High-risk Contact Research Articles

The effect of prophylactic vitamin C use on COVID-19 infection

Aim: In vitamin C deficiency, the immune system deteriorates and the body becomes more susceptible to infections. Since vitamin C levels will decrease significantly in infectious conditions due to increased metabolic requirements, the daily need for vitamin C increases. In our study, it was aimed to investigate the effects of 500 mg and more vitamin C intake on COVID-19 infection during the pandemic process.
 Material and Method: A group consisting of 100 participants who received vitamin C supplements at a daily dose of at least 500 mg daily for a minimum of 1-3 months in their diet and a control group of 100 people who did not receive vitamin supplements were included in the study. While determining the amount of Vitamin C intake of the participants; The amount of Vitamin C in oral food supplements or foods containing vitamin C in their diets (orange, tangerine, grapefruit, kiwi, pineapple, strawberry, lemon, red and green peppers, tomatoes, arugula, parsley, greens such as lettuce, fresh rosehip, broccoli, cabbage, spinach) The vitamin level was calculated according to the amount of vegetables (such as vegetables). None of the participants had side effects suggestive of vitamin C toxicity. Besides the height, weight, gender, age, known illness and other demographic data of all participants; COVID-19 disease status, contact with COVID-19 patients, and whether or not they had a COVID infection after contact were examined. In addition, data on the presence of symptoms, severity and duration of the disease were noted in patients with COVID-19 infection, and both groups were compared statistically in terms of results.
 Results: In the group receiving less than 500 mg daily; COVID-19 infection symptoms, respiratory distress, disease severity were found to be higher, and the symptoms were found to be more aggressive. While total contact and high-risk contact at all levels was higher in the group that received more than 500 mg of vitamin C daily, the rate of being COVID was lower compared to the other groups.
 Conclusion: One of the most effective precautions to be taken to increase body resistance against COVID-19 is adequate vitamin C intake. In the study, it has been shown that adequate vitamin C taken with both food and nutritional supplements reduce the risk of getting COVID-19, reduce the risk of severe respiratory distress on COVID-19, as well as reduce both symptoms and symptom duration.

Variation in water contact behaviour and risk of Schistosoma mansoni (re)infection among Ugandan school-aged children in an area with persistent high endemicity

BackgroundAnnual mass drug administration with praziquantel has reduced schistosomiasis transmission in some highly endemic areas, but areas with persistent high endemicity have been identified across sub-Saharan Africa, including Uganda. In these areas many children are rapidly reinfected post treatment, while some children remain uninfected or have low-intensity infections. The aim of this mixed-methods study was to better understand variation in water contact locations, behaviours and infection risk in school-aged children within an area with persistent high endemicity to inform additional control efforts.MethodsData were collected in Bugoto, Mayuge District, Uganda. Two risk groups were identified from a longitudinal cohort, and eight children with no/low-intensity infections and eight children with reinfections were recruited. Individual structured day-long observations with a focus on water contact were conducted over two periods in 2018. In all identified water contact sites, four snail surveys were conducted quarterly over 1 year. All observed Biomphalaria snails were collected, counted and monitored in the laboratory for Schistosoma mansoni cercarial shedding for 3 weeks.ResultsChildren came into contact with water for a range of purposes, either directly at the water sources or by coming into contact with water collected previously. Although some water contact practices were similar between the risk groups, only children with reinfection were observed fetching water for commercial purposes and swimming in water sources; this latter group of children also came into contact with water at a larger variety and number of sites compared to children with no/low-intensity infection. Households with children with no/low-intensity infections collected rainwater more often. Water contact was observed at 10 sites throughout the study, and a total of 9457 Biomphalaria snails were collected from these sites over four sampling periods. Four lake sites had a significantly higher Biomphalaria choanomphala abundance, and reinfected children came into contact with water at these sites more often than children with no/low-intensity infections. While only six snails shed cercariae, four were from sites only contacted by reinfected children.ConclusionsChildren with reinfection have more high-risk water contact behaviours and accessed water sites with higher B. choanomphala abundance, demonstrating that specific water contact behaviours interact with environmental features to explain variation in risk within areas with persistent high endemicity. Targeted behaviour change, vector control and safe water supplies could reduce reinfection in school-aged children in these settings.Graphical

