Epidemiologic Notes and Reports Update: Evaluation of Human
T-Lymphotropic Virus Type III/ Lymphadenopathy-Associated Virus
Infection in Health-Care Personnel -- United States
The occurrence of the acquired immunodeficiency syndrome (AIDS)
in
intravenous (IV) drug users, blood transfusion recipients, and
persons
with hemophilia indicates that parenteral transmission of human
T-lymphotropic virus type III/lymphadenopathy-associated virus
(HTLV-III/LAV) occurs via infectious blood or blood products (1).
Currently available practices have nearly eliminated these risks
for
transfusion recipients and persons with hemophilia (2,3). Because
health-care personnel may be inadvertently exposed to the blood of
AIDS patients, several studies have been conducted to determine the
prevalence of HTLV-III/LAV antibodies in health-care personnel who
have cared for these patients (4-10). Combining published results
with data reported to CDC shows that, to date, 1,758 health-care
workers participating in such studies have been tested for
antibodies
to HTLV-III. Twenty-six (1.5%) were seropositive, and all but
three
of these persons belonged to groups recognized to be at increased
risk
for AIDS. Epidemiologic information is not available for one of
these
three health-care workers who was tested anonymously. Because of
the
high level of interest in these studies and in the potential for
occupational transmission of HTLV-III/LAV through parenteral and
mucosal routes, the case histories for these two health-care
workers
are reported below.
Patient 1. A female health-care worker was tested for serum
antibodies to HTLV-III in November 1984 as part of a study of
hospital
personnel. She had sustained accidental needlestick injuries in
November 1983 and March 1984 (12 months and 8 months before) while
drawing blood from patients with AIDS . At the time of enrollment
in
the study, serum antibodies to HTLV-III were detected by enzyme
immunoassay (EIA) and Western blot techniques. No serum obtained
before or within 12 months after the needlesticks was available for
testing. She was in good health until June 1984, when she
developed
mild but persistent lymphadenopathy, most marked in the axilla.
Beginning in August 1984, she experienced intermittent diarrhea.
When
interviewed by a physician, the patient denied IV drug use or blood
transfusions and reported being heterosexually monogamous since
1981.
Her long-term sex partner denied homosexual activity, IV drug use,
or
other known risk factors when interviewed separately. Although
repeatedly antibody negative by EIA and Western blot methods over
an
8-month period, HTLV-III was recovered from his peripheral
lymphocytes
in April 1985 but could not be recovered from lymphocytes obtained
several months later.
Patient 2. A male laboratory worker was discovered to be
lymphopenic after he volunteered to be tested in conjunction with a
study in April 1985. At that time, he had serum antibodies to
HTLV-III by EIA and Western blot methods. No previous blood
samples
were available for testing. As part of his job, he processed
platelets pooled from individual donors for transfusion. In
December
1983, he sustained an accidental cut on the hand while processing
blood from a patient with leukemia. He also sustained an
accidental
needlestick injury in August 1984 while processing a unit of pooled
platelets. Both incidents resulted in parenteral exposure to blood
from other persons. It is not known whether any of the individual
platelet donors or the patient with leukemia had HTLV-III
infection.
The health-care worker is asymptomatic, although he had transient
cervical lymphadenopathy during early 1985. HTLV-III was recovered
from his peripheral blood lymphocytes in September 1985. During
three
independent interviews, he denied any homosexual activity, IV drug
use, foreign travel, or blood transfusions. He described himself
as
heterosexual and was not aware that any of his approximately 12
lifetime sex partners had AIDS or were at increased risk for
HTLV-III/LAV infection.
Reported by J Nadler, MD, S Landesman, MD, D Rechtman, MD, S
Holman,
MS, New York City, New York; J Groopman, MD, Boston, G Seage, MPH,
Boston Dept of Health and Hospitals, G Grady, MD, Massachusetts
Dept
of Health; J Gerberding, MD, San Francisco, California;
Environmental
Epidemiology Br, Laboratory of Tumor Cell Biology, National Cancer
Institute, National Institutes of Health; Hospital Infections
Program,
AIDS Br, Div of Viral Diseases, Center for Infectious Diseases,
CDC.
