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BACKGROUND: Medical tourism has been increasing dramatically globally, with people travelling from developed countries to low-income or middle-income countries, often to avoid high costs or long delays associated with seeking healthcare in their countries of origin. The current review summarizes healthcare-related infections associated with medical tourism, focusing on cosmetic surgery and organ transplantation. METHODS: A systematic MEDLINE and PubMed search from January 2010 to December 2019 yielded 80 relevant articles, including 49 articles on medical tourism-related infections focusing on cosmetic surgery and organ transplantation, which were included in this reviews. RESULTS: The literature reveals specific types of cross-border, healthcare-related infections depending on medical intervention. Destinations include low-income countries such as countries of Asia and the Indian subcontinent, middle-income countries including Central and South America, and high-income countries such as the United States and Europe. In terms of type of infections, in 36 (68%) and 15 (28.3%) studies, wound and blood-borne infections were documented, respectively, while in 21 studies (58.3%) non-tuberculous mycobacteria were isolated, including Mycobacterium abscessus, Mycobacterium chelonae, Mycobacterium senegalense and Mycobacterium fortuitum. The choices of medical tourists could have significant consequences for them and their home countries, including infectious complications and importation of pathogens, particularly antibiotic-resistant microorganisms, with public health implications. CONCLUSIONS: There is a need for public health strategies in order to prevent morbidity and mortality as well as future management and education of patients engaging in medical tourism.

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OBJECTIVES: Zika virus (ZIKV) transmission through semen donation has never been reported but the risk is supported by the detection of ZIKV in semen and the demonstration of ZIKV sexual transmission. The potential impact of ZIKV on assisted reproductive procedures should be evaluated. METHODS: We tested longitudinally collected semen samples provided by asymptomatic blood donors who tested positive for ZIKV RNA in plasma during ZIKV outbreaks in Puerto Rico and Florida in 2016. RESULTS: Five of the 14 (35.7%) asymptomatic blood donors provided semen samples that tested positive for ZIKV RNA, with ZIKV RNA loads ranging from 8.03 × 103 to 2.55 × 106 copies/mL. Plasma collected at the same time as the semen tested negative for ZIKV RNA for most ZIKV RNA-positive semen collections; all corresponding plasma samples tested positive or equivocal for anti-ZIKV IgG antibodies and all except one tested positive for ZIKV IgM antibodies. The rate of detection of ZIKV RNA in semen in asymptomatic donors is not significantly different from the rate previously reported for symptomatic patients. CONCLUSIONS: Our results that show a high percentage of detection of ZIKV RNA in the semen of asymptomatic men confirm that ZIKV is a new threat for reproductive medicine and should have important implications for assisted reproductive technology. We recommend that semen donations from men at risk for ZIKV infection should be tested for ZIKV RNA, regardless of symptoms of ZIKV infection.

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ABSTRACT Objective: Exposures to sharps injuries occurring in the community are relatively frequent. We describe characteristics of community sharp exposures reported in the city of Rio de Janeiro from 1997 to 2010. Methods: A cross-sectional analysis of exposure reports to sharps in the community reported to a surveillance system, designed for health care workers, of the Municipal Health Department of Rio de Janeiro. The characteristics of exposed individuals analyzed included types of exposure, the circumstances of the accident, and the prophylaxis offered. Results: 582 exposures were studied. Median age was 30 years and 83 (14%) involved children with less than 10 years of age. Two hundred and seventeen (37%) occurred with sharps found in the streets. The exposure was percutaneous in 515 (89%) and needles where involved in 406 (70%) of them. The sharps were present in the trash in 227 (39%) or in the environment in 167 (29%) of the reports. Professionals who work with frequent contact with domestic or urban waste were 196 (38%). The source was known in 112 (19%) of the exposures and blood was involved in 269 (46%). Only 101 (19%) of the injured subjects reported a complete course of vaccination for hepatitis B. Antiretroviral prophylaxis was prescribed for 392 (68%) of the exposed subjects. Conclusions: Sharps injuries occurring in the community are an important health problem. A great proportion would be avoided if practices on how to dispose needles and sharps used outside health units were implemented.

