HYPODERMIC NEEDLE: MOTHER ACTED CORRECTLY

I would like to respond to a letter to the editor that appeared in the April
19 edition of The Herald regarding hypodermic needles. It describes an
incident in which a child was poked with a needle from a syringe found on
the ground, a situation which most clinicians are unfortunately familiar
with.

While I share the mother's concern regarding the presence of used needles
and syringes discarded in public places, I would like to make several points
about the circumstances and actions described in the letter.

Fortunately, the risk of becoming infected with HIV from a discarded syringe
in Snohomish County is extremely low, because few people here are infected
with the virus. We can thank the effective prevention programs which have
been in place here since the 1980s for this. Similarly, the risk of becoming
infected with hepatitis C, although possible, is also unlikely. In a person
fully vaccinated against hepatitis B, as this child fortunately was, there
would be no risk of infection.

The mother acted correctly by her actions immediately following the
incident, and even though it was unnecessary to give a fourth dose of
hepatitis B vaccine to a child who had completed the vaccine series of three
doses, the only negative aspect of a fourth dose was the time and expense
involved. A tetanus booster would be appropriate in this situation if the
child had not received one for five or more years.

The presence of discarded needles and syringes in the environment is a
concern for everyone; studies have shown that needle-exchange programs for
injecting drug users not only reduces the transmission of HIV, but decreases
the presence of used and discarded "works" in the communities where they're
active. Effective HIV and hepatitis B prevention programs are essential for
maintaining low infection levels in a community, as they are here, so the
risk of infection will be low when unfortunate incidents such as this occur.

Jo Hofmann, M.D.
Deputy Health Officer
Snohomish Health District