Editorial Note
Editorial Note: These two health-care workers probably represent
occupational transmission of HTLV-III/LAV due to parenteral
exposure,
although in neither was a preexposure serum sample available to
date
the onset of infection. Although not reported during
investigations
of these two cases, it is difficult to totally assure that
additional
risk factors for AIDS were absent. For purposes of epidemiologic
surveillance, a case of occupationally acquired HTLV-III/LAV
infection
should ideally include all the following features: a worker with
no
identifiable risk factors for AIDS whose serum, obtained within
several of after the date of a possible occupational exposure, is
negative for antibody to HTLV-III/LAV but whose follow-up serum, in
absence of interim exposure to other risk factors, is positive for
antibody to HTLV-III/LAV. The two cases reported here do not fully
meet these ideal criteria. However, there is one published report
from England of a nurse who developed HTLV-III/LAV antibody
following
an accidental needlestick injury (11). Her serum was negative for
antibody to HTLV-III/LAV at the time of exposure. This nurse
reportedly had none of the recognized risk factors for AIDS and was
asymptomatic at the time the report was published.
The two cases reported here represent the only known evidence
of
probable occupational transmission of HTLV-III/LAV in the United
States. This confirms that the risk of transmission of
HTLV-III/LAV
infection to health-care workers from patients is extremely low
(4-10). HTLV-III/LAV infections appear to be much less
transmissible
through needlesticks than hepatitis B; nearly 26% of persons
comparably exposed to a hepatitis B surface antigen-positive
patient
develop infection (12). Nonetheless, personnel should follow
recommendations designed to minimize the risk of exposure to
parenteral or mucosal (e.g., blood spatter on conjunctiva) contact
with potentially infectious materials from patients with AIDS or
suspected AIDS (13,14).
Epidemiologic studies of needlestick injuries in hospital
personnel indicate that over 40% of the accidents are potentially
preventable if recommended precautions are followed when handling
used
needles or other sharp objects (6). Educational programs to
familiarize health-care workers with the basic practices in
infection
control are essential to the prevention of AIDS and other
infections.
Health-care workers and others should become familiar with and
follow
recommended precautions when handling specimens, secretions, and
excretions from persons known to be infected with HTLV-III/LAV.
Health-care personnel whose serum is positive for HTLV-III/LAV
antibody should follow the precautions that have been published for
health-care workers with AIDS (15).
References
CDC. Antibodies to a retrovirus etiologically associated with
acquired immunodeficiency syndrome (AIDS) in populations with
increased incidences of the syndrome. MMWR 1984;33:377-9.
CDC. Update: revised public health service definition of
persons
who should refrain from donating blood and plasma--United
States.
MMWR 1985;34:547-8.
CDC. Update: acquired immunodeficiency syndrome (AIDS) in
persons with hemophilia. MMWR 1984;33:589-92.
Hirsch MS, Wormser GP, Schooley RT, et al. Risk of nosocomial
infection with human T-cell lymphotropic virus III (HTLV-III).
N
Engl J Med 1985;312:1-4.
CDC. Update: prospective evaluation of health-care workers
exposed via the parenteral or mucous-membrane route to blood or
body fluids from patients with acquired immunodeficiency
syndrome-- United States. MMWR 1985;34:101-3.
McCray E. The cooperative needlestick study group.
Prospective
evaluation of health-care workers with parenteral or mucous
membrane exposure to blood from patients with acquired
immunodeficiency syndrome (AIDS), United States: an update.
In:
Program and abstracts of the 25th Interscience Conference on
Antimicrobial Agents and Chemotherapy. Minneapolis, Minnesota:
American Society for Microbiology, 1985 (abstract #225).
Henderson DK. Personal communication.
Gerberding JL, Moss AR, Bryant CE, Levy J, Sande MA. Risk of
acquired immune deficiency syndrome (AIDS) virus transmission
to
health care workers. In: Program and abstracts of the 25th
Interscience Conference on Antimicrobial Agents and
Chemotherapy.
Minneapolis, Minnesota: American Society for Microbiology,
1985
(abstract #226).
Weiss SH, Goedert JJ, Sarngadharan MG, et al. Screening test
for
HTLV-III (AIDS agent) antibodies. JAMA 1985;253:221-5.
Weiss SH, Saxinger WC, Rechtman DJ, et al. HTLV-III infection
among health care workers. JAMA 1985 (in press).
Anonymous. Needlestick transmission of HTLV-III from a patient
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