浙江省2002～2005年艾滋病职业暴露分析

目的为了解艾滋病（HIV）职业暴露现状，探讨职业暴露后应急预防处理的影响因素。方法对浙江省2002—2005年报告的由于职业因素引起的HIV暴露案例进行调查并统计分析。结果4-4起56人包括医务人员，公安司法职业暴露，暴露类型包括针头刺伤，抓咬伤和血液接触皮肤或粘膜，50人实施暴露后预防（PEP），有43人采用基本用药程序进行干预治疗，占76．8％（43／56）：有7人采用强化用药程序：有6人自愿不实施PEP。目前所有病例随访未发现HIV抗体阳转者，有一例发生丙肝病毒（HCV）抗体阳转。结诊HⅣ职业暴露后感染的危险较低．但是要注意加强对其他各类血液传播疾病的阻断防护。     

2014—2020年广州市HIV职业暴露变化趋势及暴露后预防相关因素分析

目的 分析广州市HIV职业暴露情况,为加强HIV职业暴露防护工作提供依据。方法 收集并分析2014—2020年广州市报告的HIV职业暴露个案,内容包括暴露者的基本情况、暴露方式、暴露等级与暴露源感染情况、暴露后紧急处理方式、暴露后预防用药时间及暴露者HIV抗体检测等信息。结果 2014—2020年,广州市累计报告HIV职业暴露个案455例,医务人员占86.8%（395/455）,锐器损伤占54.3%（247/455）,II级暴露占63.3%（288/455）,规范化暴露后处理占93.8%（427/455）,暴露后2 h内预防用药占35.4%（161/455）;医务人员暴露后2 h内预防用药比例高于警务人员（P<0.01）;男性、锐器损伤、皮肤/黏膜接触暴露、I级暴露、暴露源为轻度、强化用药方案、2 h内及2~24 h内预防用药的构成比均呈上升趋势（P<0.05或P<0.01）;传染病专科医院、II级暴露、超过24 h预防用药的比例呈下降趋势（均P<0.01）;传染病专科医疗机构暴露个案更倾向于及早预防用药（OR=0.305）,暴露源不明的暴露个案预防用药时间更晚（OR=2.713）。结论 应重点提高医护人员和一线警务人员防护意识及技能,增加暴露后预防用药的便利性;同时加强暴露源检测,减少对预防用药及时性的影响。     

Management of accidental laboratory exposure to Burkholderia pseudomallei and B. mallei

The gram-negative bacillus Burkholderia pseudomallei is a saprophyte and the cause of melioidosis. Natural infection is most commonly reported in northeast Thailand and northern Australia but also occurs in other parts of Asia, South America, and the Caribbean. Melioidosis develops after bacterial inoculation or inhalation, often in relation to occupational exposure in areas where the disease is endemic. Clinical infection has a peak incidence between the fourth and fifth decades; with diabetes mellitus, excess alcohol consumption, chronic renal failure, and chronic lung disease acting as independent risk factors. Most affected adults ( approximately 80%) in northeast Thailand, northern Australia, and Malaysia have >/=1 underlying diseases. Symptoms of melioidosis may be exhibited many years after exposure, commonly in association with an alteration in immune status. Manifestations of disease are extremely broad ranging and form a spectrum from rapidly life-threatening sepsis to chronic low-grade infection. A common clinical picture is that of sepsis associated with bacterial dissemination to distant sites, frequently causing concomitant pneumonia and liver and splenic abscesses. Infection may also occur in bone, joints, skin, soft tissue, or the prostate. The clinical symptoms of melioidosis mimic those of many other diseases; thus, differentiating between melioidosis and other acute and chronic bacterial infections, including tuberculosis, is often impossible. Confirmation of the diagnosis relies on good practices for specimen collection, laboratory culture, and isolation of B. pseudomallei. The overall mortality rate of infected persons is 50% in northeast Thailand (35% in children) and 19% in Australia.     

