Posts filed under ‘Profilaxis Pre-Exposición’

Human Rabies — Virginia, 2017

MMWR January 4, 2019  V.67 N.5152 P.1410–1414

Julia Murphy, DVM1; Costi D. Sifri, MD2; Rhonda Pruitt3; Marcia Hornberger4; Denise Bonds4; Jesse Blanton, DrPH5; James Ellison, PhD5; R. Elaine Cagnina2; Kyle B. Enfield2; Miriam Shiferaw, MD5; Crystal Gigante, PhD5; Edgar Condori5; Karen Gruszynski, PhD1,6; Ryan M. Wallace, DVM5

On May 9, 2017, the Virginia Department of Health was notified regarding a patient with suspected rabies. The patient had sustained a dog bite 6 weeks before symptom onset while traveling in India.

On May 11, CDC confirmed that the patient was infected with a rabies virus that circulates in dogs in India.

Despite aggressive treatment, the patient died, becoming the ninth person exposed to rabies abroad who has died from rabies in the United States since 2008.

A total of 250 health care workers were assessed for exposure to the patient, 72 (29%) of whom were advised to initiate postexposure prophylaxis (PEP). The total pharmaceutical cost for PEP (rabies immunoglobulin and rabies vaccine) was approximately $235,000.

International travelers should consider a pretravel consultation with travel health specialists; rabies preexposure prophylaxis is warranted for travelers who will be in rabies endemic countries for long durations, in remote areas, or who plan activities that might put them at risk for a rabies exposures.

PDF

https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm675152a2-H.pdf

More information for international travelers about rabies considerations can be found on the CDC’s rabies webpage.

FULL TEXT

https://www.cdc.gov/rabies/index.html

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January 26, 2019 at 12:41 pm

Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel

Morbidity and Mortality Weekly Report. 2018;67(43):1216-1220.

Update

Noele P. Nelson, MD, PhD1; Ruth Link-Gelles, PhD1; Megan G. Hofmeister, MD1; José R. Romero, MD2; Kelly L. Moore, MD3; John W. Ward, MD1; Sarah F. Schillie, MD1

Postexposure prophylaxis (PEP) with hepatitis A (HepA) vaccine or immune globulin (IG) effectively prevents infection with hepatitis A virus (HAV) when administered within 2 weeks of exposure. Preexposure prophylaxis against HAV infection through the administration of HepA vaccine or IG provides protection for unvaccinated persons traveling to or working in countries that have high or intermediate HAV endemicity. The Advisory Committee on Immunization Practices (ACIP) Hepatitis Vaccines Work Group conducted a systematic review of the evidence for administering vaccine for PEP to persons aged >40 years and reviewed the HepA vaccine efficacy and safety in infants and the benefits of protection against HAV before international travel….

PDF

https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6743a5-H.pdf

December 10, 2018 at 3:44 pm

Being PrEPared  – Preexposure Prophylaxis and HIV Disparities.

N Engl J of Med October 4, 2018 V.379 P.1293-1295

Perspective

Robert H. Goldstein, M.D., Ph.D., Carl G. Streed, Jr., M.D., and Sean R. Cahill, Ph.D.

If current trends persist, one in six U.S. men who have sex with men will be infected with human immunodeficiency virus (HIV) in their lifetime, according to the Centers for Disease Control and Prevention (CDC).1 This prediction highlights the long road ahead if we are to end the spread of HIV in the United States, but it does not tell the full story, which is complicated and nuanced….

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMp1804306?query=infectious-disease

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMp1804306

November 6, 2018 at 8:21 am

Randomized Controlled Trial of a Mobile Health Intervention to Promote Retention and Adherence to Pre-exposure Prophylaxis among Young People at Risk for Human Immunodeficiency Virus: The EPIC Study.

Clinical Infectious Diseases September 15, 2018.             

Liu AY1,2, Vittinghoff E3, von Felten P1, Amico KR4, Anderson PL5, Lester R6, Andrew E1, Estes I7,8, Serrano P7,8, Brothers J7,8, Buchbinder S1,2,3, Hosek S7,8, Fuchs JD2,9.

Author information

1 Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA.

2 Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.

3 Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.

4 Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.

5 Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO USA.

6 Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.

7 Ruth M. Rothstein CORE Center, Chicago, IL, USA.

8 Stroger Hospital of Cook County, Department of Psychiatry, Chicago, IL.

9 Center for Learning & Innovation, San Francisco Department of Public Health, San Francisco, CA, USA.

Abstract

BACKGROUND:

Young men who have sex with men (MSM) are among the most vulnerable to HIV infection in the United States. While pre-exposure prophylaxis (PrEP) has demonstrated effectiveness, adherence and retention in care have been low among youth.

METHODS:

We conducted a randomized controlled trial to evaluate the impact of a youth-tailored, bi-directional text-messaging PrEP support intervention (PrEPmate) on study retention and PrEP adherence. Young individuals at risk for HIV acquisition initiating PrEP within Chicago’s safety-net hospital system were randomized 2:1 to receive PrEPmate or standard of care (SoC) for 36 weeks. The primary retention outcome was study-visit completion, and the primary adherence outcome was tenofovir diphosphate (TFV-DP) concentrations ≥700 fmol/punch (consistent with ≥4 doses/week) assessed at 4, 12, 24, and 36 weeks. The impact of PrEPmate on retention and adherence was evaluated using generalized estimating equation logistic models with robust standard errors.

