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INTRODUCTION: Post-exposure prophylaxis (PEP) is an efficacious prevention method when initiated promptly after an HIV exposure. Yet, PEP has been underutilized, even among healthcare workers (HCWs) with occupational exposure in sites with PEP policies and procedures and access to PEP medications. It is important to understand the dynamics of uneven PEP use in what appears to be an optimal context to better protect the health and wellbeing of HCWs. METHODS: We conducted a scoping review to elucidate factors influencing HCWs use of PEP after occupational exposure. We searched PubMed, PsychInfo and Google Scholar for peer-reviewed literature published in English from 2014 to 2022 using the terms HIV, postexposure/post-exposure prophylaxis, acceptability, healthcare workers, and values and preferences. An inductive narrative review of the resulting 53 studies identified core themes. RESULTS: Nearly all studies (96%) with various HCW types and settings occurred in low- and middle-income countries (LMICs) in Africa and Asia. Identified themes arrayed along a trajectory of PEP use experience: awareness/knowledge; acceptability; availability/access; uptake/use; adherence/completion. Across studies, awareness of PEP for HIV prevention was high, knowledge about drug regimens and healthcare facility policies was moderate to low; acceptability of PEP was moderate to high; PEPs perceived accessibility/availability was inconsistent and varied by geographic location and setting; HCWs uptake of PEP was low, affected by not knowing how to report an exposure and being unaware of PEP availability; and adherence/completion of PEP regimens was moderate to low, impeded by side effects and a belief that completing regimens was unnecessary to avert seroconversion. HCWs consistently expressed concern about HIV stigma. DISCUSSION: Findings are limited by the inconsistent use of constructs across studies and a lack of clarity about reporting exposure events. Multi-level approaches are needed to address the interplay of individual, social and structural barriers that diminish HCWs PEP use. Improved training, incident reporting, 24-hour access to non-stigmatizing PEP services and monitoring of adherence/completion are essential to optimizing HCWs PEP use. CONCLUSIONS: Lessons from HCWs experience in LMICs may inform understanding of PEP under-use among people in these settings with non-occupational exposures.

IntroductionIdentifying the optimal approaches to offering HIV prevention to meet the needs of those at risk is a high priority, particularly given the expanding toolkit of biomedical HIV prevention options. An ongoing study in rural East African communities evaluated the uptake of choices in product, testing mode and location of care delivery through a structured patient-centred HIV prevention delivery model. In this qualitative study, we sought to understand clients' experiences of this "dynamic choice prevention model" (DCP) and highlight pathways of action to inform HIV prevention delivery models.MethodsIn-depth semi-structured interviews were conducted from November 2021 through March 2022 with a purposively selected sample of n = 56 participants in DCP trials (across outpatient departments, antenatal clinics and community settings), and n = 21 healthcare providers (total n = 77). A seven-person multi-regional team translated and inductively coded transcript data. We used a framework analysis approach to identify emergent themes.ResultsIndividuals taking up HIV pre-exposure prophylaxis (PrEP) reported feelings of relief, liberation from fears of acquiring HIV and satisfaction with being able to take action despite partners' behaviours. Couples used a range of approaches afforded by the study to persuade partners to get tested and opt for PrEP. Post-exposure prophylaxis (PEP) use was less common, although women welcomed it in the event of sexual coercion or assault. Participants discussed switching from PEP to PrEP after familiarizing themselves with usage and ascertaining ongoing risk. Participants felt respected by providers, trusted them and appreciated being able to contact them directly for telephone support. Prevention uptake was hindered by stigma, limited experience with and knowledge of prevention methods, gendered and generational power dynamics within intimate partnerships and families, and negative perceptions of methods due to the products themselves. Participants anticipated long-acting injectable PrEP could solve their challenges regarding pill size, daily pill burden and the likelihood of unwanted disclosure.ConclusionsDiverse preferences and barriers to uptake of prevention require a choice of HIV prevention options, locations and delivery modalities-but in addition, flexible, competent and friendly care provision is crucial to promote uptake. Helping clients feel valued, and addressing their unique needs and challenges, enables their agency to prioritize their health.

BackgroundAn ongoing important need exists to rapidly develop novel therapeutics for COVID-19 that will retain antiviral efficacy in the setting of rapidly evolving SARS-CoV-2 variants and potential future development of resistance of SARS-COV-2 to remdesivir and protease inhibitors. To date, there is no FDA-approved treatment for post-exposure prophylaxis against SAR-CoV-2. We have shown that the mitochondrial antioxidant mitoquinone/mitoquinol mesylate (Mito-MES), a dietary supplement, has antiviral activity against SARS-CoV-2 in vitro and in SARS-CoV-2 infected K18-hACE2 mice.MethodsIn this exploratory, pragmatic open label clinical trial (ClinicalTrials.gov identifier NCT05381454), we studied whether Mito-MES is an effective post-exposure prophylaxis treatment in people who had high-grade unmasked exposures to SARS-CoV-2 within 5 days prior to study entry. Participants were enrolled in real-world setting in Los Angeles, United States between May 1 and December 1, 2022 and were assigned to either mito-MES 20 mg daily for 14 days (n = 40) or no mito-MES (controls) (n = 40). The primary endpoint was development of SARS-CoV-2 infection based on 4 COVID-19 diagnostic tests [rapid antigen tests (RATs) or PCR] performed during the study period (14 days post exposure).FindingsOut of 40 (23 females; 57.5%) study participants who took Mito-MES, 12 (30%) developed SARS-CoV-2 infection compared to 30 of the 40 controls (75%) (difference -45.0%, 95% confidence intervals (CI): -64.5%, -25.5%). Out of 40 (19 females; 47.5%) study participants in the control group, 30 (75.0%) had at least one positive COVID-19 diagnostic test and 23 (57.5%) were symptomatic. With regards to key secondary outcomes, among symptomatic SARS-CoV-2 infections, the median duration of viral symptoms was lower in the Mito-MES group (median 3.0, 95% CI 2.75, 3.25) compared to the control group (median 5.0, 95% CI 4.0, 7.0). None of the study participants was hospitalized or required oxygen therapy. Mito-MES was well tolerated and no serious side effect was reported in any study participant.InterpretationThis work describes antiviral activity of mito-MES in humans. Mito-MES was well tolerated in our study population and attenuated transmission of SARS-CoV-2 infection. Given established safety of Mito-MES in humans, our results suggest that randomized control clinical trials of Mito-MES as post-exposure prophylaxis against SARS-CoV-2 infection are warranted.FundingThis work was supported in part by National Institutes of Health grant R01AG059501 (TK), National Institutes of Health grant R01AG059502 04S1 (TK), NIH/National Center for Advancing Translational Sciences (NCATS) UCLA CTSI Grant Number UL1TR001881 and California HIV/AIDS Research Program grant OS17-LA-002 (TK).

Background: South Africa has a high HIV incidence and oral preexposure prophylaxis (PrEP) is available as public-sector standard of care. Access to alternative prevention methods for women may further reduce HIV acquisition. Setting: South African public sector. Methods: We performed a systematic search for high-quality upto-date guidelines recommending dapivirine rings as PrEP using the Grading of Recommendations Assessment, Development, and Evaluation-Adolopment process. We appraised the systematic review and randomized controlled trial (RCT) evidence underpinning the selected guideline’s recommendations and conducted a costeffectiveness analysis. The Grading of Recommendations Assessment, Development, and Evaluation evidence-to-decision framework guided the adaptation of source guideline recommendations, according to our local context. Results: We identified the 2021 World Health Organization PrEP Guidelines, informed by 2 placebo-controlled RCTs, which were included in a contemporaneous systematic review. There were 23 fewer HIV acquisitions per 1000 clients with dapivirine ring vs placebo (95% confidence interval: 10 to 34), with no increase in adverse events (moderate certainty evidence). We found no RCTs comparing dapivirine to oral PrEP or among adolescent/pregnant/ breastfeeding clients. Dapivirine is less cost-effective than oral PrEP at $14.59/ring, at the current price. Conclusions: The source guideline recommendation was adapted for the local context. Dapivirine ring seems to be less efficacious than oral PrEP, although comparative studies are lacking. Data on adolescents and pregnancy are also lacking, currently limiting the use of dapivirine as an alternative for women unable to take oral PrEP. At the current price, dapivirine is not cost-effective and unaffordable for inclusion in the South African Essential Medicines List. [ABSTRACT FROM AUTHOR]

(1) Background: The effect of varicella emergency vaccination (EV) has not been fully evaluated. (2) Methods: This was a cohort study. Participants were categorized into five groups based on their immune status: unvaccinated group, first dose as EV group, one dose no EV group, second dose as EV group, and two doses no EV group. A Cox proportional hazards model was employed to examine the association between the EV measures and the varicella incidence rate in this outbreak. (3) Results: Demographic characteristics, vaccination details, and disease onset information were 100% (918/918) collected. The crude attack rate was 44% (11/25), 8% (3/36), 11% (24/215), 3% (6/176), and 2% (8/466) among the unvaccinated group, first dose as EV group, one dose no EV group, second dose as EV group and two doses no EV group, respectively. Compared to the unvaccinated group and the one dose no EV group, the first dose varicella vaccine as EV and the second dose as EV demonstrated an incremental effectiveness of 90% (95% CI 65–97%) and 79% (95% CI 47–92%), respectively. (4) Conclusions: Both the first dose and the second dose as EV contributed to reducing the incidence rates of varicella and offered incremental vaccine effectiveness in an outbreak setting. Our study underscores the importance and benefits of initiating emergency varicella vaccination early to reduce the disease incidence rate in an elementary school setting where there was no complete coverage of the two doses of varicella vaccine and an outbreak occurred. [ABSTRACT FROM AUTHOR]

