Blood-borne Research Articles

2663. Comprehensive at-home Sexually Transmitted and Blood Borne Infection (STBBI) Testing Program: A Pilot Initiative

Abstract Background Sexually transmitted and blood borne infection (STBBIs) remain a growing concern in North America with rates increasing dramatically since 2000. Although self-testing has been demonstrated to be valid and acceptable, no fully remote STBBI testing programs are available in Canada. To evaluate feasibility and acceptability of at-home STBBI testing, we implemented a fully remote, web-based platform of risk-responsive, non-invasive STBBI diagnostics in a large Canadian health zone. Methods A web-based risk assessment and intake form was developed using RedCap software through a community-facing website (athomestitesting.ca) in partnership with a local sexual health centre. Demographic, sexual practices, and medical history were collected from interested participants through the platform. Diagnostic kits inclusive of testing for gonorrhea/chlamydia (urine and self-swabs of vagina/pharyngeal/rectal) and syphilis/HIV/Hepatitis C (dried blood spot) were mailed to participants based on their survey responses, along with instructions and supplies for collection and return. Outcomes to be assessed include feasibility and acceptability of the web-based platform, testing and positivity rates for STIs, and time to testing and treatment (for positive cases). Results In the first month to date with limited launch, eleven participants completed the intake survey and were mailed testing kits through the platform. Of the completed testing, no new STIs were identified. The median age of the cohort was 38 years old (IQR 32, 41) and six identified as men, four as women and one non-binary. Regarding gender identity, seven identified as gay/queer/bisexual and three as straight/heterosexual. In a follow-up survey, all participants to date stated reported satisfaction or extremely satisfaction with the online testing. Conclusion The platform model demonstrates feasibility in the early pilot phase with acceptability based on participant responses. Next steps include expanded launch of the platform and assessment of testing rates and feasibility of a web-based model for STI diagnostics. Disclosures Caley B. Shukalek, MD, MSc, MPH, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Gilead Sciences: Honoraria|Merck Canada: Grant/Research Support|Merck Canada: Honoraria|PurposeMed Inc: Advisor/Consultant|PurposeMed Inc: Ownership Interest Ranjani Somayaji, M.D., CF Foundation: Grant/Research Support|CIHR: Grant/Research Support|Oncovir: Data and Safety Monitoring Board Fees|Vertex Pharmaceuticals: Advisor/Consultant|Vertex Pharmaceuticals: Grant/Research Support|Vertex Pharmaceuticals: Honoraria

Nogo-A is secreted in extracellular vesicles, occurs in blood and can influence vascular permeability

Nogo-A is a transmembrane protein with multiple functions in the central nervous system (CNS), including restriction of neurite growth and synaptic plasticity. Thus far, Nogo-A has been predominantly considered a cell contact-dependent ligand signaling via cell surface receptors. Here, we show that Nogo-A can be secreted by cultured cells of neuronal and glial origin in association with extracellular vesicles (EVs). Neuron- and oligodendrocyte-derived Nogo-A containing EVs inhibited fibroblast spreading, and this effect was partially reversed by Nogo-A receptor S1PR2 blockage. EVs purified from HEK cells only inhibited fibroblast spreading upon Nogo-A over-expression. Nogo-A-containing EVs were found in vivo in the blood of healthy mice and rats, as well as in human plasma. Blood Nogo-A concentrations were elevated after acute stroke lesions in mice and rats. Nogo-A active peptides decreased barrier integrity in an in vitro blood-brain barrier model. Stroked mice showed increased dye permeability in peripheral organs when tested 2 weeks after injury. In the Miles assay, an in vivo test to assess leakage of the skin vasculature, a Nogo-A active peptide increased dye permeability. These findings suggest that blood borne, possibly EV-associated Nogo-A could exert long-range regulatory actions on vascular permeability.

A Study to Assess the Knowledge Regarding Prevention of Blood Borne Infections among Students of Selected Nursing Institution at Mangaluru

Background of the Study: Blood borne pathogens are microorganisms such as viruses or bacteria that are carried in blood. A blood borne disease that can be spread through contamination by blood and other body fluids. In health care setting, blood born pathogen transmission usually occurs by Percutaneous exposure to the workers mostly happens when they are handling infected patients. 1The aim of our study was to assess the knowledge regarding prevention of blood borne infection among students of selected nursing institution at Mangaluru.
 Materials and Methods: A descriptive study was conducted among104 undergraduate students. Subject was selected using purposive sampling techniques. The information was collected using a demographic Proforma and a self - administered questionnaire. The overall knowledge on prevention of blood born infection was graded as adequate, good, and inadequate.
 Results: The overall knowledge score was majority (64.4%) had average, 33.7% had good and minority (1.9%) had good knowledge regarding blood born infection and its prevention. In this study there was significant (P<0.05) association between knowledge score with age, gender whereas there is no significant association between knowledge score with year of study, previous knowledge on standard precautions and source of information. 
 Conclusion: The present study concludes that the nursing students have a fair knowledge regarding the cause of blood born infections. Competent knowledge is needed to prevent the spread of blood born infections. Successful prevention strategies of blood born infections require a high level of awareness of the infected individual as well as a detailed knowledge among healthcare professionals and society.

