BACKGROUND

Rabies remains to be a neglected tropical disease in the Philippines, with the country reporting a higher number of cases compared to its counterparts in Asia.

To describe the demographics, animal bite characteristics, and post-exposure prophylaxis of animal bite patients coming in for care at the Research Institute for Tropical Medicine (RITM), a large government referral center for infectious diseases, and animal bites.

Electronic patient records from January 1, 2018 to December 31, 2019 were obtained from the National Rabies Information System (NaRIS) database of the Department of Health, and summarized using applicable descriptive statistics.

A total of 14,614 patients were included over the two-year study period, and more than third of the patients were children below 15 years old, while more than half were adult males. Lower extremities were the most frequently affected area, while with children, more than a third of exposures were in the head and neck areas. Intradermal route was mostly used for the post-exposure prophylaxis, while WHO prequalified vaccines were utilized in more than 90% of the patients. Only 55.7% of patients completed the prophylaxis regimen at RITM.

These findings reflect the significant exposure of children from animal bites, and the non-compliance of patients to the prescribed post-exposure prophylaxis.

INTRODUCTION: Paediatric sexual assault (SA) victims should be assessed for post-exposure prophylaxis (PEP) to mitigate the risk of sexually transmitted infections (STIs). We describe the clinical characteristics of children and young persons (CYPs) presenting with SA at KK Women's and Children's Hospital in Singapore, viral PEP (human immunodeficiency virus [HIV] and hepatitis B virus [HBV]) prescribing practices, and STI evaluation at follow-up. METHOD: Medical records of CYPs ≤16 years who presented with SA between January 2022 and August 2023 were reviewed, including assault and assailant characteristics, baseline and follow-up STI screening, PEP prescription, adherence and follow-up attendance. CYPs with SA in the preceding 72 hours by HIV-positive or HIV-status unknown assailants with high-risk characteris-tics were eligible for HIV PEP. RESULTS: We analysed 278 CYPs who made 292 SA visits. There were 40 (13.7%) CYPs eligible for HIV PEP, of whom 29 (82.9%) received it. Among those tested at baseline, 9% and 34.9% of CYPs tested positive for Chlamydia trachomatis and Gardnerella vaginalis, respectively. None tested positive for Neisseria gonorrhoeae, Trichomonas vaginalis, HIV, HBV or hepatitis C. Majority of CYPs tested were HBV non-immune (n=167, 67.6%); only 77 (46.1%) received the vaccine. Out of 27 CYPs eligible for HBV PEP with immunoglobulin, only 21 (77.7%) received immunoglobulin. A total of 37 CYPs received HIV PEP, including 8 who were retrospectively deemed ineligible. Only 10 (27%) completed the course. Overall, 153 (57.7%) CYPs attended follow-up, and none seroconverted for HIV or HBV. CONCLUSION We report suboptimal rates of HBV post-exposure vaccination, and low compliance to HIV PEP and follow-up among paediatric SA victims. Factors contri-buting to poor compliance should be examined to optimise care for this vulnerable population.
Humans ; Post-Exposure Prophylaxis/methods* ; Female ; Child ; Adolescent ; Singapore/epidemiology* ; HIV Infections/prevention & control* ; Male ; Sexually Transmitted Diseases/epidemiology* ; Retrospective Studies ; Hepatitis B/prevention & control* ; Follow-Up Studies ; Child, Preschool ; Sex Offenses/statistics & numerical data* ; Child Abuse, Sexual

