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Guidance

Management of bloodborne virus (BBV) risk in bomb blast victims (hepatitis B, C and HIV)

Updated 16 July 2026

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This publication is available at https://www.gov.uk/government/publications/bloodborne-viruses-managing-risk-in-bomb-blast-victims/management-of-bloodborne-virus-bbv-risk-in-bomb-blast-victims-hepatitis-b-c-and-hiv

Bloodborne virus (BBV) risk

Consider the BBV risk:

  • at all incidents where multiple people have presented with significant blast injuries
  • at other incidents where body parts may have created human tissue projectile injuries to other people
  • to rescuers and responders at such scenes who may have skin-penetrating injuries from such scenes

Key facts

It is a recognised complication of bomb injuries that implantation of human body projectiles, derived from other victims and from suicide bombers can occur, and that these projectiles create a potential risk of transmission of bloodborne viruses (BBVs).

Analysis of injuries from the London bombings in 2005 showed that victims within 2 metres of the blasts suffered significant human projectile injuries. However, it must be presumed that any person suffering from trauma at a blast scene may have incurred human projectile injury. Most of these implanted projectiles were bone fragments. The prevalence of BBV infection in the UK population is low (hepatitis B less than 1%, hepatitis C less than 0.5%, HIV less than 0.3%).

For HIV it is important to note that over 95% of people living with HIV in England are diagnosed and over 95% are on HIV treatment and virally suppressed, that is, have undetectable virus and so the virus cannot be passed on.

The probability of transmission of BBV because of a blast injury is not known. However, the usually accepted risk of transmission per incident following sharps injuries from a known infected person in clinical settings is generally quoted as being 1 in 3 for hepatitis B, 1 in 30 for hepatitis C and 1 in 300 for HIV.

Hepatitis B

Post-exposure management of hepatitis B using hepatitis B accelerated immunisation schedule has very few contra-indications and is known to be highly effective provided that it is given within 24 to 48 hours following potential exposure, but may have benefit for a couple of weeks after exposure.

Hepatitis C

There are no current evidence-based methods for the post-exposure management of hepatitis C. Current best management is based on post-exposure testing and curative treatment of HCV infection, if detected, to prevent the long-term consequences of chronic infection.

HIV

Post-exposure prophylaxis (PEP) for HIV is effective if there is good compliance with treatment and prophylaxis is started soon after exposure (within 72 hours). However, the very low risk of transmission suggests that HIV PEP should not normally be given to victims of blast injuries.

Our public health advice is that:

  • all penetrating injuries should be radiographed and all human foreign body implantations urgently removed
  • tissue specimens should be collected from the scene, at post-mortems and from survivors to enable an incident specific BBV risk assessment where required
  • for deceased victims the appropriateness and need for tissue specimens should be discussed across a wider multi-disciplinary team, including the coroner
  • blood specimens from victims with human projectile injury should be taken and stored before any specific post-exposure treatment is instituted, provided this does not delay post-exposure treatment
  • any stored blood should be tested for BBV in line with local policies, or if required as the result of a wider incident specific risk assessment
  • negative blood test results do not need routine reporting to the UK Health Security Agency (UKHSA) unless requested to support a wider incident specific BBV risk assessment
  • positive blood test results should be reported by the clinical team to their local health protection team (HPT) to enable an appropriate risk assessment and follow up
  • all victims with injuries that have breached the skin must receive an accelerated course of hepatitis B vaccination (0, 1, 2 and 12 months), starting ideally within 24 to 48 hours of initial injury, but should be considered up to 2 weeks after exposure
  • all patients should be followed up at 3 and 6 months to determine hepatitis C and HIV status (and hepatitis B status if delays in post exposure vaccination)
  • other people directly injured in explosions with penetrating injuries leading to non-intact skin who have been discharged after initial treatment should be traced from their care records and reviewed and managed as above for potential BBV exposure within 7 days of the incident

References

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