PSYCHOLOGICAL IMPACT OF COVID ON HEALTH CARE WORKER DUE TO COVID 19 PANDEMIC IN A TERTIARY CARE HOSPITAL : A CROSS SECTIONAL STUDY

Background: Corona virus disease 2019 (COVID-19) pandemic caused health crisis. It is important to assess the status of stress, depression and anxiety among medical health care worker (HCWs). Material and Methods: A cross sectional study based on online questionnaire wherein sample size was 160, and HAMD, HAMA and PSS questionnaire was applied and also a self made questionnaire was applied to assess the strategies to cope with covid stress, it consists of 3 items. Data analysed using SPSS software variables compared by using Chi-square/Fishers exact test. Students t-test was used to compare mean values in the two independent groups, and one-way ANOVA was used for more than two groups. The variables with P < 0.05 were considered as statistically significant. Result: A total of 160 sample included, in which 94 (58.1%) were medical staff and 66 (41.25%) were administrative staff. Significant difference was noted in sex(p= 0.004), educational status(p= 0.000), monthly income(p= 0.000), high risk exposure(p= 0.000) and contact with COVID positive suspect or case(p=0.000).There were significant difference noted in depression, anxiety and stress scale as compared to the administrative staff group (p = 0.004, p= 0.004 and p= 0.007) respectively. Conclusions: During this COVID-19 pandemic, HCWs reported a high prevalence of depression, anxiety and stress than the administrative staff.

Epidemiology, Diagnosis, and Control of Canine Infectious Cyclic Thrombocytopenia and Granulocytic Anaplasmosis: Emerging Diseases of Veterinary and Public Health Significance.

This review highlights the diagnostic methods used, the control strategies adopted, and the global epidemiological status of canine cyclic thrombocytopenia and granulocytic anaplasmosis at the animal–human interface. Canine anaplasmosis is an important worldwide disease, mainly caused by Anaplasma platys and A. phagocytophilum with zoonotic implications. A. platys chiefly infects platelets in canids, while A. phagocytophilum is the most common zoonotic pathogen infecting neutrophils of various vertebrate hosts. Diagnosis is based on the identification of clinical signs, the recognition of intracellular inclusions observed by microscopic observation of stained blood smear, and/or methods detecting antibodies or nucleic acids, although DNA sequencing is usually required to confirm the pathogenic strain. Serological cross-reactivity is the main problem in serodiagnosis. Prevalence varies from area to area depending on tick exposure. Tetracyclines are significant drugs for human and animal anaplasmosis. No universal vaccine is yet available that protects against diverse geographic strains. The control of canine anaplasmosis therefore relies on the detection of vectors/reservoirs, control of tick vectors, and prevention of iatrogenic/mechanical transmission. The control strategies for human anaplasmosis include reducing high-risk tick contact activities (such as gardening and hiking), careful blood transfusion, by passing immunosuppression, recognizing, and control of reservoirs/vectors.