Multi-disciplinary cooperation for the micro-elimination of hepatitis C in China: a hospital-based experience

BackgroundHepatitis C virus (HCV) infection is one of the main causes of liver cancer and imposes an enormous social and economic burden. The blood-borne virus screening policy for preventing iatrogenic infections renders hospitals important for identifying individuals infected with hepatitis C. Therefore, we aimed to investigate the establishment of a multi-disciplinary cooperation model in medical institutions to leverage the screening results of patients with hepatitis C. Our objective is to ensure that patients receive timely and effective diagnosis and treatment, thereby enabling the elimination of hepatitis C by 2030.MethodA multi-disciplinary cooperation model was established in October 2021. This retrospective study was based on the establishment of antibody-positive and HCV RNA-positive patient databases. A Chi-square test was used to compare the HCV RNA confirmation rate in anti-HCV-positive patients, as well as the hepatitis C diagnosis rate and treatment rate in RNA-positive patients before and after the multi-disciplinary cooperation. A multivariable logistic regression was used to analyse the factors affecting the treatment of patients with hepatitis C. In addition, we examined changes in the level of hepatitis C knowledge among medical staff.ResultsAfter the implementation of the multi-disciplinary cooperation model, the RNA confirmation rate of hepatitis C antibody-positive patients increased from 36.426% to 88.737%, the diagnostic accuracy rate of RNA-positive patients increased from 67.456% to 98.113%, and the treatment rate of patients with hepatitis C increased from 12.426% to 58.491%. Significant improvements were observed among the clinicians regarding their ability to understand the characteristics of hepatitis C (93.711% vs. 58.861%), identify people at high risk (94.340% vs. 53.797%), manage patients with hepatitis C after diagnosis (88.679% vs. 67.089%), and effectively treat hepatitis C (84.277% vs. 51.899%). Multi-disciplinary cooperation in medical institutions was the most important factor for patients to undergo HCV treatment (odds ratio: 0.024, 95% confidence interval: 0.007–0.074).ConclusionsThis study showed that the use of a multi-disciplinary cooperation model to utilise the results of HCV antibody screening fully in patients through further tracking, referral, and treatment may facilitate the detection and treatment of patients with hepatitis C and accelerate the elimination of HCV in China.

Development of a novel molecular tool to study molecular ecology of Ornithomya (Hippoboscidae) avian louse flies

Louse flies (Diptera: Hippoboscidae) are obligatory hematophagous ectoparasites of birds and mammals. These widely distributed parasitic flies may have a significant impact on wild and farm animals by feeding on their blood and transmitting bloodborne pathogens. However, despite their ecological importance, louse flies are clearly underrepresented in host-parasite research and implementation of genetic approaches in this group is generally hampered by lacking molecular tools. In addition, louse flies that parasitize long-distance migrants can travel long distances with their avian hosts, facilitating the large-scale spread of pathogens across landscapes and geographic regions. Given the wide diversity of louse flies that parasitize a variety of avian hosts, their direct negative impact on host survival, and their high potential to transmit bloodborne pathogens even along avian migration routes, it is surprising that our knowledge of louse fly ecology is rather modest and incomplete. Here, we aimed to develop a novel molecular tool for polyxenous avian louse flies from the genus Ornithomya, which are among the most common and widely distributed representatives of Hippoboscidae family, to improve research of their genetic population structure and molecular ecology.Using the Illumina Mi-seq sequencing, we conducted a genome-wide scan in Ornithomya avicularia to identify putative microsatellite markers. A panel of 26 markers was selected to develop amplification protocols and assess polymorphism in the Central European population of O. avicularia, as well as to test for cross-amplification in a congeneric species (O. chloropus).A genome-scan in O. avicularia identified over 12 thousand putative microsatellite markers. Among 26 markers selected for a population-wide screening; one did not amplify successfully and three were monomorphic. 22 markers were polymorphic with at least two alleles detected. Two markers showed presence of null alleles. A cross-amplification of microsatellite markers in O. chloropus revealed allelic polymorphism at 14 loci, with the mean allelic richness of 3.78 alleles per locus (range: 2–8).Our genome-wide scan in O. avicularia provides a novel and powerful tool for molecular research in Ornithomya louse flies. Our panel of polymorphic microsatellite loci should allow genotyping of louse flies from geographically distinct populations and from a wide spectrum of avian hosts, enhancing population genetic and phylogeographic research in Ornithomya.

Epidemiologic changes of infectious diseases in the post-SARS era in China, 2004–2018

ObjectivesTo outline 44 major infectious diseases in the post-SARS (severe acute respiratory syndrome) in China and describe their long-term trends and changes by age, sex, epidemic season, and province.BackgroundAfter the outbreak of severe acute respiratory syndrome (SARS) in 2003, with the change of infectious disease prevention and control system and the improvement of residents’ quality of life, the incidence and mortality of infectious diseases have undergone major changes.MethodsThe data of 44 major infectious diseases in China from 2004 to 2018 were obtained from the monthly analysis report of the China Information System for Disease Control and Prevention (CISDCP) and the Public Health Science Data Center. Joinpoint r regression models were used to examine trends in incidence and mortality for 44 major and important infectious diseases from 2004 to 2018.ResultsFrom 2004 to 2018, 20,105, 500, 772 patients (10, 306, 546, 523 males and 9, 798, 954, 249 females) were diagnosed with 44 major infectious diseases. The overall incidence of 44 infectious diseases increased significantly from 294.6 per 100,000 people in 2004 to 479.1 per 100,000 people in 2010, with 7.9% APC (95% CI 5.2% -10.7%, P < 0.001), then slowed, and then increased to 561.2 per 100,000 people in 2018, with 1.5% APC (-0.1%—3.2%, P = 0.070). The overall mortality rose significantly, from 0.49 to 1.13 per 100,000 people between 2004 and 2011, with an APC increase of 11.6% (7.7% -15.6%, P < 0.001), and then remained stable until 2018. Among these, the prevalence of vaccine-preventable diseases and gastrointestinal & enteroviral diseases remained high and increased year by year. Patients with zoonotic diseases have the greatest risk of death, while patients with sexually transmitted and blood-borne diseases have the greatest number of deaths. Incidence rates vary considerably across geographic regions. Western China has a disproportionate burden of infectious diseases compared with eastern regions.ConclusionsAfter the event of SARS in 2003, infectious disease preventing and controlling model has undergone major changes in China, and certain achievements have been made in this field. Although overall morbidity and case fatality rates are still rising, they have leveled off. In reducing the disproportionate disease burden in the western region, expanding vaccination programs, preventing further increases in rates of sexually transmitted diseases, renewing efforts for emerging and persistent infectious diseases, and addressing seasonal and unpredictable outbreaks (such as the COVID-19 pandemic), there are still remain many challenges.