Post-Exposure Prophylaxis of HIV Infection in Healthcare Workers: Recommendations for the European Setting

The European Commission funded a project for the standardisation of the management of occupational exposures to HIV/blood-borne infections and antiretroviral post-exposure prophylaxis (PEP) in Europe. Within this project, the following recommendations and rationale were formulated by experts representative of participating countries. Based on assessment of the exposure, material, and source characteristics, PEP should be started as soon as possible with any triple combination of antiretrovirals approved for the treatment of HIV-infected patients; initiation is discouraged after 72 hours Rapid HIV testing of the source could reduce inappropriate PEP. HIV testing should be performed at baseline, 4, 12, and 24 weeks, with additional clinical and laboratory monitoring of adverse reactions and potential toxicity at week 1 and 2. HIV resistance tests in the source and direct virus assays in the exposed HCW are not recommended routinely. These easy-to-use recommendations seek to maximise PEP effect while minimising its toxicity and inappropriate use.     

Evaluating the cost-effectiveness of rabies post-exposure prophylaxis: A case study in Tanzania

Although fatal if untreated, human rabies can be prevented through post-exposure prophylaxis (PEP), which involves a course of vaccination and immunoglobulin administered immediately after exposure. However, high costs and frequent lack of rabies vaccine and immunoglobulin lead to about 55,000 deaths per year worldwide. Using data from a detailed study of rabies in Tanzania, we calculate a cost-effectiveness ratio for PEP when the WHO-recommended Essen regimen, a 5-dose intramuscular vaccination schedule, is adopted. Our analyses indicate a cost-effectiveness ratio for PEP of $27/quality-adjusted life year (QALY) from a health care perspective and $32/QALY from a societal perspective in Tanzania. From both perspectives, it is “very cost-effective” to administer PEP to patients bitten by an animal suspected to be rabid. Moreover, PEP remains “very cost-effective” provided that at least 1% of doses are administered to people who were actually exposed to rabies.     

Field effectiveness of hepatitis A vaccine and uptake of post exposure prophylaxis following a change to the Australian guidelines

Background

In 2009, national guidelines for hepatitis A control in Australia changed to recommend hepatitis A vaccine (HAV), instead of normal human immune globulin (NHIG), for post-exposure prophylaxis (PEP).

Aims

(1) Determine whether the uptake of PEP among contacts of hepatitis A cases changed after the introduction of the new guidelines, and (2) assess the field effectiveness of the HAV used as PEP in preventing infection among contacts of hepatitis A cases.

Methods

A retrospective cohort of contacts from hepatitis A cases reported to metropolitan Public Health Units in Sydney, Australia, between October 2008 and June 2010, was identified. Contacts were analysed by time period, age, PEP type, and susceptibility to hepatitis A. The relative risk (RR) of hepatitis A infection among susceptible contacts who received HAV, compared with susceptible contacts who had not received HAV, was calculated to estimate the effectiveness of the HAV when used as PEP.

Results

The uptake of PEP by susceptible contacts increased from 76% (n = 133) to 89% (n = 127) after the introduction of the new guidelines. Before the change in guidelines, no one who received PEP was later reported with hepatitis A. After the change in guidelines, one of the 123 contacts who received HAV as PEP was subsequently reported with hepatitis A. However, this case was likely to have been co-exposed with a primary case. Conservatively, assuming this was a secondary case, the vaccine effectiveness of HAV was 95.6% (66.1%–99.4%). Nine of 10 incident cases of hepatitis A were contacts who did not receive any PEP.

Conclusion

The improved uptake of PEP and the high estimate of the effectiveness of HAV provides support for using HAV for PEP. The very high occurrence of hepatitis A among contacts who did not receive any PEP further highlights the importance of PEP in preventing hepatitis A infection.     

