Is hepatitis B vaccination required in all patients with human bites?

July 6, 2005

July 6, 2005

Tanzeem Iqbal, Medical Student (Manchester Royal Infirmary)

Tanzeem Iqbal, Manchester Royal Infirmary

In [all patients who have sustained a human bite] is [hepatitis B vaccination] required [to prevent hepatitis B infection]?

A healthy 28 yr old psychiatric female patient was brought into the emergency department after being bitten by another psychiatric male patient on her wrist. There was profuse bleeding of the wound. The female patient was not vaccinated against hep B. You wonder whether she needs hep B vaccination.

[MEDLINE - 1966 -06/05] - and [EMBASE -1988 -06/05].

[(hepatitis B.mp. or exp Hepatitis B) OR (Hepatitis B/ or hepatitis B infection.mp.) AND (human bite.mp. or exp Bites, Human/)] AND [(vaccination.mp. or exp VACCINATION/) OR (exp Vaccination/ or exp Immunization/ or immunisation.mp. or exp Hepatitis B/)] LIMIT to human AND English language.

Altogether 15 papers were found on EMBASE and 7 papers on MEDLINE. None were relevant to the original question.

No RCTs or meta analyses were found to answer the question. Hepatitis B virus can be detected in saliva of carriers, and epidemiological studies suggest human bite as a possible route of transmission. If there is blood in the mouth of the carrier, there is increased risk of transmission.

Vaccination should be given after immediate risk analysis based on local guidelines, until further evidence is established.