Southern African Journal of Infectious Diseases最新文献

Background: Gauteng province (GP) was one of the most affected provinces in the country during the first two pandemic waves in South Africa. We aimed to describe the characteristics of coronavirus disease 2019 (COVID-19) patients admitted in one of the largest quaternary hospitals in GP during the first two waves.

Objectives: Study objectives were to determine factors associated with hospital admission during the second wave and to describe factors associated with in-hospital COVID-19 mortality.

Method: Data from a national hospital-based surveillance system of COVID-19 hospitalisations were used. Multivariable logistic regression models were conducted to compare patients hospitalised during wave 1 and wave 2, and to determine factors associated with in-hospital mortality.

Results: The case fatality ratio was the highest (39.95%) during wave 2. Factors associated with hospitalisation included age groups 40-59 years (adjusted odds ratio [aOR]: 2.14, 95% confidence interval [CI]: 1.08-4.27), 60-79 years (aOR: 2.49, 95% CI: 1.23-5.02) and ≥ 80 years (aOR: 3.39, 95% CI: 1.35-8.49). Factors associated with in-hospital mortality included age groups 60-79 years (aOR: 2.55, 95% CI: 1.11-5.84) and ≥ 80 years (aOR: 5.66, 95% CI: 2.12-15.08); male sex (aOR: 1.56, 95% CI: 1.22-1.99); presence of an underlying comorbidity (aOR: 1.76, 95% CI: 1.37-2.26), as well as being admitted during post-wave 2 (aOR: 2.42, 95% CI: 1.33-4.42).

Conclusion: Compared to the recent omicron-driven pandemic waves characterised by lower admission rates and less disease severity among younger patients, COVID-19 in-hospital mortality during the earlier waves was associated with older age, being male and having an underlying comorbidity.

Contribution: This study showed how an active surveillance system can contribute towards identifying changes in disease trends.

Background: Vaccinations in general are considered to be one of the greatest achievements in medicine, saving millions of lives globally.

Aim: This narrative review highlights issues related to vaccination in pregnancy and provides information on those vaccines registered for use in pregnancy.

Method: Published articles on vaccinations in pregnancy are included in this review. The search engines used included PubMed, Medline, Google Scholar, and ScienceDirect.

Results: Vaccinations during pregnancy are more likely to be administered in high income countries (HICs) compared to low-income countries (LICs) due to easier access to healthcare services and better communicable disease awareness. Maternal and perinatal morbidity and mortality rates associated with infectious diseases are higher in LICs with access to maternal care services, infrastructure and hospital equipment lacking in these settings.

Conclusion: Suitable vaccinations are recommended for use in pregnancy to prevent harm to women, their foetuses and newborns from some communicable diseases, and they have resulted in declines in maternal and infant morbidity and mortality. Furthermore, this review has shown that vaccination during pregnancy is not only safe for both the woman and her foetus but also effective. Therefore, health professionals and national governments should strongly consider approved vaccinations prior to or during pregnancy.

Contribution: This review provides insight on the necessity of vaccination during pregnancy. In addition, it urges health professionals to inform patients of the importance of regular antenatal visits, and to receive the required vaccinations for a better health outcome.

Background: The National Institute for Communicable Diseases (NICDs) of South Africa (SA) provides technical support to healthcare workers (HCWs) with regard to infectious diseases through the NICD clinician hotline. Queries to the hotline are often about rabies prophylaxis. An analysis of these queries may help to identify knowledge gaps amongst HCWs regarding prevention of rabies in humans in SA.

Methods: A retrospective descriptive review was conducted to analyse rabies post-exposure prophylaxis (PEP) queries received by the NICD from 01 January 2016 to 31 December 2019.

Results: A total of 4655 queries were received by the NICD clinician hotline for the study period, of which 2461 pertained to rabies PEP (52.87%). The largest number of calls were placed by HCWs (n = 2313/2437; 94.9%). Queries originated mainly from Gauteng (n = 912/2443; 37.3%) and KwaZulu-Natal (n = 875/2443; 35.8%) provinces. A total of 50 different types of animals were related to exposures involving humans. Dogs (67.7%) and cats (11.8%) were the animals most frequently reported and exposure category III was most common (88.6%). Approximately equal numbers of callers were advised active management of administering rabies PEP and conservative management of withholding PEP. This did not seem to be affected by the exposure category related to the call.

Conclusion: This analysis shows the ongoing demand by HCWs for technical support regarding patient management following potential exposure to rabies. Gaps in HCWs rabies knowledge provide unique learning points on guiding training to achieve the goal of eliminating dog-mediated human rabies deaths by 2030.

[This corrects the article DOI: 10.4102/sajid.v37i1.351.].

Background: Different diagnostic tools could improve early detection of coronavirus disease 2019 (COVID-19). A number of antibody-based serological point-of-care tests have been developed to supplement real-time reverse transcriptase polymerase chain reaction (RT-PCR)-based diagnosis. This study describes the validity of an antibody test, namely the immunoglobulin G (IgG)/immunoglobulin M (IgM) Rapid Test Cassette^® (BNCP - 402 and BNCP402), manufactured by Spring Healthcare Services.

Methods: A prospective cohort validation study was undertaken at Chris Hani Baragwanath Academic Hospital between 16 July 2020 and 12 August 2020. A total of 101 patients admitted as COVID-19 cases under investigation were included in the study. They were divided into two categories depending on time since symptom onset: testing performed within seven days (early cohort) and after seven days (late cohort). The rapid antibody test was compared to the RT-PCR.

