Prevention and Control of AIDS
Dr Mostafa Mahmoud, MD, Ph D,
Consultant Microbiologist
Assist. Prof. of Medical Microbiolo...
Where HIV present in human body fluids?
Infectious Body Fluids Non-Infectious Body Fluids
• All body fluids containing
vis...
How can the HIV transmitted in community?
The most common modes of transmission:
• Having sex with someone who has HIV (an...
The Less common modes of transmission:
1. Being born to an infected mother (pregnancy
& breast feeding).
2. Receiving bloo...
5. Oral sex
6. Deep, open-mouth kissing if the person with HIV
has sores or bleeding gums and blood is
exchanged.
7. Conta...
Modes of transmission among HCWs
• Being stuck with an HIV-contaminated needle or
other sharp object.
• Contact between br...
Non-reported modes:
• Air or water.
• Insects, including mosquitoes or ticks.
• Saliva, tears, or sweat or spitting.
• Cas...
A. Prevention of HIV transmission in
community
1. There is no vaccine for preventing HIV
infection.
2. Male circumcision d...
6. Prevent HIV infection during anal or
vaginal sex
• Use condoms the right way every time you
have sex.
• Take medicines ...
7. Prevent HIV infection from oral sex
• Little to no risk of getting or transmitting HIV
from oral sex.
• Theoretically, ...
8. Prevent HIV infection to the baby
• By antiviral treatment of infected mother.
• Breast feeding ; stop if there is affo...
9. Pre-Exposure prophylaxis
• For those who are at very high risk for HIV
from sex or injecting drugs, by taking HIV
antiv...
10. Prevention among drug users
• Stopping injection and other drug use can
lower your chances of getting or transmitting
...
Vaccine development is difficult due to:
1. Rapid mutation of the virus especially in the
envelope region.
2. HIV spread f...
For HCWs
• High-risk settings
• Obstetric procedures
• Labour and delivery
• Immediate care of the infant
• Other blood-bo...
Prevention of HIV Transmission in HCWs
Prevent the Transmission circuits:
• from HCWs to patient
• From Patient to HCWs
• ...
Infection Control Measures
• Standard Precautions
• Management of the work environment
• Ongoing education of employees in...
Standard Precautions
–Applied universally in caring for all patients
• Hand Hygiene (HH)
• Decontamination of equipment an...
Promotion of a Safe and Supportive Work
Environment
• Management of the work environment to
promote safety includes:-
• Im...
Education in Infection Prevention
• Education of HCWs includes
• Making all staff aware of established
infection control p...
Hand Hygiene
–Recommended Practice
• Soap and water hand washing using friction
under running water for at least 15 second...
How long HIV survives in the
environment ??
• Depends upon volume & type of body fluid, pH
of environement, viral Conc., a...
4. Sewage is highly unlikely to pose a risk because
infectious HIV has never been isolated from
feces or urine.
5. HIV doe...
Disinfection and inactivation
HIV is completely inactivated by:
1. Treatment for 10 minutes at room temperature
by:
10% ho...
Managing Occupational Exposure to HIV
Infection
Post-Exposure Prophylaxis (PEP):
• PEP – Following occupational HIV exposu...
AIGH Policy for sharp injuries & Cuts
(under processing)
• Policy applied to HBV, HCV & HIV.
• Needle or Sharp Injury at W...
1. Documenting the case and all required data as
in NSI reporting form.
2. Wash needle-sticks and cuts with soap and
water...
If the staff was managed at ED he must
present to the IPC Dept. in the next
working day to have done the following:-
1. De...
Management of staff exposed to HIV-positive source:
1. There is no vaccine for HIV however; antiviral post-
exposure thera...
5. The FDA did not approve drug treatment for HIV
PEP but only for treating exiting infection.
6. HIV antiviral agents hav...
PEP after exposure to HBV-positive:
1. HBV infection have an effective vaccine and PEP by
hepatitis B immunoglobulin (HBIG...
4. Both HBV vaccine and HBIG are safe and FDA
approved.
5. Both HBV vaccine and HBIG are safe to be given
to pregnant fema...
PEP after exposure to HCV-positive:
1. Neither effective vaccine nor PE treatment
preventing HCV infection is available.