Background: Rabies is an incessant public health threat in China. The Ministry of Health implemented the Central Payment for Rabies Prevention and Control Project to assist with rabies prevention and control in a few representative provinces in 2006. Methods: Data on human rabies cases reported by the National Infectious Disease Reporting Information Management System and national surveillance sites from 2006 to 2022 were collected, and statistical and multivariate analyses were then used to assess the effectiveness of current prevention and control efforts. Results: During 2006–2022, a total of 2025 human rabies cases were collected by the national surveillance sites, with incidence rates far above the national average, but the incidence rate was consistent with the national trend. Human rabies cases demonstrated a dual peak distribution in terms of exposure and onset dates, with the peak exposure dates falling mostly in the spring and summer and the peak onset dates occurring mostly in the summer and autumn. Three danger categories are shown by the geographical distribution: high, medium and low. Dogs had a high infection rate (86.93%), with own domesticated dogs accounting for the majority of infections. The rates of post-exposure prophylaxis are not constant. The median incubation period was 71 days. Conclusions: Various measures and policies implemented by the government have played a key role in reducing the incidence of rabies. To effectively prevent and control the resurgence of epidemics and halt the spread of the virus among host animals, it is imperative to prioritize and implement a robust dog management system, accelerate research and development of animal vaccines and improve the level of post-exposure prophylaxis. [ABSTRACT FROM AUTHOR]

Healthcare workers face a high risk of blood-borne infections due to needlestick injuries, especially in developing countries like Pakistan.This study aims to evaluate the prevalence of needlestick injuries, reporting practices, and post-exposure prophylaxis measures among healthcare personnel in tertiary care hospitals in Punjab.A cross-sectional study was conducted from May to July 2019. Data were collected from healthcare personnel working in teaching hospitals across six randomly selected cities of Punjab. Data were collected from 600 healthcare personnel using a pretested, self-administered questionnaire, employing stratified random sampling to ensure representative sampling. Descriptive statistics were applied, and differences in needlestick injuries across demographic segments were assessed using the Mann-Whitney U and Kruskal-Wallis H tests.Among the 600 respondents, 533 returned the complete questionnaire, yielding a response rate of 88.8%. The majority of respondents were female (n = 341, 64.2%). The mean years of service was 5.58 (±5.78), with most participants falling in the 0.5–5 years category (n = 338, 66.4%). The prevalence of self-reported needlestick injuries in the last six months was 35.25%. Most injuries occurred during sampling (n = 95, 35.85%), followed by recapping (n = 63, 23.77%). Reporting of needlestick injuries to the respective department was poor, with only 82 (21.87%) injuries reported. The frequency of needlestick injuries differed significantly across profession, working department, and education categories (p < 0.05). Sanitary staff were more likely to sustain needlestick injuries during garbage collection and waste handling. Post-exposure screening for blood-borne infections was received by 79 (42.93%) individuals, and post-exposure prophylaxis (PEP) was administered to 67 (36.41%).The high prevalence of needlestick injuries among healthcare personnel occurred primarily during sampling and recapping. Reporting of NSIs was inadequate, and post-exposure testing and prophylaxis practices were substandard. Enhanced policies and protocols are necessary for effective NSI surveillance and the administration of pre- and post-exposure prophylaxis. [ABSTRACT FROM AUTHOR]

Introduction: The restrictions on face-to-face care for exposure to biological material during the COVID-19 pandemic required alternatives to maintain outpatient assistance. This study evaluated the impact of telemedicine on care and outcome indicators of a reference service for exposure to biological material during the COVID-19 pandemic. Methods: This pre- and post-study compared the effectiveness of telemedicine in the Hospital Correia Picanço in Recife (Pernambuco, Brazil) before (August 2018 to January 2019 [P1]) and during the COVID-19 pandemic (August 2020 to January 2021 [P2]). Individuals above 18 years old exposed to biological material who sought the service during P1 or P2 were included in the study. Results: A total of 4,494 cases were assessed (1,997 in P1 and 2,497 in P2), mostly because of sexual exposure (62.3%). The mean age was 32.2 ± 9.2 years, most individuals were male (64.9%), originated from Recife (56.6%), and the education level was up to 12 years (53.7%). P2 presented 43% more attendances and shorter intervals between the exposure and first attendance (51%), first testing (28%), and discharge (10%) than P1 (p < 0.05), and cases had no difference in discharge rate (p = 0.339). Cases of sexual exposure had the highest dropout rate in both periods. Conclusion: Telemedicine maintained similar outcomes to face-to-face care and improved the indicators, increasing the mean monthly attendance and reducing the time between exposure and follow-up. [ABSTRACT FROM AUTHOR]

Shigellosis is a gastrointestinal disease causes high morbidity and mortality worldwide, however, there is no anti- Shigella vaccine. The use of antibiotics in shigellosis treatment exacerbates antibiotic resistance. Antibodies, particularly egg yolk antibody (IgY), offer a promising approach to address this challenge. This study aimed to investigate the prophylactic effect of IgY produced against a recombinant chimeric protein containing the immunogens IpaD, IpaB, StxB, and VirG from Shigella. The chimeric protein, comprising IpaD, IpaB, StxB, and VirG, was expressed in E. coli BL21 and purified using the Ni-NTA column. Following immunization of chickens, IgY was extracted from egg yolk using the PEG-6000 method and analyzed through SDS-PAGE and ELISA techniques. Subsequently, the prophylactic efficacy of IgY was assessed by challenging of mice with 10 LD50 of S. dysenteriae and administering different concentrations of IgY (1.25, 2.5, 5, and 10 mg/kg) under various time conditions. The recombinant protein, weighing 82 kDa, was purified and confirmed by western blotting. The IgY concentration was determined as 9.5 mg/ml of egg yolk and the purity of the extracted IgY was over 90 %. The results of the ELISA showed that at least 19 ng of pure antibody identified recombinant protein and reacts with it. The challenge test employing IgY and Shigella demonstrated a direct correlation between the survival rate and antibody concentration, with increased concentrations leading to decreased mortality rates. Treatment of mice with 10 mg/kg IgY leads to 80 % survival of the mice against 10 LD50 S. dysenteriae. Our findings suggest that IgY may offer therapeutic potential in treating Shigella infections and combating antibiotic resistance. • shigella is a significant problem in developing countries. • IgY can cause prophylaxis and neutralize bacteria. • IgY produced against IpaD, IpaB, StxB and VirG of shigella could cause high prophylaxis against bacteria. • IgY is a suitable prophylaxis candidate due to easy production and cost-effectiveness advantages. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

On Friday June 16, 2023 at 4:00 pm, Niagara Region Public Health & Emergency Services (NRPH&ES) received notification of a rabies positive result for a cat that they had submitted for rabies testing earlier that week. The investigation revealed that it was a domestic cat from an urban area in St. Catharines that had been around numerous people and other animals during its infectious period. As part of the follow-up, NRPH&ES contacted all potential exposures, coordinated vaccination for those that required it and collaborated with other agencies to ensure the safety of all those involved. In addition, NRPH&ES navigated working with vaccine hesitant clients who were uncooperative in providing details pertaining to people who may have been in contact with the rabid cat, other animals living in the household, and ultimately reluctant to receive rabies post exposure prophylaxis (rPEP). Through innovation, unconventional methods and deviation from standard practice, NRPH&ES was able to build a trusting relationship with all clients, gather the information they required to conduct a fulsome investigation, and vaccinate and confine the other animal exposed to the rabid cat. [ABSTRACT FROM AUTHOR]

IntroductionOptimizing HIV prevention may require structured approaches for providing client-centred choices as well as community-based entry points and delivery. We evaluated the effect of a dynamic choice model for HIV prevention, delivered by community health workers (CHWs) with clinician support, on the use of biomedical prevention among persons at risk of HIV in rural East Africa.MethodsWe conducted a cluster randomized trial among persons (≥15 years) with current or anticipated HIV risk in 16 villages in Uganda and Kenya (SEARCH; NCT04810650). The intervention was a client-centred HIV prevention model, including (1) structured client choice of product (pre-exposure prophylaxis [PrEP] or post-exposure prophylaxis [PEP]), service location (clinic or out-of-clinic) and HIV testing modality (self-test or rapid test), with the ability to switch over time; (2) a structured assessment of patient barriers and development of a personalized support plan; and (3) phone access to a clinician 24/7. The intervention was delivered by CHWs and supported by clinicians who oversaw PrEP and PEP initiation and monitoring. Participants in control villages were referred to local health facilities for HIV prevention services, delivered by Ministry of Health staff. The primary outcome was biomedical prevention coverage: a proportion of 48-week follow-up with self-reported PrEP or PEP use.ResultsFrom May to July 2021, we enrolled 429 people (212 intervention; 217 control): 57% women and 35% aged 15-24 years. Among intervention participants, 58% chose PrEP and 58% chose PEP at least once over follow-up; self-testing increased from 52% (baseline) to 71% (week 48); ≥98% chose out-of-facility service delivery. Among 413 (96%) participants with the primary outcome ascertained, average biomedical prevention coverage was 28.0% in the intervention versus 0.5% in the control: a difference of 27.5% (95% CI: 23.0-31.9%, p

