Postexposure Monitoring Research Articles

Occupationally Acquired Hepatitis C Virus Infection in Health-Care Workers: A Case Report and Review of Literature

Abstract The incidence of occupational health exposures to the risk of blood-borne pathogens is common yet underreported in health-care workers in India. These occur despite necessary precautions and training in often trying real-world circumstances. Indian health community reports very few occupational exposures and national guidelines with regard to postexposure monitoring or detection of acute hepatitis C virus infection are not available. We describe a case where acute hepatitis C infection was detected early due to intensive monitoring postneedlestick injury where prompt initiation of direct-acting antivirals led to a rapid response with no seroconversion.

The association between lung cancer and silicosis: from theory to practice in occupational medicine

Abstract Unbound (free) crystalline-silica dust is recognized since 2012 by the International Agency for Research on Cancer as a class I carcinogen. Exposure to this professional hazard was massive at the end of the last century, and it continues to exist today, albeit at lower levels. The number of cases of occupational cancer attributed to this exposure is minimal in Romania due to the absence of adequate post-exposure monitoring and the reporting of cases that encounters multiple obstacles, such as the absence of exposure data or the disappearance of the industrial sites in which the exposure took place. Occupational exposure to free crystalline silica dust can cause silicosis, and the presence of this disease certifies the existence of significant exposure. That is why the declaration of occupational cancer in a patient previously diagnosed with silicosis should be straightforward because the proof of exposure already exists. This article presents the cancer-silicosis relationship from the perspective of current scientific data and aims to substantiate the decision of the doctors from the public health departments who investigate and declare the reported cases.

Characterization of Metal Pulsed Exposure to Aquatic Organisms with Post-Exposure Monitoring: Implications for Stormwater Exposure Assessment.

Freshwater organisms are often exposed to contaminants such as heavy metals from stormwater discharges, which are dependent on rainfall duration and intensity. Therefore, standardized (48- or 96-h) continuous exposure methods developed for whole effluent toxicity (WET) testing might not always accurately convey the effects of stormwater and runoff contaminants. The present study characterized the acute toxicity of copper (Cu), zinc (Zn), and cadmium (Cd) to freshwater amphipods (Hyalella azteca) and cadmium (Cd) to water fleas (Ceriodaphnia dubia) using a modified exposure design that integrated relevant pulsed durations and included post-exposure monitoring. Less than 24-h-old C. dubia and 7 to 8-day-old H. azteca were exposed to water spiked with Cu, Zn, or Cd using 6-, 12-, 26-, or 96-h durations under standard laboratory conditions and monitored for cumulative mortality and reproduction (C. dubia only). Lethal effect (LC10s, LC25s, LC50s) and reproductive effect (EC25s, EC50s) were determined based on either mortality or reproduction of organisms at the end of each pulse (6, 12, or 26 h) and at the end of their respective tests (96 h). For all metals exposed to each organism, acute toxicity was found to be highest for the (96 h) continuous exposures. For pulsed exposures, mortality continued to increase following transfer to clean water for post-exposure monitoring. These results indicate a latent effect of Cu, Zn, and Cd to H. azteca and Cd to C. dubia. The present study concluded that using the continuous (48- or 96-h) WET exposure method overestimates the effects of stormwater and runoff contaminants. However, pulsed exposures without post-exposure monitoring also underestimate the toxicity of contaminants. The proposed pulsed exposure design provides a compromise that is more realistic than current WET methods to assess impacts from episodic events and accounts for potential latent effects that may be overlooked without monitoring post-exposure. Environ Toxicol Chem 2022;41:2488-2499. © 2022 SETAC.

Analysis of Blood Borne Pathogen Exposure Monitoring Protocol Adherence in an Academic Medical Center: a seven year analysis and literature review

Health care workers (HCW) are at risk for occupational blood borne pathogen exposures (BBPE). Effective prevention and management of BBPEs relies upon reporting and post-exposure follow-up protocol adherence. As post-exposure monitoring completion is largely unexplored, seven years of a university healthcare system’s BBPE exposure data was explored and compared to documented rates.

