A fatal rabies case and experiences of a mass post exposure prophylaxis among healthcare workers

2021 ◽  
Author(s):  
Alper Sener ◽  
Canan Akman ◽  
Anil Akca ◽  
Behcet Varisli
Keyword(s):  
Emergency Medicine ◽  
Infection Control ◽  
Sexual Intercourse ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Radiology Technicians ◽  
Exposure Prophylaxis

AbstractWe aimed to monitor the adverse effects (AE) and efficacy of post exposure prophylaxis (PEP) in health care workers (HCWs) exposed to a rabies patient. In this study 109 HCWs and eight household contacts were PEP candidates. Contact persons without infection control precautions were in Group I (high risk-82 cases). HCWs indirectly exposed to environmental surfaces were classified in Group II (low risk-35 cases). PEP schedule was rabies vaccine (RBV) + equine rabies immunoglobulin (eRIG) in Group I and only RBV in Group II. Local and systemic AE were observed in all cases. Efficacy of post exposure prophylaxis (PEP) was determined by rabies development in a six month follow-up. 585 doses of RBV have been used in 117 cases and eRIG has been used in 82 cases. 32 Nurses (39%); 22 emergency medicine technicians (26.8%); 12 doctors (14%); six laboratory technicians (0.07%); six radiology technicians (0.07%); four cleaners (0.05%) were in Group I (82 cases), respectively. One doctor, laboratory technician, nurse and radiology technician (0.02%); two emergency medicine technicians (0.04%) and nine cleaners (25.7%) were in Group II (35 cases), respectively. Routes of transmission were blood in five (0.06%); saliva in 14 (17%); sweat in 50 (61%); CSF/serum in five (0.06%); sexual intercourse in one (0.01%); personal equipment in seven (0.09%) in Group I, respectively. Indirect contact was the only route in Group II. The most common local and systemic AE were seen in Group I; pain at injection side (19 cases) and fever (13 cases). Both of them showed statistically significant difference (P<0.05). Allergic rash has been seen at only one case. PEP failed in one case where the possible exposure way was sexual intercourse. PEP is the safest way to prevent rabies. Infection control precautions were still not enough applied. eRIGs are also safe and have rare AE.

scholarly journals 1283. Attitudes and Practices Regarding HIV Post-Exposure Prophylaxis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S462-S462
Author(s):  
William Sherrerd-Smith ◽  
Katie O’Connell ◽  
Shanedeep Gill ◽  
Alice Kisteneff ◽  
Catherine Derber ◽  
...  
Keyword(s):  
Emergency Department ◽  
Unprotected Sex ◽  
Post Exposure Prophylaxis ◽  
Provider Education ◽  
Post Exposure ◽  
Attitudes And Practices ◽  
Significant Difference ◽  
Follow Up Care ◽  
Exposure Prophylaxis

Abstract Background Research suggests nonoccupational Post Exposure Prophylaxis (nPEP) is underprescribed when indicated in the Emergency Department (ED). This study is an assessment of ED providers’ attitudes and practices regarding administration of HIV nPEP. Methods This was an anonymous survey based on literature review and modified Delphi technique. We approached 153 ED providers at work over a 4-month period from 5 hospital-based and 2 freestanding EDs with an annual census between 35,000 and 75,000 patients. The EDs are a combination of urban, suburban, and rural EDs. There were 152 completed surveys: 80 attendings, 27 residents, and 44 physician assistants. Results The majority of surveyed providers (133/149, 89.3%) believe it is their responsibility as an emergency provider to provide HIV nPEP in the emergency department (Figure 1). Although 91% (138/151) and 87% (132/151) of respondents are willing to prescribe nPEP to a patient in the ED for IV drug use and unprotected sex, respectively, only 40% (61/152) of participants felt they could confidently prescribe the appropriate regimen. Ultimately, only 25% (37/151) of participants prescribed nPEP in the last year. Number of years in practice, age, and gender did not result in a significant difference in nPEP administration. Respondents noted time (27%), access to follow-up care (26%), cost to patients (23%), patients’ perceived interest in HIV counseling (15%), and concern for ongoing risky behaviors (9%) as barriers to prescribing nPEP (Figure 2). 64% (95/149) of respondents feel that it is their responsibility as an ED provider to refer patients at risk of nonoccupational exposures for risk-reduction counseling. Conclusion This study identified an opportunity for HIV prevention in the emergency department. The majority of participants had not prescribed nPEP in the past 12 months. Although most were willing to prescribe nPEP and felt it was their responsibility, the majority of participants were not confident in prescribing it. Future interventions to increase the use of nPEP in the ED should target provider education, cost, access to follow-up care and counseling. Disclosures All authors: No reported disclosures.