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OBJECTIVE: Exposures to sharps injuries occurring in the community are relatively frequent. We describe characteristics of community sharp exposures reported in the city of Rio de Janeiro from 1997 to 2010. METHODS: A cross-sectional analysis of exposure reports to sharps in the community reported to a surveillance system, designed for health care workers, of the Municipal Health Department of Rio de Janeiro. The characteristics of exposed individuals analyzed included types of exposure, the circumstances of the accident, and the prophylaxis offered. RESULTS: 582 exposures were studied. Median age was 30 years and 83 (14%) involved children with less than 10 years of age. Two hundred and seventeen (37%) occurred with sharps found in the streets. The exposure was percutaneous in 515 (89%) and needles where involved in 406 (70%) of them. The sharps were present in the trash in 227 (39%) or in the environment in 167 (29%) of the reports. Professionals who work with frequent contact with domestic or urban waste were 196 (38%). The source was known in 112 (19%) of the exposures and blood was involved in 269 (46%). Only 101 (19%) of the injured subjects reported a complete course of vaccination for hepatitis B. Antiretroviral prophylaxis was prescribed for 392 (68%) of the exposed subjects. CONCLUSIONS: Sharps injuries occurring in the community are an important health problem. A great proportion would be avoided if practices on how to dispose needles and sharps used outside health units were implemented.

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Introduction: Dental students are often exposed to bloodborne pathogens during dental training. Several factors are involved in increased risk of human deficiency, hepatitis B and hepatitis C virus (HIV, HBV, and HCV) infection. However, there are few studies that address the risks and forms of prevention among dental students in Brazil. Methods: A cross-sectional study of occupational exposure to blood or body fluids among dental students of Universidade Federal do Rio Grande do Sul, Brazil, was performed. These students were referred to the Occupational Medicine Department of Hospital de Clínicas de Porto Alegre from January 2007 to April 2015. Analyzed data included type of exposure (needlestick injury, mucosal exposure, and exposure to non-intact skin); source patient status for HBV, HIV and HCV infection, accident during dental training, procedure performed, biological material involved, type of accident, and hepatitis B vaccination and serological protection status. The objective was to know the incidence rate and others characteristics of accidents in order to prevent them. Results: There were 312 accidents during the study period of 8 years and 4 months. Incidence rate was 87,42 exposures per 1000 students year. Source patient was known in 297 of the cases (95.2%), of which 3 were HBsAg reagent, 12 were HIV reagent, and 17 were HCV reagent. The majority of accidents occurred during procedure, but nearly as high as 40% occurred after procedure, of which 63% occurred during instrument cleaning, disinfecting or sterilizing. Most involved sharp instruments were anesthetic syringe needle and curette. Only 48% of dental students knew their antiHBs was > 10 mIU/mL. Conclusions: Dental students should be tested for hepatitis B immune status at the beginning of training, and vaccination should be available to all dental students before they start clinical practice. Work practice controls on sharp devices should be addressed at the beginning and strengthened during dental training. Dental training institutions should review instrumental cleaning process to minimize handling of loose contaminated instruments (AU)

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This study identified persons without presumed risk (PWPR) involved in accidents with blood and body fluids in 2 health care facilities between 1989 and 2012 in a state in Central Brazil. There were 181 accidents that occurred with PWPR, predominantly among women. Accidents with blood and body fluids involved needle and blood, some performed by untrained personnel. Most prematurely terminated clinical and laboratory monitoring. Accidents with blood and body fluids occur under similar circumstances to health care workers.

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Although not directly responsible for patient care, hospital housekeepers are still susceptible to accidents with biological material. The objectives of this study were to establish profile and frequency of accidents among hospital housekeepers, describe behaviors pre- and postaccident, and risk factors. This was a cross-sectional study with hospital housekeepers in Goiania, Brazil. Data were obtained from interviews and vaccination records. The observations were as follows: (1) participating workers: 94.3%; (2) incomplete hepatitis B vaccination: 1 in 3; and (3) accident rate: 26.5%, mostly percutaneous with hypodermic needles, and involved blood from an unknown source; roughly half occurred during waste management. Upon review, length of service less than 5 years, completed hepatitis B vaccination, and had been tested for anti-HBs (hepatitis B surface antigen) influenced frequency of accidents. These findings suggest that improper disposal of waste appears to enhance the risk to hospital housekeepers. All hospital workers should receive continued training with regard to waste management.

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Several mechanisms are associated with brain dysfunction during sepsis; one of the most important are activation of microglia and astrocytes. Activation of glial cells induces changes in permeability of the blood-brain barrier, secretion of inflammatory cytokines, and these alterations could induce neuronal dysfunction. Furthermore, blood-borne leukocytes can also reach the brain and participate in inflammatory response. Mechanisms involved in sepsis-associated brain dysfunction were revised here, focusing in neuroinflammation and involvement of blood-borne leukocytes and glial cells in this process.