Results: Overall, the test has a sensitivity and specificity of 85.2% and 80.0%, respectively, for a combination of IgG and IgM. Sensitivity and specificity of IgG testing alone were 81.5% and 85%. Sensitivity improved for testing with increasing time from symptom onset; however, specifity was not significantly different.

Conclusion: The study data adds to the body of evidence that because of relatively low sensitivity and specificity, there is a limited role for antibody-based point-of-care testing in the acute phase of COVID-19 infection, as was the case with this IgG/IgM Rapid Test Cassette (BNCP - 402 and BNCP402). There may exist a role for such testing in patients recovered from prior COVID-19 infection or in seroprevalence studies; however, additional evaluations at later timepoints from symptom onset are required.

Background: South Africa has experienced multiple waves of the coronavirus disease 2019 (COVID-19) with little research documenting chest imaging features in an human immunodeficiency virus (HIV) and tuberculosis (TB) endemic region.

Objectives: Describe the chest imaging features, demographics and clinical characteristics of COVID-19 in an urban population.

Method: Retrospective, cross-sectional, review of chest radiographs and computed tomographies (CTs) of adults admitted to a tertiary hospital with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, between 01 May 2020 and 30 June 2020. Imaging was reviewed by three radiologists. Clinical parameters and laboratory data were analysed.

Results: A total of 113 adult patients with a mean age of 46 years and 10 months were included. A total of 113 chest radiographs and six CTs were read. Nineteen patients were HIV-positive (16.8%), 40 were hypertensive and diabetic (35.4%), respectively, and one had TB (0.9%). Common symptoms included cough (n = 69; 61.6%), dyspnoea (n = 60; 53.1%) and fever (n = 46; 40.7%). Lower zone predominant ground glass opacities (58.4%) and consolidation (29.2%) were most frequent on chest radiographs. The right lower lobe was most involved (46.9% ground glass opacities and 17.7% consolidation), with relative sparing of the left upper lobe. Bilateral ground glass opacities (66.7%) were most common on CT. Among the HIV-positive, ground glass opacities and consolidation were less common than in HIV-negative or unknown patients (p = 0.037 and p = 0.05, respectively).

Conclusion: COVID-19 in South Africa has similar chest imaging findings to those documented globally, with some differences between HIV-positive and HIV-negative or unknown patients. The authors corroborate relative sparing of the left upper lobe; however, further research is required to validate this currently unique local finding.

The increased incidence and absence of antibiotic treatment options for New Delhi metallo-β-lactamase (NDM)-producing carbapenem-resistant Enterobacterales (CRE) infection are concerning. Recent reports have highlighted NDM-producing Serratia marcescens, as a specific concern, as it is an organism which is intrinsically resistant to colistin. In this study, a descriptive analysis of NDM-producing CRE infections was performed at the Red Cross War Memorial Children's Hospital.

Background: Chronic infection with hepatitis B virus (HBV) is a major public health concern in South Africa. Hepatitis B virus is a highly infectious blood-borne virus causing liver disease. Healthcare workers (HCWs) are at high risk of occupational exposure.

Objectives: This study aimed to investigate HBV vaccination amongst HCWs at a tertiary academic hospital in Gauteng province, South Africa.

Method: Self-administered questionnaires were used to collect data from 500 consecutively sampled HCWs. Data were analysed using Stata version 12.

Results: A total of 460 HCWs participated in the study. Most were women (68.7%), < 40 years of age (66.9%) and worked for < 10 years (66.0%). Almost 50.0% were either doctors or medical students and 40.3% were nurses or student nurses. Most HCWs in the age group of < 30 years (79.4%) had received at least 1 dose of HB vaccine. Prevaccination immunity screening was conducted on 17.5% of the HCWs, and only 11.0% reported to be protected against HBV. About 49.0% of HCWs were fully vaccinated. Post-vaccination immunity testing was conducted on 15.1%, and 24.0% of HCWs paid for vaccinations. Nursing staff and those with > 10 years of work experience were 2.5 and 2.6 times more likely to be vaccinated, respectively. Cleaning staff were less likely to be vaccinated.

Conclusion: Although not all HCWs were fully vaccinated, our study found a higher proportion of fully vaccinated HCWs than previously reported in Gauteng Province. It is recommended that HB vaccination be promoted and a local vaccination policy, aligned with the national policy, be developed and implemented for all HCWs at the tertiary academic hospital.

Paediatric HIV spontaneous controllers (HSCs) are a unique and understudied population with potential to inform alternative treatment options for patients living with HIV. As HSCs are so rare and often not recognised prior to antiretroviral treatment (ART) initiation, it can be difficult for clinicians to optimally manage this group. We describe the diagnosis, history and management of three paediatric HSCs, two girls and a boy who were followed for 2, 1.25 and 10.4 years, respectively, before starting ART. All had low but detectable viral loads throughout follow-up but mostly marginally low CD4:CD8 ratios. The reason for starting ART in all was a gradual tendency to poorer virological control. This case series should assist in recognising paediatric HSCs. Clinical dilemmas arising in the management of paediatric HSCs include arriving at a correct HIV-positive diagnosis, correct diagnosis as an HSC, as well as whether to initiate ART. Decision-making for initiation of ART in paediatric HSCs should be individualised. Factors supporting ART initiation in these patients included increased frequency of viral load blips, increasing detectable viral load, CD4 percentage and CD4:CD8 ratio. Other factors included Hepatitis C serology and highly sensitive C-reactive protein. All three patients ultimately required ART, which supports universal initiation of ART in paediatric HSCs, but further research is required.

[This corrects the article DOI: 10.4102/sajid.v36i1.241.].