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When SARS-CoV-2 variants of concern were first described, the epidemiologic situation was characterized by sequential waves of Alpha, Beta, Gamma, and Delta variants, with relatively few other variants cocirculating with [...]

We conducted a study among healthcare workers (HCWs) exposed to patients with severe acute respiratory syndrome (SARS) before infection control measures were instituted. Of all exposed HCWs, 7.5% had asymptomatic [...]

International organizations must do more to teach medical personnel in developing countries how to prevent occupational exposure to infectious organisms. In particular, they should be taught not to re-use hypodermic needles.

The case of a 48-year-old health care worker illustrates the potentially deadly interaction between HIV and the hepatitis C virus. She was stuck by a needle used on an AIDS patient. She tested negative for HIV up to 8 months after this exposure. However, 10 months after exposure, she became ill and an HIV test at that time was positive. After she developed signs of liver dysfunction, she was tested for hepatitis C virus and was found to be positive. Eighteen months after becoming HIV-positive, she died of liver and kidney failure. Her viral isolates were closely related to those isolated from the AIDS patient.

Objectives. The purpose of this study was to investigate a nosocominal outbreak of hepatitis A that occurred in the burn treatment center of a referral hospital. Methods. Retrospective cohort and case-control studies were performed to determine acquisition rates and risk factors for transmission. Adjusted infection rates were calculated by week of exposure. A case-control study was conducted to determine potential mechanisms for nosocomial acquistion. Recently infected health care workers were defined as case patients; exposed, serosusceptible health care workers without infection served as controls. Results. The outbreak of hepatitis A affected 11 health car workers and 1 other burn patient ( 1 secondary patient case). All 11 health care workers became ill after the admission of a man and his 8-month-old son who developed hepatitis A while in the hospital. The cumulative incidence risk ratio was elevated for health care workers caring for either the infant or the father during the same week of exposure. The case-control study implicated the behavior of eating on the hospital ward as the single most important risk factor for infection. Conclusion. Inadequate handwashing and subsequent oral contamination appear responsible for the outbreak. Hospitals may witness other institutional outbreaks if health care workers regularly eat on the wards. (Am J Public Health. 1993;83: 1679-1684), An outbreak of Hepatitis A on the burn unit of an Iowa hospital was most likely caused by healthcare workers eating in the unit after caring for two patients who were incubating the virus before hospitalization. A father and son, injured in a house fire, were admitted to the burn unit in Dec, 1989. Between Jan and Mar, 1990, 11 healthcare workers and one other patient on the ward became ill with Hepatitis A, a disease known to spread via fecal-oral contact. A full-scale epidemiologic investigation ensued. All patients and staff on the ward before and during the hospitalization of the father and son were screened and questioned. A case-control study matching 60 of 154 exposed healthcare workers (HCWs) to the 11 HCW cases revealed that eating on the burn center and sharing snacks among health care workers placed workers at highest risk, followed by contact with the ill infant's mother and by providing hydrotherapy to patients.

HIV-infected patients who are exposed to another patient with a positive acid-fast bacillus (AFB) sputum-smear may be more likely to develop a multidrug-resistant (MDR) tuberculosis infection. The prevalence of MDR tuberculosis may be higher among HIV-infected individuals than among other individuals. Among HIV-infected patients with tuberculosis who were treated at an HIV ward or clinic at a Florida hospital between Jan 1988 and Jan 1990, 25 developed a MDR tuberculosis infection and 62 developed a drug-susceptible tuberculosis infection. Patients with MDR tuberculosis were more likely to have been exposed to the sputum of a patient with an AFB-positive smear than those with a drug-susceptible infection. Among health care workers who worked in the HIV ward and clinic, the risk of a positive skin test for tuberculosis exposure increased with the amount of exposure to patients with positive AFB sputum.

The ethical controversy surrounding the Centers for Disease Control (CDC) and American Medical Association (AMA) guidelines for restricting the practice of HIV-infected health professionals appears to hinge on whether we give priority to the rights of infected workers or patients. We cannot simply dismiss the concerns of patients as irrational, despite the low risks of transmission. Nor can we avoid the dispute about rights by claiming with the AMA that professionals have obligations to refrain from imposing 'identifiable risks,' however low, on patients. Nevertheless, allowing the full exercise of patient rights, either by giving patients the opportunity to know the risks they face and to switch providers, or by removing infected providers (compulsory switching), would make each of us worse off. This gives us adequate reason to reject these guidelines and to emphasize other infection control measures.