自杀行为暴露与青少年非自杀性自伤关系的纵向研究

目的 青少年群体中,非自杀性自伤（non-suicidal self-injury,NSSI）行为较为普遍且受多种因素影响。本研究旨在探究中国青少年自杀行为暴露与其自身NSSI之间的关系。方法 研究对象来自山东省青少年行为与健康队列研究。选取参与了2015年基线调查和2016年第一次随访调查,并且基线调查中不存在NSSI行为史的5 154名学生为研究对象。研究内容通过自填式问卷收集,包括基本人口学信息、社会心理学信息、终生及过去一年NSSI情况、自杀行为暴露史等。采用多因素logistic回归模型分析基线自杀行为暴露与一年后NSSI间的关系。结果 5 154名研究对象的基线年龄为（14.49±1.48）岁,女性占48.5%。9.0%的青少年报告曾暴露于自杀行为,其中6.0%暴露于自杀未遂,4.9%暴露于自杀死亡,7.3%暴露于朋友/熟人的自杀行为,3.1%暴露于亲属的自杀行为。自杀行为暴露组的过去一年NSSI发生率高于非暴露组,差异有统计学意义（P<0.05）。多因素logistic回归分析显示,与非暴露组相比,暴露于自杀死亡（OR=1.91,95% CI：1.22~3.01）和暴露于亲属自杀行为（OR=1.79,95% CI：1.02~3.12）与NSSI风险增加有关。结论 暴露于自杀死亡或亲属自杀行为可能会增加青少年NSSI行为风险。自杀事件发生后,针对高危人群进行心理疏导和健康教育可促进青少年身心健康、预防自我伤害。     

青岛市男男性行为人群HIV暴露后预防药物使用及相关因素分析

目的 了解青岛市MSM对HIV暴露后预防（PEP）药物使用率及相关因素，为MSM艾滋病防控工作提供参考。方法 采用横断面调查设计，于2022年4月至2023年2月，依托青岛市MSM社会组织，采用滚雪球抽样方法招募MSM研究对象，纳入标准为年龄≥18岁男性、最近6个月发生同性肛交或口交、HIV阴性或感染状态未知，估计样本量为566人。通过现场问卷调查收集研究对象的人口学特征、性行为特征和PEP药物使用情况等信息。采用logistic回归模型分析使用PEP药物的相关因素。结果 MSM研究对象共811人，以25~34岁（53.6%，435/811）、未婚（74.7%，606/811）、月均收入≥5 000元（52.2%，423/811）和在青岛市居住时间≥10年（75.6%，613/811）为主，最近6个月知晓性伴HIV感染状态者占67.1%（544/811）、有HIV阳性性伴者占3.6%（29/811），最近6个月发生群交、发生无保护肛交和使用新型毒品者分别占86.4%（701/811）、98.2%（796/811）、80.3%（651/811）。PEP药物使用率为28.4%（230/811）。多因素logistic回归分析结果显示，研究对象使用PEP药物的相关因素包括离异/丧偶（aOR=5.46，95%CI：1.96~15.17）、月均收入≥5 000元（aOR=2.04，95%CI：1.44~2.89）、性取向为同性恋（aOR=0.40，95%CI：0.22~0.71）、最近6个月有HIV阳性性伴（aOR=2.54，95%CI：1.13~5.71）、最近6个月HIV检测≥3次（aOR=1.46，95%CI：1.04~2.06）。结论 青岛市MSM的危险行为发生率较高，PEP药物使用率较低，应加大对该人群的艾滋病防治知识宣教，倡导知情交友，降低危险行为发生率；探索PEP药物的医保报销方案，降低使用成本，促进MSM在发生HIV暴露后尽早使用PEP药物。     

Effectiveness of post-exposure prophylaxis during varicella outbreaks among primary and middle school students in Shanghai: An analysis of three-year surveillance data

ObjectivesTo evaluate the effectiveness of post-exposure prophylaxis conducted during varicella outbreaks among students in Shanghai.MethodsSurveillance data were collected from September 1, 2013 to December 31, 2016 involving 3524 susceptible students in 109 primary and middle school classes where emergency vaccinations (EVs) had been administered. Students were divided into two groups according to their prior vaccination (PV) varicella vaccine status. A secondary attack rate was used to compare EV and non-EV groups using a chi-squared test. Stratification analyses were performed, adjusting for the EV administration date, the vaccination coverage rate, and the number of cases prior to the EV.ResultsThe effectiveness rate was 92.2% (95% confidence interval (CI): 37.1–99.0%) when EV was applied within 3 days following the outbreak onset date, and 95.2% (95% CI: 79.9–98.8%) when vaccination coverage was ≥80% among students with PV. When students with PV received an EV for varicella within 3 days, the effectiveness rate was 100%.ConclusionsEV showed high protective effectiveness for varicella during outbreaks, especially if administered within 3 days of an outbreak and in conjunction with a high coverage rate.     

