Factors associated with delayed rabies post-exposure prophylaxis among dog bite victims in Nyagatare District, Rwanda, 2017 to 2019

Background Rabies is an incurable zoonotic disease of public health concern. After exposure the only effective intervention is Post-Exposure Prophylaxis (PEP). Surveillance data in Rwanda shows that a high number of dog bites do not get PEP in time. Objectives Determine factors associated with delays in post-exposure prophylaxis among victims of dog bites. Methods The retrospective cross-sectional study was conducted in Nyagatare District. It targeted people bitten by dogs and who attended Nyagatare district from January 2017 to December 2019. Review of registers and interview with victims were used to collected data using excel and analyze them using STATA version 15. Odds ratio (OR) and confidence interval (CI) were reported. Results Among 412 dog bite victims, 161 (39%) delayed getting PEP. The more likely to delay in getting PEP, were people living in rural areas, AOR = 3.54, 95%CI [2.12, 5.90], and those without medical insurance, AOR = 4.40, 95%CI [1.82-10.62]. Conclusion Seeking PEP among dog bites victims is subject to delay in Nyagatare district. Local leaders should establish initiatives to support people to get medical insurance while public health officers need to prioritize sensitization for PEP for people living in rural areas.

A retrospective review of rabies post-exposure prophylaxis queries, South Africa, 2016­2019

Background: The National Institute for Communicable Diseases (NICDs) of South Africa (SA) provides technical support to healthcare workers (HCWs) with regard to infectious diseases through the NICD clinician hotline. Queries to the hotline are often about rabies prophylaxis. An analysis of these queries may help to identify knowledge gaps amongst HCWs regarding prevention of rabies in humans in SA. Methods: A retrospective descriptive review was conducted to analyse rabies post-exposure prophylaxis (PEP) queries received by the NICD from 01 January 2016 to 31 December 2019. Results: A total of 4655 queries were received by the NICD clinician hotline for the study period, of which 2461 pertained to rabies PEP (52.87%). The largest number of calls were placedby HCWs (n = 2313/2437; 94.9%). Queries originated mainly from Gauteng (n = 912/2443; 37.3%) and KwaZulu-Natal (n = 875/2443; 35.8%) provinces. A total of 50 different types of animals were related to exposures involving humans. Dogs (67.7%) and cats (11.8%) were the animals most frequently reported and exposure category III was most common (88.6%). Approximately equal numbers of callers were advised active management of administering rabies PEP and conservative management of withholding PEP. This did not seem to be affected by the exposure category related to the call. Conclusion: This analysis shows the ongoing demand by HCWs for technical support regarding patient management following potential exposure to rabies. Gaps in HCWs rabies knowledge provide unique learning points on guiding training to achieve the goal of eliminating dog-mediated human rabies deaths by 2030.

Prevalence of needle stick injuries and utilization of post exposure prophylaxis among resident doctors in a tertiary hospital in Port Harcourt, Nigeria ­ a cross-sectional analytical study

Background:Needlestick injuries (NSIs) are percutaneous injuries sustained during delivery of medical care. They are occupational hazards faced by health workers and are a source of transmission of bloodborne pathogens.This study was aimed at determining the prevalence, utilization of post-exposure prophylaxis(PEP) and assessed the association between the sociodemographic, occupational factors, knowledge and attitude towards NSIs to its occurrence among the residents in a Tertiary hospital in Port Harcourt Nigeria.Methods: Descriptive cross-sectional analytical study design Results: The study found a 53.8% prevalence of NSIs. Annual prevalence was 50.9%. The prevalence was significantly higher among senior residents (65.1%) (p=0.006), residents in Paediatrics (75.6%) (p<0.001), and among residents who had worked three years or more (65.7%) (p<0.001). The most frequently reported factors that predisposed to NSIs were excess workload (77.9%), insufficient consumables (72.6%) and long working hours (70.2%). 77.4% of residents recapped needles, 66.1% did not report NSIs. Only 8.9% of the residents utilized PEP after injury. In 51.8% of cases, the needle had been used on a patient prior to the injury. In 25.9% of these cases, the injury involved a high-risk patient (HIV, Hepatitis B or C infected). This study found a risk of transmission of HIV following a needle stick injury to be 0.48%. Conclusion: Needlestick injuries are common among resident doctors. A large number of these injuries go unreported. The attitude toward preventive measures and use of PEP services is sub-optimal necessitating a need for more attention to be drawn to occupational health and safety in the region

Pre-exposure and Post-exposure new prophylactic treatments against COVID-19 in healthcare workers

