BACKGROUND: Statistical data of undiagnosed people living with human immunodeficiency virus (PLHIV) are of great importance to human immunodeficiency virus (HIV) infection control. This study estimated the total number of PLHIV using nationwide claims data.METHODS: This study used data of the incident HIV cases identified by the National Health Insurance System between 2009 and 2015. The number of patients with acquired immune deficiency syndrome (AIDS) was identified by diagnoses or prescription records. The estimated number of PLHIV and the time to diagnosis were calculated from the incident numbers of HIV and AIDS cases using the HIV Modeling Tool of the European Center for Disease Prevention and Control.RESULTS: Between 2009 and 2015, a total of 7,033 PLHIV and 2,899 AIDS patients were diagnosed. In 2009, the number of incident HIV cases was 873 (460 AIDS patients), increasing to 995 (337 AIDS patients) in 2015. Besides, the estimated number of prevalent cases was 10,753 in 2009, compared to 14,880 in 2015. Patients visiting health facilities accounted for 42.9% (4,616/10,753) in 2009 and 64.1% (9,544/14,880) in 2015. In 2009, there were 8,363 (77.8%) undiagnosed HIV cases, experiencing a decline to 6,215 (41.8%) in 2015. It took a mean of 6.96 years to diagnose after HIV infection.CONCLUSION: This study estimates the total burden of HIV infection in Korea for the first time using an internationally recognized HIV modeling tool. Claims data can be used to estimate the number of undiagnosed cases by identifying the total number of PLHIV and AIDS patients visiting health facilities.
Acquired Immunodeficiency Syndrome ; Diagnosis ; Health Facilities ; HIV Infections ; HIV ; Humans ; Infection Control ; Korea ; National Health Programs ; Prescriptions

BACKGROUND: Insufficient training in infection control and occupational health among healthcare workers (HCWs) in countries with high human immunodeficiency virus (HIV) and tuberculosis (TB) burdens requires attention. We examined the effectiveness of a 1-year Certificate Program in Occupational Health and Infection Control conducted in Free State Province, South Africa in an international partnership to empower HCWs to become change agents to promote workplace-based HIV and TB prevention. METHODS: Questionnaires assessing reactions to the program and Knowledge, Attitudes, Skills, and Practices were collected pre-, mid-, and postprogram. Individual interviews, group project evaluations, and participant observation were also conducted. Quantitative data were analyzed using Wilcoxon signed-rank test. Qualitative data were thematically coded and analyzed using the Kirkpatrick framework. RESULTS: Participants recruited (n = 32) were mostly female (81%) and nurses (56%). Pre-to-post-program mean scores improved in knowledge (+12%, p = 0.002) and skills/practices (+14%, p = 0.002). Pre-program attitude scores were high but did not change. Participants felt empowered and demonstrated attitudinal improvements regarding HIV, TB, infection control, and occupational health. Successful projects were indeed implemented. However, participants encountered considerable difficulties in trying to sustain improvement, due largely to lack of pre-existing knowledge and experience, combined with inadequate staffing and insufficient management support. CONCLUSION: Training is essential to strengthen HCWs' occupational health and infection control knowledge, attitudes, skills, and practices, and workplace-based training programs such as this can yield impressive results. However, the considerable mentorship resources required for such programs and the substantial infrastructural supports needed for implementation and sustainability of improvements in settings without pre-existing experience in such endeavors should not be underestimated.
Capacity Building ; Delivery of Health Care* ; Education ; Female ; HIV* ; Humans* ; Infection Control ; Interviews as Topic ; Mentors ; Methods* ; Occupational Health* ; South Africa ; Tuberculosis*

Achromobacter xylosoxidans is a non-fermentative, aerobic, oxidase, and catalase-positive Gram-negative rod similar to Pseudomonas species. This organism colonizes aquatic environments and can cause nosocomial infections, especially in patients with immune deficiency such as human immunodeficiency virus infection, cancer, cystic fibrosis, neutropenia, and immunoglobulin M deficiency. Infections are found as bacteremia, pneumonia, meningitis, urinary tract infection, abscess formation, and osteomyelitis. It is known that most effective antibiotics are piperacillin/tazobactam, meropenem, and trimethoprim/sulfamethoxazol. But there is no optimal antibiotic therapy so far. We present a case of Achromobacter xylosoxidans bacteremia in a 13-month-old Korean girl who had past history of neutropenia.
Abscess ; Achromobacter denitrificans* ; Achromobacter* ; Anti-Bacterial Agents ; Bacteremia* ; Child* ; Colon ; Cross Infection ; Cystic Fibrosis ; Female ; HIV ; Humans ; Immunoglobulin M ; Infant ; Meningitis ; Neutropenia* ; Osteomyelitis ; Oxidoreductases ; Pneumonia ; Pseudomonas ; Urinary Tract Infections

