title: Human bites: bloodborne pathogen risk and postexposure follow-up algorithm.
abstract: Human bites may transmit bloodborne pathogens (BPs) by exposing the biter's oral mucosa to the bitee's blood and the bite wound to biter's saliva. Consequently, bites may require postexposure follow-up per the Occupational Safety and Health Administration (OSHA) BP standard. Literature reveals that BP transmission via bites is rare. Review of available records in our developmental center identified no bite-related BP transmission between 1993 and 2011. To avoid unnecessary testing while remaining OSHA-compliant, we propose an algorithm for selective follow-up of bites. Since hepatitis B virus can be transmitted by mucosal exposure to blood and, rarely, also by nonintact skin exposure to blood-free saliva, all biters and bitees require hepatitis B follow-up. Since hepatitis C virus and human immunodeficiency virus (HIV) transmissions require "visible blood" exposure, and since saliva is usually bloodfree, risk of HCV-HIV transmission from biter to bitee is negligible. Therefore biters need HCV-HIV testing only after bloody saliva bites. Since biter's oral mucosa invariably gets exposed to bitee's blood (reverse exposure), all bitees should be tested for HCV-HIV infectivity. Our proposed algorithm may prevent harm and waste from unnecessary biter testing and venipuncture.
authors.affiliation: Fairview Developmental Center, 2501 Harbor Bivd, Costa Mesa, CA 92626, USA. glohiya@fdc.dds.ca.gov
authors.forename: Ghan-Shyam
authors.initials: GS
authors.lastname: Lohiya
authors.forename: Lilia
authors.initials: L
authors.lastname: Tan-Figueroa
authors.forename: Sapna
authors.initials: S
authors.lastname: Lohiya
authors.forename: Sunita
authors.initials: S
authors.lastname: Lohiya
mesh_terms: D000465:Algorithms; D001734:Bites, Human / Q000453:epidemiology*; D017848:Blood-Borne Pathogens / Q000302:isolation & purification*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D012307:Risk Factors; D012463:Saliva / Q000821:virology; D014481:United States / Q000453:epidemiology; D014766:Viremia / Q000453:epidemiology / Q000635:transmission*