A survey was conduct to analyze the usage situation of post-exposure prophylaxis(PEP) and related factors among men who have sex with men(MSM) in 6 cities of Shandong Province. Total of 2 620 subjects, the use ratio was 2.98% (78/2 620). Compared with age≤24 years,monthly income<5 000 yuan,non-commercial sex, non-DU,non-STD,role for being insert in the anal intercourse,MSM was more likely to use PEP with age≥45 years(OR=3.87, 95%CI:1.12-13.36),monthly income≥5 000 yuan(OR=1.87, 95%CI:1.07-3.28),commercial sex (OR=3.13, 95%CI:1.56-6.28), drug users (DUs) (OR=4.63, 95%CI:2.51-8.52),STD patient (OR=2.35,95%CI:1.05-5.27),the mixed sex role group(OR=2.25,95%CI:1.10-4.62).
Male ; Humans ; Young Adult ; Adult ; Middle Aged ; Homosexuality, Male ; HIV Infections/prevention & control* ; Post-Exposure Prophylaxis ; Sexual and Gender Minorities ; Sexual Behavior

Anti-HIV Agents/therapeutic use* ; HIV ; HIV Infections/prevention & control* ; Humans ; Post-Exposure Prophylaxis ; Public Health

Objectives: Leprosy is an infectious disease affecting the skin and nerves caused by Mycobacterium leprae. Closer physical distance was found to increase risk transmission. Thus, targeted provision of prophylactic medications to household contacts of patients with leprosy could possibly aid in decreasing its incidence in a cost-effective manner. This study aimed to determine the attitudes towards disclosure of the diagnosis of leprosy and acceptance of immuno- and chemoprophylaxis for household contacts of patients undergoing treatment in a dermatology outpatient clinic of a tertiary hospital in the Philippines. Methods: We conducted a prospective, single-center, cross-sectional and mixed methods study at a dermatology clinic of a tertiary hospital. All diagnosed leprosy patients, household contacts of leprosy patients, and individuals with no leprosy and no known contact with a leprosy case were invited. Eligible participants who gave consent were included in the cross-sectional survey, followed by in-depth interviews of selected participants. STATA 12 was used to analyze the data. Descriptive statistics were used to summarize information. Chi-square was computed to obtain a measure of association of important variables. The field notes and the verbatim transcriptions of the interviews and narratives were filed using an analytic memo system. Results: Fifty-five participants (22 Hansen’s disease patients, 13 household contacts, and 20 individuals unaffected by and unexposed to leprosy) were enrolled. Mean age of respondents was 38 years, 60% were female, and 85% were living in an urban setting. Majority of the patients with leprosy were borderline lepromatous (45%) to lepromatous type (27%) with mean treatment duration of 13 months. Overall, the respondents were willing to disclose the diagnosis of leprosy to their household members to facilitate provision of prophylaxis. They were also generally willing to receive prophylaxis despite potential side effects, expense, incomplete protection, and the need for yearly assessment for the development of leprosy. All respondents felt hopeful about the availability of medications that can prevent the development of leprosy and its complications, with some feeling anxious and only a few being embarrassed about receiving them. Conclusions Prophylactic medications were found to be generally acceptable despite some concerns. There is also a willingness to disclose the diagnosis of leprosy to facilitate the targeted provision of prophylaxis to household contacts.
Leprosy ; Post-Exposure Prophylaxis ; Attitude

OBJECTIVES: To determine the epidemiological features of patients and animals after bites/scratches from rabies-suspected animals in Zenica-Doboj Canton, Bosnia and Herzegovina. METHODS: Data from all patients (and the causative animals) admitted to the Antirabies Service of the Institute for Health and Food Safety Zenica in the 2009-2017 period were analyzed, including age, sex, anatomical site of the bite/scratch, animal type (stray/owned/wildlife), veterinary observations of the animal, and whether antirabies post-exposure prophylaxis (PEP) was indicated and/or administered. RESULTS: In total, 1716 patients were admitted. Bites/scratches were most frequently recorded during April and May (n=181, 10.5% and n=163, 9.5%, respectively). The persons admitted were mostly from the Zenica municipality (n=1278, 74.5%; incidence: 11.55/1000), which is 66.6% urbanized. Males were more frequently represented (n=1089, 63.6%). The patients were mostly 50-64 and 25-49 years of age (n=425, 24.7% and n=390, 22.7%, respectively). Dog bites were the most common cause (n=1634, 95.1%, of which n=1258, 77.0% were caused by stray dogs). PEP was indicated for 997 (58.1%) patients. Only 340 (19.9%) animals underwent veterinary observations (3.1% of stray and 76.1% of owned animals). The largest number of injuries were presented at lower extremities, 1044 (60.8%) cases. CONCLUSIONS: Zenica-Doboj Canton is a rabies-free region. Due to the high rate of stray animals not undergoing veterinary observations, the non-existence of a unique dog registry, and the consequent lack of information about stray animals in terms of number, vaccination, neutering, and euthanasia, there is an urgent need for improving the prevention and control of rabies within the One Health framework.
Animals ; Bosnia and Herzegovina ; Dogs ; Euthanasia ; Food Safety ; Humans ; Incidence ; Lower Extremity ; Male ; Post-Exposure Prophylaxis ; Rabies ; Vaccination