1185. Oseltamivir Prescribing Patterns for Infants with Influenza and Factors Associated with Guideline Adherence

Abstract Background The Centers for Disease Control and Prevention (CDC) recommends oseltamivir be given to children < 2 years old with confirmed or suspected influenza as they are at high risk for complications. We sought to analyze oseltamivir prescribing patterns and to describe factors associated with adherence and non-adherence to CDC guidelines. Methods We used a retrospective cohort of infants ≤ 12 months old born from January 1, 2011 to December 31, 2019 within the University of Pittsburgh Medical Center health system in Southwestern Pennsylvania and who had ≥ 2 well-child visits during their first year. Infants with laboratory-confirmed influenza from January 1, 2011 to April 30, 2020 were included. Electronic health records were reviewed to describe oseltamivir prescriptions and influenza-related characteristics. Factors associated with adherence and non-adherence to CDC influenza treatment guidelines were assessed with univariate logistic regression. Results Of 422 infants with laboratory-confirmed influenza, 86% were prescribed oseltamivir. The proportion of infants prescribed oseltamivir increased from an average of 63% during 2011-2016 to 90% during 2016-2020 (OR:5.2; 95%CI: 2.9-9.5). 96% of prescriptions instructed twice daily dosing, 2% had once daily, and 2% were unknown frequency. 91% of prescriptions were for 5 days, 7% had no duration, and 2% were for > 5 days. Infants ≥ 6 months of age compared to < 6 months were less likely to be prescribed oseltamivir (83.3% vs. 100%; p< 0.001); tested for influenza in the emergency room/urgent care (OR: 0.3; 95%CI: 0.2-0.6), or admitted to the hospital (OR:0.5; 95%CI:0.2-0.9). Infants were more likely to be treated with oseltamivir if they had a known influenza positive contact (OR:2.3; 95%CI:1.0-5.2) or had fever ≥ 38.0C (OR:2.0; 95%CI:1.2-3.5). There was no difference in prescribing practices based on history of prematurity or chronic medical conditions. Conclusion Adherence to CDC influenza treatment guidelines for infants is high and has improved over time. However, targeted education at high-risk contact points may further improve guideline adherence. Disclosures John V. Williams, MD, GlaxoSmithKline (Advisor or Review Panel member, Independent Data Monitoring Committee)Quidel (Advisor or Review Panel member, Scientific Advisory Board) Judith M. Martin, MD, Merck Sharp and Dohme (Consultant)

Assessment of COVID-19 Contact Healthcare Workers at Manisa Celal Bayar University Hospital

Introduction: In the COVID-19 pandemic process, the health of healthcare workers with a high risk of infection is critical. Many healthcare workers have become infected while serving COVID-19 patients, and they have also been and are still exposed to the disease agent at hospital, household or community-based. The aim of this study was to determine the risk status of healthcare workers in contact with COVID-19 patients working at Manisa Celal Bayar University Hospital, and to reveal COVID-19 surveillance and related results. Materials and Methods: This descriptive study was based on examining the data of healthcare workers (HW) that came in contact with the disease between 1 April and 31 December 2020 to the COVID-19 Surveillance Unit (SU), which was established by Manisa Celal Bayar University Public Health Department during the pandemic process. Results: Among the in-contact health workers;65.7% were females, 42.5% were nurses and 26.0% were physicians. 23.8% of the contacts were high, 42.9% medium and 33.3% low risk. High risk contact percanteges were statistically higher in the emergency unit personal, laboratory workers and household/community based contacts (p= 0.000). PCR positivity rate was 10.1% in high risk contact and 3.6% in medium risk contact (p= 0.000). During the research period, the rate of COVID-19 positivity in healthcare workers at Manisa Celal Bayar University Hospital was determined as 21.9% (n= 374). In the study, 24.9% of COVID-19 positive healthcare workers were physicians and 29.0 % were nurses. Conclusion: 23.8% of HCW were evaluated as high risk contact and 21.9% of the group tested positive. High risk contact percanteges were statistically higher in the emergency unit personal, laboratory workers and household/community based contacts. Protecting healthcare workers from infection in the fight against pandemics and performing contact follow-ups are also vital for continuity of service.

Post-exposure prophylaxis following high-risk contact with Ebola virus, using immunotherapies with monoclonal antibodies, in the eastern Democratic Republic of the Congo: an emergency use program

IntroductionWith the development of therapeutics and vaccine against Ebola virus disease (EVD), the question of post-exposure prophylaxis for high-risk contact has emerged. Immunotherapies (monoclonal antibodies [mAbs]) recently validated for treating infected patients appear to be a good candidate for protecting contacts. DesignDuring the tenth EVD outbreak in the Democratic Republic of the Congo, we have administrated mAbs (Mab114 or REGN-EB3) to high and intermediate-risk contacts of EVD patients. Results: Overall, 23 non-vaccinated contacts received mAbs after a median delay between contact and post-exposure prophylaxis of 1 day (interquartile range 1–2). All contacts were free of symptoms, and all had negative reverse transcriptase-polymerase chain reaction 14 days after the contact. ConclusionImmunotherapies appear to be promising candidates to protect EVD contacts. Interaction with vaccine needs to be analyzed and a larger study on efficacy conducted.

