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PEDIATRICS Vol. 104 No. 2 August 1999, pp. 318-324
AMERICAN ACADEMY OF PEDIATRICS:
Issues Related to Human Immunodeficiency Virus
Transmission in Schools, Child Care, Medical Settings, the Home, and
Community
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ABSTRACT |
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Abstract
Recommendation
References
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Current recommendations of the American Academy of Pediatrics (AAP) for infection control practices to prevent transmission of blood-borne pathogens, including human immunodeficiency virus (HIV) in hospitals, other medical settings, schools, and child care facilities, are reviewed and explained. Hand-washing is essential, whether or not gloves are used, and gloves should be used when contact with blood or blood-containing body fluids may occur. In hospitalized children, the 1996 recommendations of the Centers for Disease Control and Prevention (CDC) should be implemented as modified in the 1997 Red Book. The generic principles of Standard Precautions in the CDC guidelines generally are applicable to children in all health care settings, schools, child care facilities, and the home. However, gloves are not required for routine changing of diapers or for wiping nasal secretions of children in most circumstances. This AAP recommendation differs from that in the CDC guidelines.
Current US Public Health Service guidelines for the management of potential occupational exposures of health care workers to HIV are summarized. As previously recommended by the AAP, HIV-infected children should be admitted without restriction to child care centers and schools and allowed to participate in all activities to the extent that their health and other recommendations for management of contagious diseases permit. Because it is not required that the school be notified of HIV infection, it may be helpful if the pediatrician notify the school that he or she is operating under a policy of nondisclosure of infection with blood-borne pathogens. Thus, it is possible that the pediatrician will not report the presence of such infections on the form. Because HIV infection occurs in persons throughout the United States, these recommendations for prevention of HIV transmission should be applied universally.
The geographic occurrence of human
immunodeficiency virus (HIV) infection has expanded to involve
the entire United States. The numbers of HIV-infected children
have paralleled the reported cases of HIV infection and acquired
immunodeficiency syndrome (AIDS) in women. Of infected women, 80% are
of childbearing age, and more than 25% of women with AIDS are from
smaller cities or rural areas of the United States.1,2
Therefore, infection control recommendations based on the regional
prevalence of HIV are no longer appropriate, and recommendations are
applicable universally.
In 1996, the Centers for Disease Control and Prevention (CDC) issued
revised recommendations for infection control practices and isolation
precautions for hospitalized patients.3 The American
Academy of Pediatrics (AAP) has explicit exceptions to the CDC
guidelines for the care of children both within and out of the
hospital.
In the United States, 90% of pediatric HIV infection has been
acquired by maternal-to-infant transmission. Currently, almost all
cases of HIV infection in children younger than 13 years are acquired
perinatally. The HIV-exposed and HIV-infected infants and children are
nurtured at home or in foster homes, cared for in child care centers,
educated in schools, and participate in community activities. The
education of children and their caregivers about HIV should include a
discussion of the potential risk and means of transmission of HIV.
Education should promote understanding about the importance of
maintaining confidentiality associated with HIV infection and
compassion for families with HIV infection. All persons responsible for
the care of children need to understand appropriate infection control
practices to protect HIV-infected children, as well as their
caregivers, family members, and playmates, from acquiring transmissible
infections.
A better understanding of the longitudinal course of HIV
infection has developed in the almost 2 decades since the beginning of
the HIV epidemic. Although symptoms commonly develop in HIV-infected children during the first 2 years, the symptoms may be nonspecific, and
the child's HIV infection may not be appreciated.4 The
spectrum of disease includes 10% to 20% of infected children likely
to die by 4 years of age and a continuum of children, the remaining
80% to 90%, whose median survival will exceed 9 years of
age.5,6 The majority of HIV-infected children will attend
child care and school, a substantial number of these children will
reach adolescence, and some will reach adulthood. In addition,
adolescents are at risk of acquiring HIV infection through sexual
intercourse and intravenous drug use; an estimated 20% of adults with
AIDS were infected with HIV as teenagers. Hence, appropriate infection
control practices in the care of children of all ages and settings are
necessary to prevent transmission of blood-borne pathogens and other
communicable diseases.
