Evaluation and Management of Occupational Exposures and Postexposure Prophylaxis.

Doxycycline postexposure prophylaxis (doxyPEP) may affect RPR titers. We describe syphilis diagnosis following doxyPEP roll-out. Syphilis diagnoses decreased (3.4%-1.5%) among persons prescribed doxyPEP. Diagnosis without laboratory confirmation occurred frequently in the pre- and post-doxyPEP periods. Median RPR (1:16) did not change; however, it was 4-fold lower (1:4) among persons prescribed doxyPEP.

Factors influencing rabies post-exposure prophylaxis uptake among suspected cases: a facility-based cross-sectional study in Ethiopia

Perceived risk of occupational exposure to HIV and associated factors among health care workers at district hospitals in the Greater Accra Region of Ghana: A cross-sectional study.

Incomplete rabies post-exposure prophylaxis in international travelers: an analysis of incidence and risk factors.

New advances and challenges in sexually transmitted infections in the adolescent population. Document of the Working Group on HIV and STIs of the Spanish Society of Pediatric Infectious Diseases (SEIP).

BackgroundEnsitrelvir, an oral inhibitor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 3C-like protease, is approved in Japan for the treatment of mild-to-moderate coronavirus disease 2019 (Covid-19). Previously, no antiviral agents were approved for postexposure prophylaxis in household contacts of patients with Covid-19.MethodsIn this double-blind, randomized, placebo-controlled trial, we randomly assigned persons who were SARS-CoV-2–negative on local diagnostic testing but were household contacts of a patient with Covid-19 (the index patient) to receive either ensitrelvir (375 mg on day 1 and 125 mg daily on days 2 through 5) or placebo within 72 hours after symptom onset in the index patient. The primary end point was Covid-19 (defined by a central laboratory–confirmed positive reverse-transcriptase–polymerase-chain-reaction assay and the presence of ≥1 of 14 prespecified Covid-19 symptoms lasting ≥48 hours) by day 10 in a household contact in the modified intention-to-treat population (all the participants who underwent randomization, had a central laboratory–confirmed negative RT-PCR test for SARS-CoV-2 at baseline, and received at least one dose of the trial drug or placebo).ResultsThe modified intention-to-treat population included 1030 participants in the ensitrelvir group and 1011 in the placebo group. The mean age of the participants was 42.4 years; 71.1% had undergone randomization within 48 hours after symptom onset in the index patient, and 37.0% had at least one risk factor for severe Covid-19. The incidence of Covid-19 was lower in the ensitrelvir group than in the placebo group (2.9% vs. 9.0%; risk ratio, 0.33; 95% confidence interval [CI], 0.22 to 0.49; P<0.001). The incidence of adverse events during the trial was similar in the two groups (15.1% in the ensitrelvir group and 15.5% in the placebo group), as was the incidence of serious adverse events (0.2% in each group). No Covid-19–related hospitalizations or deaths were reported.ConclusionsEnsitrelvir administered to household contacts of a patient with Covid-19 within 72 hours after symptom onset in the index patient was effective in preventing Covid-19 in the contacts. (Funded by Shionogi; SCORPIO-PEP Japan Registry for Clinical Trials number, jRCT2031230124; ClinicalTrials.gov number, NCT05897541.)

