Surveillance for Occupationally Acquired HIV Infection -- United States, 1981-1992

Public health surveillance for and risk-assessment studies of human immunodeficiency virus (HIV) infection provide a basis for formulating measures to minimize the risk for occupational transmission of HIV to health-care workers (1-6). Data on occupational transmission of HIV have been provided by two CDC-supported national surveillance systems: one initiated in 1981 for acquired immunodeficiency syndrome (AIDS) cases and one initiated in 1991 for HIV infections acquired through occupational exposures (Table 1). This report summarizes data on occupationally acquired HIV infection from these surveillance systems through September 1992.

For surveillance purposes, health-care workers are defined as persons, including students and trainees, who worked in a health-care, clinical, or HIV-laboratory setting any time since 1978. Persons reported from these two systems have been classified with documented or possible occupationally acquired HIV infection. Those classified with documented occupationally acquired HIV infection had evidence of HIV seroconversion (i.e., a negative HIV-antibody test at the time of the exposure that was subsequently positive) following a discrete percutaneous or mucocutaneous occupational exposure to blood, body fluids, or other clinical or laboratory specimens. Persons classified with possible occupationally acquired HIV infection did not have behavioral or transfusion risks for HIV infection that could be identified during follow-up investigation; each person reported past percutaneous or mucocutaneous occupational exposure to blood, body fluids, or laboratory specimens, but seroconversion against HIV as a result of an occupational exposure was not documented.

As of September 30, 1992, CDC had received reports of 32 health-care workers in the United States with documented occupationally acquired HIV infection and 69 with possible occupationally acquired HIV infection.

Among those with documented occupationally acquired HIV infection, 27 (84%) had percutaneous exposure, four (13%) had mucocutaneous exposure, and one (3%) had both percutaneous and mucocutaneous exposures. Thirty were exposed to HIV-infected blood, one to concentrated infectious HIV, and one had a percutaneous exposure to an unspecified fluid from an unknown source patient. Seven (22%) of these workers have developed AIDS.

Of the 69 health-care workers classified with possible occupationally acquired HIV infection, four (6%) had occupational exposures to blood of patients known to be HIV-infected or to research laboratory specimens known to contain infectious HIV. Of the remaining 65, none reported exposure to blood or body fluids known to be HIV infected. Of these 69 workers, 54 (78%) have developed AIDS.

Reported by: Div of HIV/AIDS, National Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Health-care workers with AIDS and without an identified behavioral or transfusion risk for HIV infection are a priority for follow-up investigation by health departments to determine whether infection occurred through occupational exposure or by an alternate mode of transmission. In addition, in collaboration with state and local health departments, CDC conducts surveillance for HIV-infected health-care workers suspected to have become infected through occupational exposures but who do not meet the AIDS case definition (7). These surveillance systems help monitor occupational transmission of HIV and identify the circumstances that result in transmission. Although no transmission of HIV after mucocutaneous exposure has occurred in prospective studies of the risk for transmission following occupational exposures to HIV (8,9), case reports have documented such transmission (1).

The number of persons with occupationally acquired HIV infection is probably greater than the totals presented here because not all health-care workers are evaluated for HIV infection following exposures and not all persons with occupationally acquired infection are reported. Suspected cases of occupationally acquired HIV infection should be reported to CDC through state and local health department HIV/AIDS surveillance programs. To protect confidentiality of reported workers, names and other specific identifying information are not sent to CDC.

Data on health-care workers with documented and possible occupationally acquired HIV infection, as well as AIDS case surveillance, are published quarterly in CDC's HIV/AIDS Surveillance Report. Single copies of the report are available free from the CDC National AIDS Clearinghouse, P.O. Box 6003, Rockville, MD 20849-6003; telephone (800) 458-5231. Individuals or organizations can be added to the mailing list by writing to Management Analysis and Services Office, Office of Program Support, CDC, 1600 Clifton Road, NE, Mailstop A-22, Atlanta, GA 30333.

References

1. CDC. Update: human immunodeficiency virus infections in health-care workers exposed to blood of infected patients. MMWR 1987;36:285-9.

2. CDC. Update: acquired immunodeficiency syndrome and human immunodeficiency virus infection among health-care workers. MMWR 1988;37:229-34,239.

3. Chamberland ME, Conley LJ, Bush TJ, et al. Health care workers with AIDS: national surveillance update. JAMA 1991;266:3459-62.

4. Bell DM. Human immunodeficiency virus transmission in health care settings: risk and risk reduction. Am J Med 1991;91(suppl 3B):294S-300S.

5. Bell DM, Curran JW. Human immunodeficiency virus infection. In: Bennett JV, Brachman PS, eds. Hospital infections. 3rd ed. Boston: Little, Brown, and Company 1992;823-48.

6. CDC. Update: universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens in health-care settings. MMWR 1988;37:377-82,387-8.

7. CDC. Surveillance for occupationally acquired human immunodeficiency virus infection. MMWR 1992;41:501-2.

8. Marcus R, CDC Cooperative Needlestick Surveillance Group. Surveillance of health care workers exposed to blood from patients infected with the human immunodeficiency virus. N Engl J Med 1988;319:1118-23.

9. Henderson DK, Fahey BJ, Willy M, et al. Risk for occupational transmission of human immunodeficiency virus type 1 (HIV-1) associated with clinical exposures: a prospective evaluation. Ann Intern Med 1990;113:740-6.

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