Hepatitis B vaccination status and knowledge, attitude, and practice towards Hepatitis B virus among medical sciences students: A cross-sectional study.

Healthcare staff are at high risk of occupational exposure to Hepatitis B and other blood-borne diseases. Lack of education about the knowledge of Hepatitis B virus contributes to an increase in cases. This study aims to determine the knowledge of the Hepatitis B virus among the medical professionals in Duhok province, Kurdistan Region of Iraq, and to determine their knowledge of the importance of vaccination. This cross-sectional study was conducted in Duhok province, Kurdistan Region of Iraq, among medical science students from November 2022 to February 2023 and a total of 511 students participated in the study. A Self-administered questionnaire comprising 22 items categorized into five sections was distributed to the students either electronically or by paper and pen method. The survey utilized a Five-point Likert scale when assessing respondents' opinions on knowledge, attitude, and practice (KAP). Microsoft Excel and GraphPad Prism 9 were used for statistical analysis. A total of 511 responses were collected from medical, dental, pharmacy, and laboratory students. The average age of the participants was 20.74 ±1.43 years. Among the respondents, only 96 (18.8%) were fully vaccinated against the Hepatitis B virus (received 3 or more doses of the vaccine), while 294 (57.5%) were not vaccinated. Lack of vaccination programs was the major reason for not receiving a vaccination (n = 182, 62%). About 286 (55.96%) of the participants had good knowledge, attitude, and practice on Hepatitis B, manifesting median scores of 26, 18, and 20, respectively. In our study, half of the students were found to be unvaccinated, mainly due to the absence of vaccination programs. Vaccinated students exhibited better knowledge, attitude, and practice toward the infection than non-vaccinated students. Therefore, we recommend the implementation of a vaccination program as well as training on infection prevention guidelines to increase awareness and encourage vaccination.

Multi-infection screening for migrant patients in UK primary care: Challenges and opportunities

BackgroundMigrants in Europe face a disproportionate burden of undiagnosed infection, including tuberculosis, blood-borne viruses, and parasitic infections and many belong to an under-immunised group. The European Centre for Disease Control (ECDC) has called for innovative strategies to deliver integrated multi-disease screening to migrants within primary care, yet this is poorly implemented in the UK. We did an in-depth qualitative study to understand current practice, barriers and solutions to infectious disease screening in primary care, and to seek feedback on a collaboratively developed digitalised integrated clinical decision-making tool called Health Catch UP!, which supports multi-infection screening for migrant patients. MethodsTwo-phase qualitative study of UK primary healthcare professionals, in-depth semi-structured telephone-interviews were conducted. In Phase A, we conducted interviews with clinical staff (general practitioners (GPs), nurses, health-care-assistants (HCAs)); these informed data collection and analysis for phase B (administrative staff). Data were analysed iteratively, using thematic analysis. ResultsIn phase A, 48 clinicians were recruited (25 GPs, 15 nurses, seven HCAs, one pharmacist) and 16 administrative staff (11 Practice-Managers, five receptionists) in phase B. Respondents were positive about primary care's ability to effectively deliver infectious disease screening. However, we found current infectious disease screening lacks a standardised approach and many practices have no system for screening meaning migrant patients are not always receiving evidence-based care (i.e., NICE/ECDC/UKHSA screening guidelines). Barriers to screening were reported at patient, staff, and system-levels. Respondents reported poor implementation of existing screening initiatives (e.g., regional latent TB screening) citing overly complex pathways that required extensive administrative/clinical time and lacked financial/expert support. Solutions included patient/staff infectious disease champions, targeted training and specialist support, simplified care pathways for screening and management of positive results, and financial incentivisation. Participants responded positively to Health Catch-UP!, stating it would systematically integrate data and support clinical decision-making, increase knowledge, reduce missed screening opportunities, and normalisation of primary care-based infectious disease screening for migrants. ConclusionsOur results suggest that implementation of infectious disease screening in migrant populations is not comprehensively done in UK primary care. Primary health care professionals support the concept of innovative digital tools like Health Catch-UP! and that they could significantly improve disease detection and effective implementation of screening guidance but that they require robust testing and resourcing.

