Hepatitis B can transmitted through all of the following routes EXCEPT:
However universal precaution is not needed for breast milk (no occupational hazard), Human breast milk has been implicated in perinatal transmission of HIV, and HBsAg has been found in the milk of mothers infected with HBV (REF: JAMA 1988; 259:1353-6. Lifson AR, Bond WW, Petersen NJ, Gravelle CR, Favero MS. Hepatitis B virus in peritoneal dialysis fluid: A potential hazard. Dialysis and Transplantation 1982; 11:592-600.) Harrison says that serum, semen and saliva are most infectious for hepatitis B transmission. Robbin's 7th ed says that hepatitis B antigen is present in all body secretions except stools CDC GUIDELINES: (REF: style="font-size: 12px; font-family: Verdana; background-color: transparent; veical-align: baseline; white-space: pre-wrap;">) Extension of blood and body fluid precautions to all patients is referred to as "Universal Blood and Body Fluid Precautions" or "Universal Precautions." Under universal precautions, blood and ceain body fluids of all patients are considered potentially infectious for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens. BODY FLUIDS TO WHICH UNIVERSAL PRECAUTIONS APPLY: *Universal precautions apply to blood and to other body fluids containing visible blood. *Blood is the single most impoant source of HIV, HBV, and other bloodborne pathogens in the occupational setting *Universal precautions also apply to tissues and to the following fluids: semen and vaginal secretions, cerebrospinal fluid (CSF), synol fluid, pleural fluid, peritoneal fluid, pericardial fluid, and amniotic fluid. BODY FLUIDS TO WHICH UNIVERSAL PRECAUTIONS DO NOT APPLY: *Universal precautions do not apply to feces, nasal secretions, sputum, sweat, tears, urine, and vomitus unless they contain visible blood *The risk of transmission of HIV and HBV from these fluids and materials is extremely low or nonexistent. *Human breast milk has been implicated in perinatal transmission of HIV, and HBsAg has been found in the milk of mothers infected with HBV (10, 13). However, occupational exposure to human breast milk has not been implicated in the transmission of HIV nor HBV infection to health-care workers. *Whereas universal precautions do not apply to human breast milk, gloves may be worn by health-care workers in situations where exposures to breast milk might be frequent, for example, in breast milk banking. * Universal precautions do not apply to saliva. Saliva of some persons infected with HBV has been shown to contain HBV-DNA at concentrations 1/1,000 to 1/10,000 of that found in the infected person's serum. HBsAg-positive saliva has been shown to be infectious when injected into experimental animals and in human bite exposures
Milk
Semen
Stool
Blood