Medical residents and students who are directly offered the influenza vaccine at conferences and clinics are more likely to be vaccinated than those who are offered the vaccine by other methods. A total of 442 medical residents and students were sent a memorandum regarding vaccination, then half of the remaining unvaccinated individuals were sent a personal letter, half of the letter recipients received a telephone call, and the remaining unvaccinated individuals were directly offered vaccination at conferences and clinics. During the three weeks following the memorandum, 87 individuals (20%) were vaccinated. Five weeks after the letter, 61 individuals (34%) who received letters were vaccinated, compared to 30 individuals (17%) who did not receive letters. By the end of the study, 275 individuals (62%) were vaccinated, 29 (7%) refused and 138 (31%) did not receive the notices. The number of individuals who were vaccinated did not increase significantly after telephone notification. Ninety percent of the individuals offered the vaccine at conferences and clinics were vaccinated, and 10% refused.

The Centers for Disease Control (CDC) issued new guidelines in Jul 1991 for health care workers infected with HIV or hepatitis B who perform invasive procedures. The guidelines recommend that infected health care workers not perform exposure-prone procedures, and exposure-prone procedure will be defined on a case-by-case basis. The CDC estimates that the risk of contracting HIV from an infected surgeon during an invasive procedure is between one in 40,000 and one in 400,000. This risk is much smaller than others encountered every day by patients. But if patients know that a surgeon is infected with HIV, they may avoid the risk of infection completely by switching to an uninfected surgeon. Physicians should try to protect their patients from risk, but a surgeon infected with HIV may not be obligated to refrain from surgery. The CDC risk estimate does not specify whether the rights of patients or the rights of HIV-infected surgeons should be given higher priority. Enforcement of the CDC guidelines may be expensive, and they may discriminate against HIV-infected health care workers., The ethical issues surrounding the Centers for Disease Control and American Medical Association guidelines for health professionals infected with the human immunodeficiency virus are examined and discussed. Although human immunodeficiency virus transmission risks during surgery are lower than many risks we routinely face, it is not irrational for a patient to want to switch from an infected professional to an uninfected one. The American Medical Association claim that physicians have a duty to avoid imposing any identifiable risks is implausible. Knowing the Centers for Disease Control estimate of risks gives us no way to decide whether the rights of patients or those of handicapped (infected) workers should be given priority. Granting priority to patient rights, either by giving patients the opportunity to know the risks they face and to switch to another provider, or by removing infected providers (compulsory switching), makes us all worse off. This gives us reason to reject these guidelines and emphasize other infection control measures. (JAMA. 1992;267:1368-1371)

The activities of health care workers infected with the human immunodeficiency virus (HIV) may be restricted to prevent transmission of HIV to their patients. The Centers for Disease Control (CDC) has estimated that the risk of contracting HIV from an infected health care worker is between one in 42,000 and one in 420,000. Many patients are concerned about contracting HIV from infected health care workers, and believe that HIV-infected health care workers should not be allowed practice. In Jul 1991, the CDC recommended that a panel of medical experts decide on a case-by-case basis whether HIV-infected health care workers can perform surgeries and other invasive procedures. It also recommended that all health care workers should undergo HIV testing. These recommendations are under review as of Feb 1992. Health care workers should try to protect their patients from HIV infection, but their own right to privacy and a livelihood should be protected also., The tragedy of five patients who contracted human immunodeficiency virus (HIV) infection from a seropositive dentist has alarmed the public. The Centers for Disease Control (CDC) recently revised its recommendations for preventing the transmission of HIV infection to patients during invasive procedures. The CDC abandoned a previous plan to list exposure-prone invasive procedures that HIV-infected health care workers should not perform. The CDC said "expert review panels" should decide on a case-by-case basis whether seropositive health care workers may perform invasive procedures. As of February 1992, the revised recommendations were under review by the US Department of Health and Human Services. Many issues remain to be clarified, such as how these panels will operate and whether decisions will be consistent in similar cases. Disregarding the CDC guidelines or infection-control precautions may further erode public trust and lead to draconian restrictions on HIV-infected health care workers. Physicians and dentists should respond more effectively to public fears about HIV transmission. The challenge is to protect patients while respecting the privacy and livelihood of health care workers.

