13th International AIDS Conference Durban, South Africa - July 9-July 14, 2000

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. TuOrC317)

de Waal N, Cotton MF
N. de Waal, Dept Paediatrcs and Child Health, Dept Paediatrics and Child Health, Tygerberg Hospital, Parow, 7295, South Africa, Tel.: +27 219 384 538, Fax: +27 21 938 9138, E-mail: steve.ship@yebo.co.za

INTRODUCTION: Illegal dumping of medical waste occurs commonly in South Africa.Little information on management and outcome of children exposed are available. Description of incident: On 15 Sept 1999 44 children (median age 9.7 y) presented after a mass exposure incident. Used needles and syringes had been discarded on their soccer field. Children played darts with the discarded needles. On 16 Sept another 10 children were seen. Management: Bloods were drawn for HIV and Hepatitis B (HB) All were immunized against HB. A stat dose of zidovudine (ZDV) and lamivudine was given to all with visible wounds or a history percutaneous injury. Younger children were given antiretrovirals (ARV) as we considered their histories unreliable. Parents were counselled. Follow-up: Further visits were at the community clinic for patient convenience. Children were reviewed at weeks 1 & 3 for drug compliance and side effects. At week 4, the second HB vaccination was given. At 3 months, HIV and HB serology was repeated. At 6 months HB immunization and serology will be repeated.

RESULTS: 44/54 (81%) were given ARV. 18/44 (40%) had entrance wounds. Initial HIV serology was negative, 6 had antibody to HB surface ag and 2 were HB surface ag positive. At week 1, all patients on ARVs were seen. By week 3, 30 patients (55.6%) were seen and 14 of 27 (51%) on ARVs were compliant. 38 (71.4%) attended at 4 weeks. At 3 months, none of the 35 (65%) children had seroconverted for either virus. The total cost of the ARVs was R35 000. ZDV, alone, cost R13 674 and laboratory expenditure was R15 842 (R6 = $1). The exposure incident sensitized the community to HIV.

CONCLUSIONS: Follow-up of patients is difficult. Compliance with ARVs was poor. Recommendations: 1) ARV compliance should be carefully monitored. 2) ZDV alone should be adequate and is cheaper. 3) In a non-mobile community a 3 months visit is unnecessary.

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