From the Guidelines
If a patient with hepatitis A, B, or C spits in your face, immediately wash the affected area thoroughly with soap and water, as the risk of transmission through saliva is very low, but prompt cleaning is essential for safety and peace of mind. According to the most recent and highest quality study available 1, the primary concern is the potential transmission of hepatitis B, which can be managed with post-exposure prophylaxis (PEP) if necessary. For hepatitis C, there is no recommended PEP, but baseline testing and follow-up testing at 3-6 months are suggested to detect any infection early 1. For hepatitis A exposure in an unvaccinated person, hepatitis A vaccine and/or immune globulin might be recommended depending on risk factors and time since exposure.
Key Steps to Take
- Wash the affected area with soap and water immediately
- Seek medical attention within 24 hours for further evaluation and potential PEP
- For hepatitis B exposure, consider hepatitis B immune globulin (HBIG) and the hepatitis B vaccine series if not already vaccinated
- For hepatitis C, no PEP is recommended, but baseline and follow-up testing are suggested
- For hepatitis A, consider hepatitis A vaccine and/or immune globulin if unvaccinated and depending on risk factors
Importance of Prompt Action
Prompt cleaning and medical attention are crucial to minimize the risk of transmission, even though the risk of contracting hepatitis from saliva alone is minimal. Proper post-exposure management is essential for safety and peace of mind, as emphasized in the guidelines for the management of occupational exposures to HBV, HCV, and HIV 1.
From the Research
Immediate Response
If a patient with hepatitis A (Hep A), hepatitis B (Hep B), and hepatitis C (Hep C) spits in one's face, the following steps should be considered:
- Immediate washing of the face and eyes with water to reduce the risk of transmission [ 2 ]
- Reporting the incident to the infection control department for further guidance and follow-up
Risk Assessment
The risk of transmission of hepatitis viruses through spit is generally considered low, but it is not negligible:
- Hepatitis B can be transmitted through mucosal exposure to blood and, rarely, also by nonintact skin exposure to blood-free saliva [ 3 ]
- Hepatitis C transmission requires "visible blood" exposure, and since saliva is usually blood-free, the risk of HCV transmission from spitting is considered negligible [ 3 ]
- Hepatitis A is primarily transmitted through the fecal-oral route, and the risk of transmission through spit is not well-established [ 4 ]
Post-Exposure Follow-up
After being spat on by a patient with hepatitis A, B, and C, the following post-exposure follow-up may be necessary:
- Hepatitis B follow-up is required for all individuals who have been spat on, as the virus can be transmitted through mucosal exposure to blood and saliva [ 3 ]
- Hepatitis C testing may not be necessary unless there is visible blood in the saliva [ 3 ]
- Hepatitis A follow-up may not be necessary, as the risk of transmission through spit is not well-established [ 4 ]