The Severe Acute Respiratory Syndrome-related Coronavirus 2 or novel coronavirus (COVID-19) infection pandemic continues to spread. Since the outbreak of the COVID-19 in Wuhan (China), healthcare workers have been infected and are considered at high risk of contamination. Moreover, in addition to the physical effects of COVID-19, the pandemic results in important mental health issues among healthcare workers such as anxiety, stress, depression, and further nervous or mental disorders. Despite the increasing number of clinical trials aiming to develop vaccines or test antiviral molecules, till now no efficient anti- SARS-CoV-2 drugs have been validated. The COVID-19 pandemic led us to call for an urgent nutritional intervention model that should be established to prevent and/or reduce the negative impact of COVID-19 on healthcare workers. In the present paper, we suggest a safe nutritional supplementation of MgZn- B vitamins (B1, B6, B9, and B12) in healthcare workers as pre-exposure and post-exposure new prophylactic treatments. Furthermore, the paper reports the scientific arguments and the possible mechanisms by which the Mg-Zn- B vitamins supplementation may exert its beneficial effects in the healthcare workers facing the COVID-19 pandemic. Overall, the Mg-Zn- B vitamins supplementation would enhance the immune response against SARS-CoV2, prevent inflammatory processes and oxidative stress, fight or alleviate the COVID-19-related mental health issues, or even reduce the replication. Each element of the supplementation possesses important and promising effects contributing to the possible efficiency of the suggested Mg-ZnB vitamins supplementation in healthcare workers

Post-exposure prophylaxis protocol for exposure to blood-borne pathogens: an intervention to improve knowledge and practice among medical students in a South African hospital

Background:Globally, approximately three million healthcare workers experience a percutaneous injury each year. Medical students are at a particularly high risk of exposure to blood-borne pathogens. Despite this, the rate of non-reporting is still high. Objectives: The objectives of this study were to describe and improve the knowledge and practice of the post-exposure prophylaxis (PEP) protocol among medical students, through the implementation of quality-improvement interventions, with a view to improving the protocol. Methods: This was an intervention study conducted among third- to fifth-year students, in 2015 and 2016. The quality-improvement interventions took place over 11 months and included the issuing of laminated protocols, posters and lectures. Data from survey questionnaires were used to quantify the impact of these interventions. Student practice was measured by the number of correct steps of the protocol completed. McNemar and Wilcoxon signed-rank tests were used to test differences in the paired categorical data. Results: Of approximately 750 students who participated in the study intervention, 407 returned the initial questionnaire and 148 returned the post-intervention survey questionnaire. Eighty-six students (21.1%) completed both questionnaires. The blood-borne pathogen exposure rate prior to the intervention period was 28.0%. In the paired group, reporting of exposures increased from 12.2% in 2015 to 31.3% in 2016. Knowledge of the PEP protocol increased significantly in the paired group, from 17.4% to 40.2% (p < 0.001). Prior to the intervention, 91.7% completed fewer than half of the steps of the PEP protocol. This decreased significantly to 69.4% in the paired group, post-intervention (p = 0.03). Conclusion: Practice of the PEP protocol significantly improved after the intervention was implemented. In addition, there was a significant improvement in the knowledge of students about postexposure management. However, many exposures were still unreported post-intervention, indicating that more work is needed to improve reporting behaviour

Cross-sectional survey on occupational needle stick injuries amongst prehospital emergency medical service personnel in Johannesburg

Introduction:Prehospital personnel are exposed to challenging situations that place them at increased risk of sustaining a needle stick injury (NSI). Blood borne infections such as HIV and Hepatitis B or C may be transmitted from a NSI. Sub-Saharan Africa has the largest number of people living with HIV globally. There is no data pertaining to NSI among Emergency Medical Service (EMS) personnel in South Africa. This study aimed to investigate the cumulative incidence, knowledge, attitudes and practices pertaining to NSIs amongst a select group of prehospital personnel in Johannesburg.Methods:This was a prospective, questionnaire based, cross-sectional survey of personnel employed at three EMS service providers in Johannesburg.Results:Of the 240 subjects that participated in the study, there was a total of 93 NSIs amongst 63 (26.3%) subjects. Of these, 41 (65.1%) had sustained one previous NSI, 16 (25.4%) had two NSIs, 5 (7.9%) had three NSIs and one (1.6%) had five NSIs. Almost two-thirds (n = 60; 64.5%) of NSIs were sustained during intravenous line insertion. Most of the study subjects were male (n = 145, 60.4%), between the age of 25­29 years (n = 67, 27.9%), had a BLS qualification as the highest level of training (n = 89, 37.1%), had >10 years of EMS experience (n = 69; 28.8%) and were up to date with their Hepatitis B vaccination at the time of the study. HIV post exposure prophylaxis (PEP) was initiated in 82 (88.2%) out of the 93 NSI incidents. However, the recommended 28-day course of therapy was only completed in 68 (82.9%) out of the 82 cases where PEP was initiated.Conclusion:Prehospital personnel are at risk of sustaining a NSI. There is a need to promote awareness with regards to the risks, preventive measures, awareness of PEP protocoland the timely initiation and completion of HIV PEP amongst EMS personnel in Johannesburg