Understanding HIV transmission is fundamental to appropriate
infection control practices. This virus preferentially infects and
replicates in cells expressing CD4 and other coreceptors. These cells
include the CD4 lymphocytes, monocytes, macrophages, and cells in many
different tissues. The virus has been recovered from blood and other
body fluids, including cerebrospinal fluid, human milk, semen, vaginal
and cervical secretions, amniotic fluid, saliva, tears, and synovial,
pleural, peritoneal, and pericardial fluids. Other body fluids and
secretions that are visibly contaminated with blood may contain HIV and
pose a risk of transmission.
All body fluids containing HIV pose a theoretical risk, but some (eg,
tears, urine, and stool) have not been implicated in transmission of
the virus. A sufficient quantity of virus and a portal of entry that
permits infection of host cells are required for transmission. The
three recognized settings in which HIV transmission occurs are as
follows: 1) from a mother with HIV infection to her infant during
pregnancy, delivery, or breastfeeding; 2) direct inoculation of
infected blood or blood-containing tissues, including transfusion,
transplantation of organs or tissues, and use of contaminated needles
or penetrating injuries with needles or sharp objects contaminated with
blood; and 3) between sex partners by contact with infected semen,
vaginal or cervical secretions, or blood with mucosal surfaces.
Exposure to larger amounts of virus increases the likelihood of
transmission. Therefore, the titer of HIV in the inoculated material,
the volume of blood or inoculated fluid, and the route of exposure
(intravenous vs skin or mucous membrane contact) may contribute to the
risk of transmission. Varying degrees of risk are based on the type of
exposure. The risk of acquiring infection after transfusion with
infected blood has been estimated to be as high as 95%.7
The risk of transmission to a newborn from an infected mother who is
not receiving antiretroviral therapy has been estimated to be between
15% and 30% in the United States and Europe.8-10 The
risk of transmission after a single percutaneous exposure to
HIV-infected blood has been calculated from multiple prospective
studies to be 0.2% (95% confidence interval [CI],
0.1%-0.5%)11-17 and after mucous membrane
exposure, 0.10% (95% CI, 0.01%-0.50%).16
Transmission of HIV from infected children or infected adults to
uninfected persons during routine daily activities, such as household
care, is rare and likely to be related to unrecognized and unprotected
exposure to blood or infectious body fluids.
Hospital infection control practices to protect patients and
health care workers from acquiring pathogenic microorganisms have been
revised in response to new developments, including information about
the epidemiology of HIV infection. The occurrence of HIV infection in
the 1980s led to inclusion of body fluids containing blood in a
specific precaution category for all patients (1985), termed
Universal Precautions.3,18 Blood is the single
most important source of HIV in the occupational setting. Other fluids,
including semen and vaginal fluid, have been implicated in sexual
transmission of HIV infection. The use of gloves and hand-washing were
recommended for the prevention of exposure to all fluids implicated in
transmission and for those such as amniotic and cerebrospinal fluid,
for which the risk of transmission is unknown. Body fluids contaminated
with blood are considered potentially infectious, and gloves were
recommended. Feces, nasal secretions, sputum, sweat, tears, urine, and
vomitus were not included in universal precautions unless visibly
contaminated with blood.19-21
Recently, national guidelines for isolation precautions in hospitals
have been revised by the CDC. Standard Precautions, which replace
Universal Precautions, are designed to reduce the risk of transmission
of all pathogens, including HIV, in hospitals. Hand-washing is
fundamental to decreasing transmission of infection. The CDC guidelines
recommend gloves to provide a protective barrier and to prevent gross
contamination of the hands when touching blood, body fluids,
secretions, excretions, mucous membranes, and the nonintact skin of all
hospitalized patients. Gloves may reduce the contamination of the
caregivers hands. If gloves are used, caregivers must remove the gloves
and wash their hands after each child's diaper changing.
Healthy newborn infants born in a hospital and healthy infants and
young children must have their excretions and secretions attended to by
an adult. However, no data indicate that gloves are necessary for
routine changing of diapers or for wiping the tears or noses of healthy
infants or HIV-exposed or HIV-infected infants. The AAP, as a result,
recommends that for children, including those exposed and infected with
HIV, gloves are not mandatory when changing diapers, wiping tears, or
blowing noses of children in the hospital.22 This
recommendation differs from that in the CDC guidelines for hospitalized
patients. Nevertheless, routine use of gloves for diaper changing in
the hospital could minimize the potential transmission of enteric
pathogens. When symptoms are present that indicate an illness caused by
an agent transmitted by the fecal-oral route or when blood is present
in stool or a body fluid, gloves should be used.
