Abstract
We report the utility of rapid antigen tests (RAgT) in a cohort of US healthcare personnel with coronavirus disease 2019 (COVID-19) infection who met symptom criteria to return to work at ...day 5 or later of isolation. In total, 11.9% of initial RAgT were negative. RAgT can be helpful to guide return to work decisions.
To assess the rate and factors associated with healthcare personnel (HCP) testing positive for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) after an occupational exposure.
Retrospective ...cohort study.
Academic medical center with sites in Minnesota, Wisconsin, Arizona, and Florida.
HCP with a high or medium risk occupational exposure to a patient or other HCP with SARS-CoV-2.
We reviewed the records of HCP with significant occupational exposures from March 20, 2020, through December 31, 2020. We then performed regression analysis to assess the impact of demographic and occupational variables to assess their impact on the likelihood of testing positive for SARS-CoV-2.
In total, 2,253 confirmed occupational exposures occurred during the study period. Employees were the source for 57.1% of exposures. Overall, 101 HCP (4.5%) tested positive in the postexposure period. Of these, 80 had employee sources of exposure and 21 had patient sources of exposure. The postexposure infection rate was 6.2% when employees were the source, compared to 2.2% with patient sources. In a multivariate analysis, occupational exposure from an employee source had a higher risk of testing positive compared to a patient source (odds ratio OR, 3.22; 95% confidence interval CI, 1.72-6.04). Sex, age, high-risk exposure, and HCP role were not associated with an increased risk of testing positive.
The risk of acquiring coronavirus disease 2019 (COVID-19) following a significant occupational exposure has remained relatively low, even in the prevaccination era. Exposure to an infectious coworker carries a higher risk than exposure to a patient. Continued vigilance and precautions remain necessary in healthcare settings.
Healthcare workers (HCWs) undergo occupational tuberculosis screening at regular intervals. However, the risk of contracting tuberculosis at the workplace in a setting with a low background ...tuberculosis incidence is unclear. We aimed to evaluate the risk of tuberculin skin test (TST) conversion and the risk of occupational tuberculosis infection among HCWs in such a setting.
We conducted a retrospective cohort study of employees of a large tertiary medical center in the US Midwest who had undergone TST screening during the study period 1 January 1998 to 31 May 2014.
Among 40142 HCWs who received a TST, only 123 converted over 16.4 years. Only 9 (7%) of the converters had a suspected tuberculosis exposure at the workplace and none developed active tuberculosis. The majority of TST converters (66%) had a negative QuantiFERON-TB test at the time of the conversion.
In one of the largest cohorts of HCWs in a low-tuberculosis-incidence setting, we demonstrated an extremely low risk of occupational tuberculosis exposure among TST converters and no resulting active tuberculosis cases. In this setting, the approach of testing HCWs at baseline and after tuberculosis exposure, rather than at regular intervals, should be considered.
Abstract
Background
US public health strategy for eliminating tuberculosis (TB) prioritizes treatment of latent TB infection (LTBI). Healthcare personnel (HCP) are less willing to accept treatment ...than other populations. Little is known about factors associated with HCP LTBI therapy acceptance and completion.
Methods
We conducted a retrospective chart review to identify all employees with LTBI at time of hire at a large academic medical center during a 10-year period. Personal demographics, occupational factors, and clinic visit variables were correlated with LTBI treatment acceptance and completion rates using multivariate logistic regression.
Results
Of 470 HCP with LTBI for whom treatment was recommended, 193 (41.1%) accepted treatment, while 137 (29.1%) completed treatment. Treatment adherence was better with 4 months of rifampin than 9 months of isoniazid (95% vs 68%, P < .005). Increased age of the healthcare worker was independently associated with lower rates of treatment acceptance (odds ratio 95% confidence interval: 0.97 0.94–0.99 per year), as was having an occupation of clinician (0.47 0.26–0.85) or researcher (0.34 0.19–0.64). Male gender was associated with higher treatment acceptance (1.90 1.21–2.99). Treatment completion was associated with being from a low- (9.49 2.06–43.73) or medium- (8.51 3.93–18.44) TB-burden country.