A US metropolitan county health department's response to a measles outbreak in a childcare facility - challenges faced and lessons learned.

In June 2018, the Multnomah County Health Department located in Portland, Oregon, US, responded to a measles exposure in a local childcare facility. This analysis describes lessons learned and challenges encountered during this measles response that may inform public health policy and help other local public health authorities prepare for measles outbreaks. These lessons will become increasingly important as measles cases continue to increase in both the US and abroad. A semi-structured videoconference interview was conducted with nine health department staff who were directly involved in the health department's response to the measles outbreak. Interview notes were iteratively discussed between all authors to identify those outbreak response challenges and lessons learned that were generalizable to the broader public health community. Some of the key challenges and lessons learned included the need for increased provider recognition and reporting of measles cases, difficulty in determining which staff and children to exclude from attending daycare during the 21-day postexposure monitoring period, determining who would be prioritized to receive immunoglobulin, and the need for childcare staff vaccine status requirements. Lessons from this response highlight important considerations for public health practitioners and policy makers. Given the relative severity of measles and the potential for spread in facilities that serve infants and young children, the public health community must continue to address key gaps through planning and policy.

SARS-CoV-2 Exposure and Infection Among Health Care Personnel - Minnesota, March 6-July 11, 2020.

Health care personnel (HCP) are at increased risk for infection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), as a result of their exposure to patients or community contacts with COVID-19 (1,2). Since the first confirmed case of COVID-19 in Minnesota was reported on March 6, 2020, the Minnesota Department of Health (MDH) has required health care facilities* to report HCP† exposures to persons with confirmed COVID-19 for exposure risk assessment and to enroll HCP with higher-risk exposures into quarantine and symptom monitoring. During March 6-July 11, MDH and 1,217 partnering health care facilities assessed 21,406 HCP exposures; among these, 5,374 (25%) were classified as higher-risk§ (3). Higher-risk exposures involved direct patient care (66%) and nonpatient care interactions (e.g., with coworkers and social and household contacts) (34%). Within 14 days following a higher-risk exposure, nearly one third (31%) of HCP who were enrolled in monitoring reported COVID-19-like symptoms,¶ and more than one half (52%) of enrolled HCP with symptoms received positive SARS-CoV-2 test results. Among all HCP with higher-risk exposures, irrespective of monitoring enrollment, 7% received positive SARS-CoV-2 test results. Compared with HCP with higher-risk exposures working in acute care settings, those working in congregate living or long-term care settings more often returned to work (57%), worked while symptomatic (5%), and received a positive test result (10%) during 14-day postexposure monitoring than did HCP working outside of such settings. These data highlight the need for awareness of nonpatient care SARS-CoV-2 exposure risks and for targeted interventions to protect HCP, in addition to residents, in congregate living and long-term care settings. To minimize exposure risk among HCP, health care facilities need improved infection prevention and control, consistent personal protective equipment (PPE) availability and use, flexible sick leave, and SARS-CoV-2 testing access. All health care organizations and HCP should be aware of potential exposure risk from coworkers, household members, and social contacts.

Dry Blood Spot sample collection for post-exposure monitoring of chemical warfare agents – In vivo determination of phosphonic acids using LC-MS/MS

