3 research outputs found
COVID Re-Infection or Something Else? A Case Report
Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over 100 million people so far globally with few cases of reinfection reported [1, 2]. Most people with coronavirus disease 2019 (COVID-19) develop antibodies after resolution of acute infection, however the exact duration of these antibodies and the extent to which it may indicate a protective immunity to SARS-CoV-2 in humans is unknown [2, 3]. We report an unusual case of probable asymptomatic reinfection with SARS-CoV-2 while still having antibodies present. Case Presentation: A 39-year-old healthy female healthcare professional in New York City had severe myalgia, generalized body weakness, cough, and subjective fever (maximum axillary temperature 99.8F) in March of 2020. The patient was not tested for COVID-19 initially because there was no documentation of fever ≥100F and restriction of testing due to limited availability. Conservative management with analgesics and hydration was done and symptoms subsided after 7 days. One week later (April 2020), multiple family members became sick with COVID-like symptoms and tested positive to SARS-CoV-2 by polymerase chain reaction (PCR). Patient was then screened with SARS-CoV-2 RT-PCR (Roche Cobas 6800) due to close household contact and was positive. Routine COVID-19 antibody testing (Roche Cobas Elecsys) offered to hospital staff on a voluntary basis a month later and again 4 months later (September 2020) during annual employee health screening were both positive. In January 2021, the patient was tested due to mandatory return-to-work screening after out-of-state travel and was found to be positive by both PCR and antibody ('Table 1'). At that time, patient was completely asymptomatic but was required to quarantine. Six days later, she repeated both tests in an urgent care facility at which time SARSCoV-2 RNA PCR (Roche Cobas) was negative while the IgG antibodies (Abbott Alinity i) remained positive. A respiratory viral panel for SARS-CoV-2 RNA PCR and influenza A and B (Roche Cobas) done three weeks later as part of the prerequisites for clinical rotation in a different hospital was also negative. Conclusion: The asymptomatic index case had antibodies at the time she re-tested positive to SARS-CoV-2 10 months after first testing positive. This may be a case of re-infection in which the presence of antibodies kept the patient symptom-free. Less likely, she may have been carrying viral particles in her nose for 10 months as there was no documented negative test in the interim. There are no published reports of such prolonged carriage of virus [4]. Furthermore, prolonged detection of viral particles does not translate to infectivity [4, 5]. The repeat positive test could also have been a false positive. Polymerase chain reaction cycle thresholds may prove helpful to clinicians to determine the significance of a positive PCR test
Health Professional Training and Capacity Strengthening Through International Academic Partnerships: The First Five Years of the Human Resources for Health Program in Rwanda
Abstract
Background: The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health
professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent
health workforce and strengthening the capacity of academic institutions in Rwanda.
Methods: The data for this organizational case study was collected through official reports from the Rwanda Ministry of
Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and
Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors.
Results: In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99
visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019.
The HRH Program has also built capacity within the CMHS by promoting the recruitment of Rwandan faculty and the
establishment of additional partnerships and collaborations with the US academic institutions.
Conclusion: The milestones achieved by the HRH Program have been substantial although some challenges persist.
These challenges include adequately supporting the visiting faculty; pairing them with Rwandan faculty (twinning);
ensuring strong communication and coordination among stakeholders; addressing mismatches in priorities between
donors and implementers; the execution of a sustainability strategy; and the decision by one of the donors not to renew
funding beyond March 2017. Over the next 2 academic years, it is critical for the sustainability of the 22 training programs
supported by the HRH Program that the health-related Schools at the CMHS significantly scale up recruitment of new
Rwandan faculty. The HRH Program can serve as a model for other training initiatives implemented in countries affected
by a severe shortage of health professionals
Antibiotic prescribing practices in three neonatology units in Kigali, Rwanda. \u2013 an observational study
Introduction: There is limited published data on antibiotic use in
neonatal units in resource-poor settings. Objectives: This study sought
to describe antibiotic prescribing practices in three neonatology units
in Kigali, Rwanda. Methods: A multi-center, cross-sectional study
conducted in two tertiary and one urban district hospital in Kigali,
Rwanda. Participants were neonates admitted in neonatology who received
a course of antibiotics during their admission. Data collected included
risk factors for neonatal sepsis, clinical signs, symptoms,
investigations for neonatal sepsis, antibiotics prescribed, and the
number of deaths in the included cohort. Results: 126 neonates were
enrolled with 42 from each site. Prematurity (38%) followed by membrane
rupture more than 18 hours (25%) were the main risk factors for
neonatal sepsis. Ampicillin and Gentamicin (85%) were the most commonly
used first-line antibiotics for suspected neonatal sepsis. Most
neonates (87%) did not receive a second-line antibiotic. Cefotaxime
(11%), was the most commonly used second-line antibiotic. The median
duration of antibiotic use was four days in all surviving neonates
(m=113). In neonates with negative blood culture and normal C-reactive
protein (CRP), the median duration of antibiotics was 3.5 days; and for
neonates, with positive blood cultures, the median duration was 11
days. Thirteen infants died (10%) at all three sites, with no
significant difference between the sites. Conclusion: The median
antibiotic duration for neonates with normal lab results exceeded the
recommended duration mandated by the national neonatal protocol. We
recommend the development of antibiotic stewardship programs in
neonatal units in Rwanda to prevent the adverse effects which may be
caused by inappropriate or excessive use of antibiotics