Background Rabies, a zoonotic disease, poses a significant global public health challenge, and post-exposure prophylaxis (PEP) is crucial for prevention. Monoclonal antibodies (mAbs) have emerged as a promising alternative to rabies immunoglobulins due to their high efficacy and standardized manufacturing process. Materials and Methods A prospective, open-label post-marketing surveillance study was conducted with patients of WHO category-III suspected rabid animal bites. TwinRab™, a novel cocktail of docaravimab and miromavimab, was administered at a dosage of 40 IU/kg in and around the wound, along with the anti-rabies vaccine, which was administered intradermal as per Thai Red Cross regimen. Results In this study, 200 subjects received TwinRab™ with a 100% completion rate. Three (1.5%) patients showed solicited local AEs, and two (1%) patients showed solicited systemic AEs, which were resolved after appropriate treatment intervention. The overall tolerability assessment showed positive ratings from doctors (94%) and patients (74%). Conclusion The post-marketing surveillance study demonstrated the safety of TwinRab™ in patients who experienced category-III suspected rabid animal bites, thereby supporting its potential as an alternative option for PEP in the management of animal bite for the prevention of rabies.

Abstract Background Rabies is an incessant public health threat in China. The Ministry of Health implemented the Central Payment for Rabies Prevention and Control Project to assist with rabies prevention and control in a few representative provinces in 2006. Methods Data on human rabies cases reported by the National Infectious Disease Reporting Information Management System and national surveillance sites from 2006 to 2022 were collected, and statistical and multivariate analyses were then used to assess the effectiveness of current prevention and control efforts. Results During 2006–2022, a total of 2025 human rabies cases were collected by the national surveillance sites, with incidence rates far above the national average, but the incidence rate was consistent with the national trend. Human rabies cases demonstrated a dual peak distribution in terms of exposure and onset dates, with the peak exposure dates falling mostly in the spring and summer and the peak onset dates occurring mostly in the summer and autumn. Three danger categories are shown by the geographical distribution: high, medium and low. Dogs had a high infection rate (86.93%), with own domesticated dogs accounting for the majority of infections. The rates of post-exposure prophylaxis are not constant. The median incubation period was 71 days. Conclusions Various measures and policies implemented by the government have played a key role in reducing the incidence of rabies. To effectively prevent and control the resurgence of epidemics and halt the spread of the virus among host animals, it is imperative to prioritize and implement a robust dog management system, accelerate research and development of animal vaccines and improve the level of post-exposure prophylaxis.

To explore patient and health care provider HIV postexposure prophylaxis (PEP) decision making following sexual assault, semistructured interviews regarding HIV PEP provision with 15 patients and 10 health care providers were conducted. A qualitative, descriptive, thematic analysis approach was used. Four themes were derived: (a) medical concerns; (b) emotional, trauma, and support factors; (c) daily medication management; and (d) ensuring access to HIV PEP. How participants described these themes and the importance placed on factors within each theme varied between the two groups. Altering provider communication so that HIV PEP discussions better align with patient decision-making factors (e.g., trauma and ability to take in information, how to manage side effects) could facilitate improvement in HIV PEP decision making following sexual assault for patients. High-level policy changes would improve HIV PEP access for sexual assault patients without necessitating the extraordinary efforts individual providers currently undertake.

Abstract Background Associations between perceived and actual risk of HIV infection and HIV prevention services uptake are inconclusive. This study aimed to evaluate the discrepancy between the perceived and actual HIV risk, and quantify the associations between perceived and actual risk of HIV infection and three HIV prevention services utilization among men who have sex with men (MSM) in Shandong province, China. Methods A cross-sectional study was conducted in Shandong province in June 2021. Participants were eligible if they were born biologically male, aged 18 years or older, had negative or unknown HIV status, and had sex with men in the past year. Participants were recruited online. The discrepancy between their perceived and actual risk of HIV infection was evaluated by calculating the Kappa value. Bayesian model averaging was used to assess the associations between perceived and actual risk of HIV infection and HIV prevention services uptake. Results A total of 1136 MSM were recruited, most of them were 30 years old or younger (59.9%), single (79.5%), with at least college education level (74.7%). Most participants (97.4%) perceived that they had low risk of HIV infection, and 14.1% were assessed with high actual risk. The discrepancy between their perceived and actual risk of HIV infection was evaluated with a Kappa value of 0.076 (P

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background A next-generation Vero cell rabies vaccine (PVRV-NG2) was developed using the same Pitman–Moore strain as in the licensed purified Vero cell vaccine (PVRV; Verorab) and the human diploid cell vaccine (HDCV; Imovax Rabies®). Methods This dual-center, modified, double-blind, phase 3 study evaluated the immunogenic non-inferiority and safety of PVRV-NG2 with and without concomitant intramuscular human rabies immunoglobulin (HRIG) versus PVRV + HRIG and HDCV + HRIG in a simulated post-exposure prophylaxis (PEP) regimen. Healthy adults ≥18 years old (N = 640) were randomized 3:1:1:1 to PVRV-NG2 + HRIG, PVRV + HRIG, HDCV + HRIG, or PVRV-NG2 alone (administered as single vaccine injections on days [D] 0, D3, D7, D14, and 28, with HRIG on D0 in applicable groups). Rabies virus neutralizing antibodies (RVNA) titers were assessed pre- (D0) and post-vaccination (D14, D28, and D42) using the rapid fluorescent focus inhibition test. Non-inferiority, based on the proportion of participants achieving RVNA titers ≥0.5 IU/mL (primary objective), was demonstrated if the lower limit of the 95% CI of the difference in proportions between PVRV-NG2 + HRIG and PVRV + HRIG/HDCV + HRIG was >−5% at D28. Safety was assessed up to 6 months after the last injection. Results Non-inferiority of PVRV-NG2 + HRIG compared with PVRV + HRIG and HDCV + HRIG was demonstrated. Nearly all participants (99.6%, PVRV-NG2 + HRIG; 100%, PVRV + HRIG; 98.7%, HDCV + HRIG; 100%, PVRV-NG2 alone) achieved RVNA titers ≥0.5 IU/mL at D28. Geometric mean titers were similar between groups with concomitant HRIG administration at all time points. Safety profiles were similar between PVRV-NG2 and comparator vaccines. Conclusions In a simulated PEP setting, PVRV-NG2 + HRIG showed comparable immunogenicity and safety to current standard-of-care vaccines. Clinical Trials Registration NCT03965962. [ABSTRACT FROM AUTHOR]

Biomedical tools for HIV prevention such as post-exposure prophylaxis (PEP) continue to be underutilized by subgroups experiencing significant HIV inequities. Specifically, factors associated with both PEP awareness and uptake both cross-sectionally and longitudinally are under-researched, despite PEP being a part of the United States' Plan for Ending the HIV Epidemic. The current study examined longitudinal predictors of PEP awareness among Latino sexual minority men (LSMM) living in South Florida. This current study (N = 290) employed hierarchal linear modeling across three timepoints (baseline, 4-months, 8-months) to assess within-person and between-person effects over time for several psychosocial and structural factors. Most participants (67.5%) reported little to no awareness of PEP at baseline with general PEP awareness growing slightly across the study (60.5% reporting little to no awareness of PEP at 8 months). Results of the final conditional model suggest significant within-person effects of PrEP knowledge (p = 0.02) and PrEP self-efficacy (p < 0.001), as well as a significant positive between-person effect of PrEP knowledge (p < 0.01) on PEP awareness. Between-person HIV knowledge was also a significant predictor in this model (p = 0.01). This longitudinal analysis of LSMM's PEP awareness indicates that more must be done to increase PEP awareness among this subgroup. Future studies should explore how to build on existing interventions focused on HIV and PrEP knowledge and PrEP self-efficacy to incorporate information about PEP to increase the reach of this effective biomedical HIV prevention tool. [ABSTRACT FROM AUTHOR]

