Management in Custody

5.2.5.1. Staff/Victims in Contact With Disease

Follow the immediate management flow chart, making sure all available information is obtained. Inform the designated hospital and/or specialist as soon as possible. If the contact is known and is believed to be immunocom-promised and he or she has consented to provide a blood sample, it is important to tell the specialist, because the antibody tests may be spuriously negative. In this instance, a different test should be used (polymerase chain reaction [PCR], which detects viral RNA).

The staff member/victim will be asked to provide a baseline sample of blood with further samples at 4-6 weeks and again at 12 weeks. If tests are negative at 12 weeks but the risk was deemed high, then follow-up may continue for up to 24 weeks. If any of the follow-up samples is positive, then the original baseline sample will be tested to ascertain whether the infection was acquired through the particular exposure.

It is important to emphasize the need for prompt initial attendance and continued monitoring, because treatment is now available. A combination of Ribavirin (antiviral agent and interferon a-2b) (18) or the newer pegylated interferons (15) may be used. This treatment is most effective when it is started early in the course of infection.

5.2.5.2. Detainees With Disease

Unless they are severely ill, detainees can be managed in custody. Special precautions are only required if they are bleeding. Custody staff should wear gloves if contact with blood is likely. Contaminated bedding should be handled appropriately, and the cell cleaned professionally after use.

This defective transmissible virus was discovered in 1977 and requires HBV for its own replication. It has a worldwide distribution in association with HBV, with approx 15 million people infected. The prevalence of HDV is higher in southern Italy, the Middle East, and parts of Africa and South America, occurring in more than 20% of HBV carriers who are asymptomatic and more than 60% of those with chronic HBV-related liver disease. Despite the high prevalence of HBV in China and South East Asia, HDV in these countries is rare.

HDV is associated with acute (coinfection) and chronic hepatitis (superinfection) and can exacerbate pre-existing liver damage caused by HBV. The routes of transmission and at-risk groups are the same as for HBV. Staff/victims in contact with a putative exposure and detainees with disease should be managed as for HBV. Interferon-a (e.g., Roferon) can be used to treat patients with chronic HBV and HDV (21), although it would not be practical to continue this treatment in the custodial setting.

5.4. Human Immunodeficiency Virus

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