[Hepatitis B virus serologic status among hospital health care staff in Lome]. / Évaluation de la protection vaccinale contre le virus de l'hépatite B chez le personnel soignant hospitalier à Lomé

To assess the hepatitis B virus (HBV) serologic status of hospital health care personnel in Lome. From June 1 to August 31, 2007, 100 workers vaccinated against HBV and 50 unvaccinated workers participated in this comparative cross-sectional study. The data studied were: age, sex, vaccination status, history of accidental exposure to blood, and enzyme-linked immunoassay results for HBs antigen (Ag), total anti-HBc antibodies (Ab), and anti-HBs Ab. Vaccinated subjects had a mean age of 33.2 ± 8.2 years and unvaccinated subjects of 35.2 ± 9.6 years; their respective sex ratios (M:W) were 2:1 and 3:1. Protective levels (>10 IU/L) of anti-HBs Ab were found in 78% (n = 78) of vaccinated subjects compared with 44% (n = 22) of those unvaccinated. HBs Ag was found in 36% (n = 36) of vaccinated and 56% (n = 28) of unvaccinated subjects. Of subjects previously accidentally exposed to blood, 67% (n = 35) had HBs Ag compared with 30% (n = 29) of those subjects without such exposure. This study has proved the high prevalence of HBs Ag carrier status among health care workers in Lome and confirms the importance of vaccination against HBV.

Use of hub cutters and the volume of sharp waste and occurrence of needle-stick injuries during 2011 mass immunization campaigns against yellow fever in Ghana: a cohort study.

BACKGROUND: Current WHO best infection control practices for injections do not address the use of hub cutters due to insufficient evidence on safety and efficacy. OBJECTIVE: To assess the impact of the use of hub cutters on 1) the frequency of needle-stick injuries (NSIs) and other blood exposures among workers and 2) the volume of sharps waste in a mass vaccination campaign setting. METHODS: During yellow fever vaccination in Ghana, we conducted a cohort study on the use of hub cutters. We compared two groups---one group using hub cutters and a control group---for the occurrences of NSIs and the volume of sharp waste produced. RESULTS: In the control arm, vaccinators used 284 482 syringes in 825 vaccination sessions. In the group using hub cutter, vaccinators used 397 079 syringes in 1599 sessions. Among vaccinators, the rate of NSI was not significantly (p=0.14) different between the hub cutter users (0.15/10 000 syringes) and the control group (0.04/10 000). Factors such as workload, lack of organization and pressure seemed to have influence the occurrence of NSIs. With all the limitations of the work, the volume of sharp waste per 10 000 syringes was 0.24 m(3) in the hub cutter users and 0.41 m(3) in the control group---a reduction of 41.2%. Vaccinators found hub cutters easy to use and safe. Use of hub cutter was not associated with increased duration of work. CONCLUSION: The use of hub cutters did not increase the risk of NSIs. More training is needed to facilitate its implementation in mass campaign setting.

Adverse events following yellow fever preventive vaccination campaigns in eight African countries from 2007 to 2010.

BACKGROUND: Serious, but rare adverse events following immunization (AEFI) have been reported with yellow fever (YF) 17D vaccine, including severe allergic reactions, YF vaccine-associated neurologic disease (YEL-AND) and YF vaccine-associated viscerotropic disease (YEL-AVD). The frequency with which YEL-AND and YEL-AVD occur in YF endemic countries is mostly unknown. METHODS: From 2007 to 2010, eight African countries - Benin, Cameroon, Guinea, Liberia, Mali, Senegal, Sierra Leone, and Togo- implemented large-scale YF preventive vaccination campaigns. Each country established vaccine pharmacovigilance systems that included standard case definitions, procedures to collect and transport biological specimens, and National Expert Committees to review data and classify cases. Staff in all countries received training and laboratory capacity expanded. RESULTS: In total, just over 38 million people were vaccinated against YF and 3116 AEFIs were reported of which 164 (5%) were classified as serious. Of these, 22 (13%) were classified as YF vaccine reactions, including 11 (50%) hypersensitivity reactions, six (27%) suspected YEL-AND, and five (23%) suspected YEL-AVD. The incidence per 100,000 vaccine doses administered was 8.2 for all reported AEFIs, 0.43 for any serious AEFI, 0.058 for YF vaccine related AEFIs, 0.029 for hypersensitivity reactions, 0.016 for YEL-AND, and 0.013 for YEL-AVD. Our findings were limited by operational challenges, including difficulties in obtaining recommended biological specimens leading to incomplete laboratory evaluation, unknown case ascertainment, and variable levels of staff training and experience. CONCLUSIONS: Despite limitations, active case-finding in the eight different countries did not find an incidence of YF vaccine associated AEFIs that was higher than previous reports. These data reinforce the safety profile of YF vaccine and support the continued use of attenuated YF vaccine during preventive mass vaccination campaigns in YF endemic areas.