Health care workers are at significant risk for infection with the hepatitis B virus (HBV). The safety and effectiveness of the vaccine has been demonstrated in persons with healthy, functioning immune systems. Current evidence shows that, in some persons, antibodies to HBV will be maintained indefinitely. Health care personnel who received the hepatitis B vaccine were followed for persistence of hepatitis-B surface antibody (anti-HBs) for three years to evaluate response rates and to measure baseline anti-HBs in the population. The study group was drawn from the employees of the Veterans Administration Hospital Center in Buffalo, New York. The vaccine was administered in three doses, according to current dosage recommendations. Blood samples were collected 7, 12, 24 and 36 months after the first dose. Non-responders and those with demonstrable loss of antibody over time were given a fourth dose. Responses occurred in 92.5 percent of the vaccinees. Age and the magnitude of the initial antibody level, but not physical characteristics, were predictive of loss of antibody over three years. Three out of eight people who failed to respond to the initial three doses produced demonstrable antibody after the fourth dose of vaccine. The need for booster doses of vaccine is not clear; more research will be required to settle this issue. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cytomegalovirus (CMV) is one of a group of herpesviruses which inhabit the salivary glands and may result in infection or remain inactive. The virus is commonly found in infants, but may occur at any time, with variable severity. The CMV-infected individual may be without symptoms, or may have a fever or complications involving the liver or spleen. In infants, this virus can cause mental or motor retardation and death. Recent studies have indicated a greater prevalence of CMV infection among adults who have close contact with children, such as day-care workers and primary caregivers within the family. To further investigate this relationship, a four-year study was conducted among 1,250 employees at a children's hospital. The group comprised of a variety of personnel, including administrators, laboratory workers, and individuals who had direct patient contact. At the beginning of the study, 63 percent (783) of the group tested positive for cytomegalovirus. Factors that were associated with individuals who were positive for CMV antibodies were age (over 30 years), female sex, black race, less than 16 years of education, more than one year of employment, and marital status. Of the group who tested negative, 300 were followed-up for an average of 1.96 years. Out of this subgroup, only 13 individuals developed the CMV antibodies, which is comparable to the incidence that is found in the general population. No correlations were found between those testing positive and the number of hours worked or job type. It was concluded that employment in a children's hospital does not increase a worker's risk for CMV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Byline: Y. Avitzur (1), J. Amir (2) Keywords: Key Words Herpetic whitlow; Occupational hazard; General pediatrician Abstract: Herpetic whitlow is a well-known occupational hazard for medical staff. It has been reported to affect mainly workers in intensive care units who come into close contact with oral secretions. We report herpetic whitlow infection in a general pediatrician in order to increase the awareness to this infectious occupational hazard that might occur in any health care worker who deals with oral secretions. A 35-year-old male general pediatrician sustained a minor knife cut in his finger and 5 days later he developed herpetic whitlow. He was treated with acyclovir with gradual improvement. We review the clinical course, complications and treatment of herpetic whitlow. The source of the infection in the present case was unknown, but it probably derived from oral secretions of children with unrecognized infection. Simple measures like wearing gloves during oral examination will avoid unnecessary morbidity in medical staff. Author Affiliation: (1) The Hospital for Sick Children, 555 University Ave, Toronto, Ontario M5G 1X8, Canada, e-mail: yaron.avitzur@sickkids.ca, CA (2) Dept. of Pediatrics C, Schneider Children's Medical Center of Israel, Petah-Tikva, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel, IL Article note: Received: November 2, 2001 * Revision accepted: April 3, 2002

HIV-infected patients are likely to develop tuberculosis (TB) if they are exposed to a patient who has TB. Health care workers who care for TB patients are also at risk of developing TB. Of 240 patients in an HIV unit in a large hospital, 17% of those exposed to a TB patient developed TB, but only two percent of those not exposed developed TB. Overall, the HIV patients exposed to a TB patient were 11 times more likely to develop TB than those who were not exposed. Of 908 health care workers tested for TB infection, nurses in the HIV unit were six times more likely to have a positive tuberculin test than clerical workers on another floor. Nurses in the internal medicine wards, which were on the same floor as the HIV unit, were also six times more likely to have a positive tuberculin test. HIV patients should be screened for TB and should be placed in isolation and treated if they are found to be infected. Health care workers should also be screened.

A proposal to drop the requirement for HIV-infected health care workers to disclose their status to patients needs further examination. The argument for the change is that the risk of transmission is very low and disclosure violates the health care workers privacy and civil rights.

The policy requiring HIV-infected health care workers to disclose this information to patients should be changed. Research has shown that the risk of transmission in the health care setting is extremely low, and forced disclosure violates the health care worker's privacy and civil rights. An updated policy is described.