A systematic review of risk of HIV transmission through biting or spitting: implications for policy |
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| Authors: | FV Cresswell J Ellis J Hartley CA Sabin C Orkin DR Churchill |
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| Affiliation: | 1. Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK;2. Clinical Research Department, Infectious Diseases Institute, Kampala, Uganda;3. Lawson Unit, Royal Sussex County Hospital, Brighton, UK;4. Department of Infection and Immunity, University College London, London, UK;5. Worthing Hospital, Western Sussex Hospitals NHS Foundation Trust, West Sussex, Worthing, UK;6. Institute for Global Health, University College London, London, UK;7. Barts Health NHS Trust and Queen Mary University London, The Royal London Hospital, London, UK |
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| Abstract: | Objectives The perceived threat of HIV transmission through spitting and biting is evidenced by the increasing use of “spit hoods” by Police Forces in the UK. In addition, a draft parliamentary bill has called for increased penalties for assaults on emergency workers, citing the risk of communicable disease transmission as one justification. We aimed to review literature relating to the risk of HIV transmission through biting or spitting. Methods A systematic literature search was conducted using Medline, Embase and Northern Lights databases and conference websites using search terms relating to HIV, AIDS, bite, spit and saliva. Inclusion and exclusion criteria were applied to identified citations. We classified plausibility of HIV transmission as low, medium, high or confirmed based on pre‐specified criteria. Results A total of 742 abstracts were reviewed, yielding 32 articles for full‐text review and 13 case reports/series after inclusion and exclusion criteria had been applied. There were no reported cases of HIV transmission related to spitting and nine cases identified following a bite, in which the majority occurred between family (six of nine), in fights involving serious wounds (three of nine), or to untrained first‐aiders placing fingers in the mouth of someone having a seizure (two of nine). Only four cases were classified as highly plausible or confirmed transmission. None related to emergency workers and none were in the UK. Conclusions There is no risk of transmitting HIV through spitting, and the risk through biting is negligible. Post‐exposure prophylaxis is not indicated after a bite in all but exceptional circumstances. Policies to protect emergency workers should be developed with this evidence in mind. |
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| Keywords: | bite emergency workers
HIV
spit transmission |
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