Background: Antibiotic prophylaxis to prevent brucellosis after accidental exposure to Brucella is an important topic in public health. This study aimed to systematically review the efficacy of antibiotic prophylaxis following accidental exposure to Brucella in preventing human brucellosis disease. Methods: The study protocol was registered in PROSPERO (CRD42023456812). The outcomes included the incidence of brucellosis disease, adverse events rate, and antibiotic prophylaxis adherence. A comprehensive literature search, conducted until 20 November, 2023, involved Medline, Embase, Cochrane Library, and LILACS databases. Descriptive analysis and meta‐analysis using R software were performed, risk of bias was assessed using JBI Critical appraisal tools, and certainty of evidence was assessed using the GRADE tool. Results: Among 3102 initially identified records, eight studies involving 97 individuals accidentally exposed, all focused on high‐risk accidental exposure to Brucella in laboratory settings, were included in the review. All studies reported the prophylactic treatment comprising doxycycline at a dosage of 100 mg twice daily, combined with rifampicin at 600 mg, both administered over 21 days. Prophylaxis adherence was reported in 86% of cases, and incidence of brucellosis post‐treatment was 0.01. Adverse events, mainly gastrointestinal, occurred in 26% of cases. Critical appraisal revealed limitations in reporting demographics and clinical information. The certainty of evidence was rated as 'very low,' emphasising the need for caution in interpreting the observed outcomes due to study design constraints and the absence of comparative groups. Conclusions: PEP is an alternative practice reported in the literature, used in accidents with high‐risk exposure to Brucella. The currently available evidence of the efficacy of antibiotic prophylaxis is insufficient to support a recommendation for or against the widespread use of antibiotic prophylaxis, so caution is needed in interpreting results due to the very low certainty of evidence, primarily stemming from case series and lack of comparative groups. [ABSTRACT FROM AUTHOR]

ABSTRACT Background: Rabies is a zoonosis usually transmitted to mammals via contact between the saliva of infected animals and either the skin or mucosa of the attacked individual, and post-exposure prophylaxis (PEP) is the only way to avoid the disease. This study aimed to perform a descriptive analysis of PEP after attacks by dogs and cats in the state of São Paulo. Methods: We analyzed the disease compulsory notification forms Human Anti-Rabies Care (CID10: W64), available in the Notifiable Diseases Information System (SINAN), from 2013 to 2017. Treatment adequacy was analyzed according to the parameters established by the Brazilian Health Ministry. Results: A total of 572,889 notifications were reported during the study period, 94.1% (538,975) of which corresponded to dog or cat attacks, with an occurrence of 26.9 cases per 10,000 inhabitants. Among the recommended procedures, the most frequent was the observation of the animals for 10 days (44.4%), which was adopted inappropriately at a lower frequency. Prophylactic conduct was adequate in 68.8% of the cases, but only 55.5% of the individuals received adequate treatment. More than 112 thousand individuals (31,4%) received a correct recommendation for PEP but did not receive adequate treatment, leading to 246,787 doses of the vaccine and 8,888 doses of rabies immunoglobulin administered without following the recommendations of the Ministry of Health. Conclusions: The use of immunobiologicals is excessive, indicating the need for investment in training health professionals to follow the recommendations of the Ministry of Health.

Background: Human immunodeficiency virus (HIV) remains a major public health concern. Midwifery practitioners as frontline healthcare workers (HCWs) remain susceptible to occupational exposure to infections while performing their routine duties. It is estimated that 90% of occupational exposures occur because of a lack of awareness and training regarding prevention and measures to be taken in case of accidental exposure. Objectives: The study aimed to assess the knowledge, attitudes and compliance of midwifery practitioners regarding post-exposure prophylaxis (PEP) guidelines. Method: Concurrent mixed-methods research approach with qualitative nested in quantitative design was followed. A random simple sampling technique was used to collect quantitative data from 71 midwifery practitioners. Simultaneously, a purposive non-probability sampling technique was used for the qualitative approach with two occupational health and safety (OHS) practitioners and 13 midwifery practitioners. Data were collected through questionnaires and semi-structured interviews. Quantitative data were analysed with SPSS version 24 and presented in tables and figures, and thematic analysis was employed for the qualitative strand. Results: The midwifery practitioners have good knowledge about PEP for HIV. However, the study revealed the underreporting of accidental exposures to blood and body fluids (BBFs) and the underutilisation of available PEP services. Conclusion: Maternity units are high-risk clinical environments. Underreporting of incidents of exposure remains prevalent among midwifery practitioners. Contribution: The findings will inform policy development structures and hospital management regarding knowledge and implementation gaps related to PEP guidelines in the specific hospitals. Strategies to improve compliance with PEP among midwifery practitioners were developed as a derivative from study findings.

Abstract Background Rabies is a neglected tropical disease endemic in 150 countries, including India where it is present in all states and union territories except Andaman and Nicobar Islands Lakshadweep. Kerala reports high incidence of animal bites. This article discusses the preventable death of a 17-year-old tribal girl due to rabies in Kerala and the equity concerns it raises. Methods The case study was conducted using qualitative methods such as rapid key informant interviews, interactions in tribal assembly meetings, unstructured participant observations, and document verification. Thematic analysis was used, and the results are presented as an ethnographic summary with the use of quotes to substantiate the observations. Results The girl had gone to a town with her sister for a few days when she developed difficulty in eating, behavioral abnormalities, and injuries on her body. She subsequently died, and a post-mortem revealed Negri bodies in her brain, confirming rabies as the cause of death. The girl had been bitten by a puppy from the forest eight months prior, but she did not receive post-exposure prophylaxis. Multiple dogs are kept in each household in the settlement, and the community takes good care of them since they protect them from wild animals. However, awareness about the need for post-exposure prophylaxis is low, and access to it is difficult for this population. The social problems in the settlement affect their quality of life and their interactions with the outside world. Conclusions To prevent such deaths, it is essential to increase awareness and ensure equitable access to life-saving vaccines and immunoglobulin in hard-to-reach tribal areas. The cost-effectiveness of pre-exposure prophylaxis for children in high-risk areas such as this tribal settlement should be evaluated and compared with the WHO-recommended strategies of mass canine vaccination and One Health.

Abstract Background Following the outbreak of the COVID-19 pandemic, several clinical trials have evaluated postexposure prophylaxis (PEP) among close contacts of an index individual with a confirmed SARS-CoV-2 infection. Because index individuals do not directly inform the efficacy of prevention interventions, they are seldom enrolled in COVID-19 PEP studies. However, adjusting for prognostic covariates such as an index individual’s COVID-19 illness and risk behaviors can increase precision in PEP efficacy estimates, so approaches to accurately collecting this information about the index individual are needed. This analysis aimed to assess whether surveying household contacts captures the same information as surveying the index individual directly. Methods REGN 2069/CoVPN 3502, a randomized controlled trial of COVID-19 PEP, enrolled household contacts of SARS-CoV-2 index individuals. CoVPN 3502-01 retrospectively enrolled and surveyed the index individuals. We compared responses to seven similar questions about the index individuals’ transmission cofactors that were asked in both studies. We estimated the percent concordance between index individuals and their household contacts on each question, with 50% concordance considered equivalent to random chance. Results Concordance between index individuals and contacts was high on the most objective questions, approximately 97% (95% CI: 90–99%) for index individual age group and 96% (88–98%) for hospitalization. Concordance was moderate for symptoms, approximately 85% (75–91%). Concordance on questions related to the index individual’s behavior was only slightly better or no better than random: approximately 62% (51–72%) for whether they received COVID-19 treatment, 68% (57–77%) for sharing a bedroom, 70% (59–79%) for sharing a common room, and 49% (39–60%) for mask wearing at home. However, while contacts were surveyed within 96 h of the index individual testing positive for SARS-CoV-2, the median time to enrollment in CoVPN 3502-01 was 240 days, which may have caused recall bias in our results. Conclusions Our results suggest a need to survey index individuals directly in order to accurately capture their transmission cofactors, rather than relying on their household contacts to report on their behavior. The lag in enrolling participants into CoVPN 3502-01 also highlights the importance of timely enrollment to minimize recall bias.

Background: India achieved the elimination of leprosy two decades ago although its sustenance continues to be threatened by ongoing active transmission in few remaining pockets. There is a paucity of data regarding the acceptance of single-dose rifampicin (SDR) prophylaxis among healthy contacts. Aims and Objectives: The aims and objectives of the study are to assess the factors influencing the acceptability of SDR among contacts. Materials and Methods: A community-based, sequential, explanatory mixed-method study was conducted over 6 months from September 2022 to February 2023 among 168 contacts of leprosy patients from two blocks in Bankura district, West Bengal. Quantitative analysis was done for SDR acceptance and its predictors among contacts using the Chi-square test, Mann–Whitney U test, and Logistic regression. This was followed by qualitative assessment using focus group discussions and in-depth interviews among contacts to explain the findings through a thematic approach. Results: Household contacts (aOR=13.72, 95% CI=2.09–90.19), increasing knowledge score of contacts (aOR=3.18, 95% CI=1.88–5.38), counseling by health workers (aOR=11.98, 95% CI=2.20–65.15), trust in health workers (aOR=152.96, 95% CI=13.17–1776.09), and not taking other medicines for comorbidity (aOR=35.82, 95% CI=2.94–436.02) were associated with increased SDR uptake among leprosy contacts. Barriers and facilitators of post-exposure prophylaxis (PEP)-SDR were categorized as contact, health workers, and program-related factors. Conclusion: SDR acceptability among contacts was 77.4%. Facilitators of SDR-PEP were awareness of side-effects, follow-up, prompt support by health workers, IEC, belief in National programs, etc. Lack of knowledge of PEP-SDR and contraindications, ineffective counseling by health workers, stigma of the disease, the increased workload of health workers, etc., were the barriers to SDR-PEP implementation.