2...
5. For earlier detection of infection it is advised
to test for HCV RNA by PCR 4-6 weeks after
exposure.
6. No special pre...
References
• http://www.cdc.gov/hiv/risk/prep/index.html.
• http://www.cdc.gov/hiv/basics/prevention.html.
• http://www.cd...
Thank You
Prevention and Control of AIDS for World AIDS day
Prevention and Control of AIDS for World AIDS day
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Prevention and Control of AIDS for World AIDS day

Methods of transmission and control procedures for AIDS control.
Published on: Mar 4, 2016
Published in: Health & Medicine      
Source: www.slideshare.net


Transcripts - Prevention and Control of AIDS for World AIDS day

  • 1. Prevention and Control of AIDS Dr Mostafa Mahmoud, MD, Ph D, Consultant Microbiologist Assist. Prof. of Medical Microbiology & Immunology
  • 2. Where HIV present in human body fluids? Infectious Body Fluids Non-Infectious Body Fluids • All body fluids containing visible blood • Pericardial fluid • Pleural fluid • Peritoneal fluid • Cerebrospinal fluid (CSF). • Amniotic fluid • Synovial fluid • Vaginal secretion • Semen • Breast milk • Tears • Feces • Urine • Saliva • Sputum • Nasal secretions • Vomit • Sweat
  • 3. How can the HIV transmitted in community? The most common modes of transmission: • Having sex with someone who has HIV (anal sex is the highest then, vaginal and multiple partners. • Sharing needles, syringes, rinse water, or other equipment (works) used to prepare injection drugs with someone who has HIV.
  • 4. The Less common modes of transmission: 1. Being born to an infected mother (pregnancy & breast feeding). 2. Receiving blood transfusions, blood products, or organ/tissue transplants that are contaminated with HIV. 3. Eating food that has been pre-chewed by an HIV-infected person during chewing in infants (Caregivers). 4. Being bitten by a person with HIV.
  • 5. 5. Oral sex 6. Deep, open-mouth kissing if the person with HIV has sores or bleeding gums and blood is exchanged. 7. Contact between broken skin, wounds, or mucous membranes and HIV-infected blood or blood-contaminated body fluids. 8. Tattooing not reported in USA but can happen.
  • 6. Modes of transmission among HCWs • Being stuck with an HIV-contaminated needle or other sharp object. • Contact between broken skin, wounds, or mucous membranes and HIV-infected blood or blood-contaminated body fluids.
  • 7. Non-reported modes: • Air or water. • Insects, including mosquitoes or ticks. • Saliva, tears, or sweat or spitting. • Casual contact like shaking hands or sharing dishes. • Closed-mouth or “social” kissing • Toilet seats
  • 8. A. Prevention of HIV transmission in community 1. There is no vaccine for preventing HIV infection. 2. Male circumcision decrease risk to Circumcised man but not to women (inconclusive effects for circumcision in other situations). 3. Strict examination for blood, blood products, organ donation for HIV before administration. 4. No sharing of needles, brushes or razors. 5. Proper sterilization of dental & surgical instruments
  • 9. 6. Prevent HIV infection during anal or vaginal sex • Use condoms the right way every time you have sex. • Take medicines to prevent or treat HIV if appropriate (PEP). • Choose less risky sexual behaviors • Get tested for other sexually transmitted diseases (STDs) e.g. HBV, HCV, ..etc. • Limit your number of sex partners.
  • 10. 7. Prevent HIV infection from oral sex • Little to no risk of getting or transmitting HIV from oral sex. • Theoretically, transmission of HIV is possible if an HIV-positive man ejaculates in his partner’s mouth during oral sex. However, the risk is still very low, and much lower than with anal or vaginal sex
  • 11. 8. Prevent HIV infection to the baby • By antiviral treatment of infected mother. • Breast feeding ; stop if there is affordable formula, and continue if not (poor countries) with receiving antiviral treatment (WHO 2010).
  • 12. 9. Pre-Exposure prophylaxis • For those who are at very high risk for HIV from sex or injecting drugs, by taking HIV antiviral daily. medicines daily, called pre- exposure (or PrEP), can greatly reduce your risk of HIV infection.