According to the advance of antiretroviral regimen and the early treatment strategy, people living with human immunodeficiency virus (PLWH) are achieving the goal of virologic suppression and immune restoration. Most of them no more die of acquired immunodeficiency syndrome (AIDS) defining illnesses, and become older with chronic comorbidities such as cardiovascular, metabolic, hepatic, renal and neurological diseases. However some PLWH still visit hospitals as late presenters with very low CD4+ T cell counts, so that they suffer AIDS defining illnesses to die or experience severe neurological complications resulting in disabilities. Early palliative interventions are needed on the various symptoms of PLWH. Thus far chronic pains such as distal symmetric sensory polyneuropathies have been underevaluated. Active pain-relieving interventions are important to them. Recently we define end of life condition of human immunodeficiency virus (HIV) or eligibility to hospice care after adjusting current status of HIV treatment. Hospice teams should pay attention to the specific medical conditions, psychological needs, and social circumstances of PLWH. With just standard precautions as common infection control measures, general hospice cares can be provided to them like to other hospices subjects. For giving PLWH opportunities to have the end of life with value and dignity, hospice multidisciplinary team should intervene them early and aggressively. Now we need more clinical experiences and institutional improvements.
Acquired Immunodeficiency Syndrome ; Cell Count ; Chronic Pain ; Comorbidity ; HIV* ; Hospice Care ; Hospices* ; Infection Control ; Palliative Care* ; Polyneuropathies

Animal bites are a common problem managed by primary physicians and often involve wound infection, neurovascular injury, poor cosmetic outcome, and high medical costs. During clinical assessment, a thorough medical history is acquired, including details of the bite circumstances and the patient's immune status and vaccination history. A meticulous physical examination should be performed in order to identify any injuries to deep structures, in addition to exploring the wound by creating a narrow opening and using diagnostic tools such as radiograph and ultrasound where necessary. Infection is the most problematic complication after a bite injury. Cleaning, irrigation, and debridement are the most important steps in preventing infection. The use of prophylactic antibiotics is controversial, but probably indicated in immunocompromised individuals and in anatomical areas that are more likely to be infected, such as the hand and foot. The decision to close a bite wound must be based on consideration of the benefit of a good cosmetic outcome and the increased risk of infection. In Korea, human rabies has not occurred since 2005, but the transmission of rabies is still a concern with animal bites. The transmission of viral hepatitis, herpes virus and human immunodeficiency virus can occur following human bites. To prevent the transmission of various viruses, healthcare providers should know the guidelines for post-bite exposure prophylaxis.
Animals ; Anti-Bacterial Agents ; Bites and Stings ; Bites, Human ; Debridement ; Foot ; Hand ; Health Personnel ; Hepatitis ; HIV ; Humans ; Immunization ; Korea ; Physical Examination ; Rabies ; Ultrasonography ; Vaccination* ; Wound Infection ; Wounds and Injuries

Brown-Sequard Syndrome ; diagnosis ; Diagnosis, Differential ; HIV Infections ; complications ; Humans ; Male ; Middle Aged ; Mycobacterium avium-intracellulare Infection ; diagnosis

