Morbidity and Mortality Weekly Report, June 29, 2001 / 50(RR11);45-6
Centers for Disease Control and Prevention

Provide immediate care to the exposure site.

• Wash wounds and skin with soap and water.
• Flush mucous membranes with water.

Determine risk associated with exposure by

• type of fluid (e.g., blood, visibly bloody fluid, other potentially infectious fluid or tissue, and concentrated virus) and
• type of exposure (i.e., percutaneous injury, mucous membrane or nonintact skin exposure, and bites resulting in blood exposure).

Evaluate exposure source.

• Assess the risk of infection using available information.
• Test known sources for HBsAg, anti-HCV, and HIV antibody (consider using rapid testing).
• For unknown sources, assess risk of exposure to HBV, HCV, or HIV infection.
• Do not test discarded needles or syringes for virus contamination.

Evaluate the exposed person.

• Assess immune status for HBV infection (i.e., by history of hepatitis B vaccination and vaccine response).

Give PEP for exposures posing risk of infection transmission.

• HBV: See Table 3.
• HCV: PEP not recommended.
• HIV: See Table 4 and Table 5.
• --- Initiate PEP as soon as possible, preferably within hours of exposure.
• --- Offer pregnancy testing to all women of childbearing age not known to be pregnant.
• --- Seek expert consultation if viral resistance is suspected.
• --- Administer PEP for 4 weeks if tolerated.

Perform follow-up testing and provide counseling.

• Advise exposed persons to seek medical evaluation for any acute illness occurring during follow-up.

HBV exposures

• Perform follow-up anti-HBs testing in persons who receive hepatitis B vaccine.
• --- Test for anti-HBs 1--2 months after last dose of vaccine.
• --- Anti-HBs response to vaccine cannot be ascertained if HBIG was received in the previous 3--4 months.

HCV exposures

• Perform baseline and follow-up testing for anti-HCV and alanine amino- transferase (ALT) 4--6 months after exposures.
• Perform HCV RNA at 4--6 weeks if earlier diagnosis of HCV infection desired.
• Confirm repeatedly reactive anti-HCV enzyme immunoassays (EIAs) with supplemental tests.

HIV exposures

• Perform HIV-antibody testing for at least 6 months postexposure (e.g., at baseline, 6 weeks, 3 months, and 6 months).
• Perform HIV antibody testing if illness compatible with an acute retroviral syndrome occurs.
• Advise exposed persons to use precautions to prevent secondary transmission during the follow-up period.
• Evaluate exposed persons taking PEP within 72 hours after exposure and monitor for drug toxicity for at least 2 weeks.

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