Dog-mediated rabies is endemic in India. The country records the highest mortality due to dog-bite-related rabies despite the availability of interventions to prevent deaths. We present a case study of the death of a 59-year-old man in a suburban town of Northeast India after a dog bite from an owned pup. Through this case study, we investigate various omissions and commissions in communities and health professionals that make rabies rampant in India. The circumstances surrounding the death were investigated by interviewing the wife, relatives, neighbour, the hospital/nursing home where the bite case was reported, the district Rapid Response Team (RRT), and the Veterinary and Animal Health Department Officer and through the information recorded in the disease outbreak report. While the biting animal was not vaccinated and had no restriction over its movement imposed by the owners, the response of the hospital staff and public authorities was delayed and inadequate. A poignant reminder of the complexities surrounding dog-mediated rabies in India, this case study calls for a holistic protocol to address dog bites through ensuring the One Health approach encompassing education, provision of post-exposure prophylaxis (PEP) and canine rabies vaccines for dogs, promotion of responsible dog ownership, and intersectoral collaboration. Moreover, strengthening communication channels through effective data exchange and encouraging synergy among healthcare, veterinary, and public health sectors is indispensable to maximize the impact of rabies prevention and control interventions.

BackgroundThe efficacy of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) convalescent plasma (CCP) for preventing infection in exposed, uninfected individuals is unknown. CCP might prevent infection when administered before symptoms or laboratory evidence of infection.MethodsThis double-blinded, phase 2 randomized, controlled trial (RCT) compared the efficacy and safety of prophylactic high titer (≥1:320 by Euroimmun ELISA) CCP with standard plasma. Asymptomatic participants aged ≥18 years with close contact exposure to a person with confirmed coronavirus disease 2019 (COVID-19) in the previous 120 hours and negative SARS-CoV-2 test within 24 hours before transfusion were eligible. The primary outcome was new SARS-CoV-2 infection.ResultsIn total, 180 participants were enrolled; 87 were assigned to CCP and 93 to control plasma, and 170 transfused at 19 sites across the United States from June 2020 to March 2021. Two were excluded for screening SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) positivity. Of the remaining 168 participants, 12/81 (14.8%) CCP and 13/87 (14.9%) control recipients developed SARS-CoV-2 infection; 6 (7.4%) CCP and 7 (8%) control recipients developed COVID-19 (infection with symptoms). There were no COVID-19-related hospitalizations in CCP and 2 in control recipients. Efficacy by restricted mean infection free time (RMIFT) by 28 days for all SARS-CoV-2 infections (25.3 vs 25.2 days; P = .49) and COVID-19 (26.3 vs 25.9 days; P = .35) was similar for both groups.ConclusionsAdministration of high-titer CCP as post-exposure prophylaxis, although appearing safe, did not prevent SARS-CoV-2 infection.Clinical trials registrationNCT04323800.

The uptake of HIV prevention services is lower among youth than adults in sub-Saharan Africa. Existing youth livelihood trainings offer a potential entry point to HIV prevention services. We determined feasibility and preliminary effectiveness of integrating HIV prevention into youth clubs implementing an empowerment and livelihood for adolescents (ELA) intervention in rural Uganda. Staff conducted community mobilization for youth (15-24 years) over one month. Clubs met (3×/week) over six months, with local peer mentors trained to teach life-skills and sexual/reproductive health education. We integrated mentor-led education on HIV prevention, including pre- and post-exposure prophylaxis (PrEP/PEP). Clubs offered on-site HIV testing, a field trip to a local clinic and PrEP referrals after one month and six months. Surveys were conducted at baseline and six months. Forty-two participants (24 adolescent girls/young women (AGYW) and 18 adolescent boys/young men (ABYM)) joined the clubs. At baseline, no participants accepted referral for PrEP, whereas 5/18 (28%) sexually active, HIV-negative AGYW requested PrEP referral at follow-up. One ABYM requested PEP referral. Integration of HIV prevention services into an established ELA curriculum at mentor-led youth clubs in rural Uganda was feasible. PrEP uptake increased among sexually active AGYW. Evaluation of this approach for HIV prevention among youth merits further study.

Background: Rabies is a neglected tropical disease endemic in 150 countries, including India where it is present in all states and union territories except Andaman and Nicobar Islands Lakshadweep. Kerala reports high incidence of animal bites. This article discusses the preventable death of a 17-year-old tribal girl due to rabies in Kerala and the equity concerns it raises. Methods: The case study was conducted using qualitative methods such as rapid key informant interviews, interactions in tribal assembly meetings, unstructured participant observations, and document verification. Thematic analysis was used, and the results are presented as an ethnographic summary with the use of quotes to substantiate the observations. Results: The girl had gone to a town with her sister for a few days when she developed difficulty in eating, behavioral abnormalities, and injuries on her body. She subsequently died, and a post-mortem revealed Negri bodies in her brain, confirming rabies as the cause of death. The girl had been bitten by a puppy from the forest eight months prior, but she did not receive post-exposure prophylaxis. Multiple dogs are kept in each household in the settlement, and the community takes good care of them since they protect them from wild animals. However, awareness about the need for post-exposure prophylaxis is low, and access to it is difficult for this population. The social problems in the settlement affect their quality of life and their interactions with the outside world. Conclusions: To prevent such deaths, it is essential to increase awareness and ensure equitable access to life-saving vaccines and immunoglobulin in hard-to-reach tribal areas. The cost-effectiveness of pre-exposure prophylaxis for children in high-risk areas such as this tribal settlement should be evaluated and compared with the WHO-recommended strategies of mass canine vaccination and One Health. [ABSTRACT FROM AUTHOR]

A new generation, serum-free, antibiotic-free, purified Vero rabies vaccine (PVRV-NG; Sanofi) has been developed based on the same Pitman-Moore viral strain used for the currently licensed purified Vero cell rabies vaccine (PVRV; Verorab®, Sanofi) and human diploid cell vaccine (HDCV; Imovax® Rabies, Sanofi). PVRV-NG has demonstrated a satisfactory safety profile and induces robust immune responses, with non-inferiority demonstrated versus PVRV when given as a three-dose pre-exposure prophylaxis (PrEP) regimen in healthy children and adults. Here, we evaluated the safety and immunogenic non-inferiority of PVRV-NG compared to HDCV when administered as simulated post-exposure prophylaxis (PEP), with concomitant administration of human rabies immunoglobulin (HRIG), in healthy adults in the USA. Participants were vaccinated according to the 5-dose Essen intramuscular regimen (4-week, 1-injection site regimen, with a single dose given on days 0, 3, 7, 14 and 28) for PEP, with concomitant HRIG administered on day 0. Rabies virus neutralising antibodies (RVNA) were evaluated on days 0, 14, 28 and 42. Non-inferiority of PVRV-NG compared with HDCV was shown if the lower limit of the 95 % confidence interval (CI) for the difference in seroconversion rates (RVNA titers ≥ 0.5 IU/mL on day 14) between PVRV-NG and HDCV was above the non-inferiority margin of –5 %. Safety was evaluated after each vaccination and monitored throughout the study. The difference in seroconversion rate between the PVRV-NG and HDCV groups was –2.8 % (95 % CI, –8.08 to 4.20), indicating that non-inferiority was not demonstrated. The seroconversion rate was < 99 % in both study groups on day 14. There were no major safety concerns identified, and PVRV-NG demonstrated a similar safety profile to HDCV. [ABSTRACT FROM AUTHOR]

