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Epidemiologic Notes and Reports Update: Evaluation of Human T-Lymphotropic Virus Type III/ Lymphadenopathy-Associated Virus Infection in Health-Care Personnel -- United States
Publication date: 09/27/1985
Table of Contents
ArticleThe occurrence of the acquired immunodeficiency syndrome (AIDS) in intravenous (IV) drug users, blood transfusion recipients, and persons with hemophilia indicates that parenteral transmission of human T-lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) occurs via infectious blood or blood products (1). Currently available practices have nearly eliminated these risks for transfusion recipients and persons with hemophilia (2,3). Because health-care personnel may be inadvertently exposed to the blood of AIDS patients, several studies have been conducted to determine the prevalence of HTLV-III/LAV antibodies in health-care personnel who have cared for these patients (4-10). Combining published results with data reported to CDC shows that, to date, 1,758 health-care workers participating in such studies have been tested for antibodies to HTLV-III. Twenty-six (1.5%) were seropositive, and all but three of these persons belonged to groups recognized to be at increased risk for AIDS. Epidemiologic information is not available for one of these three health-care workers who was tested anonymously. Because of the high level of interest in these studies and in the potential for occupational transmission of HTLV-III/LAV through parenteral and mucosal routes, the case histories for these two health-care workers are reported below.
Patient 1. A female health-care worker was tested for serum antibodies to HTLV-III in November 1984 as part of a study of hospital personnel. She had sustained accidental needlestick injuries in November 1983 and March 1984 (12 months and 8 months before) while drawing blood from patients with AIDS . At the time of enrollment in the study, serum antibodies to HTLV-III were detected by enzyme immunoassay (EIA) and Western blot techniques. No serum obtained before or within 12 months after the needlesticks was available for testing. She was in good health until June 1984, when she developed mild but persistent lymphadenopathy, most marked in the axilla. Beginning in August 1984, she experienced intermittent diarrhea. When interviewed by a physician, the patient denied IV drug use or blood transfusions and reported being heterosexually monogamous since 1981. Her long-term sex partner denied homosexual activity, IV drug use, or other known risk factors when interviewed separately. Although repeatedly antibody negative by EIA and Western blot methods over an 8-month period, HTLV-III was recovered from his peripheral lymphocytes in April 1985 but could not be recovered from lymphocytes obtained several months later.
Patient 2. A male laboratory worker was discovered to be lymphopenic after he volunteered to be tested in conjunction with a study in April 1985. At that time, he had serum antibodies to HTLV-III by EIA and Western blot methods. No previous blood samples were available for testing. As part of his job, he processed platelets pooled from individual donors for transfusion. In December 1983, he sustained an accidental cut on the hand while processing blood from a patient with leukemia. He also sustained an accidental needlestick injury in August 1984 while processing a unit of pooled platelets. Both incidents resulted in parenteral exposure to blood from other persons. It is not known whether any of the individual platelet donors or the patient with leukemia had HTLV-III infection. The health-care worker is asymptomatic, although he had transient cervical lymphadenopathy during early 1985. HTLV-III was recovered from his peripheral blood lymphocytes in September 1985. During three independent interviews, he denied any homosexual activity, IV drug use, foreign travel, or blood transfusions. He described himself as heterosexual and was not aware that any of his approximately 12 lifetime sex partners had AIDS or were at increased risk for HTLV-III/LAV infection.
Reported by J Nadler, MD, S Landesman, MD, D Rechtman, MD, S Holman, MS, New York City, New York; J Groopman, MD, Boston, G Seage, MPH, Boston Dept of Health and Hospitals, G Grady, MD, Massachusetts Dept of Health; J Gerberding, MD, San Francisco, California; Environmental Epidemiology Br, Laboratory of Tumor Cell Biology, National Cancer Institute, National Institutes of Health; Hospital Infections Program, AIDS Br, Div of Viral Diseases, Center for Infectious Diseases, CDC.
