Risk of Hepatitis B Transmission After Accidental Blood Exposure

Hepatitis B transmission issues?

Hello, doctor: I have received the hepatitis B vaccine and have tested positive for antibodies (surface antibody 81, core antibody 0.10).
A few days ago, while changing the dressing for an uncle with liver cirrhosis at the hospital, I accidentally touched a cotton swab that had blood on it to a wound on my hand.
What is the risk of contracting hepatitis in this situation? 😭

Niming, 20~29 year old female. Ask Date: 2023/02/11

Dr. Liao Zhongxin reply Internal Medicine

1.
According to the data from the Centers for Disease Control (https://www.cdc.gov.tw/Category/Page/jlS2jBHpodI34ATlKUy3oQ):
(1) Mode of Transmission: Hepatitis B surface antigen can be found in body fluids and secretions, but only blood, semen, and vaginal secretions are infectious.
The presence of e-antigen indicates a high viral load and increased infectiousness.
Transmission can occur through perinatal infection, as well as through contact with infected blood or body fluids entering the body via skin or mucous membranes.
Therefore, exposure to untested blood and its products, sharing needles or syringes, acupuncture, ear piercing, eyebrow tattooing, tattooing, sharing toothbrushes or razors, and sexual intercourse (for individuals without Hepatitis B surface antibodies who engage in vaginal, anal, or oral sexual contact with Hepatitis B surface antigen-positive individuals without using condoms) can all lead to infection.
In Southeast Asian countries and the Far East, perinatal infection in newborns is a significant route of transmission, especially from mothers who test positive for both Hepatitis B surface antigen and e-antigen, transmitting the virus to their newborns during or after delivery.
(2) Infectious Period: The infectious period extends from a few weeks before the onset of the first clinical symptoms throughout the entire acute phase, and during the chronic carrier phase, asymptomatic infections can also lead to chronic carriage, particularly in infections that occur during infancy.
The infectiousness of chronic carriers varies, with e-antigen-positive carriers being more infectious.
(3) Incubation Period: The incubation period typically ranges from 45 to 180 days, with an average of 60 to 90 days.
The duration of the incubation period is related to the viral load at the time of infection, the mode of transmission, and host factors.
2.
According to Hello Doctor (https://helloyishi.com.tw/stomach/liver-diseases/what-is-hepatitis-b/):
The two main routes of transmission for Hepatitis B are as follows:
• Vertical Transmission: If a mother is a Hepatitis B carrier, she may transmit the virus to her fetus during or after delivery.
Since the implementation of Hepatitis B immunoglobulin and vaccination for newborns in 1984, this mode of transmission has significantly decreased.

• Horizontal Transmission (Contact Transmission): Healthy individuals can become infected by coming into contact with blood containing the Hepatitis B virus through broken skin or mucous membranes.
This can occur through blood transfusions, injections, ear piercing, tattoos, eyebrow tattoos, and sharing everyday items such as toothbrushes, towels, nail clippers, and razors.
Therefore, the likelihood of contracting Hepatitis B through wound exposure is relatively low.

Reply Date: 2023/02/11

More Info

The risk of Hepatitis B transmission after accidental blood exposure, especially in a healthcare setting, is a significant concern. However, your situation involves several factors that can help assess the level of risk more accurately.

Firstly, you mentioned that you have been vaccinated against Hepatitis B and have confirmed the presence of antibodies (surface antibody level of 81). This indicates that you have developed immunity to the virus, which is a crucial protective factor. The presence of Hepatitis B surface antibodies (anti-HBs) typically suggests that you are protected against future infections. The core antibody (anti-HBc) level of 0.10 indicates that you have not had a past infection with Hepatitis B, which further supports your immunity status.

In general, Hepatitis B is transmitted through direct contact with infectious body fluids, primarily blood. The virus can survive outside the body for at least seven days, making it possible for transmission to occur if the virus is present in the blood that comes into contact with an open wound or mucous membranes. However, the risk of transmission in your case is significantly reduced due to your vaccination status.

When you accidentally touched a blood-soaked cotton swab to a wound on your hand, the risk of transmission would depend on several factors:
1. Viral Load: The amount of Hepatitis B virus present in the blood of the infected individual. In patients with chronic Hepatitis B, especially those with liver cirrhosis, the viral load can be high, increasing the risk of transmission.

2. Type of Exposure: The nature of the exposure (e.g., whether the blood was fresh or dried, the size and depth of your wound) can also influence the risk. Fresh blood poses a higher risk than dried blood.

3. Your Immune Status: Since you have been vaccinated and have developed antibodies, your immune system is equipped to fight off the virus if exposed.

4. Wound Condition: If your wound was minor and not actively bleeding, the risk of the virus entering your bloodstream is lower compared to a deep or actively bleeding wound.

Given these factors, while there is a theoretical risk of transmission, your vaccination and the presence of antibodies significantly mitigate that risk. It is important to monitor for any symptoms of Hepatitis B infection, such as jaundice, fatigue, or abdominal pain, but the likelihood of contracting the virus in this scenario is low.

In case of any exposure to blood or body fluids in a healthcare setting, it is advisable to follow up with your hospital's infection control protocols. This may include reporting the incident, getting tested for Hepatitis B and other bloodborne pathogens, and possibly receiving post-exposure prophylaxis if deemed necessary by a healthcare professional.

In summary, while there is a risk associated with accidental exposure to blood, your vaccination status and the presence of antibodies provide a strong defense against Hepatitis B infection. Always consult with a healthcare provider for personalized advice and follow the appropriate protocols in your workplace to ensure your safety and the safety of your patients.

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