RESULTS:

From April 2015 to March 2016, 121 participants enrolled (mean age 24; 27% Black, 36% Latino). Across all visits, participants who received PrEPmate were more likely to attend study visits (86% PrEPmate vs. 71% SoC, OR=2.62, 95%CI 1.24-5.54) and have TFV-DP levels consistent with ≥4 doses/week (72% PrEPmate vs. 57% SoC, OR=2.05, 95%CI 1.06-3.94). PrEPmate efficacy did not differ significantly by age, race/ethnicity, education, or insurance. Overall, 88% reported PrEPmate to be very/somewhat helpful, and 92% would recommend PrEPmate to others.

CONCLUSIONS:

An interactive text-messaging intervention had high acceptability and significantly increased study-visit retention and PrEP adherence among young individuals at risk for HIV acquisition.

FULL TEXT

https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciy810/5098440

PDF (CLIC en PDF

October 9, 2018 at 7:52 am

Correspondence: Multidrug-resistant HIV-1 infection despite preexposure prophylaxis.

N Engl J Med 2017 Feb 2; 376:501

Knox DC et al.

To the Editor:

Preexposure prophylaxis with emtricitabine (FTC)–tenofovir disoproxil fumarate (TDF) has been shown to be efficacious in preventing human immunodeficiency virus type 1 (HIV-1) infection in men who have sex with men and in whom adherence to treatment is high, as measured by levels of tenofovir diphosphate (TFV-DP) in dried blood spots.1 We describe a case of HIV-1 infection despite FTC-TDF–based preexposure prophylaxis.2

A 43-year-old man in Toronto who reported having sex with men began to receive oral daily FTC-TDF in April 2013 and had seven nonreactive fourth-generation HIV screening tests over the next 21 months. Pharmacy dispensation records provided support for his report of “perfect” adherence to preexposure prophylaxis over 24 months……

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMc1611639

March 14, 2017 at 7:35 am

Influenza vaccination of pregnant women and protection of their infants.

N Engl J Med. 2014 Dec 11;371(24):2340.

Madhi SA, Nunes MC, Cutland CL.

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMc1412050

April 3, 2016 at 12:10 pm

Cellular immune correlates analysis of an HIV-1 preexposure prophylaxis trial.

Proc Natl Acad Sci U S A 2015 Jun 22;[e-pub].

Carlos del Rio, MD Reviewing Kuebler PJ et al.,

aDivision of Experimental Medicine, University of California, San Francisco, CA 94110;

bInstitute of Virology & Immunology, Gladstone Institutes, San Francisco, CA 94158;

cDivision of Clinical Immunology and Allergy, University of São Paulo, São Paulo, Brazil 01246;

dDepartment of Microbiology, Immunology and Tropical Medicine, George Washington University, Washington, DC 20037;

eDepartment of Epidemiology and Biostatistics, University of California, San Francisco, CA 94158;

fDepartment of Medicine, University of California, San Francisco, CA 94143

HIV-1–specific T-cell responses in exposed seronegative subjects suggest that a viral breach of the exposure site is more common than current transmission rates would suggest and that host immunity can extinguish subsequent infection foci.

The Preexposure Prophylaxis Initiative (iPrEx) chemoprophylaxis trial provided an opportunity to rigorously investigate these responses in a case–control immunology study; 84 preinfection peripheral blood mononuclear cell samples from individuals enrolled in the iPrEx trial who later seroconverted were matched with 480 samples from enrolled subjects who remained seronegative from both the placebo and active treatment arms.

T-cell responses to HIV-1 Gag, Protease, Integrase, Reverse Transcriptase, Vif, and Nef antigens were quantified for all subjects in an IFN-γ enzyme-linked immunospot (ELISpot) assay. IFN-γ responses varied in magnitude and frequency across subjects. A positive response was more prevalent in those who remained persistently HIV-1–negative for Gag (P = 0.007), Integrase (P < 0.001), Vif (P < 0.001), and Nef (P < 0.001). When correlated with outcomes in the iPrEx trial, Vif- and Integrase-specific T-cell responses were associated with reduced HIV-1 infection risk [hazard ratio (HR) = 0.36, 95% confidence interval (95% CI) = 0.19–0.66 and HR = 0.52, 95% CI = 0.28–0.96, respectively].

Antigen-specific responses were independent of emtricitabine/tenofovir disoproxil fumarate use. IFN-γ secretion in the ELISpot was confirmed using multiparametric flow cytometry and largely attributed to effector memory CD4+ or CD8+ T cells.

Our results show that HIV-1–specific T-cell immunity can be detected in exposed but uninfected individuals and that these T-cell responses can differentiate individuals according to infection outcomes.

abstract

http://www.pnas.org/content/early/2015/06/17/1501443112

PDF

http://www.pnas.org/content/early/2015/06/17/1501443112.full.pdf

July 3, 2015 at 8:10 am

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