Appropriate infection control practices must be taught to all
persons in health care settings, including hospitals, outpatient clinics, medical and dental offices, and clinical laboratories. Health
care workers should adhere rigorously to infection control precautions
to minimize the risk of exposure to blood and body fluids, including
avoidance of accidental injury by needles and other sharp instruments.
The general principles from which Standard Precautions were developed
for hospitalized patients apply to children in all health care
settings, as well as in schools, child care settings, and the home.
When managing their blood or blood-containing secretions, health care
workers must regard all children as potentially HIV-infected because
the infection status of children may not be disclosed by their
caregivers.
The elements of these Standard Precautions to prevent transmission of
HIV and other blood-borne pathogens as promulgated by the US Public
Health Service are listed in the recommendations. The basic protection
is hand-washing and fundamental barrier protection is the use of gloves
when in contact with blood or other high-risk fluids.
The prevention of percutaneous exposures to blood-borne pathogens,
including HIV, requires that injuries with needles or other sharp items
contaminated with blood must be avoided. Education is essential for all
health care workers to whom percutaneous exposure to sharp instruments
can occur. Strategies to avoid such injuries include the substitution
of routine needle-syringe combinations with retractable needles, use of
retractable needle-butterfly combinations for intravenous
infusions, safe handling of needles (eg, not recapping) and other sharp
instruments, and providing puncture-resistant containers for the
deposit and disposal of needles.
Prospective studies of exposed health care workers suggest that the
risk of transmission of HIV by percutaneous exposure is greater than
that after mucous membrane or skin exposure. Cutaneous, mucous
membrane, or percutaneous blood contact was reported during 30% of
vaginal deliveries, 43% of cesarean deliveries, 4% of emergency department procedures, and 30% of operating room
procedures.23-25 Therefore, specific areas of the
hospital where the potential for exposure to blood is increased include
delivery rooms, emergency rooms, and operating rooms. As a general
principle, attempts should be made to minimize or prevent emergency
mouth-to-mouth resuscitation. Mouth pieces and appropriate
resuscitation equipment for the unexpected delivery of a newborn infant
regardless of gestational age should be readily available in the
emergency department and intensive care units.
Appropriate barrier precautions for operating rooms and delivery rooms
include masks, protective eyewear, gloves, and gowns. These precautions
apply to persons who have contact with placentas or the blood and
amniotic fluid on the skin of newborn infants. Mechanical suction
should be used in the care of newborns, and gloves should be worn for
umbilical cord care in the nursery. Infants born to known HIV-infected
women do not need to be isolated from other infants in the newborn
nursery.
In the United States, women who are HIV-infected should not breastfeed
their infants because of the additional risk of HIV transmission from
breastfeeding and safe alternative sources of nutrition are readily
available. Only HIV-seronegative women who are not at high risk of HIV
should donate human milk.26 Gloves are not recommended for
routine handling of expressed human milk, but should be worn by health
care workers in situations in which heavy and repetitive exposures
occur, such as in processing milk for milk banking.26
Clinical Laboratories
Health care workers in clinical laboratories need to handle all
blood and body fluids as though they are potentially infectious. Specimens of blood and body fluids need to be collected and transported in leakproof containers for transport and contamination of the outside
of the container or laboratory form avoided. Persons processing blood
and body fluid specimens should wear gloves as should persons obtaining
blood specimens. Masks and protective eyewear should be worn in
anticipation of membrane contact with blood or body fluids. Histologic
and pathologic or microbiologic culturing done routinely does not
require a biological safety cabinet. A safety cabinet (class I or II)
must be used for procedures that may generate droplets. Mechanical
pipetting devices rather than mouth pipetting should be used. Needles
and syringes should be used only when no alternative is available, with
appropriate measures to prevent injuries with needles as previously
described. Spills involving blood or other body fluids on laboratory
work surfaces should be removed and the surface disinfected with a
freshly prepared solution of 1:10 household bleach applied for at least
30 seconds, and wiped after the minimum contact
time.3,20,27 The contaminated materials used in laboratory
tests should be disinfected before reprocessing or placed in bags and
discarded in accordance with institutional policies for the disposal of infected waste.28 Scientific equipment that has been contaminated with blood or other body fluids should be disinfected and