Management of rabies

Rabies is endemic in South Africa and human rabies cases continue to be reported annually. Most human cases in South Africa are dog-transmitted. Whilst efforts are underway to control and eventually eliminate dog rabies in the country, prevention of the disease through appropriate use of rabies postexposure prophylaxis is critical to save lives. This article provides a summary of rabies in South Africa and key aspects of the prevention of the disease in exposed humans

Southern African Guidelines on the Safe Use of Pre-Exposure Prophylaxis in Persons at Risk of Acquiring HIV-1 Infection

The Southern African HIV Clinicians Society published its first set of oral pre-exposure prophylaxis (PrEP) guidelines in June 2012 for men who have sex with men (MSM) who are at risk of HIV infection. With the flurry of data that has been generated in PrEP clinical research since the first guideline; it became evident that there was a need to revise and expand the PrEP guidelines with new evidence of safety and efficacy of PrEP in several populations; including MSM; transgender persons; heterosexual men and women; HIV-serodiscordant couples and people who inject drugs. This need is particularly relevant following the World Health Organization (WHO) Consolidated Treatment Guidelines released in September 2015. These guidelines advise that PrEP is a highly effective; safe; biomedical option for HIV prevention that can be incorporated with other combination prevention strategies in Southern Africa; given the high prevalence of HIV in the region. PrEP should be tailored to populations at highest risk of HIV acquisition; whilst further data from studies in the region accrue to guide optimal deployment to realise the greatest impact regionally. PrEP may be used intermittently during periods of perceived HIV acquisition risk; rather than continually and lifelong; as is the case with antiretroviral treatment. Recognition and accurate measurement of potential risk in individuals and populations also warrants discussion; but are not extensively covered in these guidelines

Guideline on the Management of Occupational and Non-Occupational Exposure to the Human Immunodeficiency Virus and Recommendations for Post-Exposure Prophylaxis: 2015 Update

This guideline is an update of the post-exposure prophylaxis (PEP) guideline published by the Southern African HIV Clinicians Society in 2008. It updates the recommendations on the use of antiretroviral medications to prevent individuals who have been exposed to a potential HIV source; via either occupational or non-occupational exposure; from becoming infected with HIV. No distinction is made between occupational or non-occupational exposure; and the guideline promotes the provision of PEP with three antiretroviral drugs if the exposure confers a significant transmission risk. The present guideline aligns with the principles of the World Health Organization PEP guidelines (2014); promoting simplification and adherence support to individuals receiving PEP

Dog Bites and Human Rabies in the Uthungulu District Of Kwazulu-Natal Province; 2008-2010: a Review of Surveillance Data

The Uthungulu District in KwaZulu-Natal province is the area that is most affected by rabies in South Africa. Usually; the transmission of rabies to humans occurs through the bites of infected dogs. In 2008; Uthungulu commenced a programme to eliminate human rabies in the district. This paper describes the epidemiology of dog bites and human rabies in the UThungulu District from 2008-2010; and the extent of adherence to rabies post-exposure prophylaxis (PEP). The method was a retrospective analysis of dog-bite and human rabies surveillance data that were collected in Uthungulu from January 2008-December 2010. Dog-bite injuries in Uthungulu increased from 1 176 in 2008 to 2 365 in 2009; and decreased to 1 598 in 2010. Of 2 601 patients who were offered rabies PEP in 2009 and 2010; 83.7 [95 confidence interval (CI): 82.4-85.2] completed the treatment. Logistic regression analysis found that investigation of the report by an environmental healthcare practitioner [odds ratio (OR) = 3.95; 95 CI: 2.43-6.43; p-value = 0 .0001]; the availability of patient telephone contact details in the healthcare facility's records (OR = 1.76; 95 CI: 1.02-3.03; p-value = 0.041); and bite wounds that were classified as Category 3 exposure injuries (OR = 2.96; 95 CI: 1.39-6.29; p-value = 0.004); were independently associated with completion of rabies PEP. Seven human rabies cases were reported (four in 2008; two in 2009 and one in 2010). Annualised human rabies incidence rates decreased from four cases per million in 2008 to one case per million in 2010. The findings suggest that the rabies elimination initiative is having an impact on the reduction of the incidence of human rabies in Uthungulu. The district should strengthen the follow-up of people who are exposed to rabies to ensure PEP completion