Doxycycline post-exposure prophylaxis (doxyPEP) has been shown to reduce syphilis and chlamydia incidence among gay, bisexual and other men who have sex with men (gbMSM) and transgender women (TGW). However, evidence among other populations remains limited. This study aimed to assess knowledge, attitudes, willingness and use of doxyPEP among sexual health clinic attendees and healthcare workers in Dublin. Data were collected via two anonymous surveys in two sexual health services for service users and healthcare workers. Surveys were collected between January and March 2024. Logistic regression analyses explored factors associated with willingness to use doxyPEP. Among 378 clinic attendees (median age 32), 72% (272/378) identified as gbMSM, TGW, non-binary or gender fluid; 17% (64/378) cisgender women and 11% (42/378) heterosexual men. Overall, 62% (235/378) expressed willingness to use doxyPEP, with higher willingness observed in the gbMSM, TGW, non-binary and gender fluid group (70%, 190/272). This group also reported the highest level of knowledge of doxyPEP compared with other groups: 107/272 (39.3%). After adjustment, logistic regression analyses revealed that individuals with prior sexually transmitted infection (STI) diagnoses were more willing to use doxyPEP (adjusted OR (aOR) per number of STI diagnosed 2.00, 95% CI 1.28 to 3.03, p=0.002). 9% (35/378) reported doxyPEP use in the past 1 year. Among 52 healthcare workers, 81% (42/52) were aware of doxyPEP studies, 62% (32/52) believed it could reduce STIs, but 89% (46/52) had concerns, primarily around antimicrobial resistance. This is the first study evaluating doxyPEP attitudes in Ireland. Willingness to use doxyPEP was high among individuals at greatest STI risk, supporting its potential for targeted implementation. There was also interest among cisgender women and heterosexual men. However, clinician concerns about antimicrobial resistance remain a barrier. These findings highlight the need for national guidelines, ongoing surveillance and research, including among heterosexual men and cisgender women, to inform equitable and safe doxyPEP prescription.

Rabies is a universally fatal yet preventable disease when post-exposure prophylaxis (PEP) is administered promptly and appropriately. To describe exposure characteristics, risk categorization and real-world PEP practices among children in an endemic urban setting. We conducted a retrospective study of children (< 18 years) presenting with rabies-risk contact between January 2013 and October 2023. Data were extracted from the provincial (İzmir) rabies surveillance system and included demographics, exposure type, time to presentation, animal species, risk category, wound care, rabies vaccination, rabies immunoglobulin (RIG) and tetanus prophylaxis. A total of 3732 children were included (median age 9 years, IQR 5-13), with 63.3% being male. Most exposures involved dogs (49.8%) and cats (44.8%) and occurred in İzmir. Same-day presentation occurred in 48.8% of cases, while 0.9% presented after more than 30 days. Risk categorization was documented in only 33.6% of patients, most commonly Category II (61.5%) and Category III (30.5%). RIG was administered to 2.6% of patients and more frequently after wild animal exposures. Substantial gaps in risk documentation and variability in pediatric rabies PEP practices were observed, highlighting the need for standardized risk assessment and improved clinical guidance.

Respiratory infections are the most important trigger of acute exacerbations of chronic airway diseases. As a prevalent pathogen, the influenza virus accounts for a markedly higher proportion of cases during epidemic seasons. Patients with chronic airway diseases constitute a high-risk population for influenza; upon infection, their clinical manifestations, diagnosis, treatment and prevention all exhibit distinct characteristics underscoring the urgent need for standardized clinical management. In light of the expanding body of evidence-based research in this field, this guideline addresses 12 critical clinical questions, ranging from influenza prevention and screening to antiviral management, comorbidity care, and the integration of traditional Chinese medicine. By offering 11 targeted recommendations, this document clarifies essential protocols-including annual vaccination indications, pre- and post-exposure prophylaxis, early etiological detection, and the rational application of antibacterials and glucocorticoids-to provide guidance for both general practitioners and respiratory specialists.

Durability of doxycycline effectiveness against gonorrhoea after implementation of post-exposure prophylaxis in southern California, USA: a retrospective, test-negative, observational study.