Background: Following the outbreak of the COVID-19 pandemic, several clinical trials have evaluated postexposure prophylaxis (PEP) among close contacts of an index individual with a confirmed SARS-CoV-2 infection. Because index individuals do not directly inform the efficacy of prevention interventions, they are seldom enrolled in COVID-19 PEP studies. However, adjusting for prognostic covariates such as an index individual's COVID-19 illness and risk behaviors can increase precision in PEP efficacy estimates, so approaches to accurately collecting this information about the index individual are needed. This analysis aimed to assess whether surveying household contacts captures the same information as surveying the index individual directly. Methods: REGN 2069/CoVPN 3502, a randomized controlled trial of COVID-19 PEP, enrolled household contacts of SARS-CoV-2 index individuals. CoVPN 3502-01 retrospectively enrolled and surveyed the index individuals. We compared responses to seven similar questions about the index individuals' transmission cofactors that were asked in both studies. We estimated the percent concordance between index individuals and their household contacts on each question, with 50% concordance considered equivalent to random chance. Results: Concordance between index individuals and contacts was high on the most objective questions, approximately 97% (95% CI: 90–99%) for index individual age group and 96% (88–98%) for hospitalization. Concordance was moderate for symptoms, approximately 85% (75–91%). Concordance on questions related to the index individual's behavior was only slightly better or no better than random: approximately 62% (51–72%) for whether they received COVID-19 treatment, 68% (57–77%) for sharing a bedroom, 70% (59–79%) for sharing a common room, and 49% (39–60%) for mask wearing at home. However, while contacts were surveyed within 96 h of the index individual testing positive for SARS-CoV-2, the median time to enrollment in CoVPN 3502-01 was 240 days, which may have caused recall bias in our results. Conclusions: Our results suggest a need to survey index individuals directly in order to accurately capture their transmission cofactors, rather than relying on their household contacts to report on their behavior. The lag in enrolling participants into CoVPN 3502-01 also highlights the importance of timely enrollment to minimize recall bias. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals (HCPs) are at increased risk of contracting hepatitis B due to frequent exposure to patients with the disease. Post-exposure prophylaxis (PEP) can effectively manage this risk. This study aimed to assess the level of awareness of hepatitis B PEP among healthcare workers in the Quetta district. Methodology: Conducted from November 1, 2022, to November 30, 2022, this cross-sectional study targeted healthcare professionals in Quetta, Balochistan, Pakistan. Data were collected from three main public tertiary care institutions and various private hospitals using simple random sampling. A structured questionnaire covering demographic information, immunization status, and hepatitis B PEP was administered. Data analysis was performed using SPSS version 19, summarizing data with frequencies and percentages. Odds ratio analysis was conducted to identify associations between awareness of hepatitis B PEP and other variables. Results: Of the 263 participants, 181 (68.8%) were female, and 167 (63.5%) were aged 31-40 years. Most participants (88.5%) were doctors, followed by nurses and pharmacists. While 87.1% had heard of hepatitis B PEP, only 11.8% received formal training on it. Awareness of PEP components was lacking, despite familiarity with its existence. Factors associated with awareness included previous PEP knowledge, hepatitis B screening, and perceived job-related risk. Conclusion: Although many healthcare providers were aware of hepatitis B PEP, knowledge regarding its components was insufficient. Training and education initiatives are crucial to improving awareness and understanding among healthcare professionals. [ABSTRACT FROM AUTHOR]

Rabies presents with a high fatality rate, which imposes a significant global public health challenge, and therefore the use of post-exposure prophylaxis (PEP) is crucial for prevention. Monoclonal antibodies (mAbs) have emerged as a promising substitute for rabies immunoglobulins (RIGs) due to their high efficacy and standardized manufacturing process. A prospective, open-label, post-marketing surveillance study (PMS) was conducted at Byramjee Jeejeebhoy Medical College (BJMC), Pune. The study included patients aged more than 2 years who had recently sustained Category III-suspected rabid animal bite exposures. These patients were administered TwinRabTM at a dosage of 40 IU/ kg in and around the wound as intralesional transfer, along with the anti-rabies vaccine (ARV). Adverse events (AEs) grading was performed with reference to the Food and Drug Administration (FDA) toxicity grading. In this study, 215 subjects received the TwinRabTM mAb with a 100% completion rate. Out of 215 patients, three (1.3%) patients in the range of 18 to 65 years of age showed solicited local AEs, which were resolved after the appropriate treatment intervention, but causality assessment was non-assessable. The overall tolerability assessment showed positive ratings from doctors (91.63%) and patients (67.91%) for the mAb cocktail. The PMS demonstrated the safety of TwinRabTM in patients who experienced Category III-suspected rabid animal bites, thereby supporting its potential as an alternative option for post-exposure prophylaxis in the management of animal bites for the prevention of rabies [ABSTRACT FROM AUTHOR]

Background Post-exposure prophylaxis (PEP) is an effective tool to prevent infection with HIV. Patients seeking PEP after potential HIV exposure usually present to the emergency department (ED). Our study sought to determine the concordance of ED physicians' decisions on HIV-PEP with national guidelines (primary objective) and to assess the clinical relevance of drug–drug interactions (DDIs) between the HIV-PEP regimen and patients' concomitant medication (secondary objective). Methods We conducted a retrospective cohort study at the ED of Hannover Medical School, Germany. Between 1 January 2018 and 31 December 2019, 113 of 11 246 screened patients presented to the ED after potential HIV exposure and were enrolled in the study. Results The median age of the patients (82.3% male) was 30 y (IQR 25–35.5), 85.8% of potential HIV exposures were characterised as sexual and 85.0% presented within 72 h. ED physicians' decisions on HIV-PEP were concordant with national guidelines in 93.8%. No clinically relevant DDIs were detected. Conclusions ED physicians' decisions on HIV-PEP were highly concordant with national guidelines. Approximately 1% of patient presentations to the ED were related to HIV exposure; therefore, training ED physicians on HIV transmission risk assessment and indications/contraindications for HIV-PEP is paramount. [ABSTRACT FROM AUTHOR]

Background: India achieved the elimination of leprosy two decades ago although its sustenance continues to be threatened by ongoing active transmission in few remaining pockets. There is a paucity of data regarding the acceptance of single-dose rifampicin (SDR) prophylaxis among healthy contacts. Aims and Objectives: The aims and objectives of the study are to assess the factors influencing the acceptability of SDR among contacts. Materials and Methods: A community-based, sequential, explanatory mixedmethod study was conducted over 6 months from September 2022 to February 2023 among 168 contacts of leprosy patients from two blocks in Bankura district, West Bengal. Quantitative analysis was done for SDR acceptance and its predictors among contacts using the Chi-square test, Mann–Whitney U test, and Logistic regression. This was followed by qualitative assessment using focus group discussions and in-depth interviews among contacts to explain the findings through a thematic approach. Results: Household contacts (aOR=13.72, 95% CI=2.09–90.19), increasing knowledge score of contacts (aOR=3.18, 95% CI=1.88–5.38), counseling by health workers (aOR=11.98, 95% CI=2.20–65.15), trust in health workers (aOR=152.96, 95% CI=13.17–1776.09), and not taking other medicines for comorbidity (aOR=35.82, 95% CI=2.94–436.02) were associated with increased SDR uptake among leprosy contacts. Barriers and facilitators of post-exposure prophylaxis (PEP)-SDR were categorized as contact, health workers, and program-related factors. Conclusion: SDR acceptability among contacts was 77.4%. Facilitators of SDR-PEP were awareness of side-effects, follow-up, prompt support by health workers, IEC, belief in National programs, etc. Lack of knowledge of PEP-SDR and contraindications, ineffective counseling by health workers, stigma of the disease, the increased workload of health workers, etc., were the barriers to SDR-PEP implementation. [ABSTRACT FROM AUTHOR]

We report a case of exposure to Coxiella burnetii in a surgical nurse who underwent an injury of her finger with a scalpel blade during a native aortic valve replacement with a bio-prosthetic cardiac valve conducted on a patient suffering from C. burnetii aortic endocarditis. Given the positivity of C. burnetii culture and PCR from the patient's aortic valve, she was prescribed prophylactic doxycycline 100 mg twice a day for 10 days. Q fever is an occupational zoonosis resulting usually of exposure to infected animals by inhalation of infected aerosols or consumption of contaminated raw milk. Apart from materno-foetal transmission, about 180 cases of human-to-human C. burnetii transmission have been published from 1949 to today, including transmission by blood transfusion, sexual relations, transmission in the healthcare setting to staff, patient attendants and other patients that were likely infected from inhalation of aerosol from respiratory or placental products, transmission to staff during autopsies of patients with Q fever and transmission in familial settings. As C. burnetii is a highly infectious bacterium, that may cause infection with a low inoculum, it should be added to the list of organisms which may be of concern following blood exposure among healthcare professionals. [ABSTRACT FROM AUTHOR]

Simple Summary: In Mongolia, where nomadic pastoralism is still commonly practiced, a majority of reported human rabies exposure is attributed to dogs, with this case study highlighting an atypical exposure via horse bite occurring in an urban setting. The infected horse had been attacked by stray dogs prior to biting a 6 year old, which likely was the source of the rabies infection. This report highlights a successful response by the National Center for Zoonotic Diseases in conducting a thorough rabies investigation following a suspected exposure event and PEP initiation. Also discussed are common challenges in managing rabies in Mongolia, including limited access to vaccinations for domestic animals and wildlife due to financial constraints. Prompt and indiscriminate PEP initiation in rabies-endemic regions will need to be readily available across Mongolia, not just within proximity to Ulaanbaatar. Furthermore, integrated rabies management in Mongolia will need to be paired with community outreach and require coordination between veterinarians, health professionals, and policymakers to ensure proper access to care following exposure events from atypical sources such as livestock and horses. Rabies is a highly fatal zoonotic disease that causes an estimated 60,000 human deaths each year, many of which occur in Africa and Asia where the disease is likely underreported. Uncontrolled transmission of rabies presents a major threat to public health in countries such as Mongolia, where 26% of the population lives a pastoralist lifestyle characterized by increased interaction with livestock animals. Here, we report a case of rabies exposure in a six-year-old male after being bitten by a horse in both the head region and the leg. At the suspicion of rabies, post-exposure prophylaxis (PEP) was initiated, with the patient receiving four doses of PEP vaccine as well as a single treatment of rabies immunoglobulin. The horse was later confirmed to be rabies-positive through rapid antigen testing and RT-PCR. Human rabies exposure from horses is unusual within Mongolia, given that historically over 70% of human rabies cases within the country are attributed to dogs, wolves, or foxes. This case further emphasizes the need for more routine vaccination of domestic animals within Mongolia. Additionally, animal bites, even from animals not frequently associated with rabies, should be treated as possible rabies exposure events. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives: to analyze the factors associated with university students’ knowledge about HIV and preand post-exposure prophylaxis. Methods: a cross-sectional study was conducted with 503 university students from a southern state in Brazil; data were collected using a characterization tool and a questionnaire containing 16 statements about the topic; descriptive measures and Poisson regression models with robust variance were used for analysis. Results: the prevalence of adequate knowledge (i.e., scoring more than 12 correct answers) was 27.83%; students older than 24 years, enrolled in health-related courses, who had not engaged in sexual relations in the last quarter, with a history of rapid HIV testing, and who knew or had heard about the prophylaxes showed a higher likelihood of scoring more than 12 correct answers. Conclusions: generally, the knowledge of young people about HIV and its prophylaxes was found to be inadequate and influenced by sociodemographic, educational, and behavioral factors.