Incidence of dog bite injuries and clinical rabies in a tertiary health care institution: A 10-year retrospective study

Background: It is widely recognized that rabies is grossly under-reported even though it is a notifiable disease and a lack of accurate figures has rendered rabies a low public health and veterinary priority. This study aimed at determining the incidence of dog bite injuries and clinical rabies in a tertiary health care centre.Materials and Methods: Case records of patients managed at the accident and emergency unit of Ahmadu Bello University Teaching Hospital, Zaria, between June 2000 and May 2010 with diagnosis of dog bite and rabies were retrieved. Relevant clinical data were extracted using a structured questionnaire designed for the study.Results: Eighty-one persons out of 24,683 consultations in the accident and emergency unit presented with dog bite injuries with two clinical cases of human rabies. Mean age of victims of dog bite injuries was 21.1 ± 14.3 years and the majority (55.6%) were children. Males were more affected than females with a male:female ratio of 4.8:1, lower limb/buttock injuries were significantly higher in children than adults, but the adults sustained significantly more severe (type III) injury. The majority of dog bite injuries were washed with soap and irrigated with water or saline and 87.7% of the victim of dog bite received postexposure anti-rabies vaccine.Conclusion: Hospital incidence of dog bite injuries was low, but the use of postexposure prophylaxis was high

Knowledge of Human Immunodeficiency Virus Post-Exposure Prophylaxis among Doctors in a Nigerian Tertiary Hospital

Background: The mainstay of prevention of occupationally-acquired HIV infection is compliance with universal precautions. Appropriate post-exposure prophylaxis is an integral part of prevention; control and workplace safety. This study was undertaken to assess the level of knowledge of post-exposure prophylaxis (PEP) against human immunodeficiency virus (HIV) among doctors in Federal Medical Centre; Gombe; Nigeria. Materials and Methods: Ethical committee approval for the conduct of the study was obtained. Questionnaires were served to all cadres of doctors from house officers to consultants; it was completed and returned on anonymous basis. Results: Sixty six (88.0) of the 75 distributed questionnaires were returned completed and formed the basis of further analysis. The overall knowledge level of post-exposure prophylaxis against human immunodeficiency virus infection was very low. About 62.1are aware of the existence of PEP policy in the hospital. The level of knowledge concerning the high-risk fluid and three drugs used in PEP is high. Over 90are not aware of the risk of sero-conversion following significant needle-sticks injury and mucous membrane exposure. The study also revealed poor knowledge concerning actions to be taken; how soon to commence the PEP treatment and the duration of medication following needle stick injury. More than 50of the surveyed doctors had experienced significant exposure to potentially infective materials and none reported or sought PEP advice. Conclusion: There is the need to educate the doctors and other health workers about the PEP guideline policy; what to do in the event of injury; whom to contact and the importance of seeking urgent advice following injury or exposure

Awareness and Attitude of Nigerian Dentists to Occupational HIV Post-Exposure Prophylaxis

Background: The incidence of human immunodeficiency virus infection in Nigeria remains worrisome. Dentists are increasingly becoming at risk of occupational exposure to the virus. Post-exposure prophylaxis is known to reduce the risk of sero-conversion when appropriately administered. This study assessed the awareness and attitude of Nigerian Dentists towards post-exposure prophylaxis. Methods: A total of 177 Nigerian Dentists from the geopolitical regions of Nigeria were surveyed in 2003 by use of a self-administered questionnaire in a cross sectional; purposive; pilot study and assessed for awareness and attitude to HIV post-exposure prophylaxis. Results: The mean age of respondents was 33.2 years (S.D = 7.66). Sixty-one percent were males while 39were females. Seventy five percent are General Dental Practitioners and 25Specialists. Similarly; 80.8are government employed and 19.2in private practice. About 58.8of the total respondents reported being aware of occupational post exposure prophylaxis; 33.3were not aware while 7.9were unsure. About 84.7indicated a willingness to accept; 5.1were not willing to accept and 10.2were unsure of whether to accept or reject the post-exposure prophylaxis regime. By geopolitical zone; Dental Surgeons from the South West (63.5) were more aware of PEP than other zones while Dentists from the North Central and North West (88) were most willing to accept post-exposure prophylaxis. Only 38.9had attended continuing medical education on human immunodeficiency virus/acquired immune deficiency disease in the preceeding two years. Conclusion: This study indicates that slightly over half the population of Nigeria Dentists is aware of and have good attitude to occupational human immunodeficiency virus post-exposure prophylaxis treatment. Continuing medical education programmes on human immunodeficiency virus/acquired immune deficiency disease is recommended