Despite advances in oral and injectable HIV prevention options and oral prophylaxis for sexually transmitted infections (STIs) of bacterial origin, there remains a critical need for effective on-demand topical (vaginalandrectal) products for pre- and post-exposure prophylaxis (PrEP and PEP). To fill this gap, we have developed single and first-in-kind multi-active topical inserts for bacterial STIs and HIV/STIs prevention. We have formulated two different inserts, one containing doxycycline (DOX) at 10, 50, and 100mg doses for bacterial STI prevention, and a multipurpose prevention product (TED insert) that combines DOX (10mg) with the antiretrovirals tenofovir alafenamide (TAF; 20mg) and elvitegravir (EVG; 16mg) to target both bacterial STIs and HIV. Inserts were manufactured using a simpleand cost-effective process. Drug loading was within 95-105% of the labeled amount, confirming a robust manufacturing process. In vitro, theinserts disintegrated within 10min with > 95% drug release within 60min. The dissolution behavior of DOX inserts showed surface erosion but was affected by medium volume and drug amount. The inserts met key physicochemical targets: hardness (5-8kg), friability (< 1%), moisture content (< 2%), and osmolality (< 550mOsm/kg). Based on 6-month storage stability, DOX inserts maintained their physicochemical properties, indicating a shelf life of > 2years. Preliminary 1-month stability of TED inserts under accelerated conditions showed preservation of their physicochemical properties. These data describe the formulation development and in vitro characterization of topical inserts containing DOX alone or in combination with antiretrovirals(TAF and EVG). Both inserts offer a novel, on-demand topical STI prevention option that supports flexible PrEP/PEP use by both women and men.

Rabies is a vaccine-preventable but fatal zoonotic disease. In India, where animal bite incidents are common, many reexposed patients do not have documentation of prior postexposure prophylaxis. This results in unnecessary administration of anti-rabies vaccines (ARVs) and rabies immunoglobulin (RIG), which leads to waste of resources and increased healthcare costs. This study aimed to quantify the burden and underlying causes of missing documentation in rabies reexposure cases. A prospective cross-sectional observational study was conducted at a tertiary Anti-Rabies Clinic in North India from August 2024 to November 2024, enrolling 200 patients with category 2 or 3 animal bites. Data were collected through validated questionnaires and analyzed using descriptive and inferential statistics. Of 61 patients with a prior bite exposure history, 78.7% lacked documentation, with the primary reasons being loss of documents (56.2%) and lack of awareness (31.2%). Undocumented patients incurred 2.18 times higher treatment costs, spending ₹13,200 on ARVs and ₹12,960 on RIG. Significant associations were found between documentation status and occupation (P = 0.02) and time since the last bite (P = 0.002). The high rates of undocumented prior rabies exposure contribute to avoidable biological and financial burdens on healthcare systems. This study suggests integrating digital health tools such as short messaging service reminders, mobile applications, and centralized electronic health records to lower costs and improve case management, thereby enhancing the efficiency of rabies prevention programs in resource-limited settings.

The most significant infections via needle-stick injuries (NSIs) involve hepatitis B, hepatitis C, and HIV, and the most common device is a hollow-bore needle or suture needle. This study aimed to determine the epidemiology and associated factors that contribute to occupational exposures to blood and bodily fluids at a hospital in South Trinidad and Tobago. This study was conducted retrospectively from 2011 to 2016 in one tertiary public health institution in Trinidad and Tobago. Data were extracted from incident reports, occupational health records, and infection prevention and control (IPC) unit documentation. Primary outcomes included demographic characteristics, occupation, and departmental distribution of NSIs. Secondary outcomes assessed the circumstances of injury, anatomical site, glove use, laboratory investigations, and administration of post‑exposure prophylaxis (PEP). A total of 221 healthcare workers reported NSIs, with a mean age of 34.97 years. Most affected individuals were women and clinical staff. "Other" (e.g., psychiatry, or in transit outside wards/units) accounted for the highest proportions of injuries, followed by internal medicine, while the IPC unit received the majority of first reports. Procedures were the most common activity associated with injury, followed by discarding needles and recapping. Fingers were the most frequently affected sites, particularly the right index and left ring fingers. Documentation gaps were notable, especially regarding glove use and time to reporting. PEP was administered in most cases, and official reporting to the IPC unit was associated with a higher likelihood of receiving PEP. Laboratory testing commonly included renal and liver function tests, complete blood counts, and screening for blood‑borne pathogens. NSIs reflect ongoing challenges in occupational safety. Strengthening IPC training, improving reporting practices, promoting safer sharps handling, and implementing safety‑engineered devices are essential to reducing NSI incidence and improving post‑exposure management.

