Safety Practices and Covid-19 Antibody Positivity among Health Care Workers in a Tertiary Hospital in Southern Nigeria.

INTRODUCTION: The COVID-19 pandemic has surpassed 211 million cases and 4.4 million deaths globally. Seroprevalence among Health care workers (HCWs) ranges from 10.6% (Qatar) to 45.1% in Southwest Nigeria. We surveyed Staff of the University of Uyo Teaching Hospital (UUTH), Uyo - Nigeria to determine the prevalence of IgM and IgG seropositivity, compliance with safety practices and IgG seropositivity risk factors. METHODS: A cross-sectional survey of 180 asymptomatic hospital staff done in July 2020. A 33-item structured questionnaire was completed after informed consent with adequate safety practice defined as ≥75% compliance rate. The COVID-19 IgM/IgG Rapid Test Cassette (Zhejiang Orient-Gene Biotech, China) was used. Statistical analysis was done using SPSS version 20 with p ≤ 0.05 considered significant. Ethical approval was obtained prior to the study. RESULTS: The 166 participants (64.5% female) with valid results had a mean age of 38.8±7.9 years. Twenty five patients were IgM positive (15.1%) while 47 were IgG positive (28.3%). Only hand hygiene was adequate (90.4%) with social distancing and face mask usage inadequate at 55% and 60.2% respectively. Compared to those aged <30years, staff aged 30-39years and 40- 49years had significantly lower odds of IgG positivity (0.01 and 0.02 respectively). Nurses/CHOs and Administrative staff had significantly higher associations with IgG seropositivity compared to Doctors. CONCLUSION: Over a quarter of HCWs in UUTH Nigeria had positive COVD-19 IgG. Safety practices were mostly inadequate with Nurses and Administrative staff having higher risk of IgG seropositivity. Improved compliance with safety practices by hospital staff may reduce prevalence rates. Keywords: Safety practices, COVID-19, antibody positivity, health care worker, Nigeria.

INTRODUCTION: La pandémie de COVID-19 a dépassé les 211 millions de cas et 4,4 millions de décès dans le monde. La séroprévalence parmi les travailleurs de la santé (TS) varie de 10,6% (Qatar) à 45,1% dans le sud-ouest du Nigeria. Nous avons mené une enquête auprès du personnel de l'University of Uyo Teaching Hospital (UUTH), Uyo - Nigeria pour déterminer la prévalence de la séropositivité IgM et IgG, la conformité aux pratiques de sécurité et les facteurs de risque de la séropositivité IgG. MÉTHODES: Une enquête transversale auprès de 180 membres asymptomatiques du personnel hospitalier réalisée en juillet 2020. Un questionnaire structuré de 33 items a été rempli après consentement éclairé, les pratiques de sécurité adéquates étant définies comme un taux de conformité ≥ 75 %. La cassette de test rapide COVID-19 IgM/IgG (Zhejiang Orient-Gene Biotech, Chine) a été utilisée. L'analyse statistique a été réalisée à l'aide de SPSS version 20, avec p ≤ 0,05 considéré comme significatif. L'approbation éthique a été obtenue avant l'étude. RÉSULTATS: Les 166 participants (64,5 % de femmes) ayant des résultats valides avaient un âge moyen de 38,8±7,9 ans. Vingt-cinq patients étaient positifs aux IgM (15,1%) tandis que 47 étaient positifs aux IgG (28,3%). Seule l'hygiène des mains était adéquate (90,4 %), la distance sociale et l'utilisation du masque facial étant inadéquates (55 % et 60,2% respectivement). Par rapport aux personnes âgées de moins de 30 ans, le personnel âgé de 30 à 39 ans et de 40 à 49 ans présentait une probabilité significativement plus faible de positivité aux IgG (0,01 et 0,02 respectivement). Les infirmières/chefs de service et le personnel administratif présentaient des associations significativement plus élevées avec la séropositivité IgG par rapport aux médecins. CONCLUSION: Plus d'un quart du personnel soignant de l'UUTH Nigeria présentait des IgG positives au COVD-19. Les pratiques de sécurité étaient généralement inadéquates, les infirmières et le personnel administratif présentant un risque plus élevé de séropositivité aux IgG. Un meilleur respect des pratiques de sécurité par le personnel hospitalier pourrait réduire les taux de prévalence. MOTS CLÉS: Pratiques de sécurité, COVID-19, positivité des anticorps, personnel de santé, Nigeria.

Severe bullous systemic lupus erythematosus successfully treated with low dose rituximab: a case report from sub-Saharan Africa.

Bullous systemic lupus erythematosus (BSLE) is a blistering skin condition occurring in lupus patients. Although cutaneous manifestations are common in lupus (59-85%), BSLE is rare, affecting <5% of lupus patients with very few reported cases among Africans. Dapsone is effective in mild to moderate cases, but off-label standard-dose rituximab (1,000 mg 2 weeks apart) has led to good outcomes in refractory cases. We report the case of a 39-yearold African lady with BSLE, who was successfully treated with low-dose rituximab (500 mg 2 weeks apart), healing her skin lesions at one year post-treatment. Low-dose rituximab may be as effective as standard dosing for the treatment of severe bullous SLE and is recommended in low resource settings.

Rituximab-induced acute thrombocytopaenia in an African lupus patient: a case report

Drug-induced acute thrombocytopaenia (DITP) is a complication of various medications resulting in a platelet count <50 x 109/L from prior normal levels. It typically occurs within 1-2 weeks postadministration but can occur rapidly within 1-3 days with previous exposure. Rituximab (an anti-CD20 antibody) used to treat many autoimmune cytopaenias, has been reported to cause thrombocytopaenia mostly in lymphoma patients. Reports in lupus are rare possibly because of off-label use. We hereby highlight the case of a 39-year old African lady who developed acute thrombocytopenia 12 days post-rituximab. Frequent monitoring of blood counts will enhance identification and treatment of this complication