cleaned after use and before repair in the laboratory or transport to
the manufacturer. All persons should wash their hands after completing
laboratory activities and should remove protective clothing before
leaving the laboratory.21
Standard sterilization and disinfection procedures for patient care
equipment currently recommended for use in health care settings,
including hospitals, medical and dental clinics and offices,
hemodialysis centers, emergency care facilities, and long-term nursing
care facilities, are adequate to sterilize or disinfect instruments,
devices, or other items contaminated with other body fluids from
persons infected with blood-borne pathogens, including
HIV.1929-32
An occupational exposure may place the worker at risk
of acquiring HIV infection and is defined as a percutaneous injury or contact of mucous membranes or skin with blood, tissues, or body fluid
to which Standard Precautions apply. A system for evaluation, counseling, and follow-up should be available to employees. Workers must be educated before such exposures so that appropriate
interventions can be initiated promptly. The relevant information about
such an exposure is recorded in the worker's confidential medical
record. If the person who is the source of the blood or potentially
contaminated material is HIV-seronegative, further follow-up of the
exposed worker for HIV is unnecessary unless the source (or the worker) has recently been exposed to HIV or recently engaged in high-risk behavior. When the source cannot be identified, decisions about appropriate follow-up must be individualized. Serologic testing for HIV
should be available to workers who are concerned about possible
infection.
In 1998, the CDC issued revised provisional recommendations for
chemoprophylaxis in health care workers with occupational exposure to
blood from a source known to be HIV-positive, at high risk of HIV
infection, or of unknown status.33 These recommendations
are based primarily on a retrospective case-control study of
percutaneous exposure to HIV. The factors associated with transmission
were demonstrated to be deep injury, visible contamination of the
needle or device with blood, procedures for placing a device in a blood
vessel, and terminal illness in the source patient.34
Zidovudine given immediately after exposure may be protective for
health care workers; the reduction of transmission has been reported to
be 79% (95% CI, 43%-94%).34 Despite the limitations
inherent in a retrospective case-control study, health care workers
should be informed of these data, including the potential to decrease
transmission with zidovudine as postexposure prophylaxis. According to
current recommendations for chemoprophylaxis, regimens of two or more
antiretroviral agents after certain occupational exposure to HIV are
indicated. The highest risk exposures include percutaneous exposure to
larger quantities of blood, deep injury, and a source of the blood with
a high titer of HIV.33,35
Several large investigations and risk estimates based on modeling
techniques indicate that the risk for HIV transmission from an infected
health care worker to a patient, even during an invasive procedure, is
very low, but no precise estimate of the HIV transmission rate from
infected health care workers to patients can be
provided.36,37 Only one instance in the United States in
which HIV was transmitted from an infected health care worker to
patients has been substantiated. Transmission occurred in a dental
practice, and the mode of virus transmission remains
unknown.38 To minimize the risk of HIV transmission, all
health care workers should adhere to Standard Precautions. Health care
workers with exudative lesions or weeping dermatitis should completely
cover the lesion and refrain from direct patient care and from handling
equipment used in patient care including devices used to perform
invasive procedures. Currently available data provide the basis for the
recommendation that in most circumstances, the practice of health care
workers infected with HIV should not be restricted.39 The
risk to a health care worker of acquiring HIV infection from exposure
to infected blood or body fluids is far greater than the risk to a
patient of acquiring HIV from an infected health care worker. Universal testing of health care workers for HIV is therefore not recommended.
Epidemiologic studies of persons with AIDS have identified the
most common modes of transmission, ie, sexual, from blood or blood
products, and perinatal. Laboratory techniques, such as genetic
sequencing, can be used as molecular epidemiologic methods to determine
the source of HIV transmission.
In the United States and Europe, studies evaluating the risk of
transmission after household contact not involving sex or shared
needles have demonstrated no transmission of HIV among 657 HIV-infected
persons and more than 1100 uninfected persons, including more than 326 children, followed up for more than 1700 person
years.40 The 95% CI for the rate of transmission is 0 to 0.2 infections per 100 patient years.40
Nevertheless, individual reports of household transmission have
appeared.