Investigating the Relationship between Endogenous Factor VIII Levels and Annual Bleed Rates and Health-Related Quality of Life in Patients with Hemophilia a Not Treated with Factor VIII Prophylaxis

Background Haemophilia A (HA) is a rare genetic disorder characterized by excessive bleeding caused by dysfunctional or absent clotting factor VIII (FVIII). Levels of FVIII determine severity of HA; 5% to &amp;lt;40% of normal FVIII levels is classified as mild disease, 1-5% is moderate, and &amp;lt;1% is severe. Current standard of care for severe hemophilia A is prophylaxis, with FVIII replacement keeping levels above 3-5% to prevent bleeding episodes. Less severe patients, or patients who opt-out of prophylaxis, may be treated on-demand. In patients not on prophylaxis, factor levels (FLs) are considered endogenous. Aims The purpose of the study was to explore the relationship between endogenous FLs and ABR; and FLs and Health-Related Quality of Life (HRQoL), in patients across all severities treated on-demand. Methods The analysis was conducted using the CHESS II dataset - a retrospective, cross-sectional study conducted in Denmark, France, Germany, Italy, The Netherlands, Romania, Spain, and The United Kingdom [2018-19]. Physicians completed questionnaires about their patients, and patients completed HRQoL questionnaires. The inclusion criteria for this analysis was restricted to adult male patients without inhibitors or treated with prophylaxis. ABR was defined as the total number of bleeds recorded in the patient's medical records within the previous 12 months from patient enrolment. HRQoL was measured using the EQ5D-5L and valued using UK preference weights for comparison. Spearman's correlation was used to assess the relationships between FLs and both ABR and HRQoL. Regression models were used to estimate the relationships controlling for key covariates, including age, body mass index, and blood-borne viruses (HIV, Hepatitis B and C). Results A total of 403 patients from six countries (Italy, France, Germany, Spain, Romania, and United Kingdom) were included. Patients with mild, moderate, or severe HA accounted for 30%, 33%, and 37% of the sample, respectively. The mean age was 37.2 years with mean BMI 24.5 kg/m 2. The mean baseline FLs of all patients in the sample was 7 IU/dL (SD, 10.2) overall and 8.1 IU/dL (SD, 11.3) for the subset with HRQoL data (N = 167). The mean ABR was 2.3 bleeds/year (SD, 2.64) and the mean HRQoL score (n = 167) was 0.777 (SD, 0.197). Correlation analyses identified statistically significant, non-linear relationships between FLs and ABR, and FLs and HRQoL. The model showed lower ABRs in patients with higher endogenous FLs (figure 1). The regression suggests that on average, for every 1% higher endogenous FLs, ABR is 3.9% [95%CI: 2.8, 5.0%] (0.09 units) lower. In other words, an increase in FLs of 11% is associated with a reduction in ABR of approximately 1 bleed per year (figure 1). For HRQoL and FLs, the regression analyses show higher HRQoL with higher FLs (figure 2). The model showed every 1% higher FLs was associated with 0.0054 [95%CI: 0.003, 0.008] points higher EQ5D scores on average; therefore, an increase in FLs of 13% could achieve a minimal clinically important difference in HRQoL. Given non-linearity of the relationship, larger gains in HRQoL may come from raising FLs in more severe patients. Conclusion The results of this study reflect the spectrum of patients with HA treated on-demand in Europe. Due to the selection of patients not treated with prophylaxis, some of whom may have lower bleeding phenotypes, bleed rates and HRQoL are likely underestimated. The analyses show patients with higher endogenous FLs may experience fewer bleeds and better HRQoL than patients with lower FLs. This relationship may be maintained when considering FLs during prophylactic treatment. Higher FLs are not only related to clinical benefits, but also humanistic outcomes.

An Innovative Deep Learning Method to Diagnose Mosquito-Borne Illnesses in Blood Image Analysis

Introduction: Malaria, an infectious illness carried by the bite of infected mosquitoes, is a significant public health concern, especially in Africa. The management of mosquito-human contact is crucial to mitigate its transmission. Artificial intelligence, including machine learning and deep learning techniques, is being utilized to enhance the diagnosis and identification of mosquito species. This advancement aims to facilitate the development of more efficient control measures.&#x0D; Aims and Objective: To analyze the efficiency of three deep learning models in identifying blood-borne diseases by evaluating the macro and micro picture of blood samples.&#x0D; Method: In this retrospective investigation, three deep learning algorithms, namely Convolutional Neural Networks (CNN), MobileNetV2, and ResNet50, were used to identify mosquito-borne illnesses, focusing on malaria. The research used a dataset of 120 blood samples gathered over one year from the hospital's pathology department. The CNN model streamlines preprocessing with multilayer perceptrons, simplifying malaria component extraction. MobileNetV2, a lightweight network, outperforms others with fewer parameters. Its compact blocks in Dense-MobileNet models minimize constraints and computation expenses. ResNet50 resolves degradation issues with a residual structure, preventing overfitting as hidden layers increase.&#x0D; Results: The study evaluated three deep learning models (CNN, MobileNetV2, and ResNet50) for medical classification. The study also demonstrated improved True Positive Rates as False Positive Rates increased, indicating better accurate identification while controlling false positives. ResNet50 consistently outperformed the other models, showcasing its superior performance. The study revealed high precision scores for all models, classifying "Uninfected" and "Infected" cases. ResNet50 exhibited slightly higher precision, indicating its precision-based superiority. Overall, all models demonstrated vital accuracy, and ResNet50 showed exceptional performance. The study found that ResNet50 performs better in True Positive and False Positive Rates.&#x0D; Conclusion: The study has concluded that ResNet50 has shown the best performance in detecting blood-borne diseases.