Phosphonic acids are the direct and immediate metabolites of organophosphorus chemical warfare agents (OP-CWAs). Accordingly, their detection serves for evaluating exposure to OP-CWAs in a terror or war scenario. After exposure, phosphonic acids are present in the blood; however, blood drawing must be carried out by medical personnel, hence the number of samples that can be drawn in a mass-casualty event is limited. Herein, we describe a new approach developed for the determination of phosphonic acids in blood using Dry Blood Spots (DBSs) on a filter paper. The method is based on a simple sample preparation protocol, followed by LC-MS-MS targeted (MRM) analysis. The detection limits of Soman (GD), Cyclosarin (GF) and VX metabolites in whole blood were as low as 1 ng/ml, while the detection limits were 0.3 ng/ml for the GF metabolite and 0.5 ng/ml for the Sarin (GB) metabolite. Good recoveries were obtained in the range of 1–100 ng/ml for GB and GD metabolites, and 3–100 ng/ml for GF, VX and RVX metabolites, with a linear response (R2 = 0.99). The method has proven to be reliable even with DBS samples stored up to 35 days at room temperature before analysis. This method was implemented in a 24 h time-course determination of the Sarin metabolite in an in - vivo experiment, after rat exposure to 1 LD50 of Sarin. This technique is simple, rapid, sensitive, robust, long lasting and compatible with field collection and storage; hence, it can serve for large-scale sampling and reliable monitoring of potential OP-CWAs casualties. Since DBS sampling is amenable to nonprofessionals, including self-sampling, this technique is highly suitable for mass-casualty incidents.

Combined static electromagnetic radiation and plant extract contribute to the biosynthesis of instable nanosilver responsible for the growth of microstructures

The instant biosynthesis of silver nanoparticles under static electromagnetic induction, its antibacterial activity and its post exposure monitoring were reported here. A mix of silver nitrate solution and Ruta chalepensis leaf extract was irradiated by a static electromagnetic field (SMF) of 200mT. The characteristics and stability of the biosynthesized silver nanoparticles (Ag NPs) were determined. Compared to the non-irradiated exposure, the morphology and state of the obtained material change once the exposition to SMF is turned off. Shifting from 453 to 473nm, the percentage of the needles shaped silver nanoparticles increased and continue to win and dominate the biomixture toward the spherical silver nanoparticles. TEM microscopy showed a wide range of silver materials designed in different nanoscale morphology and beyond where they undergo major changes affecting mainly the size, shape and form (dispersity) of nanosilver.

The development of an intermediate-duration tag to characterize the diving behavior of large whales.

The development of high‐resolution archival tag technologies has revolutionized our understanding of diving behavior in marine taxa such as sharks, turtles, and seals during their wide‐ranging movements. However, similar applications for large whales have lagged behind due to the difficulty of keeping tags on the animals for extended periods of time. Here, we present a novel configuration of a transdermally attached biologging device called the Advanced Dive Behavior (ADB) tag. The ADB tag contains sensors that record hydrostatic pressure, three‐axis accelerometers, magnetometers, water temperature, and light level, all sampled at 1 Hz. The ADB tag also collects Fastloc GPS locations and can send dive summary data through Service Argos, while staying attached to a whale for typical periods of 3–7 weeks before releasing for recovery and subsequent data download. ADB tags were deployed on sperm whales (Physeter macrocephalus; N = 46), blue whales (Balaenoptera musculus; N = 8), and fin whales (B. physalus; N = 5) from 2007 to 2015, resulting in attachment durations from 0 to 49.6 days, and recording 31 to 2,539 GPS locations and 27 to 2,918 dives per deployment. Archived dive profiles matched well with published dive shapes of each species from short‐term records. For blue and fin whales, feeding lunges were detected using peaks in accelerometer data and matched corresponding vertical excursions in the depth record. In sperm whales, rapid orientation changes in the accelerometer data, often during the bottom phase of dives, were likely related to prey pursuit, representing a relative measure of foraging effort. Sperm whales were documented repeatedly diving to, and likely foraging along, the seafloor. Data from the temperature sensor described the vertical structure of the water column in all three species, extending from the surface to depths >1,600 m. In addition to providing information needed to construct multiweek time budgets, the ADB tag is well suited to studying the effects of anthropogenic sound on whales by allowing for pre‐ and post‐exposure monitoring of the whale's dive behavior. This tag begins to bridge the gap between existing long‐duration but low‐data throughput tags, and short‐duration, high‐resolution data loggers.

Large-scale monitoring of effects of clothianidin-dressed oilseed rape seeds on pollinating insects in Northern Germany: effects on honey bees (Apis mellifera).

