Management of potential bloodborne virus exposure following severe serial penetrating injury attack
Updated 3 October 2025
© Crown copyright 2025
This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gov.uk.
Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.
This publication is available at https://www.gov.uk/government/publications/bloodborne-viruses-managing-severe-serial-penetrating-injuries/management-of-potential-bloodborne-virus-exposure-following-severe-serial-penetrating-injury-attack
Background
Serial attacks with bladed or other forms of penetrating weapons carry the possibility of transmission of blood borne viral infections (hepatitis C, hepatitis B and HIV).
For this risk to be present the following characteristics must be present:
- multiple victims have been injured
- using the same weapon, and
- the injuries incurred are of a nature that the transfer of significant amounts of blood or other body tissues may have occurred
Key facts
The UK Health Security Agency (UKHSA)’s interim advice on the management of the bloodborne viral risk incurred is similar to that for victims of bomb blast injuries. However, it should be noted that the risk of transmission from serial penetrating injury attacks is different than that for bomb blast incidents and should only exist if one of the persons in the chain is infected with a bloodborne virus.
The risk of transmission of bloodborne viral infections in such circumstances is predicated on the prevalence of hepatitis B, C and HIV carriage in the UK population. This is generally low, with estimates suggesting that the population prevalence of hepatitis B is less than 1%, and hepatitis C less than 0.5%.
In regard to HIV it is important to note that there is a very high rate of viral suppression (and so negligible transmission risk) in those currently in treatment for HIV (that is, with a known diagnosis) – with more than 95% effectively virally suppressed. Around 5% of people living with HIV in England are undiagnosed, an estimated 4,700 people in 2023.
The probability of transmission of these bloodborne viruses in such incidents is unknown. However, the usually accepted risks of transmission per incident following sharps injuries from known infected persons in clinical settings, which may be the closest natural model, is generally quoted as being 1:3 for hepatitis B, 1:30 for hepatitis C and 1:300 for HIV.
Recommendations
For all patients with injuries that have breached the skin:
- blood specimens should be taken before any specific post-exposure treatment is instituted (provided this does not delay post-exposure treatment) and tested for hepatitis B, hepatitis C and HIV. Consent should be sought to share the results of these tests with UKHSA to help inform and to review UKHSA’s assessment of risk to those involved
- an accelerated course of hepatitis B vaccination (0, 1, 2 and 12 months) must be given, ideally starting within 24 to 48 hours of initial injury (but may have benefit up to 7 days later)
- all patients should be followed up at 3 and 6 months to determine hepatitis C and HIV status (and then managed accordingly)
- HIV post-exposure prophylaxis is not recommended