Teclistamab in Relapsed Refractory Multiple Myeloma: Multi-Institutional Real-World Study

Introduction: Teclistamab is the first BCMA-targeting bispecific antibody (bsAb) that has received FDA approval in RRMM based on the MajesTEC-1 study, which showed a single-agent ORR of 63%. In this report, we present the safety and efficacy of teclistamab since its approval in a real-world multi-institutional cohort. Methods: All consecutive patients with RRMM treated with at least one dose of standard-of-care teclistamab at 5 academic centers in the US were included in this study. Data including patient demographics, disease, and treatment characteristics at the most recent assessment before starting treatment were retrospectively collected. Results: A total of 89 patients were treated across 5 academic institutions. The median age was 68 years (range: 37-89), with 48% (n=43) females. Among the patients, 30% (n=27) were Black, 2.2% (n=2) Asian and 12% (n=11) were other minorities. High-risk cytogenetic profile was observed in 65% (n=49/75) of the patients. About 48% (n=39) of the patients exhibited EMD on PET-CT. Four patients had CNS involvement, 1 had pPCL, and 3 had concomitant AL amyloidosis. Furthermore, 98% (n=87) of the patients had triple-class refractory MM, while 85% (n=76) had penta-refractory MM. The median prior lines of therapy were 6 ( range: 3-13) and 80% (n=71) of patients received a prior ASCT. About 37% (n=33) had received prior BCMA-directed therapy, which included BCMA CAR-T in 17, BCMA BsAb in 5, and Belantamab mafadotin in 11 patients . Table 1 compares this patient cohort with the MajesTEC-1 study population. Grade 1/2 CRS was observed in 48% (n=43) of patients, while 3% (n=3) experienced grade 4 CRS. Grade 1/2 ICANS was noted in 7% (n=6) of patients, grade 3/4 in 4.4% (n=4), and grade 5 in 1 patient. Steroids were utilized in 22% (n=16) of patients, while tocilizumab was administered in 44% (n=32) of patients. Notably, step-up dosing of teclistamab was administered entirely in the outpatient setting in 9% (n=8) of patients. For the remaining, inpatient step-up dosing was administered, and the median hospitalization duration was 10 days. At a median follow-up of 1.35 months (range: 0.16-4.38), the ORR among the evaluable patients was 55%, with rates of ≥ VGPR and PR at 37% (n=28) and 18% (n=13), respectively. The 3-month PFS rate was 54% (95% CI: 43%, 69%), while the 3-month OS rate was 80% (95% CI: 71%, 90%). Multivariate analysis did not reveal any significant associations between disease response and the following factors: number of prior lines of therapy (HR 1.03, 95% CI 0.76-1.42), baseline lymphocyte counts (HR 0.98, 95% CI 0.47-2.02), high-risk cytogenetics (HR 0.38, 95% CI 0.09-1.39) and the presence of extramedullary disease (HR 0.56, 95% CI 0.15-1.93). There was a trend towards worse ORR in patients with prior exposure to BCMA targeting agents, albeit not quite significant (HR 0.28, 95% CI 0.07-1.04, p=0.065). There were 61 infectious events with 50%, 45% and 5% of these being viral, bacterial, and fungal infections, respectively. The most common sources of infections were upper respiratory tract infections/pneumonias (33%), blood borne infections including bacteremia and viremia (27%) and urinary tract infections (11%). The cumulative incidence of any infection at 3 months was 55% and grade 3/4 infections were seen in 55% (n= 54) of cases. There was one grade 5 infection noted in this study due to COVID 19 pneumonia. Primary IVIG and PJP prophylaxis were used in 40% (n=34) and 51% (n=43) of patients, respectively and the use of such was associated with a significant reduction of infectious events (26/51 [51%] of any infectious event for no IVIG use vs 13/34 [38%] for IVIG use, p= 0.015). The results will be updated with longer follow-up at the meeting. Conclusion : In this large real-world, multi-institutional study including a diverse cohort of heavily pretreated patients with triple-class and penta-refractory MM, including approximately 40% with prior BCMA exposure, teclistamab demonstrated a respectable ORR of 55% with ≥ VGPR in 37% of cases. The incidence of Grade 3 or higher infections at 3 months remained high at 56%, however the use of prophylactic measures, including primary IVIG prophylaxis was associated with a significant reduction of all infections and should be strongly considered in patients receiving teclistamab.

A large-scale survey on epidemiology and underreporting of needlestick and sharp injuries among healthcare workers in China.

Needlestick and sharp injuries (NSI) carry the risk of transmitting numerous bloodborne pathogens, leading to both health and economic burdens. The underreporting of NSIs among healthcare workers (HCWs) is a global issue of concern, as timely treatment and prevention of complications rely on proper reporting. Underreporting further impedes accurate surveillance and appropriate resource allocation, with developed and developing nations facing disparities due to differences in healthcare policy. The purpose of this research is to examine the epidemiology of NSIs and NSI underreporting, as well as to identify the determinants associated with the occurrence of NSIs and the underreporting of such injuries. A retrospective online survey was conducted from January 15 to January 31, 2022 among healthcare workers (HCWs) across Gansu Province, China. A total of 7,283 healthcare workers (HCWs) from various institutions participated in this study. After quality assurance checks, 6,464 (88.77%) responses were included in the final analysis. Results revealed a 32.86% self-reported needlestick and sharp injury (NSI) incidence among respondents, with 28.53% of NSIs going unreported. Contrary to common belief, more experienced HCWs exhibited higher rates of both NSIs and underreporting compared to their less experienced peers. The primary reasons cited for NSIs and underreporting were lapses in concentration and not perceiving patients as infectious. Multivariate regression analysis exposes the significant influence of training frequency, occupation, department and years of services on the occurrence of NSIs. Conversely, the reporting of NSIs is primarily influenced by training, reimbursement,occupation, department and hospital grade. Compared to HCWs with no training, those who received ≥3 training sessions per year showed a 12.16% lower NSI incidence (27.12% vs. 39.28%, p < 0.001) and a 55.68% lower underreporting rate (14.61% vs. 70.29%, p < 0.001). There is a pressing need for enhanced surveillance, tailored training programs, and more efficient reporting mechanisms to combat this significant occupational health challenge.