Abstract Introduction Post‐exposure prophylaxis (PEP) is an efficacious prevention method when initiated promptly after an HIV exposure. Yet, PEP has been underutilized, even among healthcare workers (HCWs) with occupational exposure in sites with PEP policies and procedures and access to PEP medications. It is important to understand the dynamics of uneven PEP use in what appears to be an optimal context to better protect the health and wellbeing of HCWs. Methods We conducted a scoping review to elucidate factors influencing HCWs’ use of PEP after occupational exposure. We searched PubMed, PsychInfo and Google Scholar for peer‐reviewed literature published in English from 2014 to 2022 using the terms HIV, postexposure/post‐exposure prophylaxis, acceptability, healthcare workers, and values and preferences. An inductive narrative review of the resulting 53 studies identified core themes. Results Nearly all studies (96%) with various HCW types and settings occurred in low‐ and middle‐income countries (LMICs) in Africa and Asia. Identified themes arrayed along a trajectory of PEP use experience: awareness/knowledge; acceptability; availability/access; uptake/use; adherence/completion. Across studies, awareness of PEP for HIV prevention was high, knowledge about drug regimens and healthcare facility policies was moderate to low; acceptability of PEP was moderate to high; PEP's perceived accessibility/availability was inconsistent and varied by geographic location and setting; HCWs’ uptake of PEP was low, affected by not knowing how to report an exposure and being unaware of PEP availability; and adherence/completion of PEP regimens was moderate to low, impeded by side effects and a belief that completing regimens was unnecessary to avert seroconversion. HCWs consistently expressed concern about HIV stigma. Discussion Findings are limited by the inconsistent use of constructs across studies and a lack of clarity about reporting exposure events. Multi‐level approaches are needed to address the interplay of individual, social and structural barriers that diminish HCWs’ PEP use. Improved training, incident reporting, 24‐hour access to non‐stigmatizing PEP services and monitoring of adherence/completion are essential to optimizing HCWs’ PEP use. Conclusions Lessons from HCWs’ experience in LMICs may inform understanding of PEP under‐use among people in these settings with non‐occupational exposures.

To assess the factors that influencing the persistence of virus neutralizing antibody (VNA), and to establish prediction models to provide the appropriate timing for booster administration, a cohort of post-exposure rabies vaccine recipients was investigated. The VNA determined records from 2019 to 2023 and interrelated factors were analyzed, including gender, age, rabies immunoglobulin (RIG) administration, vaccine products, vaccination schedule, and vaccination intervals etc. The geometric mean of VNA titre within 1 month after primary vaccination with 2-1-1 schedule was statistically higher than that with 5-dose course (P = 0.031). The interaction between exposure and vaccination schedule was observed on primary vaccination, which showed that a decrease of 19.74 % (95 % CI: 5.99%–64.95 %, P = 0.008) of VNA titre among vaccinee with 5-dose and exposure III. Individuals with RIG administration produced lower VNA titres than those without RIG administration (P = 0.001). Vaccine products (Chengda, P = 0.015; human diploid cell, P = 0.026) and re-exposed time (P = 0.000) exhibited independent effects following booster vaccination. Based on the prediction model, the 99 % individual prediction intervals (IPI) of VNA titres were established at 3, 6, 12 and 18 months for the 12 characteristic populations respectively. The cases of VNA below 0.5 IU/ml first appeared at 6 months in group D of primary vaccinations and at 10 years in group F of boosters. We conclude that for primary vaccination 2-1-1 schedule is more efficient than 5-dose; the use of residual rabies immunoglobulin for distal intramuscular injection isn't recommended. The 99 % IPI of VNA titres could provide the appropriate timing for booster vaccination.

Objective: HIV pre-exposure prophylaxis (PrEP) became available in Victoria, Australia, in 2016. We examined non-occupational post-exposure prophylaxis (nPEP) usage among gay, bisexual and other men who have sex with men (MSM) before and after PrEP became available. Methods: We included MSM attending Melbourne Sexual Health Centre for nPEP between 2011 and 2021. We analysed three periods: the ‘pre-PrEP’ (01 Jan 2011 to 25 Jul 2016), ‘PrEP before COVID-19’ (26 Jul 2016 to 31 Dec 2019), and ‘PrEP during COVID-19’ (01 Jan 2020 to 31 Dec 2021). Results: There were 222,978 consultations for MSM; 8292 (3.7%) were nPEP consultations. The proportion of nPEP consultations increased from 3.3% (3093/94263) in the pre-PrEP period to 4.3% (3843/89251) in the PrEP before COVID-19 period then dropped to 3.4% (1356/39464) during the COVID-19 period. Compared to Australian-born MSM, MSM born in Central/South America (adjusted odds ratio [aOR]: 1.75; 95% confidence interval [CI]: 1.27–2.40) had the highest odds of accessing nPEP, followed by Asian-born MSM (aOR: 1.47; 95% CI: 1.27–1.71) after adjusting for PrEP availability and COVID-19. Those newly arrived in Australia in ≤4 years had higher odds (aOR: 1.14; 95% CI: 1.05–1.22) of accessing nPEP than those living in Australia for >4 years. Conclusion: nPEP prescriptions declined with PrEP availability. Newly arrived overseas-born MSM who are unlikely to have access to subsidised PrEP have a higher demand of nPEP. Implications for Public Health: Increasing PrEP education and ensuring equal access is vital in the drive to reduce new HIV diagnoses.

Abstract Introduction Identifying the optimal approaches to offering HIV prevention to meet the needs of those at risk is a high priority, particularly given the expanding toolkit of biomedical HIV prevention options. An ongoing study in rural East African communities evaluated the uptake of choices in product, testing mode and location of care delivery through a structured patient‐centred HIV prevention delivery model. In this qualitative study, we sought to understand clients’ experiences of this “dynamic choice prevention model” (DCP) and highlight pathways of action to inform HIV prevention delivery models. Methods In‐depth semi‐structured interviews were conducted from November 2021 through March 2022 with a purposively selected sample of n = 56 participants in DCP trials (across outpatient departments, antenatal clinics and community settings), and n = 21 healthcare providers (total n = 77). A seven‐person multi‐regional team translated and inductively coded transcript data. We used a framework analysis approach to identify emergent themes. Results Individuals taking up HIV pre‐exposure prophylaxis (PrEP) reported feelings of relief, liberation from fears of acquiring HIV and satisfaction with being able to take action despite partners’ behaviours. Couples used a range of approaches afforded by the study to persuade partners to get tested and opt for PrEP. Post‐exposure prophylaxis (PEP) use was less common, although women welcomed it in the event of sexual coercion or assault. Participants discussed switching from PEP to PrEP after familiarizing themselves with usage and ascertaining ongoing risk. Participants felt respected by providers, trusted them and appreciated being able to contact them directly for telephone support. Prevention uptake was hindered by stigma, limited experience with and knowledge of prevention methods, gendered and generational power dynamics within intimate partnerships and families, and negative perceptions of methods due to the products themselves. Participants anticipated long‐acting injectable PrEP could solve their challenges regarding pill size, daily pill burden and the likelihood of unwanted disclosure. Conclusions Diverse preferences and barriers to uptake of prevention require a choice of HIV prevention options, locations and delivery modalities—but in addition, flexible, competent and friendly care provision is crucial to promote uptake. Helping clients feel valued, and addressing their unique needs and challenges, enables their agency to prioritize their health.

Abstract Objective: To analyze HIV Post-Exposure Prophylaxis (PEP) prescription and return for follow-up appointments. Methods: This was a descriptive cross-sectional study using data on people who sought PEP in emergency care units (UPAs) and specialized medical services in Salvador, BA, Brazil, between January-December/2018. Results: Of the 1,525 people who sought PEP at UPAs, 1,273 (83.5%) met PEP eligibility criteria, while 252 (16.5%) did not; of the eligible group, 1,166 (91.6%) had antiretrovirals prescribed, while 107 (8.4%) eligible people did not; of the total number of people with PEP prescriptions, only 226 (19.4%) returned for the first follow-up appointment, 115 (9.9%) for the second, and 33 (2.8%) for the third in order to complete the protocol. Conclusion: We found a significant proportion of eligible users who did not have PEP prescribed at UPAs and a significant loss of return for specialized service follow-up appointments.