Comparison of the Mental Status of COVID-19 Intensive Care Unit and General Intensive Care Unit Staff

Aim: The coronavirus disease 2019 (COVID-19) pandemic may predispose front-line intensive care staff to experience mental health problems. The aim of this study was to compare the COVID-19 fear experienced by COVID-19 intensive care unit staff and general intensive care unit staff, and the effects of this fear on mental health. Material and Methods: In this cross-sectional study, a total of 156 participants, 90 (57.7%) participants from the COVID-19 intensive care unit and 66 (42.3%) from the general intensive care unit, were included. A printed questionnaire consisting of the Fear of COVID-19 Scale (FCV-19S), Depression Anxiety Stress Scale (DASS-21), and demographic data were used. Results: Female gender, being a nurse, and working in COVID-19 intensive care unit, were associated with higher depression, anxiety, and stress scores. A significant relationship was found between fear of COVID-19 and depression (ρ=0.399, p=0.044), anxiety (ρ=0.456, p=0.019), and stress (ρ=0.418, p=0.033). Furthermore, as compared to general intensive care unit staff, COVID-19 intensive care unit staff who may have high-risk contact were approximately twice times more likely to experience anxiety and fear of COVID-19 and 3.5 times more likely to suffer from depression and stress. Conclusion: The COVID-19 pandemic has adversely affected the mental health of intensive care staff. Attention should be paid to the mental health of females and nurses working in the COVID-19 intensive care unit. The mental health of intensive care workers should be supported to protect the health workforce.

The Clinical Characteristics and Incidence of Pulmonary Tuberculosis of 7632 HIV Patients in Yunnan Province from 2005 to 2017

Objective: To analyze the age and gender distribution characteristics of 7,632 HIV/AIDS patients at the onset of HIV infection-related high-risk intravenous drug abuse and sexual contact in Yunnan province. Methods: Data were collected from the database of Chinese Medicine Treatment of AIDS Pilot Project in Yunnan province. Gender, age and demographics of HIV/AIDS patients were analyzed. Results: The patients were almost in relatively high educational background. The number of male intravenous drug users (12.90%) was more than female, and the earliest average age was 10-14 years. The percentages of men in 10-19 years and 35-59 years were more than that of women. No obvious difference was found in heterosexual sexual contact in both men (48.11%) and women (51.89%), and the earliest ages was 15-19 years in males and 10-14 years in females. The percentage of males at 10-34 years old was less than that of females, just opposite to the age of 35-85 years. Homosexual contact was more in males (92.73%) than that in females (7.27%). The earliest homosexual sexual contact associated with HIV infection was 15-19 years in males and 25-29 years in females. Among 128 AIDS patients with pulmonary tuberculosis infection, intravenous drug abuse accounted for the highest proportion (76.56%) of the three high-risk behaviors related to HIV infection. Conclusions: Reducing risk behaviors and preventing intravenous drug abuse could be effective in preventing AIDS. Compared with other high-risk behaviors, patients with intravenous drug use and AIDS are at greater risk of contracting tuberculosis.

COVID-19 outbreak in Islamabad resulting from a travel-associated primary case: A case series