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Species in the bacterial genus, Bartonella, can cause disease in both humans and animals. Previous reports of Bartonella in bats and ectoparasitic bat flies suggest that bats could serve as mammalian hosts and bat flies as arthropod vectors. We compared the prevalence and genetic similarity of bartonellae in individual Costa Rican bats and their bat flies using molecular and sequencing methods targeting the citrate synthase gene (gltA). Bartonellae were more prevalent in bat flies than in bats, and genetic variants were sometimes, but not always, shared between bats and their bat flies. The detected bartonellae genetic variants were diverse, and some were similar to species known to cause disease in humans and other mammals. The high prevalence and sharing of bartonellae in bat flies and bats support a role for bat flies as a potential vector for Bartonella, while the genetic diversity and similarity to known species suggest that bartonellae could spill over into humans and animals sharing the landscape.

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Healthcare workers (HCWs) are at a high risk for exposure to pathogens in the workplace. The objective of this study was to evaluate HCW adherence to follow-up after occupational exposure to blood and body fluids at a tertiary care university hospital in the city of São Paulo, Brazil. Data were collected from 2102 occupational exposures to blood and body fluids reports, obtained from the Infection Control Division of the Universidade Federal de São Paulo/Escola Paulista de Medicina/Hospital São Paulo, in São Paulo, Brazil, occurring between January of 2005 and December of 2011. To evaluate adherence to post-exposure follow-up among the affected HCWs, we took into consideration follow-up visits for serological testing. For HCWs exposed to materials from source patients infected with human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV), as well as from source patients of unknown serological status, follow-up serological testing was scheduled for 3 and 6 months after the accident. For those exposed to materials from source patients co-infected with HIV and HCV, follow-up evaluations were scheduled for 3, 6, and 12 months after the accident. During the study period, there were 2056 accidental exposures for which data regarding the serology of the source patient were available. Follow-up evaluation of the affected HCW was recommended in 612 (29.8%) of those incidents. After the implementation of a post-exposure protocol involving telephone calls and official letters mailed to the affected HCW, adherence to follow-up increased significantly, from 30.5 to 54.0% (P = 0.028). Adherence was correlated positively with being female (P = 0.009), with the source of the exposure being known (P = 0.026), with the source patient being HIV positive (P = 0.029), and with the HCW having no history of such accidents (P = 0.047). Adherence to the recommended serological testing was better at the evaluation scheduled for 3 months after the exposure (the initial evaluation) than at those scheduled for 6 and 12 months after the exposure (P = 0.004). During the study period, there was one confirmed case of HCW seroconversion to HCV positivity. The establishment of a protocol that involves the immediate supervisor of the affected HCWs, in the formal summoning of those HCWs is necessary in order to increase the rate of adherence to post-exposure follow-up.

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BACKGROUND: More than 200 different diseases may be transmitted from exposure to blood in the dental setting. The aim of this study is to identify possible faults in the crosscontamination chain control in a dental school clinic searching for traces of blood in the clinical contact surfaces (CCS) through forensic luminol blood test. METHODS: Traces of invisible blood where randomly searched in CCS of one dental school clinic. RESULTS: Forty eight surfaces areas in the CCS were tested and the presence of invisible and remnant blood was identified in 28 (58.3%) items. CONCLUSIONS: We suggest that the luminol method is suitable for identifying contamination with invisible blood traces and this method may be a useful tool to prevent cross-contamination in the dental care setting.

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The Retrovirus Epidemiology Donor Study (REDS) program was established in the United States in 1989 with the purpose of increasing blood transfusion safety in the context of the HIV/AIDS and human T-lymphotropic virus epidemics. REDS and its successor, REDS-II were at first conducted in the US, then expanded in 2006 to include international partnerships with Brazil and China. In 2011, a third wave of REDS renamed the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) was launched. This seven-year research program focuses on both blood banking and transfusion medicine research in the United States of America, Brazil, China, and South Africa. The main goal of the international programs is to reduce and prevent the transmission of HIV/AIDS and other known and emerging infectious agents through transfusion, and to address research questions aimed at understanding global issues related to the availability of safe blood. This article describes the contribution of REDS-II to transfusion safety in Brazil. Articles published from 2010 to 2013 are summarized, including database analyses to characterize blood donors, deferral rates, and prevalence, incidence and residual risk of the main blood-borne infections. Specific studies were developed to understand donor motivation, the impact of the deferral questions, risk factors and molecular surveillance among HIV-positive donors, and the natural history of Chagas disease. The purpose of this review is to disseminate the acquired knowledge and briefly summarize the findings of the REDS-II studies conducted in Brazil as well as to introduce the scope of the REDS-III program that is now in progress and will continue through 2018.