Six of the eight reported instances of household transmission have
involved children.41-45 Three of four children and
adolescents who acquired the virus from an infected child living in the
same household had viruses that were genetically similar to that of the
source case.17,42,43 A child and adolescent had hemophilia
and had received home intravenous therapy on multiple occasions at the
same time as their HIV-infected siblings.17,43 The mode of
transmission is unknown, but intravenous or percutaneous exposure to
blood was possible. The third child-to-child household transmission
with genetic confirmation was a child living in a household with an HIV-infected child, and unrecognized exposure to blood was
possible.42 Little information is available about the
fourth instance of transmission between siblings.45
Two additional instances of household transmission to a child have
occurred. In one case, virus from an infected mother was genetically
related to that acquired by her 5-year-old child.41 Contact of the child with mother's bleeding skin and shared use of
toothbrushes with known maternal gingival bleeding was reported. In the
other, transmission of the virus occurred from child to caregiver, and
the opportunity for blood contact existed but was unproven.44
All persons who care for children, especially those who are in contact
with HIV-infected persons must be educated about appropriate precautions. This recommendation applies to child care because child
care facilities place varying numbers of children of different ages in
contact in an environment that may be analogous to the home. Children
who enter child care should not be required to be HIV
tested46 or to disclose their HIV status. Disclosure is a
decision that should be made in the best interests of the child and is
the responsibility of the parents who may want to include the child's
pediatrician in the decision-making process. No need exists to restrict
the placement of HIV-infected children in child care settings to
protect personnel or other children. When medical personnel believe
that the probability that the child will expose others to blood or
contaminated fluids is enhanced, an individual decision can be made.
Biting is common in preschool and child care settings. Although biting
theoretically is a possible mode of transmission of blood-borne
illness, such as HIV infection, the risk of such transmission is
believed to be extremely low. If a bite results in blood exposure to
either person involved, the US Public Health Service recommends
postexposure follow-up, including consideration of postexposure
prophylaxis.33
The guidelines, including barrier precautions, for preventing exposure
to blood should be observed in households and other settings in which a
person infected with HIV resides. Practices that increase the
possibility of blood contact, including sharing of razors and
toothbrushes, should be avoided. Routine changing of diapers or wiping
of noses should be followed by careful hand-washing but does not
require gloves unless blood is visible or the child has an infection
with another respiratory or fecal pathogen that requires contact
precautions. Hands and other parts of the body should be washed
immediately after contact with blood even though gloves are used. When
blood or blood-containing fluids are spilled, the contaminated surfaces
should be cleaned, then disinfected with 30 seconds of contact with a
freshly prepared 1:10 dilution of household bleach.
Children with HIV or other chronic illnesses may be immunodeficient,
and, thus, their caregivers should be informed of exposure to readily
communicable illnesses in child care settings that might compromise
their health, such as pneumococcal infections, varicella, or
measles.47 The policy of child care programs should be to
inform all families when such communicable diseases have been
identified in any child. Prevention of measles and varicella in any
exposed susceptible child is prudent; appropriate preventive measures
are recommended in the 1997 Red Book46,48 and
in the 1998 AAP statement.49 Exposure of children to tuberculosis, irrespective of HIV infection status, requires notification of families, appropriate evaluation for infection, and
prophylaxis or, if infected, treatment.
Schools
Knowledge of a child's HIV status is unnecessary for school
entry. Disclosure of a child's HIV status to the school should not be
required. The decision to disclose HIV infection status should be made
in the best interests of the child and is the responsibility of the
parents, who may want to include the child's pediatrician in the
decision-making. When a decision is made to notify the school that a
child is HIV-positive, the number of persons aware of the child's
infection can be limited so that the information is disclosed only to
those who need such knowledge to care for the child. This
recommendation does not imply that the classroom teacher must be
notified.
