Occupational Post-exposure Prophylaxis after Blood and Body Fluids Exposure among Healthcare Workers in Siriraj Hospital

Objective: The present study aimed to describe the characteristics of occupational exposure to bloodborne pathogens and occupational post-exposure prophylaxis (oPEP) in Siriraj Hospital. Materials and Methods: A descriptive, retrospective cohort study was performed of healthcare workers (HCWs) who had experienced occupational injury in Siriraj Hospital in 2015. Data were extracted from the hospital database. Results: In total, 389 injury episodes were described; of which 293 (75.3%) involved female staff, and 112 (28.8%) involved nurses. The highest number of accidents (112, 28.8%) occurred in the operation room. Needlestick injury (210, 54%) was the most common injury. Overall, 94 (24.1%) HCWs received oPEP; 67 (71.2%) events carried a risk of HIV acquisition, and in 27 (28.7%) cases, the patients decided to take oPEP. Common oPEP regimens were TDF/XTC/LPV/r (33, 35.1%) and TDF/XTC/RPV (32, 34%). Nearly half of the HCWs who received an LPV/r-based oPEP regimen had gastrointestinal intolerance and switched to second-line regimens. Among those who received oPEP, 52 (77.6%) returned at 1 month and 26 (38.8%) returned at 3 months after exposure for a serology test. There was no seroconversion in this cohort. Conclusion: Occupational exposure to bloodborne pathogens is a common and increasing risk of infection among HCWs. oPEP with effective antiretroviral drugs within 72 hours after exposure is the main strategy for HIV prevention. The selection of an oPEP regimen with less toxic pills should be considered for efficacy, safety, and adherence. Interventions such as a tracking system or message reminders should be implemented to improve the follow-up rate among HCWs

A Risk Prediction Model and Risk Score of SARS-CoV-2 Infection Following Healthcare-Related Exposure

Hospital workers are at high risk of contact with COVID-19 patients. Currently, there is no evidence-based, comprehensive risk assessment tool for healthcare-related exposure; so, we aimed to identify independent factors related to COVID-19 infection in hospital workers following workplace exposure(s) and construct a risk prediction model. We analyzed the COVID-19 contact tracing dataset from 15 July to 31 December 2021 using multiple logistic regression analysis, considering exposure details, demographics, and vaccination history. Of 7146 included exposures to confirmed COVID-19 patients, 229 (4.2%) had subsequently tested positive via RT-PCR. Independent risk factors for a positive test were having symptoms (adjusted odds ratio 4.94, 95%CI 3.83–6.39), participating in an unprotected aerosol-generating procedure (aOR 2.87, 1.66–4.96), duration of exposure >15 min (aOR 2.52, 1.82–3.49), personnel who did not wear a mask (aOR 2.49, 1.75–3.54), exposure to aerodigestive secretion (aOR 1.5, 1.03–2.17), index patient not wearing a mask (aOR 1.44, 1.01–2.07), and exposure distance <1 m without eye protection (aOR 1.39, 1.02–1.89). High-potency vaccines and high levels of education protected against infection. A risk model and scoring system with good discrimination power were built. Having symptoms, unprotected exposure, lower education level, and receiving low potency vaccines increased the risk of laboratory-confirmed COVID-19 following healthcare-related exposure events

Serological Response of Patients with Influenza A (H1N1) pdm09-Associated Pneumonia: An Observational Study

