Published online August 1, 2008
PEDIATRICS Vol. 122 No. 2 August 2008, pp. e487-e492 (doi:10.1542/peds.2008-0290)

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ARTICLE

Pediatric Injuries From Needles Discarded in the Community: Epidemiology and Risk of Seroconversion

Jesse Papenburg, MD^a,b, Denis Blais, BScN^c, Dorothy Moore, MD, PhD^a, Mohammed Al-Hosni, MD^a, Céline Laferrière, MD^d, Bruce Tapiero, MD^c and Caroline Quach, MD, MSc^a,b

^a Infectious Diseases Division, Department of Pediatrics
^b Department of Microbiology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
^c Infectious Diseases Division, Department of Pediatrics
^d Department of Microbiology, Hôpital Sainte-Justine, University of Montreal, Montreal, Quebec, Canada

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.

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Key Words: needlestick injuries • nonoccupational exposure • pediatrics • accident prevention • bloodborne pathogens • antiretroviral agents

Abbreviations: CA-NSI—community-acquired needle-stick injury • HBV—hepatitis B virus • HCV—hepatitis C virus • IDU—injection drug user • MCH—Montreal Children's Hospital • HSJ—Hôpital Sainte-Justine • HBIG—hepatitis B immunoglobulin • PI—protease inhibitor • CI—confidence interval

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Accepted Mar 12, 2008.

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