Prothrombotic Profile in Patients with Active Multiple Myeloma and the Impact of Immunomodulators: The Roadmap-MM Study

Backround: Thromboembolism occurs in about 10% of patients with multiple myeloma (MM). The incidence of VTE is higher in newly diagnosed MM patients as compared to those with relapsed or refractory disease and it is higher during the first 3 to 6 months after the initial diagnosis and treatment initiation. Some of the treatments administered to patients with MM are independent risk factors for VTE. Immunomodulatory agents (IMiDs) among anti-myeloma treatments stand out as having a considerable prothrombotic effect. Recognizing the significant risk associated with the use of immunomodulatory agents (the International Myeloma Working Group (IMWG) 2014 statement, and the European Myeloma Network Guidelines in 2015 both included guidance on the prevention of VTE in MM patients who receive IMiDs. The prospective, longitudinal observational study ROADMAP-MM CAT was designed to explore alternative strategies for the development of risk stratification tools in patients with multiple myeloma. To this target we evaluated the baseline profile of hypercoagulability in multiple myeloma patients with various disease status. Blood borne hypercoagulabity partly consisted of enhanced thrombin generation, a common phenomenon in patients with malignancies . It remains to be seen whether this phenomenon appears for multiple myeloma patients during the physical course of the disease. Aim: We conducted a study to explore the relationship between stages of MM and alterations of various thrombosis-related biomarkers in patients with MM and their relationship with MM therapy. Materials and Methods Patients with MM (n=162) were recruited and stratified to the following groups: 59 newly diagnosed treatment-naïve patients (ND), 49 patients receiving IMiDs (IM), 52 in complete remission (CR) and 12 patients in partial remission on IMiDs (PR/IM). Patients on anticoagulant treatment were excluded from the study. The control group (CG) consisted of 30 healthy age and sex-matched individuals. Samples of platelet-poor plasma (PPP) were assessed for thrombin generation (TG) with the TF 5pM PPP-Reagent® on Calibrated Automated Thrombogram (Diagnostica Stago, France). Plasminogen activator inhibitor-1 (PAI-1), soluble endothelial protein C receptor (sEPCR), and soluble vascular cell adhesion molecule-1 (sVCAM-1), Procoag-PPL were measured using antibody-based ELISA kits (Invitrogen International Inc., CA, USA, and Diagnostica Stago, France ). TF expression MPC-derived microparticles (MPC-dMPs) were detected using a Zymuphen MP-TF activity kit (Hyphen BioMed, Neuville sur Oise, France). The upper and lower normal limits (LNL and UNL) were calculated by the mean±2 SD. Results A total of 162 patients were enrolled (age 66.0±12.0 yrs; 53% male). Distribution of disease stage was as follows: 32% ISS I, 23% ISS II, 45% ISS III. Bone disease was present in 71% of patients and 19% of patients had high risk cytogenetic lesions. Patients with ongoing MM (ND, IM, PR/IM) had significantly lower Peak, ETP and MRI as compared to the CG. In contrast, patients in CR had Peak, ETP, MRI values similar to the CG. Patients with PR had lower ETP and MRI values as compared to the CR group. In ND 9% had TG &amp;gt;UNL and 22% had TG&amp;lt;LNL. In IM 10% had TG&amp;gt;UNL and 67% had TG&amp;lt;LNL. None in PR/IM had TG&amp;gt;UNL and 35% had TG&amp;lt;LNL. In CR, 23% had TG&amp;gt;UNL and 12% had TG&amp;lt;LNL. MP-TF levels and PPL were higher in untreated MM (CR) patients compared to control. MP-TF and PPL levels decreased significantly after chemotherapy in PR/IM but MP-TF remained high at CR. The plasma concentrations, PAI-1, sEPCR, and sVCAM-1 were higher in MM patients than controls. , Treatment with IMDs reduced all biomarker levels gradually from PR/IM to CR (Table 1). Conclusion Patients with active MM showed attenuated TG which was enhanced in the presence of IMiDs treatment. Complete remission was associated with normalization of TG. The plasma concentrations, TF-MP , PAI-1, sEPCR, and sVCAM-1 were increased in MM patients suggesting vascular aggression which is followed by release of these markers that could contribute to the procoagulant environment. Attention should be paid to therapy-related thrombosis indeed the effect the suggested role of IMiDs in hypercoagulability does not seem to be confirmed and requires further studies .

Effectiveness of interventions to reduce sexually transmitted infections and blood-borne viruses in incarcerated adult populations: a systematic review protocol.