HIV非职业暴露后预防药物使用的影响因素研究进展

非职业暴露后预防（nPEP）是阻断HIV传播的一种生物学手段,欧美等国家及WHO均推荐在HIV高危人群中推广使用nPEP,但至今其使用率依然很低。信息-动机-行为技巧模型（IMB模型）可以准确的解释健康行为的发生和改变,本文以该模型为理论框架对nPEP药物使用的影响因素研究进行综述,为更深入研究如何促进nPEP的使用提...     

The effects of combined exposure to road traffic noise and whole body vibration on types of attention among men

Background: Noise and vibration are considered as harmful physical agents in the environment which have adverse effects on cognitive performance. One of the occupations at risk is driving, where there is a possibility of simultaneous exposure to road traffic noise and whole body vibration (WBV) transferred through the vehicle. This study aims to assess the effects of single and combined exposure to road traffic noise and WBV on different types of attention in men. Methods: The experiment was conducted on 24 men in 4 steps, executed on each participant inside an acoustic room. After recording a number of various attention scores at background conditions (27 dBA noise, no vibration) the participants were given single and combined exposure to noise levels at 55 and 85 dBA and vibration magnitude of 0.65 and 0.95 m/s² r.m.s. Results: As for combined exposure to noise and vibration, increasing vibration acceleration and noise levels at the same time compared to background condition caused a rise in the score of all visual attention types among groups exposed to low vibration acceleration and those exposed to medium acceleration and low noise. Nevertheless, when noise level and vibration acceleration is increased at the same time compared to background, auditory attention type scores mostly fell among groups with similar vibration accelerations. Conclusions:Overall, single and combined exposure to environmental stressors under investigation had a predominantly negative effect on auditory attention while the effects on visual attention were inconclusive. Definitive conclusions however require further systematic and comprehensive experiments.     

济宁市2011—2015年狂犬病暴露人群流行病学特征分析

目的了解山东省济宁市狂犬病暴露人群暴露流行病学特征及暴露后处置情况,为狂犬病防控提供科学参考依据。方法收集2011—2015年济宁市狂犬病暴露登记资料进行统计分析。结果 2011—2015年共接诊狂犬病暴露病例221 272例,性别比为1.49:1,0~14岁儿童最多,占32.71%;各月均有暴露者发生,7—8月为高峰,占22.51%;致伤动物以犬类为最多,占83.92%;暴露者到狂犬病处置门诊处理为主,占79.22%,全程接种人用狂犬病疫苗的145 092例,占Ⅱ、Ⅲ级暴露的72.16%,注射过狂犬病被动免疫制剂的12 783例,占Ⅲ级暴露的18.6%。结论济宁市群众对狂犬病防控知识缺乏,狂犬病暴露规范处置率较低,应加强狂犬病监测和健康教育,提高狂犬病防治知识。     

Determinants of delay in initiating post-exposure prophylaxis for rabies prevention among animal bite cases: Hospital based study

Background

India is highly endemic for rabies. Although fatal, rabies is a preventable disease. Several factors interfere with the timely utilization of post exposure prophylaxis (PEP) in the population. There is a need to explore the factors leading to delay in PEP initiation.

Objective

To study the factors associated with delay in initiation of PEP among animal bite cases attending anti-rabies clinic in the out-patient department (OPD) of a hospital in Delhi.

Materials and methods

A cross-sectional hospital based study was conducted among 200 patients attending the anti-rabies clinic. After obtaining informed consent, the patients were interviewed using a pre-tested, semi-structured questionnaire to find out the delay in initiation of PEP and the factors associated with it.

