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

Report By: Tanzeem Iqbal - Medical Student
Search checked by Tanzeem Iqbal - Medical Student
Institution: Manchester Royal Infirmary
Date Submitted: 6th July 2005
Last Modified: 6th July 2005
Status: Blue (submitted but not checked)

Three Part Question

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

Clinical Scenario

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.

Search Strategy

[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.

Search Outcome

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

Comment(s)

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.

Clinical Bottom Line

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