Recent papers report HIV sequence clusters in sub-Saharan Africa best explained by bloodborne transmission. Based on these clusters and on persistent reports of HIV infections best explained by bloodborne transmission, this brief considers three policy challenges for regional governments: (a) whether to warn the public about HIV risks during health care; (b) how to find and stop HIV transmission through medical procedures; and (c) whether to punish careless healthcare workers. Consideration of these challenges leads to three recommendations: Governments can warn the public about risk during health care are by inviting patients attending medical facilities suspected to have caused one or more recognized infections to come for tests. Governments that do so can find and stop bloodborne risks. Not punishing healthcare staff facilitates such investigations.

Background: Needlestick injuries (NSIs) pose a threat to healthcare workers (HCWs) by exposing them to bloodborne pathogens. Irrespective of safety devices and policies, knowledge, practice, and reporting gaps still exist. This study aimed to audit the knowledge, attitudes, and practices of HCWs regarding NSIs in a tertiary hospital and to determine the effects of educational and system-level interventions.Methods: A two-cycle quality-improvement audit was held at Port Sudan Teaching Hospital. Cycle 1 defined compliance at the baseline level through review of documents, staff surveys, and observation. Interventions were education sessions, practical workshops, quick-reference materials, better access to safety-engineered devices, and promotion of a nonpunitive reporting culture. Repeat measurements were conducted in Cycle 2 using the same standards: safety device use, no recapping, sharps container practices, immediate first aid, reporting, and postexposure prophylaxis (PEP) procedures. A total of 97 HCWs participated (Cycle 1: n = 53; Cycle 2: n = 44).Results: The interventions produced significant improvements. Recognition of hepatitis B virus as a bloodborne risk increased from 33/53 (62.3%) to 39/44 (88.6%) (p = 0.003). Correct initiation of PEP within 72 hours rose from 18/53 (34.0%) to 34/44 (77.3%) (p < 0.001). Safety behaviors improved markedly: use of safety-engineered devices increased from 17/53 (32.1%) to 35/44 (79.5%) (p < 0.001); needle recapping decreased from 21/53 (39.6%) to 2/44 (4.5%) (p < 0.001); and correct use of sharps boxes (two-thirds full) increased from 15/53 (28.3%) to 34/44 (77.3%) (p < 0.001). Training uptake rose significantly: formal training increased from 6/53 (11.3%) to 21/44 (47.7%) (p < 0.001), and refresher training from 2/53 (3.8%) to 12/44 (27.3%) (p = 0.001). Awareness of a formal reporting system improved from 8/53 (15.1%) to 21/44 (47.7%) (p < 0.001). However, awareness of the hepatitis C virus and human immunodeficiency virus (HIV) as risk factors and some unsafe first-aid practices persisted as areas requiring further strengthening.Conclusions: An education-based approach, reinforced by practical training, improved device availability, and a favorable reporting culture, led to significant improvements in NSI knowledge and safe practice. Continued refresher education and stronger communication about HCV/HIV risks are required to maintain and extend gains. Limitations include the single-center design, reliance on self-reports, and potential underreporting.

Background: Medical students are at a high risk of exposure to Blood-borne Pathogens (BBP) through their earlier clinical exposure. Aim: Herein, we aim to evaluate their knowledge about BBP and demonstrate their attitudes toward reporting the exposure incident. Methods: A cross-sectional study was conducted using a structured questionnaire amongst medical students-Umm Al-Qura University. Results: With a moderate response rate (66.5%, n = 905), about 90% (n = 817) of participants had previous knowledge about BBP, 53.5% (n = 484) of the students had a high knowledge level about the mode of transmission of BBP, 78.7% (n = 713) demonstrated low attitudes toward the BBP. About 18% (n= 164) of the respondents were exposed at least once to BBP. The main hazards for student exposure to BBP were younger age, females, lacking prior education about BBP at or after the third year, human immunodeficiency virus as a BBP of major concern, and ignorance of reporting procedures. Conclusion: Inadequate knowledge about BBP and some gaps in reporting were observed. Actual effective education for prevention and management is essential to minimize occupational exposure. In addition, it is compulsory to ensure students' knowledge and understanding before allowing them to start clinical training.