This review will identify, synthesize, and make recommendations regarding the effectiveness of interventions to reduce sexually transmitted infections (STIs) and blood-borne viruses (BBVs) in incarcerated adult settings. High-risk sexual behaviors, intravenous drug use, piercing, and tattooing are well documented within incarceration environments. Despite the World Health Organization's Global Health Sector Strategy on Sexually Transmitted Infections 2016-2021 and the Global Health Sector Strategies on, Respectively, HIV, Viral Hepatitis, and Sexually Transmitted Infections for the Period 2022-2030, STI rates within adult incarceration environments continue to rise. Identifying and implementing best-practice interventions to prevent and manage STIs and BBVs will aid infection reduction in correctional settings. The review results will inform the development of educational programs, health promotion, and policies and procedures to improve health outcomes for incarcerated populations. This review will consider studies in any language from any adult incarceration facility. Studies set in juvenile facilities or detention centers will be excluded. Any intervention for preventing or reducing STI and/or BBV transmission will be included. This review will follow the JBI methodology for systematic reviews of effectiveness. Databases to be searched will include PubMed, CINAHL (EBSCO), Ovid Library, PsycINFO (EBSCO), Cochrane CENTRAL, and Scopus. Two independent reviewers will screen titles and abstracts and assess full-text citations against inclusion criteria. Methodological quality will be appraised using JBI's standardized critical appraisal instruments. Where possible, studies will be pooled using meta-analysis. Where statistical pooling is not possible, findings will be presented in narrative format. Certainty of evidence will be ascertained using the GRADE approach. PROSPERO CRD42022325077.

Recent increases in crack injection and associated risk factors among people who inject psychoactive drugs in England and Wales

BackgroundCrack use is higher in the United Kingdom (UK) than other European countries. Crack is a stimulant with a short half-life, requiring frequent injection to maintain its euphoric effects, thus increasing the risk of blood borne viruses (BBVs) and skin and soft tissue infections (SSTIs). We assessed trends in the prevalence of current crack injection among people who inject drugs (PWID) and investigated harms and other factors associated with its use. MethodsWe used data from the annual Unlinked Anonymous Monitoring Survey of PWID, which recruits people who have ever injected psychoactive drugs through specialist services. Participants provide a biological sample and self-complete a questionnaire. We included participants from England and Wales who had injected in the past month. We examined trends in crack injection over time (2011–2021) and factors associated with crack injection using multivariable logistic regression (2019–2021). ResultsThe proportion of people self-reporting crack injection in the past month almost doubled between 2011–2020/21, from 34 % (416/1237) to 57 % (483/850). Crack injection was more frequently reported by males than females (adjusted odds ratio 1.46, 95 % confidence interval: 1.15–1.87) and injected alongside heroin (6.67, 4.06–10.97) more frequently than alone. Crack injection was independently associated with injecting equipment sharing (1.64, 1.30–2.07), groin injection (2.03, 1.60–2.56) in the past month, overdosing in the past year (1.90, 1.42–2.53), homelessness in the past year (1.42, 1.14–1.77) and ever having hepatitis C infection (1.64, 1.31–2.06). ConclusionCrack injection has increased significantly over the past decade in England and Wales. People injecting crack are more likely to engage in behaviours that increase the risk of BBV and SSTI acquisition, such as needle/syringe sharing, groin injection and polydrug use. Harm reduction and drug treatment services should adapt to support the needs of this growing population of people injecting stimulants.

Detection of early phase human T-cell leukemia virus type 1 and 2 infection with an improved confirmatory test.

Human T-cell leukemia virus type 1 (HTLV-1) is a blood-borne virus, and mandatory testing of donated blood for HTLV-1 antibodies has been adopted by Japanese Red Cross blood centers since 1986. A confirmatory line immunoassay was initiated in 2019 for individuals who were seroreactive in the screening test. This decreased the incidence of indeterminate individuals, however, donors with indeterminate results are not informed of their HTLV-1 seroreactivity and they can continue to donate blood. To clarify the characteristics of indeterminate line immunoassay results among Japanese blood donors. Of 759,259 blood donors in the Kyushu district of Japan, an area endemic for HTLV-1, 101 cases were classified as indeterminate by line immunoassay testing. We examined these cases using alternative secondary antibodies, anti-human-Ig (IgG/IgM/IgA) and -IgM antibodies, to detect the early phase of HTLV infection. Using anti-human-Ig and -IgM antibodies, HTLV infection status was confirmed in 37 individuals (HTLV-1-positive, 2; HTLV-positive, 27; HTLV-negative, 8). Among the remaining 64 indeterminate individuals, we identified one HTLV-2-infected 18-year-old female. A previous blood donation from this individual showed a negative anti-HTLV screening test result (signal-to-cutoff ratio=0.1). Therefore, this case was considered to be an HTLV-2 seroconversion case. These results indicate that the procedure for diagnosing HTLV infection should be reconsidered and that an accurate detection system for the early phase of HTLV infection is urgently needed for public health in Japan. Moreover, the issue of HTLV-2 infection needs a higher profile in Japan.

Adverse health outcomes among people who inject drugs who engaged in recent sex work: findings from a national survey

ObjectivesThis study explores trends in sex work among people who inject drugs (PWID) by gender and the relationship between sex work and adverse health outcomes including overdose, injection-site, and blood-borne virus (BBV) infections. Study designThe Unlinked Anonymous Monitoring Survey of PWID is an annual cross-sectional survey that monitors BBV prevalence and behaviours, including transactional sex, among PWID recruited through specialist services in England, Wales, and Northern Ireland. MethodsTrends in sex work among PWID (2011–2021) were described. Data were analysed to assess differences between PWID who engaged in sex work in the past year (sex workers [SWs]) and those who did not (non-SWs) by gender (Pearson Chi2 tests) (2018–2021). Associations between sex work in the past year and adverse health outcomes were investigated using logistic regression. ResultsBetween 2011 and 2021, sex work among PWID remained stable, with 31% of women and 6.3% of men who inject, reporting having ever engaged in sex work, and 14% of women and 2.2% of men engaging in sex work in the past year. Between 2018 and 2021, SWs had greater odds of reporting symptoms of an injection-site infection (adjusted odds ratio (aOR): 1.68 [95% confidence interval {CI}: 1.31–2.16], P < 0.001) and reporting overdose (aOR: 2.21 [CI: 1.74–2.80], P < 0.001) than non-SWs had in the past year. Among men, SWs had 243% greater odds of having HIV than non-SWs (aOR: 3.43 [CI: 1.03–11.33], P = 0.043). ConclusionsOur findings highlight disproportionate vulnerability and intersection of overlapping risk factors experienced by PWID SWs and a need for tailored interventions which are inclusive and low-threshold.