Healthcare personnel (HCP) face a wide range of occupational hazards, including needle-stick injuries, back injuries, latex allergy, violence, and stress. In particular, occupational exposures to infectious agents, such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV),or tuberculosis, are devastating to the victims. The World Health Organization (WHO) estimates the global burden of disease from occupational exposure to be 40% of hepatitis B and C virus infections and 2.5% of the HIV infections among HCP. Infectious disease cases for which compensation is given by the Korean Occupational Safety and Health Agency are increasing, and tuberculosis is the most common infectious disease compensated by KOSHA for HCP in Korea. While viral respiratory infections are common in health care settings, systematic surveillance has not been established yet in Korea. Infection control programs for HCP, such as engineering control in medical facilities, immunization, post exposure prophylaxis, and use of personal protective equipment need to be improved in Korea. This article describes the epidemiologic characteristics of occupational infectious diseases among HCP in Korea, especially focusing on needle-stick injuries and airborne infections. Also brief commentary is offered concerning effective measures for the control and prevention of occupational infectious disease transmission among HCP.
Back Injuries ; Communicable Diseases ; Compensation and Redress ; Delivery of Health Care ; Disease Transmission, Infectious ; Hepacivirus ; Hepatitis B ; Hepatitis B virus ; HIV ; HIV Infections ; Humans ; Immunization ; Infection Control ; Korea ; Latex Hypersensitivity ; Needlestick Injuries ; Occupational Diseases ; Occupational Exposure ; Occupational Health ; Post-Exposure Prophylaxis ; Respiratory Tract Infections ; Tuberculosis ; Violence ; Viruses ; World Health Organization

The healthcare industry employs over one million workers in Korea and encompasses a usually broad spectrum of occupations and related exposures. There are so many biological exposures in healthcare settings, including blood-borne pathogens, HIV, hepatitis B and hepatitis C, air-borne pathogens such as tuberculosis, and a wide variety of respiratory viruses. The World Health Organization (WHO) estimates the global burden of disease (GBD) from occupational exposure to be 40% of Hepatitis B and C infections and 2.5% of the human Immunodeficiency virus (HIV) infections among Healthcare workers (HCWs). Some countries have used surveillance systems to monitor national trends and incidence rates of occupational infections among HCWs; identify newly emerging hazards for HCWs; assess the risk of occupational exposures and infections; and evaluate preventive measures including engineering controls, work practices, protective equipment, and post-exposure prophylaxis to prevent occupational infections. Infection control programs such as engineering control in medical facilities, immunization, post exposure prophylaxis, and use of personal protective equipment (PPE) have been widely introduced to reduce occupational infectious disease among HCWs. Thus some developed countries which have actively introduced infection control program have decreased incidences of occupational infectious diseases among HCWs. This study describes the epidemiologic characteristics of occupational infectious diseases among HCWs, the kinds of surveillance system to monitor infectious diseases among HCWs, and infection control measures that apply to healthcare settings.
Blood-Borne Pathogens ; Communicable Diseases ; Delivery of Health Care ; Developed Countries ; Health Care Sector ; Hepatitis ; Hepatitis B ; Hepatitis C ; HIV ; Humans ; Immunization ; Incidence ; Infection Control ; Korea ; Occupational Exposure ; Occupations ; Organothiophosphorus Compounds ; Post-Exposure Prophylaxis ; Tuberculosis ; World Health Organization

Isolated bone marrow infection by nontuberculous mycobacteria (NTM) is extremely rare. Recently, we encountered a case of bone marrow Mycobacterium avium complex (MAC) infection, which presented as a fever of unknown origin shortly after starting continuous ambulatory peritoneal dialysis (CAPD). The patient was diagnosed with MAC infection on the basis of PCR-restriction fragment length polymorphism analysis and sequencing of DNA obtained from bone marrow specimens. Although this was a case of severe MAC infection, there was no evidence of infection of other organs. End-stage renal disease (ESRD) patients undergoing dialysis can be considered immunodeficient; therefore, when these patients present with fever of unknown origin, opportunistic infections such as NTM infection should be considered in the differential diagnosis.
Aged ; Anti-Bacterial Agents/therapeutic use ; Bacterial Proteins/genetics ; Bone Marrow/microbiology/pathology ; Diagnosis, Differential ; Female ; HIV Infections/diagnosis ; Humans ; Kidney Failure, Chronic/therapy ; *Mycobacterium avium Complex/genetics/isolation &purification ; Mycobacterium avium-intracellulare Infection/*diagnosis/drug therapy/microbiology ; *Peritoneal Dialysis, Continuous Ambulatory ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Sequence Analysis, DNA

Adult ; Antigens, CD ; metabolism ; Antigens, Differentiation, Myelomonocytic ; metabolism ; HIV Enteropathy ; complications ; metabolism ; microbiology ; pathology ; Humans ; Male ; Mycobacterium avium Complex ; isolation & purification ; Mycobacterium avium-intracellulare Infection ; complications ; metabolism ; microbiology ; pathology ; Young Adult