Routine follow up of community needlestick injuries in children is unnecessary

Children sustaining a needlestick injury in the community do not need routine follow up for hepatitis B (HBV) and C (HCV), nor HIV prophylaxis, doctors have concluded from a prospective study in Birmingham, UK. Immunisation against HBV and tetanus is sufficient outside inner London.

The study collected data on all children referred with needlestick injuries in the community to a paediatric infectious diseases clinic of one Birmingham hospital during August 1995-September 2003 from its own accident and emergency department and that at Birmingham Children’s Hospital. Both hospitals introduced guidelines for managing such injuries, in 1997 and 1999, respectively.

Three quarters of the 53 children referred had the primary dose of HBV vaccine at presentation, as per the guidelines; HIV PEP was not indicated. Blood was taken from all children for HBV, HVC, and HIV testing. Forty children (75%) attended a later outpatient appointment and 25 of them (63%) had repeat tests at six months at their parents’ request; none was positive, and all completed the three dose HBV vaccine regimen. Children lost to follow up were likely to be uninfected because of the low risk in this part of the UK.

The children’s median age was 8.4 (range 1.7–16.5) years, and 63% were boys. Most presented directly and got their injuries by playing with needles discarded in public areas or, in the home, needles used in measuring blood sugar concentration.

Needlestick injuries have been growing ever since first reports in 1987 and are a potential hazard for infections from intravenous drug users.