Editorial NoteEditorial Note: These two health-care workers probably represent occupational transmission of HTLV-III/LAV due to parenteral exposure, although in neither was a preexposure serum sample available to date the onset of infection. Although not reported during investigations of these two cases, it is difficult to totally assure that additional risk factors for AIDS were absent. For purposes of epidemiologic surveillance, a case of occupationally acquired HTLV-III/LAV infection should ideally include all the following features: a worker with no identifiable risk factors for AIDS whose serum, obtained within several of after the date of a possible occupational exposure, is negative for antibody to HTLV-III/LAV but whose follow-up serum, in absence of interim exposure to other risk factors, is positive for antibody to HTLV-III/LAV. The two cases reported here do not fully meet these ideal criteria. However, there is one published report from England of a nurse who developed HTLV-III/LAV antibody following an accidental needlestick injury (11). Her serum was negative for antibody to HTLV-III/LAV at the time of exposure. This nurse reportedly had none of the recognized risk factors for AIDS and was asymptomatic at the time the report was published.
The two cases reported here represent the only known evidence of probable occupational transmission of HTLV-III/LAV in the United States. This confirms that the risk of transmission of HTLV-III/LAV infection to health-care workers from patients is extremely low (4-10). HTLV-III/LAV infections appear to be much less transmissible through needlesticks than hepatitis B; nearly 26% of persons comparably exposed to a hepatitis B surface antigen-positive patient develop infection (12). Nonetheless, personnel should follow recommendations designed to minimize the risk of exposure to parenteral or mucosal (e.g., blood spatter on conjunctiva) contact with potentially infectious materials from patients with AIDS or suspected AIDS (13,14).
Epidemiologic studies of needlestick injuries in hospital personnel indicate that over 40% of the accidents are potentially preventable if recommended precautions are followed when handling used needles or other sharp objects (6). Educational programs to familiarize health-care workers with the basic practices in infection control are essential to the prevention of AIDS and other infections. Health-care workers and others should become familiar with and follow recommended precautions when handling specimens, secretions, and excretions from persons known to be infected with HTLV-III/LAV. Health-care personnel whose serum is positive for HTLV-III/LAV antibody should follow the precautions that have been published for health-care workers with AIDS (15).
- CDC. Antibodies to a retrovirus etiologically associated with acquired immunodeficiency syndrome (AIDS) in populations with increased incidences of the syndrome. MMWR 1984;33:377-9.
- CDC. Update: revised public health service definition of persons who should refrain from donating blood and plasma--United States. MMWR 1985;34:547-8.
- CDC. Update: acquired immunodeficiency syndrome (AIDS) in persons with hemophilia. MMWR 1984;33:589-92.
- Hirsch MS, Wormser GP, Schooley RT, et al. Risk of nosocomial infection with human T-cell lymphotropic virus III (HTLV-III). N Engl J Med 1985;312:1-4.
- CDC. Update: prospective evaluation of health-care workers exposed via the parenteral or mucous-membrane route to blood or body fluids from patients with acquired immunodeficiency syndrome-- United States. MMWR 1985;34:101-3.
- McCray E. The cooperative needlestick study group. Prospective evaluation of health-care workers with parenteral or mucous membrane exposure to blood from patients with acquired immunodeficiency syndrome (AIDS), United States: an update. In: Program and abstracts of the 25th Interscience Conference on Antimicrobial Agents and Chemotherapy. Minneapolis, Minnesota: American Society for Microbiology, 1985 (abstract #225).
- Henderson DK. Personal communication.
- Gerberding JL, Moss AR, Bryant CE, Levy J, Sande MA. Risk of acquired immune deficiency syndrome (AIDS) virus transmission to health care workers. In: Program and abstracts of the 25th Interscience Conference on Antimicrobial Agents and Chemotherapy. Minneapolis, Minnesota: American Society for Microbiology, 1985 (abstract #226).
- Weiss SH, Goedert JJ, Sarngadharan MG, et al. Screening test for HTLV-III (AIDS agent) antibodies. JAMA 1985;253:221-5.
- Weiss SH, Saxinger WC, Rechtman DJ, et al. HTLV-III infection among health care workers. JAMA 1985 (in press).
- Anonymous. Needlestick transmission of HTLV-III from a patient
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