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Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant (B.1.1.529) is dominating coronavirus disease 2019 (COVID-19) worldwide. The waning protective effect of available vaccines against the Omicron variant is a critical public health issue. This study aimed to assess the impact of the third COVID-19 vaccination on immunity against the SARS-CoV-2 Omicron BA.1 strain in older individuals. Materials and Methods: Adults aged ≥60 years who had completed two doses of the homologous COVID-19 vaccine with either BNT162b2 (Pfizer/BioNTech, New York, NY, USA, BNT) or ChAdOx1 nCoV (SK bioscience, Andong-si, Gyeongsangbuk-do, Korea, ChAd) were registered to receive the third vaccination. Participants chose either BNT or mRNA-1273 (Moderna, Norwood, MA, USA, m1273) mRNA vaccine for the third dose and were categorized into four groups: ChAd/ChAd/BNT, ChAd/ChAd/m1273, BNT/BNT/BNT, and BNT/BNT/m1273. Four serum specimens were obtained from each participant at 0, 4, 12, and 24 weeks after the third dose (V1, V2, V3, and V4, respectively). Serum-neutralizing antibody (NAb) activity against BetaCoV/Korea/KCDC03/2020 (NCCP43326, ancestral strain) and B.1.1.529 (NCCP43411, Omicron BA.1 variant) was measured using plaque reduction neutralization tests. A 50% neutralizing dilution (ND50) >10 was considered indicative of protective NAb titers. Results: In total, 186 participants were enrolled between November 24, 2021, and June 30, 2022. The respective groups received the third dose at a median (interquartile range [IQR]) of 132 (125 - 191), 123 (122 - 126), 186 (166 - 193), and 182 (175 - 198) days after the second dose. Overall, ND50 was lower at V1 against Omicron BA.1 than against the ancestral strain. NAb titers against the ancestral strain and Omicron BA.1 variant at V2 were increased at least 30-fold (median [IQR], 1235.35 [1021.45 - 2374.65)] and 129.8 [65.3 - 250.7], respectively). ND50 titers against the ancestral strain and Omicron variant did not differ significantly among the four groups (P = 0.57). NAb titers were significantly lower against the Omicron variant than against the ancestral strain at V3 (median [IQR], 36.4 (17.55 - 75.09) vs. 325.9 [276.07 - 686.97]; P = 0.012). NAb titers against Omicron at V4 were 16 times lower than that at V3. Most sera exhibited a protective level (ND50 >10) at V4 (75.0% [24/32], 73.0% [27/37], 73.3% [22/30], and 70.6% [12/17] in the ChAd/ChAd/BNT, ChAd/ChAd/m1273, BNT/BNT/BNT, and BNT/BNT/m1273 groups, respectively), with no significant differences among groups (P = 0.99). Conclusion: A third COVID-19 mRNA vaccine dose restored waning NAb titers against Omicron BA.1. Our findings support a third-dose vaccination program to prevent the waning of humoral immunity to SARS-CoV-2. [ABSTRACT FROM AUTHOR]

A 35-year-old man who returned from Germany developed fever, generalized pain, severe anal pain, and generalized skin rash, confirmed to be monkeypox (mpox). While he was previously confirmed to be human immunodeficiency virus infected, antiretroviral therapy ensured his immunocompetence. The mpox-related prodromal symptoms disappeared before isolation, and subsequent several vesicular skin lesions healed after admission. While moderate anal pain persisted for a few days, it improved during hospitalization. The mpox virus was no longer detected in samples taken from the upper respiratory tract and skin by polymerase chain reaction upon admission. However, isolated perianal ulcers developed after admission without any other mpox-related symptoms or signs, and a viable mpox virus was isolated from these ulcers. Considering the novel feature of asynchronous mucocutaneous lesion development in the current mpox epidemic, meticulous physical examination of newly developing lesions, especially in anogenital areas, should be performed during mpox management. [ABSTRACT FROM AUTHOR]

배경: During the coronavirus disease 2019 pandemic, the number of newly diagnosed HIV patients, which had increased until 2019, had markedly decreased in Korea. This study aimed to evaluate the decrease in new HIV patients was resulted from whether a decrease in actual incidence of HIV infection, and/or aggravated underdiagnoses or delayed diagnoses during the pandemic. 방법: Patients newly diagnosed with HIV were retrospectively enrolled from four general hospitals in Korea from February 2018 to January 2022. The basic characteristics of patients were described, and univariate analysis was performed between pre-pandemic and pandemic period. The lapse time from infection to diagnosis was estimated using HIV modelling tool based on the extended back-calculation method built by European Centre for Disease Prevention and Control. 결과: In total, 587 patients were enrolled, and 96.4% was male. The estimated mean lapse time to diagnosis was 5.68 years in pre-pandemic period and shortened to 5.41 years in pandemic period. And the proportion of patients with AIDS-defining illnesses, who are expected to visit medical institutions regardless of the pandemic, was decreased as 11.9% in pandemic period from 17.2% in pre-pandemic period. In referred cases, the duration from HIV testing to the first visit of medical institutions for treatment was significantly delayed during the pandemic as median 29 days from median 20 days before the pandemic (p=0.007). Although the duration from HIV testing to treatment was delayed during the pandemic, these results suggest that there was no clear evidence of worsening underdiagnoses or delayed diagnoses given the shortened estimated lapse time to diagnosis and decreased proportion of AIDS-defining illnesses in pandemic period. 결론: The decrease in newly diagnosed HIV patients in Korea during the pandemic seems to be resulted from the actual decrease in incidence of HIV infection, rather than aggravated underdiagnoses and delayed diagnoses due to the pandemic. [ABSTRACT FROM AUTHOR]

