AtRisk Groups

HBV is an occupational hazard for anyone who may come into contact with blood or bloodstained body fluids through the routes described. Saliva alone may transmit HBV. The saliva of some people infected with HBV contains HBV-DNA concentrations 1/1000-1/10,000 of that found in their serum (8). This is especially relevant for penetrating bite wounds. Infection after exposure to other body fluids (e.g., bile, urine, feces, and cerebrospinal fluid) has never been demonstrated unless the fluids are contaminated with blood.

Intravenous drug users who share needles or other equipment are also at risk. HBV can also be transmitted through unprotected sexual contact, whether homosexual or heterosexual. The risk is increased if blood is involved. Sexual assault victims should be included in this category.

Evidence has shown that the virus may also be spread among members of a family through close household contact, such as through kissing and sharing toothbrushes, razors, bath towels, etc. (9-11). This route of transmission probably applies to institutionalized patients, but there are no available data.

Studies of prisoners in western countries have shown a higher prevalence of antibodies to HBV and other BBVs than the general population (1214); the most commonly reported risk factor is intravenous drug use. However, the real frequency of transmission of BBVs in British prisons is unknown owing to the difficulty in compiling reliable data.

HBV can be transmitted vertically from mother to baby during the perinatal period. Approximately 80% of babies born to mothers who have either acute or chronic HBV become infected, and most will develop chronic HBV. This has been limited by the administration of HBV vaccine to the neonate. In industrialized countries, all prenatal mothers are screened for HBV. Vaccine is given to the neonate ideally within the first 12 hours of birth and at least two more doses are given at designated intervals. The WHO recommends this as a matter of course for all women in countries where prevalence is high. However, the practicalities of administering a vaccine that has to be stored at the correct temperature in places with limited access to medical care means that there is a significant failure of vaccine uptake and response.

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