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The Retrovirus Epidemiology Donor Study (REDS) program was established in the United States in 1989 with the purpose of increasing blood transfusion safety in the context of the HIV/AIDS and human T-lymphotropic virus epidemics. REDS and its successor, REDS-II were at first conducted in the US, then expanded in 2006 to include international partnerships with Brazil and China. In 2011, a third wave of REDS renamed the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) was launched. This seven-year research program focuses on both blood banking and transfusion medicine research in the United States of America, Brazil, China, and South Africa. The main goal of the international programs is to reduce and prevent the transmission of HIV/AIDS and other known and emerging infectious agents through transfusion, and to address research questions aimed at understanding global issues related to the availability of safe blood. This article describes the contribution of REDS-II to transfusion safety in Brazil. Articles published from 2010 to 2013 are summarized, including database analyses to characterize blood donors, deferral rates, and prevalence, incidence and residual risk of the main blood-borne infections. Specific studies were developed to understand donor motivation, the impact of the deferral questions, risk factors and molecular surveillance among HIV-positive donors, and the natural history of Chagas disease. The purpose of this review is to disseminate the acquired knowledge and briefly summarize the findings of the REDS-II studies conducted in Brazil as well as to introduce the scope of the REDS-III program that is now in progress and will continue through 2018.

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Hepatitis C virus (HCV) genotype 5 is extremely rare and there is very little reported on its management in the medical literature. We present herein the case of a patient with HCV genotype 5 that presumably acquired the disease through a blood transfusion during infancy. Sustained virologic response was achieved after 24 weeks of treatment. According to the available information on HCV genotype 5 treatment, it has a similar response to that of HCV genotype 1. Our patient presented with various favorable outcome factors. There is much less reported on the treatment of HCV genotype 5 than there is regarding HCV genotypes 1, 2, 3, and 4. This is mainly due to the low prevalence of genotype 5 in the Mexican environment.

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BACKGROUND: Crack use constitutes a major problem in cities across Brazil. While existing data suggest that crack use is generally concentrated among disenfranchised young people with extensive health problems and crime involvement, extensive data gaps exist. To address this issue, this study aimed to assess key characteristics of young crack users in two Brazilian cities. METHODS: N=160 regular and young adult (ages 18-24) crack users were recruited by community-based methods in the cities of Rio de Janeiro (Southeast) and Salvador (Northeast). Assessments included an interviewer-administered questionnaire on key social, drug use, health and service use characteristics, as well as serological testing of HBV, HCV and HIV status, and were conducted anonymously between November 2010 and June 2011. Participants provided informed consent and received transportation vouchers following assessment completion. The study was approved by institutional ethics review boards. RESULTS: The majority of participants were: male, with less than high school education, unstably housed (Rio only); gained income from legal or illegal work; arrested by police in past year (Salvador only); had numerous daily crack use episodes and shared paraphernalia (Salvador only); co-used alcohol, tobacco, cannabis and cocaine; had no injection history; rated physical and mental health as 'fair' or lower (Salvador only); had unprotected sex; were never HIV tested; were not HIV, HBV or HCV positive; and did not use existing social or health services, but desired access to crack user specific services. CONCLUSION: Crack users in the two Brazilian sites featured extensive socio-economic marginalization, crack and poly-drug use as well as sexual risk behaviours, and compromised health status. Social and health service utilization are low, yet needs are high. There is an urgent need for further research and for targeted interventions for crack use in Brazil.

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Este artigo aborda o contexto histórico e o marco conceitual da implantação dos programas de redução de danos no campo da saúde pública, com ênfase nos programas brasileiros. A presente revisão teve como objetivo principal investigar a pertinência atual de tais programas no enfrentamento das infecções de transmissão sexual e sanguínea, em especial, a AIDS e a hepatite C. Os resultados sistematizados pela literatura nacional e internacional indicam que as ações práticas de redução de danos são mais efetivas quando integradas a outras medidas de saúde pública, guiadas por princípios em comum. Iniciativas de redução de danos afinadas com princípios de saúde pública não se prendem a modelos, nem se esgotam em cuidados de saúde propriamente ditos. Abrangem diversas modalidades de ações pragmáticas, com base em políticas públicas, devem estar em sintonia com a comunidade desde seu planejamento, e serem executadas em parceria com esta.