<em>Background:</em> On 18 March 2020, the second case of COVID-19 in the capital territory was reported by the local health department of Islamabad who presented with typical COVID-19 symptoms and had travel history. As per directions of Chief FEDSD, a team of field epidemiologists conducted outbreak investigations. The main objectives of this study were to investigate the clinical and epidemiological patterns of disease transmission and implementation of recommended SOPs. <em>Methods:</em> Descriptive outbreak investigation followed by contact tracing was done in Kot Hathyal, Islamabad, from 21March to 4 April 2020. Each case was enrolled as per the WHO predefined case definition and questionnaire, and data was maintained in line list. The daily health status of affected individuals was monitored physically as well as through phone calls. Data was maintained in Microsoft Excel. Secondary attack rate, median age, male to female ratio and 95% confidence interval was calculated in OpenEpi (version 3.01) for low and high risk contact groups. <em>Results:</em> During investigation, 17 confirmed COVID-19 cases were enrolled as a result of contact with index case, male to female ratio was 5:1, and median age was 41 years (34 to 56 years). All cases exhibited symptoms compatible with COVID-19 except two. The median incubation period was 4 days. The secondary attack rate was 81.80%. No transmission from asymptomatic cases were noted. <em>Conclusion:</em> The index case was a foreign national who had arrived in Pakistan mid-November 2019 to attend a religious gathering at Lahore from 12 to 15 March 2020. The intra and inter city travel caused the introduction of 17 new cases in Islamabad. Due to the lack of fully-fledged isolation centers in Islamabad, a home-based isolation strategy was introduced for the first time in the country. As the affected area was densely populated, the whole area was cordoned off for two weeks. This was also the country’s first lockdown.

Pilot evaluation of risk assessment and enhanced protocols regarding contacts at an international professional golf event

ObjectivesThe aim of this study was to assess whether a risk assessment and managed risk approach to contact tracing was practical and feasible at the Gran Canaria Lopesan Open 2021...

A University Hospital Healthcare Workers' High-Risk Contact with Patients Diagnosed with Coronavirus Disease (COVID-19): a Cross-Sectional Evaluation

Aim: This study aimed to determine the risk level of contact with COVID-19 positive patients among healthcare workers (HCW) at a university hospital in Turkey and to demonstrate the factors associated with high-risk contact. Materials and Methods: This cross-sectional study included all contacts from March 11 to May 31, 2020. Risk contact status (High / Medium / Low) was the dependent variable. Independent variables are defined on the basis of personal characteristics, occupational health and safety data and communication data. Logistic regression analysis was performed to determine the corrected relationships of all descriptive variables obtained using chi-square and student’s t tests with the dependent variable. Results: A total of 1043 contact cases were included. Taking COVID-19 clinics as a reference, other clinics and areas outside the clinics were found to involve 1.57-fold [95%CI:1.10–2.22] and 2.20-fold (95%CI:1.22–3.96) higher risk of exposure, respectively. The contact of HCW with each other was found to pose a 5.78-fold (95%CI: 4.07–8.20) higher risk, whereas nonhospital settings posed a 13.34-fold (95% CI:5.24–33.96) higher risk than contact with patients. Conclusion: The fact that high-risk contact was less common among the frontline sites and HCW’s can be interpreted as an indicator that HCW have improved themselves in terms of the use of personal protective equipment and infection control measures.

A University hospital healthcare workers' high-risk contact with patients diagnosed with coronavirus disease (COVID-19): a cross- sectional evaluation

A University hospital healthcare workers' high-risk contact with patients diagnosed with coronavirus disease (COVID-19): a cross- sectional evaluation

Social Determinants of Adherence to COVID-19 Risk Mitigation Measures Among Adults With Cardiovascular Disease.