Possible effects of clothianidin seed-treated oilseed rape on honey bee colonies were investigated in a large-scale monitoring project in Northern Germany, where oilseed rape usually comprises 25–33 % of the arable land. For both reference and test sites, six study locations were selected and eight honey bee hives were placed at each location. At each site, three locations were directly adjacent to oilseed rape fields and three locations were situated 400 m away from the nearest oilseed rape field. Thus, 96 hives were exposed to fully flowering oilseed rape crops. Colony sizes and weights, the amount of honey harvested, and infection with parasites and diseases were monitored between April and September 2014. The percentage of oilseed rape pollen was determined in pollen and honey samples. After oilseed rape flowering, the hives were transferred to an extensive isolated area for post-exposure monitoring. Total numbers of adult bees and brood cells showed seasonal fluctuations, and there were no significant differences between the sites. The honey, which was extracted at the end of the exposure phase, contained 62.0–83.5 % oilseed rape pollen. Varroa destructor infestation was low during most of the course of the study but increased at the end of the study due to flumethrin resistance in the mite populations. In summary, honey bee colonies foraging in clothianidin seed-treated oilseed rape did not show any detrimental symptoms as compared to colonies foraging in clothianidin-free oilseed rape. Development of colony strength, brood success as well as honey yield and pathogen infection were not significantly affected by clothianidin seed-treatment during this study.

Role of the PRNP S127 allele in experimental infection of goats with classical caprine scrapie.

Classical scrapie is a transmissible spongiform encephalopathy affecting domestic goats and sheep and associated with accumulation of a misfolded isoform (PrPSc) of the PRNP gene product. Multiple PRNP polymorphisms have been reported in goats.1, 2 Experimental scrapie inoculation studies revealed that PRNP polymorphisms at codons 146, 154, 211, and 222 can provide resistance or a prolonged incubation period.3-5 A recent study identified the association between a polymorphism at codon 127 (G127S) and reduced probability of developing clinical signs of scrapie in goats with PrPSc detectable in the brain.6 In that study, the length of the incubation period (time from infection to clinical signs) was not known. The aim of this study was to identify whether goats with the heterozygous (G/S127) genotype have an extended incubation period compared with goats homozygous for G127 (G/G127) following classical caprine scrapie inoculation. Intracerebral inoculation was performed with brain homogenates from two natural field cases of scrapie, one G/G127 and one G/S127, as described (Table S1). Data were combined from previous reports4, 5 to achieve efficient animal use. Because the previous report6 suggested a prolonged incubation time for G/S127 goats, a one-tailed nonparametric exact test (see Appendix S1) was used to assess the recipient genotype hypothesis that G/S127 goats have longer incubation times than do G/G127 goats when intracerebrally inoculated with classical caprine scrapie from G/G127 genotype source material. In the absence of preliminary data, two-tailed nonparametric exact tests were used for all other analyses. All inoculated goats developed clinical signs of scrapie (Table S1), with disease confirmed by the detection of PrPSc in brainstem at the obex and most lymphoid tissues by immunohistochemistry8 (Fig. S1). A significant (P = 0.019) increase in incubation time was observed in G/S127 goats following inoculation with the G/G127 caprine brain homogenate (range: 647–1333 days). No significant difference in incubation time was observed for G/G127 versus G/S127 inoculum in G/G127 goats (P = 0.30). Incubation times in control G/G127 goats inoculated with the G/G127 brain homogenate (range: 261–332 days) were significantly shorter than observed in prior work (both P < 0.054, 5). Our findings include the first reported classical scrapie incubation times for G/S127 goats, confirming that S127 is not protective in goats.6, 7 These data suggest that eradication programs need to include extended traceback periods and longer post-exposure monitoring times for infected herds containing G/S127 goats. This work was supported by USDA-ARS Grant 2090-32000-030-00D. We thank Linda Hamburg, Thomas Truscott, Lori Fuller, Dongyue Zhuang, and Emma Karel for technical assistance. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Biological monitoring from the perspective of nursing managers