Discussions about children with HIV infection attending schools have
disclosed that discrimination has occurred and that erroneous information, ie, HIV is likely to be transmitted in the school setting,
has been given. These situations create unnecessary hardships for
children and their families and illustrate the continuing need for
community educational programs about HIV transmission. No cases in the
school setting of HIV transmission have been reported, and no
epidemiologic data justify excluding children with HIV infection from
school or isolating them in school to protect other children. Children
who are infected with HIV should be encouraged to participate in all
school activities as long as they are able to do so.50
Appropriate barrier precautions for blood should be implemented for all
children in schools.
The AAP recommends that athletes with HIV infection be permitted to
participate in all competitive sports.51 The confidentiality and the right to privacy of families should be protected. Routine testing of athletes is not indicated. Because it is
not recommended that the school be notified of HIV infection, it may be
helpful if the pediatrician notifies the school that he or she is
operating under a policy of nondisclosure of infection with blood-borne
pathogens. Thus, it is possible that the pediatrician will not report
the presence of such infections on the form.
Because school personnel will have contact with blood and body fluids,
the Occupational Safety and Health Administration Hazard Communication
Standard encourages schools to institute employee education as well as
routine procedures for handling blood or other body
fluids.52 Health care workers, teachers, administrators,
and other school employees, including maintenance personnel, need to be
educated about routine precautions for the prevention of HIV infection
and other blood-borne precautions.53 Gloves should be
readily available in the event an injury occurs with bleeding that
requires intervention. Disinfection of soiled surfaces with a freshly
prepared 1:10 dilution of household bleach is recommended.
HIV TRANSMISSION
STANDARD PRECAUTIONS IN ACUTE CARE HOSPITALS
RECOMMENDATIONS IN OTHER SETTINGS
MANAGEMENT OF OCCUPATIONAL EXPOSURE TO HIV
HEALTH CARE WORKERS WITH HIV INFECTION
HOME, CHILD CARE, AND OUT-OF-HOME SETTINGS
RECOMMENDATIONS
Top
Abstract
Recommendation
References
COMMITTEE ON PEDIATRIC AIDS,
1998-1999
Catherine M. Wilfert, MD, Chairperson
Jane Ellen Aronson, MD
Donna T. Beck, MD
Alan R. Fleischman, MD
Mark W. Kline, MD
Lynne M. Mofenson, MD
Gwendolyn B. Scott, MD
Diane W. Wara, MD
Patricia N. Whitley-Williams, MD
LIAISON REPRESENTATIVE
Mary Lou Lindegren, MD
Centers for Disease Control and Prevention
COMMITTEE ON INFECTIOUS DISEASES, 1998-1999
Neal A. Halsey, MD, Chairperson
Jon S. Abramson, MD
P. Joan Chesney, MD
Margaret C. Fisher, MD
Michael A. Gerber, MD
S. Michael Marcy, MD
Dennis L. Murray, MD
Gary D. Overturf, MD
Charles G. Prober, MD
Thomas N. Saari, MD
Leonard B. Weiner, MD
Richard J. Whitley, MD
EX-OFFICIO
Carol J. Baker, MD
Georges Peter, MD
Larry K. Pickering, MD
LIAISON REPRESENTATIVES
Anthony Hirsch, MD
AAP Council on Pediatric Practice
Richard F. Jacobs, MD
American Thoracic Society
Noni E. MacDonald, MD
Canadian Paediatric Society
Martin G. Myers, MD
National Vaccine Program Office
Walter A. Orenstein, MD
Centers for Disease Control and Prevention
Peter A. Patriarca, MD
Food and Drug Administration
N. Regina Rabinovich, MD
National Institutes of Health
Ben Schwartz, MD
Centers for Disease Control and Prevention
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FOOTNOTES |
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The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
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ABBREVIATIONS |
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HIV, human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome; CDC, Centers for Disease Control and Prevention; AAP, American Academy of Pediatrics; CI, confidence interval.
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REFERENCES |
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Abstract
Recommendation
References
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- Centers for Disease Control and Prevention. Update: acquired immunodeficiency syndrome: United States, 1992. MMWR Morb Mortal Wkly Rep. 1993;42:547-551, 557
- Wortley PM, Fleming PL AIDS in women in the United States: recent trends. JAMA. 1997; 278:911-916 [Abstract]
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Barnhart HX,
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The natural history of human immunodeficiency virus disease in perinatally infected children: an analysis from the Pediatric Spectrum of Disease Project.