The Prevalence of Blood Borne Diseases in Blood Donors of Peshawar, Khyber Pakhtunkhwa, Pakistan.

The goal of the study was to investigate the burden of transfusion- transmitted infections (TTIs) hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), syphilis, and malarial parasite (MP) in ABO Blood Groups and Rh Type System among voluntarily blood donors in Khyber Pakhtunkhwa (KPK), Pakistan. It is a retrospective single center cross sectional study. This study was conducted from June 2020 to September 2021 (16 months) at the frontier foundation thalassemia center Peshawar KPK. Donors were physically healthy and fit for donation. Donors with physical disabilities and/or having co-morbid conditions were excluded from the report. All the samples were screened for anti-HIV, anti-HCV, HBsAg, Syphilis, and Malarial Parasite via ELISA kit and Immune Chromatographic Technique (ICT), respectively. A total of 6311 blood donations were evaluated. The majority of the donations (92%) were from (VNRBD) voluntary non-remunerated blood donation, while only 8% came from replacement donors. Amongst 6311 blood donations, 1.50 % (n = 95) were infected at least with one pathogen, HBV positive cases were 0.855 % (n = 54), HCV positive cases were 0.316% (n = 20), syphilis positive were 0.30% (n = 19) and MP positive cases were only 0.031% (n = 2). HBV, HCV, syphilis and malaria infections rates were found to be low as compared to the previous data published, while no case was reported for HIV. The study also revealed the distribution pattern of the aforementioned pathogens in blood groups and the Rh type system of the reactive samples. The lower reported in our study indicates the awareness among the people of Peshawar about TTIs and their precautions. The prevalence rate that we are reporting is less than previously published articles in the same domain.

A descriptive study of hepatitis C in people who inject drugs.

The seroprevalence of the hepatitis C virus (HCV) in general population is higher than that of human immunodeficiency virus (HIV) in India. People who inject drugs (PWIDs) constitute a high-risk group for all blood-borne infections. Multiple behavioural surveillance surveys have provided a rich typology of HIV-infected PWIDs, but this information is missing for HCV infection. We describe awareness, transmission risk factors and the treatment continuum for HCV infection among PWID. We also report spatial clustering of HCV infection in PWIDs residing in Bengaluru. Information from clinical records was collected and telephonic interviews of retrospectively identified PWIDs who received treatment at a tertiary-level addiction treatment facility between 2016 and 2021 were conducted. We identified 391 PWIDs; 220 (56.26%) received an anti-HCV antibody test (4 th Generation HCV-Tridot). Individuals reporting unsafe injection practices were more often tested than those who did not ( χ2 =44.9, df=1, P <0.01). Almost half of the tested and more than a quarter of the whole sample (109/220, 49.9%; 109/391, 27.9%) were seropositive for HCV infection. The projected seropositivity in this group was between 27.9 per cent (best case scenario, all untested assumed negative) and 71.6 per cent (worst case scenario, all untested assumed positive). Only a minority of participants interviewed were aware of HCV (27/183, 14.7%). HCV infection and its associated risk behaviour (PWID) were clustered in certain localities (Diggle and Chetwynd Test; P =0.001) in Bengaluru in the southern district of Karnataka. Undetected HCV infection is common in PWIDs; awareness and treatment uptake is poor in this group. Spatial clustering of infections in a district shows transmission in close networks and provides opportunities for targeted interventions.

Needlestick and Sharps Injuries Among Healthcare Workers at a Tertiary Care Hospital: A Retrospective Single-Center Study.

Healthcare workers are still at risk from needlesticks and sharps injuries, which can expose them to blood-borne diseases like hepatitis B, hepatitis C, and HIV. We aimed to investigate the proportion of needlesticks and sharps injuries among healthcare workers in a tertiary care hospital in Somalia and also evaluate associated risk factors. This retrospective study was conducted at the Mogadishu Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital. The data was retrieved from the hospital record of the infection prevention and control department over a six-year period between 2017 and 2022. There were a total of 233 needlestick and sharps injury incidents. The highest number of needlestick and sharps injury cases were reported among nurses (52.4%), followed by cleaners (22.3%), physicians (18.5%), and technicians (6.9%) during the six-year period. Operation theaters were the most frequent place (21.9%) where injuries happened, followed by inpatient care (17.6%) and emergency rooms (16.7%). The most commonly reported instrument that resulted in injuries was a hypodermic needle (81.1%). About 24.9% of the needles or sharps devices that caused needlestick and sharps injury cases were contaminated with hepatitis B. There was a significant difference between gender and place of injury for needlestick and sharps injuries (P=0.001). Healthcare professionals around the world continue to face major health risks from needle stick and sharps injuries. The present study found that 8.6%of healthcare workers sustained a needle stick and sharps injuries incident in the past year. According to our findings, healthcare institutions need to regularly teach healthcare professionals, especially nurses and cleaners about the significance of needle stick and sharps injuries.