Work accidents (WA) due to percutaneous or mucocutaneous injury are extremely frequent among health professionals. The notification of these accidents ensures not only the compliance with legal requirements, but it also enables health institutions to develop, implement and evaluate strategies to prevent them. This study aimed to estimate the proportion of underreporting of work accidents caused by percutaneous and mucocutaneous lesions in a hospital setting, as well as its determinants. A self-administered questionnaire was made available to all hospital employees. Age, gender, professional category and type of service adjusted odds ratios (OR) and 95% confidence intervals (95%CI) were computed by multivariate logistic regression models. Underreporting of WA associated with biological risk factors was high, particularly in accidents by mucocutaneous injury (80.9%). Physicians were the professional category that least reported this type of work accidents (OR=4.64; 95%CI 2.20-9.78). The main determinants of underreporting were the underestimation of the risk of transmission and the excessive bureaucracy. The underreporting of work accidents associated with biological risk factors was considerable and it contributes to a high degree of uncertainty on accidents' characterization.

Universal hepatitis B vaccination in adults aged 19–59 years: Updated recommendations of the advisory committee on immunization practices—United States, 2022

This article presents the research from the first phase of our study on blood-borne risk management, wherein we solicited epidemiologists’ and healthcare practitioners’ expert opinions on a blood-borne infection risk assessment in Poland. Forty-two experts were recommended by epidemiology consultants and recruited from all districts in Poland. We used the SWOT (Strengths, Weaknesses, Opportunities, Threats) method in the evaluation. Experts’ opinions showed that there is room for improvement in the prevention of blood-borne infections. Commonly reported weaknesses in the risk assessment included gaps in knowledge and inappropriate procedures, which are largely caused by financial constraints and practitioners’ lack of awareness of developments in their trade. Strengths included legal regulations for medical services and procedures, surveillance, and increasing awareness on the part of medical staff. When paired with the existing statistical data, these results provide a comprehensive view of the problem of blood-borne infections in Poland. The analysis supported the development of a strategy proposal to prevent blood-borne infections and enhance existing risk assessment procedures.

South Africa, one of the wealthiest countries in Africa, has one of the world’s worst HIV epidemics with 30.8% of pregnant women HIV-positive at their first antenatal visit in 2015. The government has been making good progress testing people for HIV and treating those found infected, with an estimated 54% of HIV-infected adults having suppressed viral loads in 2017. However, government has not investigated unexpected infections (not from sex, mother-to-child, or injection drug use) despite many surveys finding that large proportions of infections are unexpected. Investigations of unexpected infections in countries outside Africa have found outbreaks from blood-borne transmission with hundreds to more than 55,000 HIV infections. With more HIV testing, more South Africans are finding they have unexpected infections; more public awareness could push government to investigate. If, as some evidence suggests, blood-borne risks contribute a sizeable proportion of infections, investigations could dramatically reduce HIV transmission. In any case, investigations demonstrate government commitment to health care safety, warn everyone to be more careful with skin-piercing instruments, and undermine the stigma that all HIV comes from sex.

Better knowledge about how HIV transmits in sub-Saharan Africa can guide more effective HIV prevention efforts. Studies that look for similarities among HIV genetic sequences can provide insights into patterns of HIV transmission: similarities point to recent transmission links. This review found seven studies that sampled HIV from communities in Africa, systematically identified at least some sexual partners, sequenced HIV, and looked for similarities pointing to transmission links. Across these seven studies, 0-13% (median 9.3%) of sequences were similar to (clustered with) sequences from known sexual partners. Because the HIV source for the first person infected in a sex-linked cluster is unknown, these studies provide a sexual explanation for 0-7.5% (median 4.6%) of HIV infections. More sequences were in clusters with no known sexual link. Although most sex partners are in or close to home, genetic diversity showed little or no geographic structure in the three studies that looked at the issue. Evidence from these studies does not support the common view that sex accounts for most HIV infections in Africa. Studies did not do what they could to elucidate risks: no study traced and tested sexual partners not already in the sample or reported blood-borne risks.

