Human bites: bloodborne pathogen risk and postexposure follow-up algorithm.

Human bites may transmit bloodborne pathogens (BPs) by exposing the biter's oral mucosa to the bitee's blood and the bite wound to biter's saliva. Consequently, bites may require postexposure follow-up per the Occupational Safety and Health Administration (OSHA) BP standard. Literature reveals that BP transmission via bites is rare. Review of available records in our developmental center identified no bite-related BP transmission between 1993 and 2011. To avoid unnecessary testing while remaining OSHA-compliant, we propose an algorithm for selective follow-up of bites. Since hepatitis B virus can be transmitted by mucosal exposure to blood and, rarely, also by nonintact skin exposure to blood-free saliva, all biters and bitees require hepatitis B follow-up. Since hepatitis C virus and human immunodeficiency virus (HIV) transmissions require "visible blood" exposure, and since saliva is usually bloodfree, risk of HCV-HIV transmission from biter to bitee is negligible. Therefore biters need HCV-HIV testing only after bloody saliva bites. Since biter's oral mucosa invariably gets exposed to bitee's blood (reverse exposure), all bitees should be tested for HCV-HIV infectivity. Our proposed algorithm may prevent harm and waste from unnecessary biter testing and venipuncture.