Introduction

This chapter provides information on the prevalence of hepatitis B, hepatitis C and human immunodeficiency virus (HIV) – collectively referred to as blood-borne viruses (BBVs) – in risk groups, identifies the risks of specific body fluids and the routes of transmission. It further acts as a guide to the immediate management of at-risk exposures from BBVs both for the recipient and the contact, and any follow-up management this may entail. It will also cover some basic infection control guidance that will be helpful in the safe and practical day-to-day running of a custody suite. Although not exhaustive, it aims to cover the more commonly raised concerns and how best they should be managed.

Prevalence of BBVs: at-risk groups, body fluids and routes of transmission

Hepatitis B

Around 350 million people worldwide are chronically infected with hepatitis B and are therefore at risk of developing chronic liver disease. There are around 180000 people in this category in the UK. In general the world can be divided into three broad areas by prevalence of chronic infection (Table 14.1). About 75% of the world's population live in areas of high prevalence.

The virus can be transmitted through contact with body fluids (blood, saliva, semen, vaginal fluids, sweat, breast milk and any other if bloodstained) via percutaneous or mucosal exposure. In areas of high prevalence, infection most commonly occurs perinatally or in early childhood. In areas of intermediate prevalence, needle sharing, acupuncture, tattooing and body piercing are also important modes of transmission.