[Evaluation of the Widal-Felix serodiagnostic test in Togo]. / Evaluation de la pratique du sérodiagnostic de Widal et Félix au Togo.

PURPOSE: To evaluate the efficacy of Widal-Felix serodiagnostic testing in Togo. METHOD: This study using a cohort of 200 patients recruited at hospitals in Lome and Atakpame from November 2005 to April 2006 was designed to compare the sensitivity and specificity of the routinely used technique (plate agglutination) and reference technique (tube agglutination). RESULTS: Findings showed that the prevalence of typhoid fever was 1.5% while that of paratyphoid fever was nil. The hardest-hit age group was young people between 11 to 20 years. Men were two times more likely than women to be infected (sex-ratio, 0.5). The most useful symptoms for discriminating patients seropositive for Salmonella typhi from other serological profiles were abdominal pain (p<0.034) and diarrhea (p<0.008). The thick-drop malaria test was positive in all 3 patients (100%) with proven typhoid fever in comparison with 3.9% of the 154 patients with negative Widal-Felix serodiagnostic tests and 26.2% of the 42 patients with intermediate serological profiles. The sensitivity and specificity of the plate technique were 60.0% and 98.06% respectively. The sensitivity and specificity of laboratory analysis were 60.0% and 91.08% respectively. CONCLUSION: The gap between the specificity of the routine plate technique and laboratory analysis underscores the difficulty of performing and interpreting the Widal-Felix serodiagnostic test. The low sensitivity and specificity of the Widal-Felix serodiagnostic test also cast doubt on systematic use for diagnosis in patients presenting fever and on initiation of antibiotic treatment based on agglutination of a single antigen. To improve the specificity of the Widal-Felix serodiagnostic test, we recommend standardization of interpretation criteria and use of tube agglutination. We also see the need for development of another reproducible immunologic test for the diagnosis of typhoid and paratyphoid infections.

[Serologic markers used for hepatitis B surveillance in Togo: status report and action proposals]. / Marqueurs sérologiques utilisés dans la surveillance de l'infection par le virus de l'hépatite B au Togo: état des lieux et propositions.

UNLABELLED: The hepatitis B surface antigen (HBsAg) is the only marker used for diagnosis and follow-up of hepatitis B infection in Togo. The purpose of this study was to evaluate the use of HBsAg testing for follow-up of hepatitis B infection. This study was conducted in 230 patients referred to the National Institute of Hygiene for HBsAg testing. In all cases the requested test was performed and the request and results were evaluated. RESULTS: The study group included 159 women (69%) and 71 men (31%). The overall prevalence of HBsAg was 10.87%. Prevalence was higher in men than in women. Highest prevalence rates were observed in the age groups 20 to 50, which corresponds to the peak period of sexual activity. The indication for testing was often not clearly specified by Laboratory engineers (85.71%), Clinical officers (73.68%) and physicians (61.24%). When mentioned, the indication was suspicion of hepatitis B (20.87%), work-up for pregnancy (8.70%), testing prior to vaccination (8.26%) and surveillance of an infected patient (1.30%). The prevalence of HBsAg was 0.00% in prevaccination tests, 5% in pregnancy workup tests, and 10.42% in hepatitis B suspicion tests. Test results were negative in one infected patient referred for follow-up. None of the patients with positive results returned for therapeutic follow-up testing and no marker other than HBsAg was requested regardless the indication. CONCLUSION: the laboratory of serology is under-used for hepatitis B surveillance. Hepatitis B follow-up using antigen HBsAg alone is inadequate and the equipment required for testing other markers is the same.