? edit- do they give hbig choice?

let me see if i can find numbers on the second dose of heb b vax.

[carriebft]

http://www.cdc.gov/mmwr/preview/mmwrhtml/00041917.htm

there's more from the cdc, they seem most concerned, when the source has unknown hepB status, that you get one dose of vaccine within 7 days; then they go on to say get the rest of the series "as recommended."

I am not an expert, but it seems to me that the first dose is the most critical, but I just can't be sure what the importance of the second or third is when talking about possible exposure. all the studies I am looking at are checking antibodies after dose 2 and 3, but give no numbers after one. they seem to agree that three doses can be over 95% protective, lower percentage after two. I might infer that to mean even lower after one?

[crunchy_mommy]

Vaccinating her after the fact won't prevent anything, it's 'too late' -- your body needs time to build up antibodies BEFORE being exposed -- though it could help if she encounters a similar situation down the line.

[carriebft]

that is not the case, actually. vaccination or use of hbig are both effective in preventing the infection post exposure.

[crunchy_mommy]

Originally Posted by carriebft

that is not the case, actually. vaccination or use of hbig are both effective in preventing the infection post exposure.

OK I stand corrected, I was only half paying attention to it & now see that it was Hep B in question, I shouldn't have posted without reading carefully. But regardless, the only studies I have found in support of this were not very well-designed, i.e. 4 monkeys with no controls... I'd love more research on post-exposure vaccination if you have it available!! (I'm sure it would help the OP with her decision as well!)

[MountainMamaGC]

My husband works in a prison and the actual chance of getting something like HIV (0.3%) from one needlestick is pretty low. Hep C is 1.8%.

Hep B is more contagious so I would actually vaccinate or do the immunoglobulin if I thought my child had been exposed. Isnt the shot like 3 months down the line? I dont she would still be in danger 3 months later.

I got the info here

http://www.ccohs.ca/oshanswers/disea..._injuries.html

[emmavix]

Thanks for all your replies. The immuno globulin wasn't offered to us so she's just had the standard vaccine. I'm still not sure about doses 2 & 3 and the information doesn't seem to make this clear...

Any more help also appreciated!

Victoria