Results

Most common biting animal was found to be dog (96%). Out of the studied subjects (n = 200), 134 (67%) were males, 123 (61.5%) were from rural areas and 61 (30.5%) were illiterate. Delay in initiation (vaccine initiation in more than or equal to 48 h) of PEP was found among 41% of the studied subjects. The mean time spent during each visit by the study subjects were 3.46 h (SD 1.60). Delay was more likely in people living at a distance of more than 10 km from the vaccination centre (p < 0.001) and with a monthly family income less than 5000 INR (p = 0.004). Delay showed an increasing trend with age (p = 0.041). Most commonly cited reasons by the respondents (n = 82) for the inability to come early for vaccination included work related barriers (42.68%), anti-rabies clinic being closed on Sundays/national holidays (36.59%) and unawareness about timely PEP (31.71%).

Conclusion

Accessibility and lower economic status were the major factors associated with delay in initiation of PEP for rabies prevention.     

Cost-effectiveness of rabies post-exposure prophylaxis in the context of very low rabies risk: A decision-tree model based on the experience of France

IntroductionBenefit-risk of different anti-rabies post-exposure prophylaxis (PEP) strategies after scratches or bites from dogs with unknown rabies status is unknown in very low rabies risk settings.Design and settingA cost-effectiveness analysis in metropolitan France using a decision-tree model and input data from 2001 to 2011.PopulationA cohort of 2807 patients, based on the mean annual number of patients exposed to category CII (minor scratches) or CIII (transdermal bite) dog attacks in metropolitan France between 2001 and 2011.InterventionsFive PEP strategies: (A) no PEP for CII and CIII; (B) vaccine only for CIII; (C) vaccine for CII and CIII; (D) vaccine+ rabies immunoglobulin (RIG) only for CIII; and (E) vaccine for CII and vaccine+ RIG for CIII.Main outcomes measuresThe number of deaths related to rabies and to traffic accidents on the way to anti-rabies centers (ARC), effectiveness in terms of years of life gained by reducing rabies cases and avoiding traffic accidents, costs, and incremental cost-effectiveness ratios (ICER) associated with each strategy.ResultsStrategy E led to the fewest rabies cases (3.6 × 10⁻⁸) and the highest costs (€1,606,000) but also to 1.7 × 10⁻³ lethal traffic accidents. Strategy A was associated with the most rabies cases (4.8 × 10⁻⁶), but the risk of traffic accidents and costs were null; therefore, strategy A was the most effective and the least costly. The sensitivity analysis showed that, when the probability that a given dog is rabid a given day (P_A) was >1.4 × 10⁻⁶, strategy D was more effective than strategy A; strategy B became cost-effective (i.e. ICER vs strategy A <3 × French Gross Domestic Product per capita) when P_A was > 1.4 × 10⁻⁴.ConclusionsIn the metropolitan France's very low rabies prevalence context, PEP with rabies vaccine, administered alone or with RIG, is associated with significant and unnecessary costs and unfavourable benefit-risk ratios regardless to exposure category.     

Preventable exposure to trimethyl tin chloride: a case report

Trimethyl tin chloride (TMTC) is a highly toxic organotin compound that affects four main target organs: the brain, liver, immune system and skin. Exposure can occur by inhalation, ingestion or direct skin absorption. Trimethyl tin is but one of many hazardous substances with potentially serious health consequences to which individuals working in research laboratories may be exposed. We report a preventable case of TMTC exposure. Better understanding of the Canadian Workplace Hazardous Materials Information System (WHMIS) legislation and its applicability to the research laboratory situation would prevent such unnecessary exposure to hazardous substances.     

Occupational exposure to HIV and the use of post-exposure prophylaxis

The use of antiretroviral therapy as post-exposure prophylaxis against human immunodeficiency virus (HIV) is now routine following high-risk exposure to the HIV virus. This article summarizes the management of health care workers and others exposed to HIV in an occupational setting, and the evidence behind it.