Social determinants of health (SDOH) may limit the practice of coronavirus disease 2019 (COVID-19) risk mitigation guidelines with health implications for individuals with underlying cardiovascular disease (CVD). Population-based evidence of the association between SDOH and practicing such mitigation strategies in adults with CVD is lacking. We used the National Opinion Research Center's COVID-19 Household Impact Survey conducted between April and June 2020 to evaluate sociodemographic disparities in adherence to COVID-19 risk mitigation measures in a sample of respondents with underlying CVD representing 18 geographic areas of the United States. CVD status was ascertained by self-reported history of receiving heart disease, heart attack, or stroke diagnosis. We built de novo, a cumulative index of SDOH burden using education, insurance, economic stability, 30-day food security, urbanicity, neighborhood quality, and integration. We described the practice of measures under the broad strategies of personal protection (mask, hand hygiene, and physical distancing), social distancing (avoiding crowds, restaurants, social activities, and high-risk contact), and work flexibility (work from home, canceling/postponing work). We reported prevalence ratios and 95% CIs for the association between SDOH burden (quartiles of cumulative indices) and practicing these measures adjusting for age, sex, race/ethnicity, comorbidity, and interview wave. Two thousand thirty-six of 25 269 (7.0%) adults, representing 8.69 million in 18 geographic areas of the United States, reported underlying CVD. Compared with the least SDOH burden, fewer individuals with the greatest SDOH burden practiced all personal protection (75.6% versus 89.0%) and social distancing measures (41.9% versus 58.9%) and had any flexible work schedule (26.2% versus 41.4%). These associations remained statistically significant after full adjustment: personal protection (prevalence ratio, 0.83 [95% CI, 0.73-0.96]; P=0.009), social distancing (prevalence ratio, 0.69 [95% CI, 0.51-0.94]; P=0.018), and work flexibility (prevalence ratio, 0.53 [95% CI, 0.36-0.79]; P=0.002). SDOH burden is associated with lower COVID-19 risk mitigation practices in the CVD population. Identifying and prioritizing individuals whose medical vulnerability is compounded by social adversity may optimize emerging preventive efforts, including vaccination guidelines.

Assessment of COVID-19 Risky Contact of Healthcare Workers in an University Hospital

Healthcare workers are the group with the highest risk of COVID-19 transmission. The illness of healthcare workers poses a risk to patients admitted to the hospital, colleagues and households besides their own health. In this study, it was aimed to determine the risk assessment and the factors associated with risk status of an university hospital healthcare workers after risky COVID-19 contact. The data of the descriptive study were obtained from 773 follow-up records of 555 healthcare workers who applied with COVID-19 risky contact between 06.04-10.05.2020. Employees who were positive for RT-PCR evaluated as "patients" and others as "risky contact". Risk assessment was classified as no risk, low, medium and high risk contact according to the "Algorithm of Assessment of Health Workers with COVID-19 Contact" of the Ministry of Health. The relationship between the risk levels of the participants and their demographic and workplace characteristics and their usage of personal protection were evaluated. Mean, standard deviation, percentage, chi-square and ANOVA tests were used in the analysis of the data. The average age of the healthcare workers was determined as 34.4 ± 7.6 years. It was determined that 56.2% of those who had contact were female, 62.9% were married and 17.5% had an additional disease. It was determined that 45.6% of the risky contacts were nurses, 18.4% were supportive personnel and 16.9% were doctors. While 46.5% of the contacts were found as medium, 28.0% low, 17.1% high risk and 8.4% risk free. 38.2% of risky contacts occurred while working in internal/surgical clinics. While 66.0% of the employees had risky contact during patient care and treatment, 25% had risky contact with colleagues in social settings. High-risk contact was higher in social relations between employees. The source of the contact was a colleague in 73.2% of the employees. The average age of high-risk employees was smaller than those of low-risk. While 54.5% of the employees wore surgical masks during contact, 67.8% of the patients did not have a mask. Of 555 employees followed, 37 (6.7%) were diagnosed as COVID-19; 48.6% of the patients were nurses and 18.9% were doctors. It was determined that 48.6% of the healthcare workers were working in the COVID-19 service, outpatient clinic or intensive care unit at the time of diagnosis. The source of the infection was thought to be a colleague in 51.6% of the patients. COVID-19 was more common in nurses and doctors. It was determined that risky contact also occurred in services other than the units where COVID-19 patients were treated and risky contact often took place while providing healthcare to the patients and during social relations between the employees. Unprotected contact of the employees with each other in the workplace was identified as an important risk source. Inadequate use of personal protective equipment by healthcare workers led to an increase in medium and high risk contacts. The use of masks by patients and their relatives during the health service delivery and the proper use of personal protective equipment by healthcare professionals will reduce the risk. With the physical improvement of the rest areas of the employees and the arrangement of the breaks, the risky contact between colleagues in the social areas will be reduced.