BackgroundPrisoners are at high risk of blood borne and sexually transmitted infections due to their high involvement in risky behaviors. In this descriptive/cross-sectional study, the prevalence, sero-prevalence, and risk factors for bloodborne tumor viruses including HTLV-I, HBV, HCV, and KSHV were evaluated among inmates of two central prisons in the northeast of Iran.MethodsBlood samples of 1114 inmates were analyzed for the presence of anti HTLV-I, KSHV, and HCV antibodies and HBsAg by ELISA. PCR tests were performed to confirm the presence of these viruses in plasma and identify the current infections.ResultsThe sero-prevalence of HCV, HBV, HTLV-I, and KSHV was 24.5%, 4.2%, 3.4%, and 3.2% and the prevalence of HCV, HBV, HTLV-I, and KSHV was 19.1%, 2.1%, 2%, and 3%, respectively. HCV infection was significantly associated with history of imprisonment, tobacco consumption, alcohol consumption, intravenous drug use, length of imprisonment, and type of crime committed. Thirty one (2.8%) prisoners had HCV-KSHV co-infection, 16 (1.5%) had HCV-HTLV-I co-infection, and 14 (1.3%) had HBV-HCV co-infection. Triple co-infection was observed in seven cases and one case had four infections concomitantly.ConclusionsThis epidemiological study indicated different rates and transmission risks for these viruses. HCV was the most contagious viral infection and HTLV-I was the weakest in the prisoners. Apart from KSHV infection which its prevalence was as twice as in the general population, the prevalence of HBV and HTLV-I in prisoners was nearly in ranges of the general population.

Background. Since 2000, incidence of sexually acquired hepatitis C virus (HCV)-infection has increased among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM). To date, few case-control and cohort studies evaluating HCV transmission risk factors were conducted in this population, and most of these studies were initially designed to study HIV-related risk behavior and characteristics.Methods. From 2009 onwards, HIV-infected MSM with acute HCV infection and controls (HIV-monoinfected MSM) were prospectively included in the MOSAIC (MSM Observational Study of Acute Infection with hepatitis C) study at 5 large HIV outpatient clinics in the Netherlands. Written questionnaires were administered, covering sociodemographics, bloodborne risk factors for HCV infection, sexual behavior, and drug use. Clinical data were acquired through linkage with databases from the Dutch HIV Monitoring Foundation. For this study, determinants of HCV acquisition collected at the inclusion visit were analyzed using logistic regression.Results. Two hundred thirteen HIV-infected MSM (82 MSM with acute HCV infection and 131 MSM without) were included with a median age of 45.7 years (interquartile range [IQR], 41.0–52.2). Receptive unprotected anal intercourse (adjusted odds ratio [aOR], 5.01; 95% confidence interval [CI], 1.63–15.4), sharing sex toys (aOR, 3.62; 95% CI, 1.04–12.5), unprotected fisting (aOR, 2.57; 95% CI, 1.02–6.44), injecting drugs (aOR, 15.62; 95% CI, 1.27–192.6), sharing straws when snorting drugs (aOR, 3.40; 95% CI, 1.39–8.32), lower CD4 cell count (aOR, 1.75 per cubic root; 95% CI, 1.19–2.58), and recent diagnosis of ulcerative sexually transmitted infection (aOR, 4.82; 95% CI, 1.60–14.53) had significant effects on HCV acquisition.Conclusions. In this study, both sexual behavior and biological factors appear to independently increase the risk of HCV acquisition among HIV-infected MSM.

Campylobacter fetus bacteremia is rare and occurs mainly in elderly and immunosuppressed patients. We report an original observation of C. fetus bacteremia complicating acute mucoid diarrhea in a young epileptic with no known risk factors. Our observation suggests that antiepileptic treatment could increase the risk of blood-borne of C. fetus infection.

