title: Infectious risk for suicide bomber attack victims: management of penetrative wounds in French Army personnel.
abstract: In suicide bomber attacks (SBAs), the explosive forces may disperse fragments from the body of the bomber to which the device is attached. This biologic material can cause physical injury to bystanders and may represent a source of severe infectious diseases.
  
  
  
  Two French soldiers, victims of an SBA in Africa, were managed in the Percy Military Teaching Hospital. They sustained multiple injuries, including some caused by bony fragments converted into projectiles by the explosion. One patient had multiple superficial wounds managed conservatively. The other was treated surgically by serial debridement with removal of a bony piece related to the suicide bomber. The decision not to prescribe antiretroviral therapy was determined after discussion with infectious disease specialists.
  
  
  
  Blood tests for HIV, HCV and HBV were taken at months zero, three and six; all were negative.
  
  
  
  In the French Military Health Service, guidelines are based on evaluation of the viral status of the bomber and on the regional HIV prevalence breakpoint. There is no indication for HCV post-exposition prophylaxis (PEP). Accessible human foreign bodies related to an SBA should be removed as soon as possible, in association with antibiotic medication and a possible HIV PEP. These infectious risks have been discussed in some military and law enforcement literature. It should be a risk-based decision supported by medical intelligence.
authors.affiliation: Clinic of Traumatology and Orthopaedics, Percy Military Hospital, Clamart, France. ndelescalopier@gmail.com.
authors.forename: Nicolas
authors.initials: N
authors.lastname: de l'Escalopier
authors.affiliation: Clinic of Traumatology and Orthopaedics, Percy Military Hospital, Clamart, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Mathieu
authors.affiliation: Clinic of Traumatology and Orthopaedics, Percy Military Hospital, Clamart, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Valade
authors.affiliation: Infectious Diseases Department, Bégin Military Hospital, Saint-Mandé, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Ficko
authors.affiliation: Clinic of Traumatology and Orthopaedics, Percy Military Hospital, Clamart, France.|Department of Surgery, French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Rigal
mesh_terms: D000328:Adult; D001753:Blast Injuries / Q000150:complications* / Q000628:therapy; D003141:Communicable Diseases / Q000209:etiology*; D019548:Crime Victims; D005107:Explosions; D005602:France; D006801:Humans; D008297:Male; D008889:Military Personnel; D056990:Post-Exposure Prophylaxis / Q000379:methods*; D012306:Risk; D013405:Suicide; D014950:Wounds, Penetrating / Q000150:complications* / Q000628:therapy
keywords: French Army; HBV; HCV; HIV; Infectious diseases; Suicide bombers