Seroprevalence of hospital staff in a province with zero COVID-19 cases

COVID-19 seroprevalence data, particularly in less developed countries with a relatively low incidence, has been scant. We aimed to explore the seroprevalence of hospital staff in the area with zero confirmed COVID-19 case to shed light on the situation of COVID-19 infection in zero or low infection rate countries where mass screening was not readily available. A locally developed rapid immunoglobulin M (IgM)/immunoglobulin G (IgG) test kit was used for hospital staff screening of Ranong hospital which is located in a province with zero COVID-19 prevalence in Thailand from 17th April to 17th May 2020. All staff was tested, 100 of which were randomly invited to have a repeating antibody test in one month. (Thai Clinical Trials Registry: TCTR20200426002). Of 844 hospital staff, 82 were tested twice one month apart (response rate for repeating antibody test 82%). Overall, 0.8% of the participants (7 of 844) had positive IgM, none had positive IgG. Female staff had 1.0% positive IgM (95% CI: 0.5-2.1%) while male had 0.5% positive IgM (95% CI: 0.1-2.6%). No participants with a history of travel to the high-risk area or close contact with PCR-confirmed COVID-19 case developed SARS-CoV-2 antibodies. Among 844 staff, 811 had no symptoms and six of them developed IgM seropositive (0.7%) while 33 had minor symptoms and only one of them developed IgM seropositive (3.0%). No association between SARS-CoV-2 IgM status and gender, history of travel to a high-risk area, close contact with PCR-confirmed or suspected COVID-19 case, presence of symptoms within 14 days, or previous PCR status was found. None of the hospital staff developed SARS-CoV-2 IgG. COVID-19 antibody test could detect a considerable number of hospital staff who could be potential silent spreaders in a province with zero COVID-19 cases. Accurate antibody testing is a valuable screening tool, particularly in asymptomatic healthcare workers. Trial registration: This study was approved by the Institutional Review Board of Chulalongkorn University (IRB No.236/63) and the Institutional Review Board of Ranong Hospital. (Thai Clinical Trials Registry: TCTR20200426002).

Contact tracing of staff in the emergency department during the COVID-19 pandemic.

Contact tracing of staff in the emergency department during the COVID-19 pandemic.

Clinical Characteristics, Treatment Outcomes and Experiences Gained in Caring COVID-19 Cases in a Private Hospital in Thailand

OBJECTIVES: To describe clinical characteristics and treatment outcomes and to document adaptation of medical services of COVID-19 cases receiving care at Bangkok Hospital Headquarters (BHQ) from January to May 2020. MATERIAL AND METHODS: Clinical and laboratory data of confirmed COVID-19 cases were collected using the case record form designed by the clinical team providing care to suspected and confirmed COVID-19 cases. Data were analyzed for clinical characteristics and treatment outcomes. In parallel, the Infection Control Nurse (ICN) team gathered and summarized data on hospital responses, including statistics of hospital staff exposed to COVID-19 cases and their clinical symptoms and test results. RESULT: From January to May 2020, Bangkok Hospital Headquarters provided COVID-19 screening test using RT-PCR to 2,362 patients, of which 40 (1.69%, 95%CI 1.61%, 1.78%) were positive. Upon diagnosis, two cases wanted to stay in other hospitals. Among 38 cases, the majority (63.0%) had no or mild symptoms, while a quarter (28.9%) had moderate and a few (7.9%) were severely ill. Common symptoms that presented among more than half of the cases were fever (79%), cough (71%), myalgia (58%), rhinitis (55%) and body pain (52%). Anosmia or hyposmia was reported among a third (37%) and ageusia among a quarter (21%). All moderate to severe cases had abnormal chest x-ray on arrival. Focal or patchy infiltration was found among mild to moderate cases. Among advanced or severe cases, chest x-Ray showed bilaterally diffused ground glass infiltration. Compared with asymptomatic or mild symptoms, cases with moderate to severe symptoms had significantly lower neutrophils (p = 0.018) and lymphocytes (p = 0.039) counts. Among 11 moderately ill cases, seven (64%) developed more severe symptoms during admission. In summary, among 38 COVID-19 confirmed cases receiving care in our hospital, half (19/38, 50%) recovered, 15 cases (39.5%) improved, two cases (5.3%) were transferred to other settings and one (2.6%) died. Hospital’s adaptation to the epidemic was in line with national protocols. A “war room” was established and 11 guidelines were created. Responses started from the first week of January 2020 before the first case in Thailand was detected. With strong preventive measures, there was no COVID-19 transmission from patients to health care workers. Among 117 high-risk close contact staff, 27 (23.0%) and 21 of 441 low-risk close contact staff (4.8%) had fever or upper respiratory track symptoms. All of the low-risk close contact staff tested negative for COVID-19 according to national standards set by Department of Disease Control. Only one of 117 high-risk close contact staff tested positive (0.9%). This staff was a computer technician sitting closely with a confirmed case who contracted COVID-19 outside of hospital. CONCLUSION: Although we were only a small part of the national response, what we learned was meaningful. Clinical and management teams are confident that if another wave of COVID-19 occurs, the hospital will be able to respond immediately using the existing knowledge and experience that was gained.