<div><p>Background</p><p>Little is known about the dynamics or magnitude of antibody response in patients with influenza A (H1N1) pdm09-associated pneumonia. We described and compared the antibody response to influenza A (H1N1) pdm09 in patients with and without pneumonia.</p> <p>Methods</p><p>We collected serum samples and determined antibody titers by the hemagglutination inhibition (HI) and microneutralization (mNT) assays from patients with RT-PCR confirmed influenza A (H1N1) pdm09 virus at baseline, 1, 2 and 6 months after onset of illness. </p> <p>Results</p><p>Fifty-nine patients were enrolled, 45 (76.3%) were between 15 and 60 years of age, 49 (83.1%) were hospitalized and 25 (42.4%) had complications with pneumonia. Ninety-four percent of patients had HI titers ≥ 1: 40 and 90% had mNT titers ≥ 1: 160 at 2 months after illness. Geometric mean titers (GMT) of HI and mNT increased significantly (<i>p</i><0.001) between baseline and months 1 or 2, then declined significantly (<i>p</i><0.001) at month 6 by the HI assay, but dropped to an insignificant level (<i>p</i>=0.24) by the mNT assay. The mNT-GMT was at least twice as high as corresponding HI antibodies over a 6 month period. The GMT of HI and mNT in those with pneumonia (1 mo) peaked earlier than that of those without pneumonia (2 mo). When adjusted by age and gender, those with pneumonia had a higher HI-GMT than those without pneumonia at 1 month (264 vs. 117, <i>p</i>=0.007), 2 months (212 vs. 159, <i>p</i>=0.013), and 6 months (160 vs. 82, <i>p</i>=0.018). </p> <p>Conclusions</p><p>The patients recovered from influenza A (H1N1) pdm09-associated pneumonia, clearly developed an earlier and more robust antibody response until 6 months after onset of illness. The results in our study are useful to determine an appropriate donor and timing to obtain convalescent plasma for adjunctive treatment of seriously ill patients with pandemic H1N1 influenza.</p> </div

A pilot program of HIV pre-exposure prophylaxis in Thai youth.

IntroductionThere are gaps in knowledge and experience of antiretroviral pre-exposure prophylaxis (PrEP) delivery in adolescents.MethodsThis pilot study enrolled Thai adolescents 14-20 year-old without HIV who reported risk behaviour. All participants were offered daily tenofovir/emtricitabine (TDF-FTC) and followed for 24 weeks. HIV testing, renal function, bone density scan, and sexually transmitted infection (STI) testing including syphilis serology and urine molecular testing for gonorrhoea and C. trachomatis were performed at baseline and weeks 12 and 24. Adherence was evaluated through intracellular tenofovir diphosphate (TFV-DP) levels in dried blood spots.ResultsOf the 61 enrolled adolescents, median age 18.1 (IQR: 14.8-20.9) years, 46 (75.4%) were males and 36 (59%) were MSM. Retention to week 24 was 80.3%. One third (36%) had TFV-DP levels consistent with taking ≥6 pills/week at week 12 and 29% at week 24. The factors associated with taking ≥6 pills/week were being MSM (adjusted odds ratio [aOR]: 53.2, 95% CI: 1.6-1811; p = 0.027), presence of STI at baseline (aOR: 9.4, 95% CI: 1.5-58.5; p = 0.016), and self-report of decreased condom use while taking PrEP (aOR: 8.7, 95% CI: 1.4-56.6; p = 0.023). 31% had an STI at baseline and this declined to 18% at week 24. No renal or bone toxicity was observed and there were no HIV seroconversions.ConclusionsDaily oral PrEP with FTC-TDF in high-risk Thai adolescents is feasible, accepted, well-tolerated, and had no increased risk compensation; however, low adherence was a major challenge. Adolescent-specific PrEP strategies including long-acting modalities are needed for successful HIV prevention

Geometric mean titers (GMT) of antibodies among different age groups.

<p>A) GMT of hemagglutination inhibition antibodies (HI-GMT) and B) GMT of neutralization antibodies (NT-GMT) among three age groups (Age < 15, 15-59 and ≥ 60) of 59 patients infected with influenza A (H1N1) pdm09 virus.</p

Geometric mean titers of hemagglutination inhibition (HI) and neutralization (NT) antibodies over 6 months.

<p>Geometric mean titers of hemagglutination inhibition (HI) and neutralization (NT) antibodies over 6 months.</p

CONSORT diagram shows the flow of the study participants through 6 months period.

<p>The patients who had at least one follow-up visit remained including in the study. </p

Factors associated with adherence to pre-exposure prophylaxis treatment among participants retained at week 24.

Factors associated with adherence to pre-exposure prophylaxis treatment among participants retained at week 24.</p

Factors associated with adherence to pre-exposure prophylaxis treatment among male participants retained at week 12.

Factors associated with adherence to pre-exposure prophylaxis treatment among male participants retained at week 12.</p

Adherence to pre-exposure prophylaxis treatment in participants determined by TFV-DP concentration at week 12 and 24.

TFV-DP categories were based on ≥ 700 fmol/punch for ≥ 4 doses/week, ≥ 1050 fmol/punch for ≥ 6 doses/week, and ≥ 1250 fmol/punch for 7 doses/week.</p