HIV diagnosis following psychiatric hospitalization among a large cohort of privately-insured people in the United States, 2003-2024.

Rabies is a fatal encephalitis caused by the rabies virus. Japan is currently free of endemic rabies; the last domestically acquired human case of rabies infection was reported in 1956. Four rabies cases have been reported in Japan since then, all of which were imported infections. The clinical forms of rabies include furious and paralytic rabies, with the former being more common. No effective antiviral drugs are available against the rabies virus, and management is limited to symptomatic treatment. Post-exposure prophylaxis is critical in cases of suspected rabies virus infection. Vaccination is recommended for travelers in rabies-endemic areas.

Recent advancements in vaccinology and the introduction of new vaccines warrant a revision of the existing immunization guidelines. To review and revise the IAP recommendations (2023) on immunization of children aged 0 to 18years and issue recommendations on existing and new vaccines. The Advisory Committee on Vaccines and Immunization Practices (ACVIP) of the Indian Academy of Pediatrics (IAP) discussed the updates and drafted evidence-based consensus recommendations after several rounds of meetings convened both in-person and virtually. The contents were finalized during the meeting held at the IAP Office, Navi Mumbai, on November 23, 2025. The major changes include recommendation of replacing the quadrivalent (A/H1N1, A/H3N2, B/Victoria, B/Yamagata) influenza vaccines with trivalent (A/H1N1, A/H3N2, B/Victoria) influenza vaccines. The use of nirsevimab for respiratory syncytial virus is recommended for high-risk cases, after consultation with the parents. Immunocompetent girls aged 9 to 15years may receive a single dose of the human papilloma virus (HPV) vaccine. A 5-dose intramuscular rabies vaccination schedule administered on days 0, 3, 7, 14, and 28 is recommended for post-exposure prophylaxis (PEP), along with rabies immunoglobulin (RIG) or rabies monoclonal antibody (RMAb) based on the category of exposure.

This study assesses doxycycline postexposure prophylaxis awareness, perceptions, and concerns among bathhouse-affiliated individuals. Antimicrobial resistance, adverse effects, and accessibility were primary concerns. Partnerships with bathhouses present opportunities to address these barriers through targeted education, enhancing acceptance and promoting doxycycline postexposure prophylaxis's effectiveness in preventing sexually transmitted bacterial infections.

Effects of doxycycline post-exposure prophylaxis on bacterial sexually transmitted infections and antiretroviral therapy adherence among adolescents and young adults living with HIV.

Urogenital infections caused by Neisseria meningitidis (Nm) are increasing globally, yet the prevalence, antimicrobial resistance profiles, and transmission dynamics of Nm in men who have sex with men (MSM) remain poorly defined. We conducted an oropharyngeal carriage study in 174 MSM attending a London sexual health clinic in 2023, prior to the implementation of 4CMenB vaccination and doxycycline post-exposure prophylaxis (doxyPEP). Nm was detected in 21.26% of participants, with carriage significantly associated with throat gonorrhoea, consistent with frequent co-colonisation. Whole-genome sequencing identified diverse lineages, including hyperinvasive clonal complexes (CC)11 and CC4821, and revealed widespread tetracycline resistance: 43% of isolates carried either a conjugative tet(M) plasmid or chromosomal tet(B) efflux locus. These findings indicate that MSM represent an important reservoir of tetracycline-resistant Nm, with the potential amplification of this phenotype following doxyPEP implementation, underscoring the need for genomic surveillance of Neisseria species in sexual networks.