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[Abstract/Free Full Text] - Byers B, Caldwell B, Oxtoby M. Pediatric Spectrum of Disease Project: survival of children with perinatal HIV infection: evidence for two distinct populations [abstract]. Presented at the Ninth International Conference on AIDS; June 1993; Berlin, Germany. Abstract WS-C10-6
- Donegan E, Stuart M, Niland JC, Infection with human immunodeficiency virus type I (HIV-1) among recipients of antibody-positive blood donations. Ann Intern Med. 1990; 113:733-739
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- Thomas PA, Weedon J. NY City Perinatal HIV Transmission Collaborative Study Group. Maternal predictors of perinatal HIV transmission [abstract]. Eighth International Conference on AIDS, July 1992; Amsterdam, The Netherlands. Abstract WeC 1059
- European Collaborative Study Risk factors for mother to child transmission of HIV-1. Lancet. 1992; 339:1007-1012 [CrossRef][Medline]
- Gerberding JL, Bryant-LeBlanc CE, Nelson K, Risk of transmitting the human immunodeficiency virus, cytomegalovirus, and hepatitis B virus to health care workers exposed to patients with AIDS and AIDS related conditions. J Infect Dis. 1987; 156:1-8 [Medline]
- Gerberding JL Incidence and prevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and cytomegalovirus among health care personnel at risk for blood exposure: final report from a longitudinal study. J Infect Dis. 1994; 170:1410-1417 [Medline]
- Henderson DK, Fahey BJ, Willy M, Risk for occupational transmission of human immunodeficiency virus type 1 (HIV-1) associated with clinical exposure: a prospective evaluation. Ann Intern Med. 1990; 113:740-746
- Marcus R Surveillance of health care workers exposed to blood from patients infected with the human immunodeficiency virus. N Engl J Med. 1988; 319:1118-1123 [Abstract]
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Tokars JL,
Marcus R,
Culver DH,
Surveillance of HIV infection and zidovudine use among health care workers after occupational exposure to HIV-infected blood: the CDC Cooperative Needle Stick Surveillance Group.
Ann Intern Med.
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[Abstract/Free Full Text] - Ippolito G, Puro V, De Carli G The risk of occupational human immunodeficiency virus infection in health care workers: Italian multicenter study: Italian study group on occupational risk of HIV infection. Arch Intern Med. 1993; 153:1451-1458 [Abstract]
- Centers for Disease Control and Prevention HIV infection in two brothers receiving intravenous therapy for hemophilia. MMWR Morb Mortal Wkly Rep. 1992; 41:228-231 [Medline]
- Centers for Disease Control and Prevention. Recommendations for preventing transmission of infection with human T-lymphotropic virus type III/lymphadenopathy-associated virus in the workplace. MMWR Morb Mortal Wkly Rep. 1985;34:681-686, 691-695
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- Centers for Disease Control and Prevention Guidelines for prevention of transmission of human immunodeficiency virus and hepatitis B virus to health-care and public-safety workers. MMWR Morb Mortal Wkly Rep. 1989; 38(suppl 6):1-37
- American Academy of Pediatrics. Infection control for hospitalized children. In: Peter G, ed. 1997 Red Book: Report of the Committee on Infectious Diseases. 24th ed. Elk Grove Village, IL: American Academy of Pediatrics; 1997:104
- Marcus R, Culver DM, Bell DM, Risk of human immunodeficiency virus infection among emergency department workers. Am J Med. 1993; 94:363-370 [CrossRef][Medline]
- Panlilio AL, Foy DR, Edwards JR, Blood contacts during surgical procedures. JAMA. 1991; 265:1533-1537 [Abstract]
- Panlilio AL, Welch BA, Bell DM, Blood and amniotic fluid contact sustained by obstetrical personnel during deliveries. Am J Obstet Gynecol. 1992; 167:703-708 [Medline]
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American Academy of Pediatrics, Committee on Pediatric AIDS
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Pediatrics (ISSN 0031 4005). Copyright ©1999 by the American Academy of Pediatrics
Statement of retirement:
- AAP Publications Retired or Reaffirmed, October 2006
- American Academy of Pediatrics
Pediatrics 2007 119: 405.[Extract] [Full Text] [PDF]
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