社区中废弃针头导致的儿童伤害：流行病学及血清转化风险

Pediatric injuries from needles discarded in the community: epidemiology and risk of seroconversion.

作者信息

Papenburg Jesse, Blais Denis, Moore Dorothy, Al-Hosni Mohammed, Laferrière Céline, Tapiero Bruce, Quach Caroline

机构信息

Infectious Diseases Division, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.

出版信息

Pediatrics. 2008 Aug;122(2):e487-92. doi: 10.1542/peds.2008-0290.

DOI:10.1542/peds.2008-0290

PMID:18676535

Abstract

OBJECTIVES

Although anxiety exists concerning the perceived risk of transmission of bloodborne viruses after community-acquired needlestick injuries, seroconversion seems to be rare. The objectives of this study were to describe the epidemiology of pediatric community-acquired needlestick injuries and to estimate the risk of seroconversion for HIV, hepatitis B virus, and hepatitis C virus in these events.

METHODS

The study population included all of the children presenting with community-acquired needlestick injuries to the Montreal Children's Hospital between 1988 and 2006 and to Hôpital Sainte-Justine between 1995 and 2006. Data were collected prospectively at Hôpital Sainte-Justine from 2001 to 2006. All of the other data were reviewed retrospectively by using a standardized case report form.

RESULTS

A total of 274 patients were identified over a period of 19 years. Mean age was 7.9 +/- 3.4 years. A total of 176 (64.2%) were boys. Most injuries occurred in streets (29.2%) or parks (24.1%), and 64.6% of children purposely picked up the needle. Only 36 patients (13.1%) noted blood on the device. Among the 230 patients not known to be immune for hepatitis B virus, 189 (82.2%) received hepatitis B immunoglobulin, and 213 (92.6%) received hepatitis B virus vaccine. Prophylactic antiretroviral therapy was offered beginning in 1997. Of the 210 patients who presented thereafter, 82 (39.0%) received chemoprophylaxis, of whom 69 (84.1%) completed a 4-week course of therapy. The use of a protease inhibitor was not associated with a significantly higher risk of adverse effects or early discontinuation of therapy. At 6 months, 189 were tested for HIV, 167 for hepatitis B virus, and 159 for hepatitis C virus. There were no seroconversions.

CONCLUSIONS

We observed no seroconversions in 274 pediatric community-acquired needlestick injuries, thereby confirming that the risk of transmission of bloodborne viruses in these events is very low.

摘要

目的

尽管人们对社区获得性针刺伤后血源性病原体传播的感知风险存在担忧，但血清转化似乎很少见。本研究的目的是描述儿童社区获得性针刺伤的流行病学情况，并评估这些事件中感染人类免疫缺陷病毒（HIV）、乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）的血清转化风险。

方法

研究人群包括1988年至2006年间在蒙特利尔儿童医院以及1995年至2006年间在圣贾斯汀医院出现社区获得性针刺伤的所有儿童。2001年至2006年期间在圣贾斯汀医院前瞻性收集数据。所有其他数据通过标准化病例报告表进行回顾性审查。

结果

在19年期间共识别出274例患者。平均年龄为7.9±3.4岁。共有176例（64.2%）为男孩。大多数刺伤发生在街道（29.2%）或公园（24.1%），64.6%的儿童故意捡起针头。只有36例患者（13.1%）注意到器械上有血迹。在230例未知对HBV免疫的患者中，189例（82.2%）接受了乙型肝炎免疫球蛋白治疗，213例（92.6%）接受了HBV疫苗接种。从1997年开始提供预防性抗逆转录病毒治疗。在此之后出现的210例患者中，82例（39.0%）接受了化学预防，其中69例（84.1%）完成了为期4周的治疗疗程。使用蛋白酶抑制剂与不良反应风险显著升高或治疗早期停药无关。在6个月时，189例接受了HIV检测，167例接受了HBV检测，159例接受了HCV检测。均未发生血清转化。