Background: In December 2015, the World Health Organization, the World Animal Health Organization, and the Food and Agriculture Organization of the United Nations convened the International Congress on the elimination of rabies in Geneva. How to use epidemiological factors of post-exposure prophylaxis to prevent rabies has become the focus of attention. Objective: To analyze the epidemiological characteristics of 9772 patients with rabies in a four-year period in one hospital, to clarify the outbreak law of rabies and to explore the corresponding prevention and control strategies. Methods: The epidemiological data of rabies patients were collected from the infectious disease reporting information management system of the hospital from July 2018 to June 2022. The distributional characteristics of 13 influencing factors were analyzed using the chi-square test and linear regression. Results: There was a significant correlation between the number of wounds and age, and the numbers of female and male patients were close. People over the age of 44 were more likely to get bites or scratches on their lower extremity (P

Introduction An appropriate economic evaluation of post-exposure prophylaxis (PEP) should consider the effectiveness of different regimens prescribed for patients. Studies have not evaluated the comparative effectiveness of different PEP antiretrovirals (ARVs) based on their costs. Therefore, the aim of the present study was to determine the cost-effectiveness of ARVs regimens used for PEP in Nigerian tertiary hospitals. Material and methods This cross-sectional study collated patients’ demographic and clinical data from PEP databases of United States’ President Emergency Plan for AIDS Relief – AIDS Prevention Initiative in Nigeria hospitals. Costs of ARVs were obtained from donors’ price list. Effectiveness was measured as the percentage of human immunodeficiency virus (HIV)-negative patients one-month post-PEP. Average cost-effectiveness ratios (ACERs) were computed as the unit cost of the regimens/HIV infection averted (HIA). Probabilistic sensitivity analysis was conducted using 1,000 iterations using Monte-Carlo simulation. Results Out of 575 patients identified, 198 (34.4%) had non-occupational exposure. Of the 14 regimens, tenofovir (TDF) + lamivudine (3TC) + ritonavir-boosted atazanavir (ATV/r) was prescribed for 230 (40.00%) patients. HIV-negative results were documented in 129 (22.4%) of the 185 patients with post-PEP test. Zidovudine (AZT) + 3TC + ATV-r was the most effective (95.5%, n = 63 of 66) regimen, while TDF + emtricitabine (FTC) + ritonavir-boosted lopinavir (LPV/r) was the most expensive ($23.66). With an ACER of $8.110/HIV infection prevented (95% CI: $8.052-$8.168), TDF + 3TC + efavirenz (EFV) was the most cost-effective regimen. Conclusions AZT + 3TC + LPV/r was the most effective regimen, while TDF + FTC + ATV/r was the most expensive. However, TDF + 3TC + EFV combination was the most cost-effective regimen used in providing PEP service to HIV patients in Nigerian hospitals.

Abstract Background Leprosy is an infectious disease with a slow decline in global annual caseload in the past two decades. Active case finding and post-exposure prophylaxis (PEP) with a single dose of rifampicin (SDR) are recommended by the World Health Organization as measures for leprosy elimination. However, more potent PEP regimens are needed to increase the effect in groups highest at risk (i.e., household members and blood relatives, especially of multibacillary patients). The PEP++ trial will assess the effectiveness of an enhanced preventive regimen against leprosy in high-endemic districts in India, Brazil, Bangladesh, and Nepal compared with SDR-PEP. Methods The PEP++ study is a cluster-randomised controlled trial in selected districts of India, Brazil, Bangladesh, and Nepal. Sub-districts will be allocated randomly to the intervention and control arms. Leprosy patients detected from 2015 − 22 living in the districts will be approached to list their close contacts for enrolment in the study. All consenting participants will be screened for signs and symptoms of leprosy and tuberculosis (TB). In the intervention arm, eligible contacts receive the enhanced PEP++ regimen with three doses of rifampicin (150 − 600 mg) and clarithromycin (150 − 500 mg) administered at four-weekly intervals, whereas those in the control arm receive SDR-PEP. Follow-up screening for leprosy will be done for each individual two years after the final dose is administered. Cox’ proportion hazards analysis and Poisson regression will be used to compare the incidence rate ratios between the intervention and control areas as the primary study outcome. Discussion Past studies have shown that the level of SDR-PEP effectiveness is not uniform across contexts or in relation to leprosy patients. To address this, a number of recent trials are seeking to strengthen PEP regimens either through the use of new medications or by increasing the dosage of the existing ones. However, few studies focus on the impact of multiple doses of chemoprophylaxis using a combination of antibiotics. The PEP++ trial will investigate effectiveness of both an enhanced regimen and use geospatial analysis for PEP administration in the study communities. Trial registration NL7022 on the Dutch Trial Register on April 12, 2018. Protocol version 9.0 updated on 18 August 2022 https://www.onderzoekmetmensen.nl/en/trial/23060

Ubah Mumin Ali Osman,1 Selim Turfan,1 Mohamed Farah Yusuf Mohamud1– 3 1Emergency Department, Mogadishu Somali Turkey Training and Research Hospital, Mogadishu, Somalia; 2Faculty of Medicine, Mogadishu University, Mogadishu, Somalia; 3Tayo Institute for Health and Development, Mogadishu, SomaliaCorrespondence: Mohamed Farah Yusuf Mohamud, Emergency Department, Mogadishu Somali Turkey Training and Research Hospital, Digfer Street, Hodan District, Mogadishu, Somalia, Tel +252615591689, Email m.qadar59@gmail.comAbstract: Rabies is a neglected zoonotic disease caused by a virus. It is an acute progressive neurological disease that affects people in many parts of the world, especially in low income countries including Somalia and it is always lethal once symptoms appear without immediate post-exposure prophylaxis (PEP). Nearly half of rabies cases occur in children. This case report presents a tragic and unique clinical scenario involving a 14-year-old boy from a rural area in Somalia who presented to our tertiary hospital after a bite from a honey badger. The patient’s younger sister, who was also bitten by the same honey badger, sadly succumbed to the disease two weeks prior. This report aims to contribute to the medical literature by highlighting the challenges faced in diagnosing and managing rabies in resource-constrained settings.Keywords: rabies, honey badger, post-exposure prophylaxis, zoonotic disease, Somalia

We report the experience of bictegravir/emtricitabine/tenofovir alafenamide for nonoccupational postexposure prophylaxis in sexual assault cases. Between June 2021 and October 2023, 39 individuals completed the 28-day follow-up; 41% experienced some side effects, and 1 person discontinued the drug because of a rash. No individuals seroconverted to HIV during the follow-up period. [ABSTRACT FROM AUTHOR]

Rabies is a highly fatal zoonotic disease that causes an estimated 60,000 human deaths each year, many of which occur in Africa and Asia where the disease is likely underreported. Uncontrolled transmission of rabies presents a major threat to public health in countries such as Mongolia, where 26% of the population lives a pastoralist lifestyle characterized by increased interaction with livestock animals. Here, we report a case of rabies exposure in a six-year-old male after being bitten by a horse in both the head region and the leg. At the suspicion of rabies, post-exposure prophylaxis (PEP) was initiated, with the patient receiving four doses of PEP vaccine as well as a single treatment of rabies immunoglobulin. The horse was later confirmed to be rabies-positive through rapid antigen testing and RT-PCR. Human rabies exposure from horses is unusual within Mongolia, given that historically over 70% of human rabies cases within the country are attributed to dogs, wolves, or foxes. This case further emphasizes the need for more routine vaccination of domestic animals within Mongolia. Additionally, animal bites, even from animals not frequently associated with rabies, should be treated as possible rabies exposure events.

(1) Background: The effect of varicella emergency vaccination (EV) has not been fully evaluated. (2) Methods: This was a cohort study. Participants were categorized into five groups based on their immune status: unvaccinated group, first dose as EV group, one dose no EV group, second dose as EV group, and two doses no EV group. A Cox proportional hazards model was employed to examine the association between the EV measures and the varicella incidence rate in this outbreak. (3) Results: Demographic characteristics, vaccination details, and disease onset information were 100% (918/918) collected. The crude attack rate was 44% (11/25), 8% (3/36), 11% (24/215), 3% (6/176), and 2% (8/466) among the unvaccinated group, first dose as EV group, one dose no EV group, second dose as EV group and two doses no EV group, respectively. Compared to the unvaccinated group and the one dose no EV group, the first dose varicella vaccine as EV and the second dose as EV demonstrated an incremental effectiveness of 90% (95% CI 65–97%) and 79% (95% CI 47–92%), respectively. (4) Conclusions: Both the first dose and the second dose as EV contributed to reducing the incidence rates of varicella and offered incremental vaccine effectiveness in an outbreak setting. Our study underscores the importance and benefits of initiating emergency varicella vaccination early to reduce the disease incidence rate in an elementary school setting where there was no complete coverage of the two doses of varicella vaccine and an outbreak occurred.