scholarly journals Iranian Dentists’ Knowledge of Post-exposure Prophylaxis Against HBV, HCV, and HIV

2020 ◽  
Vol 12 (2) ◽  
pp. 63-67
Author(s):  
Maryam Amirchaghmaghi ◽  
Hooman Keshavarz ◽  
Farid Haghdadi
Keyword(s):  
Educational Interventions ◽  
Post Exposure Prophylaxis ◽  
Dental Practice ◽  
Cross Sectional ◽  
Post Exposure ◽  
Practice Experience ◽  
Significant Difference ◽  
The Mean ◽  
General Dentists ◽  
Exposure Prophylaxis

Background: Dentists are at higher risk of exposure to blood-borne pathogens including HBV (hepatitis B virus), HCV (hepatitis C virus), and HIV (human immunodeficiency virus). The aim of this study was to evaluate the knowledge about post-exposure prophylaxis (PEP) against HBV/HCV/HIV among the general dentists working in Mashhad in 2016. Methods: This cross-sectional study was conducted on a random sample (141 persons) of the general dentists working in Mashhad. The data gathering tool in this study was a self-administered questionnaire. The validity of the questionnaire was assessed by a group of relevant specialists. The reliability of the questionnaire was also tested by a test-retest method with a two-week interval. The agreement between the two steps (test and retest) was at least 70%, and Cronbach’s alpha was 0.74. The total score of each person’s knowledge ranged from -20 to +20. One-way analysis of variance (ANOVA) and t test were used for statistical analyses. Results: Out of 141 dentists selected randomly, 101 subjects (69.3% male) participated in the study. The mean age of the participants was 42.3 years, And the mean duration of dental practice experience was 16.3 years. Regarding the mean age (P = 0.11), and the mean duration of dental practice experience (P = 0.12), there was no statistically significant difference between the two genders. The mean score of knowledge among the participants was -2.8, and there was no statistically significant difference between the two genders in this regard (P = 0.72). Conclusions: This study indicated that the level of knowledge about PEP against HBV/HCV/HIV was very low among the general dentists working in Mashhad. Therefore, improving knowledge of general dentists working in Mashhad through appropriate educational interventions seems necessary.

scholarly journals P073: Single and dual vs. standard triple agent regimens for HIV post-exposure prophylaxis in the sexual assault victim population

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S103
Author(s):  
T. Kumar ◽  
K. Sampsel ◽  
I.G. Stiell
Keyword(s):  
Side Effects ◽  
Sexual Assault ◽  
Triple Therapy ◽  
Single Agent ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Number Of Patients ◽  
Significant Difference ◽  
Patient Reported ◽  
Exposure Prophylaxis