Malaria and HIV are among the two most important global health problems of developing countries. They cause more than 4 million deaths a year. These two infections interact bidirectionally and synergistically with each other. HIV infection increases the risk of an increase in the severity of malaria infection and burdens of malaria, which in turn facilitates the rate of malaria transmission. Malaria infection is also associated with strong CD4+ cell activation and up-regulation of proinflammatory cytokines and it provides an ideal microenvironment for the spread of the virus among the CD4+ cells and for rapid HIV-1 replication. Additionally, malaria increases blood viral burden by different mechanisms. Therefore, high concentrations of HIV-1 RNA in the blood are predictive of disease progression, and correlate with the risk of blood-borne, vertical, and sexual transmission of the virus. Therefore, this article aims to review information about HIV malaria interactions, the effect of malaria on HIV transmission and progression and the implications related to prevention and treatment of coinfection.

Background: In prior research, Africans who knew about blood-borne risks were modestly less likely to be HIV-infected than those who were not aware of such risks.Objectives/Methods: I examined the association between knowledge of specific HIV transmission modes and prevalent HIV infection with data from the 2009 Mozambique AIDS Indicator Survey.Results: Respondents displayed high awareness of blood exposures and vaginal sex as modes of HIV transmission. However, only about half of respondents were aware of anal sex as a way HIV can be transmitted. After adjustments for demographics and sexual behaviors, respondents who knew that HIV could spread by contact with infected blood or by sharing injection needles or razor blades were less likely to be infected than those who did not know about these risks. Respondents who knew about sexual risks were as, or more, likely to be HIV infected as those who did not know about sexual risks. Also, children of HIV-uninfected mothers were less likely to be infected if their mothers were aware of blood-borne HIV risks than if their mothers were unaware.Conclusion: HIV education campaigns in Mozambique and elsewhere in sub-Saharan Africa should include a focus on risks from blood exposures and anal sex.

Background: In prior research, Africans who knew about blood-borne risks were modestly less likely to be HIV-infected than those who were not aware of such risks. Objectives/Methods: I examined the association between knowledge of specific HIV transmission modes and prevalent HIV infection with data from the 2009 Mozambique AIDS Indicator Survey. Results: Respondents displayed high awareness of blood exposures and vaginal sex as modes of HIV transmission. However, only about half of respondents were aware of anal sex as a way HIV can be transmitted. After adjustments for demographics and sexual behaviors, respondents who knew that HIV could spread by contact with infected blood or by sharing injection needles or razor blades were less likely to be infected than those who did not know about these risks. Respondents who knew about sexual risks were as, or more, likely to be HIV infected as those who did not know about sexual risks. Also, children of HIV-uninfected mothers were less likely to be infected if their mothers were aware of blood-borne HIV risks than if their mothers were unaware. Conclusion: HIV education campaigns in Mozambique and elsewhere in sub-Saharan Africa should include a focus on risks from blood exposures and anal sex.

Benchmarking of percutaneous injuries at a teaching tertiary care center in Saudi Arabia relative to United States hospitals participating in the Exposure Prevention Information Network

Accurate, comprehensive knowledge of an infectious pathogen's modes of transmission helps people to avoid infection. Growing evidence suggests that blood-borne HIV transmission is widespread in sub-Saharan Africa. I examined the association between knowledge of blood-borne HIV risk and prevalent HIV infection in Demographic and Health Survey data from 16 sub-Saharan African countries. I also searched three online databases for evidence of public education campaigns focused on blood-borne HIV risks in these countries. Knowledge was moderately to strongly inversely related to HIV prevalence at the national level (i.e., countries in which many respondents were aware of blood-borne risk had lower HIV prevalence than countries in which few respondents were aware of such risk). At the individual level, respondents who knew about blood-borne HIV risks were modestly less likely to be infected than those who did not show awareness of this risk, independent of demographic and sexual behavior variables. This relationship was stronger in southern Africa than in west, central, and east Africa. In parallel analyses, knowledge of condom use as a way to prevent HIV was positively associated with prevalent HIV infection at both the national and individual levels. West, central, and east African countries with low to moderate HIV prevalence had implemented public education campaigns that included a focus on blood-borne transmission risks. Such campaigns were absent from high prevalence countries in southern Africa. These findings suggest that knowledge of blood-borne HIV risk protects against HIV infection and that public education campaigns are important for spreading that knowledge.