  • 13. 10. Prevention among drug users • Stopping injection and other drug use can lower your chances of getting or transmitting HIV a lot. • If you keep injecting drugs, use only sterile needles and works. Never share needles or works.
  • 14. Vaccine development is difficult due to: 1. Rapid mutation of the virus especially in the envelope region. 2. HIV spread from cell to cell via a fusion process without contacting blood containing the antibodies 3. Lack of an appropriate animal model for AIDS
  • 15. For HCWs • High-risk settings • Obstetric procedures • Labour and delivery • Immediate care of the infant • Other blood-borne infections: –Hepatitis B and C –Syphilis –Malaria –Bacterial infections like Brucellosis
  • 16. Prevention of HIV Transmission in HCWs Prevent the Transmission circuits: • from HCWs to patient • From Patient to HCWs • From Patient to patient (Equipment) by Application of the Standard Precautions. •Patient to patient Sterilize contaminated equipment and devices
  • 17. Infection Control Measures • Standard Precautions • Management of the work environment • Ongoing education of employees in all aspects of infection prevention
  • 18. Standard Precautions –Applied universally in caring for all patients • Hand Hygiene (HH) • Decontamination of equipment and devices • Use and disposal of needles and sharps safely (no recapping) • Wearing personal protective equipment (PPE) • Prompt cleaning up of blood and body fluid spills. • Systems for safe collection of waste and disposal
  • 19. Promotion of a Safe and Supportive Work Environment • Management of the work environment to promote safety includes:- • Implementation, monitoring and evaluation of use of Standard Precautions. • Procedures for reporting and treating occupational exposure to HIV infection • Maintaining and monitoring of appropriate staff levels. • Providing protective equipment and materials • Providing appropriate disinfectants.
  • 20. Education in Infection Prevention • Education of HCWs includes • Making all staff aware of established infection control policies • Ongoing training to build skills in safe handling of equipment and materials • Monitoring and evaluation of practices to remedy deficiencies
  • 21. Hand Hygiene –Recommended Practice • Soap and water hand washing using friction under running water for at least 15 seconds • Using alcohol-based hand rubs (or antimicrobial soap) and water for routine decontamination
  • 22. How long HIV survives in the environment ?? • Depends upon volume & type of body fluid, pH of environement, viral Conc., and temp.:- 1. HIV remains relatively stable in blood at RT, and may persist for at least a week in dried blood at 4°C. 2. HIV may survive for up to four weeks in syringes after HIV-infected blood has been drawn up into the syringe and then flushed out. 3. HIV may survive in dried blood at RT for up to five or six days in optimal pH.
  • 23. 4. Sewage is highly unlikely to pose a risk because infectious HIV has never been isolated from feces or urine. 5. HIV does not survive as long as other viruses in sea water. 6. Infectious HIV has been recovered from human cadavers between 11 and 16 days after death in bodies stored at the usual mortuary temperature of 2°C. 7. No studies have investigated the survival of HIV in semen outside the body
  • 24. Disinfection and inactivation HIV is completely inactivated by: 1. Treatment for 10 minutes at room temperature by: 10% household bleach 50% ethanol , 0.5% Lysol , 0.3% hydrogen peroxide 2. Extremes of pH 3- Heating at 56 °C for 10 minutes 4- Lyophilized blood products heated at 68 °C for 72 hours (N.B. Cold not inactivate HIV in blood even at -70 oC)
  • 25. Managing Occupational Exposure to HIV Infection Post-Exposure Prophylaxis (PEP): • PEP – Following occupational HIV exposure, short-course of ARV drugs can be used to reduce the likelihood of infection. • Register occupational exposures. • Ensure that HIV counselling, testing, and ARV drugs are available. • Educate healthcare workers.
  • 26. AIGH Policy for sharp injuries & Cuts (under processing) • Policy applied to HBV, HCV & HIV. • Needle or Sharp Injury at Working hours (8 AM to 4 PM): to IPC Dept. • After Working hours (4 PM to 8 AM) and in vacations (Friday & Saturday): to the ED dept. • Procedures to be done in either departments:
  • 27. 1. Documenting the case and all required data as in NSI reporting form. 2. Wash needle-sticks and cuts with soap and water. 3. Flush splashes to the nose, mouth, or skin with water. 4. Irrigate eyes with clean water, saline, or sterile irrigants. N.B.- Squeezing of the wound or the use of antiseptics have nothing to do and not recommend also, the use of caustic agents are not recommended.