Introduction: Although Tenofovir/Emtricitabine was approved in 2012 as a single-agent regimen for pre-exposure prophylaxis, there have been no studies to our knowledge that demonstrate the efficacy of single and dual agent regimens in post-exposure prophylaxis. Our goal was to compare outcomes of post-exposure prophylaxis with single and dual agent regimens versus triple therapy in victims of sexual assault. Methods: This was a before and after cohort study of patients seen by the Sexual Assault and Partner Abuse Care Program (SAPACP) at the Ottawa Hospital. We reviewed charts of patients seen by the SAPACP from Jan. 1-Dec. 31 2013, when triple therapy was usual care, and Jan. 1-Dec. 31 2015, after the introduction of alternative regimens. Patients who were deemed high risk or who did not get initial treatment at the SAPACP were excluded. Our primary outcome was the number of patients who completed the entire 28-day post-exposure prophylaxis regimen. Secondary objectives were to assess HIV seroconversion rates and patient reported side effects. Results: Six hundred-thirty charts were reviewed, and 429 were included in the study. Baseline characteristics were similar between the two years. We found no significant difference in completion rates of HIV post-exposure prophylaxis between the two cohorts (50.5% vs. 51.6%). However, we did note a decrease in reported side effects in the 2015 cohort (72.2% vs. 17.6%, p&lt;0.0001). In our secondary analysis, we compared all patients in all years who received triple therapy (N=128) versus those who received alternative single or dual agent regimens (N=47). We found that the alternative regimen group had a higher completion rate (66.0% vs. 42.2%; p=0.03), and a dramatic decrease in rate of reported side effects (19.1% vs. 53.9%; p&lt;0.0001). Specifically, we saw decreased reported rates of nausea (12.8% vs. 36.7 %), constipation (0% vs. 7.9%), diarrhea (2.1% vs. 21.1%), mood changes (0% vs. 10.9%), headache (2.1% vs. 16.4%), and fatigue (6.4% vs. 26.6%). There were no HIV seroconversions in either group. Conclusion: Our results suggest that single and dual agent HIV post-exposure prophylaxis regimens are better tolerated by patients and associated with higher rates of completion than triple therapy, and should be considered as stand-alone therapy in the sexual assault victim population.

scholarly journals Epidemiology and trend of rabies post exposure prophylaxis at anti rabies clinic of a tertiary care hospital in India

2021 ◽  
pp. 20-24
Author(s):  
Mousumi Datta
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Post Exposure Prophylaxis ◽  
Care Hospital ◽  
Due Dates ◽  
Health Seeking ◽  
Effective Prevention ◽  
Post Exposure ◽  
Significant Difference ◽  
Exposure Prophylaxis

Background and Objectives Effective prevention of rabies is possible by vaccination following a rabid animal bite. Objectives of this study was to describe demographics, circumstances of bite and the trend of vaccination over last three years (January 2019-November 2021) in an anti-rabies clinic of a tertiary care hospital. Materials and Methods This was an observational study of prospective design. All animal bite victims who attended the anti rabies clinic (ARC) of the study institution during the study period were invited to participate in the study. Data was collected using a structured schedule on first visit and at 28th day to check for on time compliance to vaccination schedule. On time completion was defined as taking all vaccine doses on due dates. Distribution of variables was shown by frequencies and percentages. Indicators were recorded for three consecutive years. Year wise indicators were compared by chi-square test. Results Data was collected for 293 victims. Median age of bite victims was 41.8 years (range 3-78 years) while 58.7 % respondents were below 45 years of age; 71.3 % victims were male. 82.3 % bites were by dogs; 38 % victims had multiple bites. Post-exposure prophylaxis (PEP) with anti-rabies vaccine (ARV) was initiated within 72 hours for 80 % victims and it was completed on time for 66.2 % victims. Three years trend for PEP indicators did not show a statistically significant difference. Conclusion On time PEP schedule completion was fairly high at the studied ARC. Health seeking for PEP following animal bite was not affected by the corona virus pandemic

scholarly journals HIV Non-Occupational Post-Exposure Prophylaxis Awareness Among Undergraduate Students of a Private University in South-West Nigeria

2020 ◽  
Vol 3 (2) ◽  
pp. 19-27
Author(s):  
Charles J Elikwu ◽  
Tinuade A Ajani ◽  
Victor U Nwadike ◽  
Babtunde Tayo ◽  
Chika C Okangba ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Occupational Exposure ◽  
Sexual Intercourse ◽  
Undergraduate Students ◽  
Private University ◽  
Sub Saharan Africa ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Immunodeficiency Virus ◽  
Exposure Prophylaxis