This article assesses the historical context and the conceptual frame of setting up damage containment programs in the field of public health, with special emphasis on the Brazilian experience. The survey seeks to assess the relevance of such programs in the ongoing efforts to curb the spread of blood-borne and sexually transmitted infections, especially AIDS and hepatitis C. Findings from both the Brazilian and the international literature demonstrate that practical damage containment initiatives tend to be more effective when integrated with other public health measures based on common goals. Damage containment initiatives, aligned with the basic principles of public health do not limit themselves to a priori models or health care per se. They encompass a variety of pragmatic measures based on public policies and should be in line with the demands of the communities since the moment of their inception and implemented in the context of full partnership with such communities.

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We report a laboratory confirmed case of vertical transmission of dengue in a mother-child pair in the eastern part of Puerto Rico. The clinical course of the pregnant female suggested a GBS infection, but laboratory tests confirmed it was dengue infection, one week after delivery. The male infant was healthy at birth, but one week after birth developed clinical complications related to vertical transmission of dengue. This report targets physicians in dengue endemic countries like Puerto Rico to be aware of the possibility of vertical transmission of dengue in symptomatic pregnant patients, especially around the time of delivery.

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BACKGROUND: Confidential unit exclusion remains a controversial strategy to reduce the residual risk of transfusion-transmitted infections. OBJECTIVE: This study aimed to analyze confidential unit exclusion from its development in a large institution in light of confidential donation confirmation. METHODS: Data of individuals who donated from October 1, 2008 to December 31, 2009 were analyzed in a case-control study. The serological results and sociodemographic characteristics of donors who did not confirm their donations were compared to those who did. Variables with p-values < 0.20 in univariate analysis were included in a logistic multivariate analysis. RESULTS: In the univariate analysis there was a statically significant association between positive serological results and response to confidential donation confirmation of "No". Donation type, (firsttime or return donor - OR 1.69, CI 1.37-2.09), gender (OR 1.66, CI 1.35-2.04), education level (OR 2.82, CI 2.30-3.47) and ethnic background (OR 0.67, CI 0.55-0.82) were included in the final logistic regression model. In all logistic regression models analyzed, the serological suitability and confidential donation confirmation were not found to be statistically associated. The adoption of new measures of clinical classification such as audiovisual touch-screen computer-assisted self-administered interviews might be more effective than confidential unit exclusion in the identification of donor risk behavior. The requirement that transfusion services continue to use confidential unit exclusion needs to be debated in countries where more specific and sensitive clinical and serological screening methods are available. CONCLUSION: Our findings suggest that there are not enough benefits to justify continued use of confidential donation confirmation in the analyzed institution.

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BACKGROUND: Confidential unit exclusion remains a controversial strategy to reduce the residual risk of transfusion-transmitted infections. OBJECTIVE: This study aimed to analyze confidential unit exclusion from its development in a large institution in light of confidential donation confirmation. METHODS: Data of individuals who donated from October 1, 2008 to December 31, 2009 were analyzed in a case-control study. The serological results and sociodemographic characteristics of donors who did not confirm their donations were compared to those who did. Variables with p-values < 0.20 in univariate analysis were included in a logistic multivariate analysis. RESULTS: In the univariate analysis there was a statically significant association between positive serological results and response to confidential donation confirmation of "No". Donation type, (firsttime or return donor - OR 1.69, CI 1.37-2.09), gender (OR 1.66, CI 1.35-2.04), education level (OR 2.82, CI 2.30-3.47) and ethnic background (OR 0.67, CI 0.55-0.82) were included in the final logistic regression model. In all logistic regression models analyzed, the serological suitability and confidential donation confirmation were not found to be statistically associated. The adoption of new measures of clinical classification such as audiovisual touch-screen computer-assisted self-administered interviews might be more effective than confidential unit exclusion in the identification of donor risk behavior. The requirement that transfusion services continue to use confidential unit exclusion needs to be debated in countries where more specific and sensitive clinical and serological screening methods are available. CONCLUSION: Our findings suggest that there are not enough benefits to justify continued use of confidential donation confirmation in the analyzed institution.

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