Distinct Hepatitis B and HIV co-infected populations in Canada.

Due to shared modes of exposure, HIV-HBV co-infection is common worldwide. Increased knowledge of the demographic and clinical characteristics of the co-infected population will allow us to optimize our approach to management of both infections in clinical practice. The Canadian Hepatitis B Network Cohort was utilized to conduct a cross-sectional evaluation of the demographic, biochemical, fibrotic and treatment characteristics of HIV-HBV patients and a comparator HBV group. From a total of 5996 HBV-infected patients, 335 HIV-HBV patients were identified. HIV-HBV patients were characterized by older median age, higher male and lower Asian proportion, more advanced fibrosis and higher anti-HBV therapy use (91% vs. 30%) than the HBV-positive / HIV seronegative comparator group. A history of reported high-risk exposure activities (drug use, high-risk sexual contact) was more common in HIV-HBV patients. HIV-HBV patients with reported high-risk exposure activities had higher male proportion, more Caucasian ethnicity and higher prevalence of cirrhosis than HIV-HBV patients born in an endemic country. In the main cohort, age ≥60years, male sex, elevated ALT, the presence of comorbidity and HCV seropositivity were independent predictors of significant fibrosis. HIV seropositivity was not an independent predictor of advanced fibrosis (adj OR 0.75 [95%CI: 0.34-1.67]). In conclusion, Canadian co-infected patients differed considerably from those with mono-infection. Furthermore, HIV-HBV-infected patients who report high-risk behaviours and those born in endemic countries represent two distinct subpopulations, which should be considered when engaging these patients in care.

Symptoms in healthcare professionals infected with SARS-CoV-2 at a university hospital.

IntroductionHealthcare professionals are among the main risk groups for novel coronavirus disease (COVID 19). The identification of respiratory symptoms is important in the clinical assumption of infection, but it may be asymptomatic or paucisymptomatic.ObjectivesTo compare the proportion of professionals with symptoms suggestive of COVID-19 who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with the proportion of positive asymptomatic professionals with high-risk contact; and to identify respiratory and non-respiratory symptoms of professionals with suspected COVID-19 and the proportion of those who tested positive for SARS CoV-2.MethodsThis is a cross-sectional study that retrospectively analyzed clinical records of health professionals who spontaneously sought the occupational health service of a university hospital center from March to August 2020 for presenting with symptoms and/or for having had high risk contact with a confirmed case of COVID-19 and who, in this context, underwent the reverse transcription polymerase chain reaction test for SARS-CoV-2.ResultsCOVID-19 was confirmed in 27 of the 420 symptomatic professionals vs. three of the 193 asymptomatic professionals (p = 0.009). Of the 371 professionals with respiratory symptoms, 19 were positive for COVID-19 vs. 11 among the 242 with no respiratory symptoms (p = 0.750). Nasal congestion and rhinorrhea were the respiratory symptoms with the highest proportion of positive cases (11.43 and 8.97%, respectively). Conclusions: Although COVID-19 is typically associated with respiratory symptoms, not all these symptoms were predictive of disease. It becomes crucial to value mild symptoms among healthcare professionals.