This is a qualitative, descriptive and exploratory research aimed at analyzing nursing managers’ knowledge on adherence to nursing workers monitoring after occupational accidents due to exposure to biological fluids, seeking to recommend strategies to reduce monitoring abandonment. We interviewed twelve nursing managers from health institutions in the city of Curitiba-Paraná, from August to November 2010, and after the transcription of these interviews we carried out a thematic analysis. Results showed that eight out of the twelve interviewed nurses have no worker supervision control with regards to complete post-exposure monitoring. The interaction between the victim’s workplace and health institutions was proposed to improve monitoring. Therefore, nurse managers and technical managers should raise awareness and monitor workers seeking to achieve adherence to full accompaniment policies and compliance with the current legislation in order to make this practice more efficient.

Performance of the DiaSorin LIAISON ® anti-HBs II for the detection of hepatitis B surface antibodies: Comparison with the Abbott Architect anti-HBs assay

Background Detection of hepatitis B virus (HBV) surface antibodies (anti-HBs) is required in order to evaluate the response to hepatitis B vaccination and to optimize post-exposure monitoring. The widespread use of vaccines has highlighted the need for accurate and consistent quantification, yielding comparable quantitative results. Objectives This study assessed the adequacy of DiaSorin LIAISON ® anti-HBs II assay in detecting anti-HBs antibodies and determined the correlation with Abbott Architect anti-HBs quantification. Study design Anti-HBs levels were measured in parallel using Abbott and DiaSorin kits on WHO international standard dilutions and 350 routine samples pre-screened with Abbott Architect anti-HBs. Three different serological panels were tested: vaccinated subjects ( n = 121); subjects with past HBV infection ( n = 109); and subjects with no HBV infection marker ( n = 69). Serial dilutions from nine high-titer anti-HBs samples were used to address linearity. Results Anti-HBs concentration measured on WHO standard dilutions indicated a good calibration of DiaSorin values against international units, while results for Abbott were below those expected. A strong impact of the dilution matrix used was observed when performing dilutions on high-titer samples. Despite difference in absolute quantification, the overall clinical agreement between the two assays was 96.9%, with strong correlation ( r = 0.92) between concentrations and good linearity over the quantification range. Conclusions The DiaSorin LIAISON ® anti-HBs II assay shows excellent standardization to the WHO standard and good linearity. The assay is suitable for current clinical laboratory practice.

General Anesthesia Improves Fetal Cerebral Oxygenation without Evidence of Subsequent Neuronal Injury

Anesthetic exposure during pregnancy is viewed as a relatively routine medical practice. However, recent rodent studies have suggested that common anesthetic agents can damage the developing brain. Here we assessed this claim in a higher order species by exposing previously instrumented near-term pregnant sheep at gestational day 122 (+/-1) to a combination of midazolam, sodium thiopental, and isoflurane at clinically relevant doses and means of anesthetic delivery (i.e., active ventilation). Four hours of maternal general anesthesia produced an initial increase in fetal systemic oxygenation and a sustained increase in fetal cerebral oxygenation, as determined by in utero near-infrared spectroscopy. Postexposure monitoring failed to identify changes in physiologic status that could be injurious to the fetal brain. Finally, through the histologic assessment of noninstrumented sheep at the same gestational time point, we found no evidence for a direct fetal neuro-toxic effect of our triple-drug regimen. Collectively, these results appear to corroborate the presumed safety of inhalational anesthetic use during pregnancy.

Accidental Exposure to Blood and Biological Products in a Tertiary Teaching Hospital in Romania

Disclosure of the announcement rate of occupational exposure to blood and other biological fluids and the compliance rate for post exposure prophylaxis and monitoring measures among employees of the Regional Institute of Gastroenterology-Hepatology �Prof. Dr. Octavian Fodor� Cluj-Napoca. A prospective study was conducted between 2011-2016. All the hospital employees were included in the study. Descriptive analysis of reported cases of exposure to biological products was performed. Considering the number of employees and professional categories throughout the years of study, there was reported a very small number of accidents due to biological sample exposure, compared to statistical data. We have assessed the compliance of the exposed medical staff to post-exposure monitoring protocol, which was very low.