  • 28. If the staff was managed at ED he must present to the IPC Dept. in the next working day to have done the following:- 1. Define the type, and location of the injury, and the purpose of sharp sage. 2. After defining of the source of infection the virological status of the source to be defined HBV, HCV, HIV. 3. If the source status is unknown and available, he or she must be examined for these viruses (HBV, HCV, & HIV) by the IPC staff sending samples to the lab. - After that staff must go to the SHC for PEP
  • 29. Management of staff exposed to HIV-positive source: 1. There is no vaccine for HIV however; antiviral post- exposure therapy can prevent HIV infection. So, PEP is recommended in certain cases. 2. Combination of Two antiviral therapy is recommended for 4 weeks can be modified on a case-to-case basis. 3. If the source is unknown virological status, follow up must be done for 6 months. 4. PE treatment must started within hours in exposure to positive source (delay for 24-36 hours is less effective in preventing HIV infection).
  • 30. 5. The FDA did not approve drug treatment for HIV PEP but only for treating exiting infection. 6. HIV antiviral agents have many side effects and the benefits of administration must be balanced against the possibility of getting infected in routine cases and also in pregnancy. 7. Follow up for 6 months after exposure is important and for drug toxicity if receiving antiviral treatment. 8. Post-exposure precautions for 6-12 weeks in HIV include; no blood donation, no organ donation, no sexual intercourse (or use of condoms), no breast-feeding !!.
  • 31. PEP after exposure to HBV-positive: 1. HBV infection have an effective vaccine and PEP by hepatitis B immunoglobulin (HBIG). 2. If the staff is not vaccinated, the staff must receive HBIG injection as early as possible within 24 hours of exposure and not more than 7 days after exposure. 3. Start HBV vaccination at once for 3 successive doses for non-vaccinated staff regardless the source is positive or negative for HBV at (0, 1 and 6 months) with measurement of the HBsAb Titer after one month to test for immunization (> 10 mIU/ml). 4. If the staff is vaccinated then give booster dose of the vaccine and no need for HBIG.
  • 32. 4. Both HBV vaccine and HBIG are safe and FDA approved. 5. Both HBV vaccine and HBIG are safe to be given to pregnant females. 6. No follow up is needed after treatment and vaccination against HBV is required. 7. No special precautions are required after exposure to HBV positive and receiving treatment. 8. If the virological status of the source is unknown, then manage the exposed staff as positive exposure and start vaccination.
  • 33. PEP after exposure to HCV-positive: 1. Neither effective vaccine nor PE treatment preventing HCV infection is available. 2. Neither immunoglobulin nor antiviral therapy is recommended after exposure. 3. Prevention of the exposure the cornerstone of management and is imperative. 4. Follow up by HCV Ab testing and liver enzymes (ALT) must be done for 6 months after exposure to HCV positive or Unknown status.
  • 34. 5. For earlier detection of infection it is advised to test for HCV RNA by PCR 4-6 weeks after exposure. 6. No special precautions after exposure to HCV positive case are required as the risk of becoming infected or transmit the infection to others are very low.
  • 35. References • http://www.cdc.gov/hiv/risk/prep/index.html. • http://www.cdc.gov/hiv/basics/prevention.html. • http://www.cdc.gov/hiv/basics/transmission.html. • http://www.who.int/bulletin/volumes/88/1/10-030110/en/. • Abdala N et al. Survival of HIV-1 in syringes. J Acquir Immune Defic Syndr Hum Retrovirol 20(1):73-80, 1999. • Voeller B Heterosexual transmission of HIV. JAMA 267(14):1917-8, 1992 • Advisory Committee on Dangerous Pathogens HIV - the causative agent of AIDS and related conditions. Department of Health, 1990 • Slade JS et al. The survival of human immunodeficiency virus in water, sewage and sea water. Water Science and Technology 21(3): 55-59, 1989.
  • 36. Thank You

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