Cut and puncture accidents involving health care workers exposed to biological materials

The first repor of occupational acquisition of HIV appeared in 1984, and, by june,1997, the Centers for Disease Control and Prevention (CDC) had reported 52 document cases of sero-conversion following occupational exposure to HIV-1 by health care workers of those cases. 47(90.3 percent) were exposed to blood. The most frequent type of accident reported was percutaneous needlestick injury. Prospective studies have estimated that the risk of HIV transmission following percutaneous exposure to infected blood is 0,3 percent (Confidence Interval 95 percent=0,2 percent to 0,5 percent). Following a mucous membrane exposure, the risk is 0,09 percent (CI95 percent=0.006 percent to 0,5 percent). The risk of hepatitis B acquisition ranges from 6 percent to 30 percent, and hepatitis C acquisition, 3 percent to 10 percent. Since 1992, the São Paulo Hospital's Hospital Infectious Prevention and Control Service (SPCIH) has notified and treated all workers exposed to accidents involving biological materials. In the last six years, we have handled approximately 1,300 cases of reported accidents, of which 90 percent were percutaneous, most involving needlesticks. Such cases were frequently caused by the inadequate disposal and reccaping of needles. In these accidents, 20 percent of the source patients were HIV positive, 10 percent were hepatitis C positive, and 7,6 percent were hepatitis B positive. This review summarizes the guidelines for a standardized response When deadling with accidents involving health care workers. Transmission of hepatitis B and HIV can be reduced if adequate preventive measures are taken in advance. If proper prophyllaxis is not being done, it should be initiated immediately.

Meningoencefalite na fase aguda do sarampo: relato de seis casos / Meningoencephalitis in the acute phase of measles: report of 6 cases

Apresentamos 6 casos de meningoencefalite aguda por sarampo, diagnosticados durante epidemia na cidade de São Paulo, em 1997. Os prontuários dos 6 pacientes foram analisados retrospectivamente. O diagnóstico de meningoencefalite baseou-se nas alterações clínicas e liquóricas, e foi confirmado por sorologia específica. Dos 467 pacientes com sarampo atendidos no Instituto de Infectologia Emílio Ribas nesse período, estes 6 evoluíram com alterações neurológicas e liquóricas durante a fase exantemática, sendo a sonolência e rigidez de nuca os achados mais frequentes. Os pacientes tinham entre 2 meses e 28 anos de idade. O exame do líquor mostrou pleocitose em todos. Não houve correlação entre a severidade do quadro clínico e liquórico com a evolução. Em 4 casos foi necessária internação na unidade de terapia intensiva; destes, 2 foram intubados. Apenas 2 pacientes apresentaram alterações na tomografia computadorizada de crânio. Todos tiveram boa evolução, sem sequelas.