Background: Post-exposure prophylaxis (PEP) is the most important means of preventing rabies. Intradermal PEP was developed to improve compliance, still, many recipients fail to complete this regimen Objective: To determine the non-monetary factors contributing to non-compliance to PEP among patients in the Animal Bite Treatment Center (ABTC) of San Lazaro Hospital (SLH). Methods: This was an analytical, cross-sectional study. The authors randomly reviewed patient records of SLH-ABTC for one-year period. We characterized the cases according to World Health Organization (WHO) parameters. They determined the day intervals between exposure, first consultation, PEP initiation and follow-up visits. Statistical analyses used were descriptive statistics, χ2 test for independence and binary logistic regression. Results: The authors evaluated 667 records. Patients mostly had Category III exposures (76.91%, 95%CI: 73.92%80.62%). The chances of completing active immunization were more likely among patients exposed to unvaccinated animals (OR=1.85, 95%CI: 1.21-2.84, p=0.004). The chances of receiving passive immunization were higher for injuries on the head/neck regions (OR=8.18, 95%CI: 2.4-27.9, p=0.001). Overall, compliance to PEP was 70.21% and 40.70% for Categories II and III exposures, respectively. PEP compliance was moderately dependent on the exposure category (χ2=38.14, df=1, p<0.001, φ=0.25. Conclusion Category II exposure patients had better compliance than Category III, since rabies immunoglobulins are not required. The authors did not identify any factors that significantly affected Category II regimen compliance. Among Category III patients, compliance was better if the injuries were bite-inflicted while those who were exposed from “healthy”looking animals were less likely to comply.
Rabies ; Post-Exposure Prophylaxis

Anthrax, caused by Bacillus anthracis, is a non-contagious infectious disease that affects a wide range of animal species (primarily ruminants) including humans. Due to the often-fatal outcome in humans, quick administration of definitely effective antimicrobials is crucial either as prophylaxis or as a clinical case therapy. In this study, 110 B. anthracis strains, temporally, geographically, and genetically different, isolated during anthrax outbreaks in Italy from 1984 to 2017, were screened using a broth microdilution method to determine their susceptibility to 16 clinically relevant antimicrobial agents. The strains were isolated from various matrices (human, animal, and environmental samples) and were representative of thirty distinct genotypes previously identified by 15-loci multiple-locus variable-number of tandem repeats analysis. The antimicrobials tested were gentamicin, ceftriaxone, streptomycin, penicillin G, clindamycin, chloramphenicol, vancomycin, linezolid, cefotaxime, tetracycline, erythromycin, rifampin, amoxicillin, ciprofloxacin, doxycycline, and trimethoprim. All isolates were susceptible to most of the tested antimicrobials, with the exception of trimethoprim for which all of them showed high minimal inhibitory concentration values. An intermediate level of susceptibility was recorded for ceftriaxone and cefotaxime. Although the Centers for Disease Control and Prevention recommend the use of doxycycline, ciprofloxacin, penicillin G, and amoxicillin for treatment of human cases and for post-exposure prophylaxis to anthrax spores, this study shows a high degree of in vitro susceptibility of B. anthracis to many other antimicrobials, suggesting the possibility of an alternative choice for prophylaxis and therapy.
Amoxicillin ; Animals ; Anthrax ; Anti-Infective Agents ; Bacillus anthracis ; Bacillus ; Cefotaxime ; Ceftriaxone ; Centers for Disease Control and Prevention (U.S.) ; Chloramphenicol ; Ciprofloxacin ; Clindamycin ; Communicable Diseases ; Disease Outbreaks ; Doxycycline ; Erythromycin ; Genotype ; Gentamicins ; Humans ; In Vitro Techniques ; Italy ; Linezolid ; Methods ; Microbial Sensitivity Tests ; Penicillin G ; Post-Exposure Prophylaxis ; Rifampin ; Spores ; Streptomycin ; Tandem Repeat Sequences ; Tetracycline ; Trimethoprim ; Vancomycin