To determine the prevalence of sexually transmitted and blood-borne infections among incarcerated adolescents in Salvador, Brazil, we interviewed 300 incarcerated youth aged 11-18 years to participate in a physical examination and to provide a blood sample to test for HIV-1, hepatitis B and C viruses exposure, human T-cells lymphotrophic virus, and syphilis. Overall prevalence was anti-HIV, 0.34%; anti-HBc, 11.1%; HBsAg, 2.4%; anti-HCV, 6.4%; HTLV, 1.09%; and syphilis, 3.4%. The majority (86.3%) reported a history of sexual activity; 27% had never used condoms. Girls also reported previous pregnancy (35%), abortion (26%) and sexual abuse (74%). Many youth reported a family history of alcohol abuse (56%), illicit drug use (24.7%), or legal problems (38%). Serological results show that youth in Salvador are at high risk for blood-borne and sexually transmitted infections. Policies to reduce the risk and impact of these infections should be a requisite part of health care for incarcerated youth.

There is little understanding about how the social networks of cocaine injectors are different from those of heroin users and about how such differences are associated with injection risk behaviours. Therefore, the objective of this study was to compare drug-injecting network characteristics of cocaine and heroin injectors believed to be associated with a risk of bloodborne infections. Active injection drug users (IDUs) were recruited between April 2004 and January 2005 from three syringe exchange and two methadone treatment programs in Montreal, Canada. Characteristics of each participant and of up to 10 social network members (IDU and non-IDU) with whom frequent contact had occurred in the past month were elicited using a structured, interviewer-administered questionnaire. The current analysis focussed on the drug-injecting network members. Logistic regression was used to examine network characteristics in relation to cocaine and heroin injection. Of 282 study subjects, 81% used cocaine and 19% used heroin as their primary injected drug in the past 6 months. Compared to heroin injectors, participants who injected cocaine had lower odds of knowing their network members for a longer time (OR=0.92, 0.85-0.99), were more likely to report a larger IDU network (OR=1.64, 1.18-2.29) and have IDU partners who had a history of attending shooting galleries (OR=2.42, 1.05-5.56). This study identified high-risk network-related factors associated with bloodborne infections in cocaine injectors. Prevention efforts may benefit from tailoring interventions according to type of drug used, with particular attention to the drug injecting-network of IDUs.

Sexually transmitted infection and blood-borne virus screening in juvenile correctional facilities: A review of the literature and recommendations for Australian centres

To outline the incidence, presenting features, treatment response, and outcome of human immunodeficiency virus (HIV)-associated malignancies in infancy and childhood, together with the estimated risk of HIV-associated cancer in children born to mothers infected with HIV. The Italian Register for HIV Infection in Children collected data by specific registration and follow-up forms. By March 1999, 5,060 children were recruited, including 4,889 with perinatal exposure to HIV-1. Overall, 1,331 infected children were enrolled onto the Register and classified according to current Centers for Disease Control criteria; of them, 1,163 were vertically infected (24% of those with perinatal exposure). Of these 1,163, 569 (49%) were considered to have been prospectively followed-up since they had been registered at birth or within the first 3 months of age. Of the 1,331 children observed for a median time of 6.5 years, 35 developed 36 malignancies, four of which occurred in patients with blood-borne risk. For the 1,163 vertically infected children, the cumulative number of years of observation was 7,178 child-years and the cumulative incidence of HIV-associated tumors was 4.18 per 1,000 children/yr (95% confidence interval [CI], 2.92 to 5.98). When only the 569 vertically infected children prospectively followed up since birth were considered, the cumulative number of years of observation was 2,803 child-years. In this group, 10 tumors were observed, with a cumulative incidence of HIV-associated tumors of 3.57 per 1,000 children per year (95% CI, 1.92 to 6.63). The risk of cancer was significantly higher but not restricted to symptomatic and/or immune-compromised children. Cancer-directed treatment should be given promptly to these patients, who have a fair chance to survive their tumor in view of potential highly aggressive antiretroviral therapy-associated improvement in survival and quality of life.