Objectives: The Human Immunodeficiency virus causes an infection of public health importance with about 71% of the global burden in Sub-Saharan Africa. In Nigeria, 3.2 million people are living with HIV, and 838,000 - 1.3 million of the cases are found among youths. Although Non- Occupational Human Immunodeficiency Virus (HIV) post-exposure prophylaxis (nPEP) is a safe and efficacious method of HIV prevention, it remains an underutilized prevention strategy in Nigeria.  This study aimed to determine the awareness level of nPEP after sexual and other non-occupational exposure to HIV among undergraduate students of a private University. Methods: A descriptive cross-sectional survey was conducted among 395 undergraduates’ students. Data was collected by pre-tested structured self-administered questionnaires. Data obtained from the study were analyzed using the IBM SPSS Statistics version 20 software program and Frequency distribution tables with percentages and cross-tables were used for data description. Results: About 42.8% were aware of nPEP. Most of the respondents 361 (91.4%) knew that PEP is to be given after HIV exposure risk following sexual intercourse. Although 79.5% of the respondents indicated that they will see their physician after unprotected sexual intercourse and other non-occupational exposure to HIV, the majority neither knows about nPEP initiation time, 247 (62.5%) nor its duration, 286 (72.4%). Conclusions: A low level of awareness was observed among our study participants, therefore, consistent health education and promotion of nPEP will improve its awareness, uptake, and possibly reduce the prevalence of HIV among our youths.

scholarly journals Nonoccupational post-exposure prophylaxis for HIV after sexual intercourse among women in Brazil: Risk profiles and predictors of loss to follow-up

Medicine ◽  
2019 ◽  
Vol 98 (39) ◽  
pp. e17071
Author(s):  
Alexandre Grangeiro ◽  
Maria Mônica Paulino do Nascimento ◽  
Eliana Miura Zucchi ◽  
Dulce Ferraz ◽  
Maria Mercedes Escuder ◽  
...  
Keyword(s):  
Sexual Intercourse ◽  
Post Exposure Prophylaxis ◽  
Risk Profiles ◽  
Loss To Follow Up ◽  
Post Exposure ◽  
Exposure Prophylaxis

Low awareness and use of post-exposure prophylaxis among adolescents and young adults in South Africa: implications for the prevention of new HIV infections

2020 ◽  
Vol 19 (3) ◽  
pp. 242-248
Author(s):  
Anthony Idowu Ajayi ◽  
Mohammed Sanusi Yusuf ◽  
Elmon Mudefi ◽  
Oladele Vincent Adeniyi ◽  
Ntombana Rala ◽  
...  
Keyword(s):  
South Africa ◽  
Young Adults ◽  
Hiv Infections ◽  
Adolescents And Young Adults ◽  
Post Exposure Prophylaxis ◽  
Post Exposure ◽  
Exposure Prophylaxis

Study of sharp injuries and blood splash exposures among healthcare workers in a tertiary hospital in Bangalore

2016 ◽  
Vol 12 (3) ◽  
Author(s):  
Shalini Sivananjiah Pradeep ◽  
Suman Gadicherla Raghu ◽  
Prathab A G ◽  
Banashankari G Rudresh ◽  
Radhika Kunnavil
Keyword(s):  
Healthcare Workers ◽  
Tertiary Hospital ◽  
Post Exposure Prophylaxis ◽  
Care Hospital ◽  
Post Exposure ◽  
Increased Risk ◽  
Management Procedures ◽  
Exposure Prophylaxis ◽  
Sharps Injury ◽  
Sharps Injuries

The working environment of healthcare workers (HCW) exposes them to sharp injuries. This communication attempts to examine the injury registers, incidence of sharps injuries and blood splash exposures, and the post-exposure prophylaxis status of employees in a tertiary care hospital. Analysis included records form 54 locations of two units of a tertiary hospital attached to a Medical College. Maintenance of the injury register overall was highly satisfactory in both units. Two hundred and nine injuries were recorded from both units of the hospital. The majority of injuries (60.5%) occurred in the age group of 20-30 years with 70% among females. Waste handlers were at increased risk during waste management procedures. Thirty two percent of sharps injury injuries occurred in wards. Of the ward nursing staff, 25.3% received sharps injuries. Post-exposure prophylaxis for Hepatitis B (primary dose) was given to 25 HCWs; 11 received booster doses. The basic regimen for HIV post-exposure prophylaxis was given to 4 HCWs. Awareness about records maintenance, regular documentation, awareness and training, and implementation of appropriate preventive measures can reduce the incidence of injuries. Key words: Sharps, injury register, Health care workers (HCW),Post exposure prophylaxis (PEP)

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