Despite the coronavirus disease 2019 (COVID-19) vaccination roll-out, variant-related outbreaks have occurred repeatedly in Korea. Although public hospitals played a major role in COVID-19 patients’ care, difficulty incorporating evolving COVID-19 treatment guidelines called for a clinical pathway (CP). Eighteen public hospitals volunteered, and a professional review board was created. CPs were formulated containing inclusion/exclusion criteria, application flow charts, and standardized order sets. After CP roll-out, key parameters improved, such as increased patient/staff five-point satisfaction scores (0.41/0.57) and decreased hospital stays (1.78 days)/medical expenses (17.5%). The CPs were updated consistently after roll-out as new therapeutics drugs were introduced and quarantine policies changed. Despite the coronavirus disease 2019 (COVID-19) vaccination roll-out, variant-related outbreaks have occurred repeatedly in Korea. Although public hospitals played a major role in COVID-19 patients’ care, difficulty incorporating evolving COVID-19 treatment guidelines called for a clinical pathway (CP). Eighteen public hospitals volunteered, and a professional review board was created. CPs were formulated containing inclusion/exclusion criteria, application flow charts, and standardized order sets. After CP roll-out, key parameters improved, such as increased patient/staff five-point satisfaction scores (0.41/0.57) and decreased hospital stays (1.78 days)/medical expenses (17.5%). The CPs were updated consistently after roll-out as new therapeutics drugs were introduced and quarantine policies changed. [ABSTRACT FROM AUTHOR]

배경: Evidence of the effectiveness of nirmatrelvir-ritonavir in the real-world, where the omicron variant of SARS-CoV-2 is dominant and most of the population at risk had been vaccinated, is lacking. 방법: A retrospective cohort study was performed at four COVID-19-designated hospitals in Seoul, Korea. Mild COVID-19 patients who had risk factors for disease progression (aged 60 years and over or aged 40 years and over with underlying disease) and were admitted to the hospitals from February to April 2022 within five days of symptom onset were included. Nirmatrelvir-ritonavir recipients were matched to control using propensity scores (PS). The primary outcome was time to O2 support free survival and secondary outcome included a composite outcome of disease progression (applying mask, high flow nasal cannula, mechanical ventilator, or all-cause mortality). Multivariate analyses were conducted in the matched cohorts. 결과: A total of 634 mild COVID-19 patients (nirmatrelvir-ritonavir recipients (n = 258) and control (n = 376)) were included. After PS-matching, the analysis included 236 nirmatrelvir-ritonavir recipients and 236 controls. The Characteristics of participants were presented in Table. Nirmatrelvir-ritonavir recipients showed significantly longer O2 supporting-free survival than matched control, with adjusted hazard ratio (HR) 0.07 (95% C.I. 0.01, 0.30; P <0.001) (Figure). Multivariable Cox regression analysis found that nirmatrelvir-ritonavir, age (HR 1.03, 95% C.I. 1.00, 1.07), NEWS2 score at admission (HR 1.36, 95% C.I. 1.08, 1.71), women (HR 0.37, 95% C.I. 0.15, 0.88), and days from symptom onset to admission (HR 0.67, 95% C.I. 0.48, 0.95) were significantly associated with O2 supporting. However, any factor did not show a reduced risk for progression to a composite outcome of severe disease. 결론: Nirmatrelvir-ritonavir treatment was associated with a reduced risk of progression to O2 support for high-risk COVID-19 patients. [ABSTRACT FROM AUTHOR]

On the 12th day of abacavir treatment, a 39-year old HIV-infected male patient was admitted with fever, generalized rash, abdominal pain, and watery diarrhea that had persisted for five days. Results of blood tests indicated rapid progression of hepatitis and renal failure. The day after stopping anti-retroviraI therapy, his fever subsided and his liver function began to normalize. He was clinically diagnosed with abacavir hypersensitivity and was found to carry the HLA-B*57:01 allele. This is the first reported case of abacavir hypersensitivity associated with the presence of the HLA-B*57:01 allele in Korea. [ABSTRACT FROM AUTHOR]

The author reflects on the behavioral aspects of hand hygiene (HH) compliance among medical personnel. Topics discussed include the guidelines of the World Health Organization (WHO) on HH, which has five components, including system change, education of healthcare personnel and performance feedback, and the importance of an individual's perceptions on HH compliance. Also mentioned is a research which assessed the improvement in adherence and in perception and attitude regarding HH.