14 Pediatric Community-Acquired Needlestick Injuries: Description and Risk of Seroconversion

Community-acquired needlestick injuries (CA-NSI) are an emerging phenomenon. Although anxiety exists concerning the perceived risk of transmission of blood-borne viruses, seroconversion in this setting appears to be a rare event.

To describe the circumstances surrounding pediatric CA-NSI and to document the rate of seroconversion of HIV, HBV and HCV in these children.

We conducted a retrospective chart review of a cohort of children presenting with a CA-NSI to the Emergency Department of the Montreal Children's Hospital between January 1, 1988 and October 30, 2003. Patients were identified by review of the Infectious Disease Clinic records. The variables collected included demographics (date of birth, sex, postal code), circumstances of injury, prophylaxis offered (HIV, HBV), vaccination status and follow-up serology at 6 months post-injury. Data were analyzed using descriptive statistics.

Ninety-two cases were identified over a period of 14 years and 10 months. Mean age was 8.2 years±3.4 years, ranging from 2.6 to 17.7 years of age. Sixty-three (68.5%) were boys. Most injuries occurred in streets (38.0%) and most children purposely picked up the needle (76.1%). Only 11 (12.0%) patients reported a syringe containing blood. Sixty-nine (75.0%) presented on the day of the injury. Among the 86 patients not known to have been previously vaccinated for HBV, 74 (86.0%) received HBIG and 83 (96.5%) received HBV vaccine. Seventy-two of the 83 (86.7%) who received HBV vaccine completed a 3-dose course in follow-up. Prophylactic antiretroviral therapy (ART) was offered as of 1998. Of the 51 patients who presented thereafter, 30 (58.8%) received ART, of whom 26 (86.7%) completed a four-week course of therapy. At 6 months, 62 were tested for HBV, 71 for HIV and 41 for HCV. There was no seroconversion. Fourteen patients were lost to our follow-up and testing is pending for 3 patients.

The majority of pediatric NSI can be prevented. Therefore, children and parents need to be educated about the risks of discarded needles. Our study showed no infections in this setting.