Conclusions
Geographic and occupational factors affect acceptance and completion of LTBI therapy. Short-course regimens may improve adherence. Physicians, researchers, and HCP from high-TB-burden countries have lower treatment rates than other HCP. Improving LTBI treatment in HCP will require attending to cultural and occupational differences.
The aim of the study is to identify lessons learned implementing JYNNEOS vaccination for laboratory workers exposed to orthopoxviruses such as mpox.
Workers at risk of laboratory exposure were ...offered vaccine in a carefully planned occupational health program. Vaccine was procured from the Centers for Disease Control and Prevention (CDC) Drug Service, which has special requirements. Reasons for accepting or declining vaccine and adverse effects were obtained by survey.
Most workers accepted JYNNEOS, and occupational risk was the most commonly cited reason for acceptance. Most experienced mild local adverse effects. The administrative requirements of the Centers for Disease Control and Prevention Drug Service are documented.
Occupational health programs caring for laboratory workers handling unusual biological agents require careful planning and coordination to facilitate access to vaccines that are not commercially available, anticipate and mitigate barriers to vaccination, and comply with special Centers for Disease Control and Prevention requirements.
OBJECTIVE:The National Institute for Occupational Safety and Health recommends that institutions establish a medical surveillance program for workers who handle hazardous drugs. Our aim was to ...investigate current practices with occupational medicine practice (OMP) national leaders.
METHODS:A series of qualitative telephone interviews were conducted with 11 OMP national leaders from medical centers in 10 states. Interviews were recorded, transcribed, and coded using a directed content analysis. Codes were organized into themes.
RESULTS:All respondents were board-certified physicians in medical center OMP. Interviews up to 45 minutes found three themespolicy interpretation, benefits and barriers to surveillance, and potential respondent-generated solutions. Three of 10 medical centers provided medical surveillance.
CONCLUSIONS:Medical surveillance for hazardous drugs is infrequent, and consensus is lacking regarding standard practices. Further work is needed to minimize risk to health care workers.
Abstract
Background
The protective efficacy of prior coronavirus disease 2019 (COVID-19) with or without vaccination remains unknown. This study sought to understand if 2 or more messenger RNA (mRNA) ...vaccine doses provide additional protection in patients with prior infection, or if infection alone provides comparable protection.
Methods
We conducted a retrospective cohort study of the risk of COVID-19 from 16 December 2020 through 15 March 2022, among vaccinated and unvaccinated patients of all ages with and without prior infection. A Simon-Makuch hazard plot illustrated the incidence of COVID-19 between groups. Multivariable Cox proportional hazards regression was used to examine the association of demographics, prior infection, and vaccination status with new infection.
Results
Among 101 941 individuals with at least 1 COVID-19 polymerase chain reaction test prior to 15 March 2022, 72 361 (71.0%) received mRNA vaccination and 5957 (5.8%) were previously infected. The cumulative incidence of COVID-19 was substantially higher throughout the study period for those previously uninfected and unvaccinated, and lowest for those previously infected and vaccinated. After accounting for age, sex, and the interaction between vaccination and prior infection, a reduction in reinfection risk was noted during the Omicron and pre-Omicron phases of 26% (95% confidence interval CI, 8%–41%; P = .0065) to 36% (95% CI, 10%–54%; P = .0108), respectively, among previously infected and vaccinated individuals, compared to previously infected subjects without vaccination.
Conclusions
Vaccination was associated with lower risk of COVID-19, including in those with prior infection. Vaccination should be encouraged for all including those with prior infection, especially as new variants emerge and variant-specific booster vaccines become available.
COVID-19 mRNA vaccination was associated with lower risk of COVID-19, including in those with prior COVID-19. Vaccination should be encouraged for those with remote prior infection, especially as new variants emerge and variant-specific booster vaccines become available.
Graphical Abstract
Graphical Abstract
This graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/COVID-19-vaccination-is-boosts-more-protective-immunity-in-previously-infected/update
PDF