Needlestick injury (NSI) is a serious occupational hazard against healthcare workers (HCWs) in a hospital setting with multiple implications, thus adherence to post-NSI management including follow-up protocol is crucial.This research was conducted to describe the distribution of NSI cases among HCWs working in Ministry of Health Malaysia (MOH)’s hospital in Selangor and adherence to a follow-up protocol, as well as the factors related to it.This was a cross-sectional quantitative study reviewing retrospectively all notified NSI cases in January-September 2016. Data were taken from Sharps Injury Surveillance (SIS) system and analyzed into descriptive and analytical statistics.There were 143 notified NSI cases. The majority of the cases were female(76.2%), Malay(60.1%), medical doctors(56.6%) and in a medical-based department (44.8%). The median age of NSI cases was 27 years old (IQR:5) and median years of employment was 1.5 (IQR:4.5). Most cases happened in a ward setting (58.7%) involving contaminated (95.8%) hypodermic needle (43.4%), occurred mostly during the procedure of drawing blood (23.1%). Only 86.7% of NSI cases were source-known and some were tested positive with blood borne pathogens. However, no occurrence of seroconversion among the injured HCWs detected. The overall adherence rate to the follow-up protocol was 72.3%. Multiple logistic regression yielded significant association between age, gender, department, device contamination, procedure conducted and source HBV status with adherence to follow-up of post-NSI protocol. Further comprehensive studies involving more determinants such as therapy-related factors and potential interventions are needed to optimize adherence rate to the follow-up protocol post-NSI.
guideline adherence ; needlestick injuries ; health personnel ; post-exposure prophylaxis ; blood-borne pathogens

OBJECTIVE: This study examined patients who visited the emergency department of a national medical center equipped with rabies vaccine and rabies immunoglobulin to confirm whether the treatment for rabies vaccination was appropriate in the emergency department. METHODS: This was a retrospective study that included 397 patients from January 1, 2014, to October 31, 2017. The patients finally diagnosed with animal bites according to the International Classification of Diseases, 10th revision code, at emergency department were collected. RESULTS: Most of the patients were 20–30 years old. Most of them were bitten by a dog, especially in the upper limb. Only 84% of patients who met the domestic rabies post-exposure prophylaxis (PEP) criteria were vaccinated. Patients who did not meet the criteria, approximately 22.3%, were also vaccinated. Complications after vaccination included clinical symptoms, such as headache, numbness, mild itching, and heating sensation. CONCLUSION: Rabies is a disease that can be prevented through PEP. Rabies PEP is relatively expensive and difficult to vaccinate easily, so it is desirable to subdivide the existing domestic rabies PEP guidelines into reality. Emergency physicians should know the proper rabies vaccination criteria and vaccinate patients only if necessary. This will help reduce medical resources and the complications of rabies vaccinations.
Animals* ; Bites and Stings ; Dogs ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Headache ; Heating ; Hot Temperature ; Humans ; Hypesthesia ; Immunoglobulins ; International Classification of Diseases ; Post-Exposure Prophylaxis* ; Pruritus ; Rabies Vaccines ; Rabies* ; Retrospective Studies ; Sensation ; Upper Extremity ; Vaccination