Risk of occupational exposure to the HBV infection in non-clinical healthcare personnel.

BACKGROUND: Occupational risk of blood-borne infections is investigated mostly among nurses and doctors, studies concerning non-clinical health personnel (nCHP) being rare. The analysis of the occupational exposure to the hepatitis B virus (HBV) infection and the history of vaccination against the HBV in the nCHP group has been the aim of the study. MATERIAL AND METHODS: A retrospective analysis of 458 cases of the occupational exposure to biological agents was conducted: group I - doctors (N = 121, 28%), group II - nursing staff (N = 251, 55%), group III - nCHP (N = 86, 19%). RESULTS: In the group III the source was usually unknown (group: I - 0.83%, II - 11.16%, III - 86.05%, p < 0.001), and the proportion of individuals vaccinated against hepatitis B before the exposure was the lowest (group: I - 98.35%, II - 97.19%, III - 77.91%, p < 0.001). In this group most exposures resulted from injuries caused by needles/sharps deposited in waste sacks (60%) or anywhere outside of the medical waste container (5%). The possibility of the HBV infection risk during the exposure was found in 25 cases and was significantly more frequent in the group III. The qualification for the HBV post-exposure prophylaxis was also significantly more frequent in the group III. CONCLUSIONS: The exposure to the occupational risk of the HBV infection also concerns the non-clinical healthcare personnel. The non-clinical healthcare personnel comprises one of the main groups of the HBV post-exposure recipients. It is essential to determine the causes of the low hepatitis B vaccination coverage in the nCHP and consider introduction of mandatory vaccination in this group in Poland. Med Pr 2016;67(3):301-310.

Tubo-ovarian abscess during therapy of chronic hepatitis C with pegylated interferon and ribavirin.

BACKGROUND: Serious infections are rare complications of standard treatment in chronic hepatitis C with pegylated interferon alpha (Peg IFN) and ribavirin. CASE: We report two cases of life-threatening tubo-ovarian abscess (TOA) in women older than 40 year of age. No casual risk factors of TOA could be identified in them. In one case septic shock and acute renal failure occured. TOA was caused by endogenic bacteria (Porphyromonas asaccharolytica in the first case and Streptococcus intermedius in the latter). Surgical treatment and interruption of IFN therapy was necessary in both cases. CONCLUSIONS: Serious gynecological infections may have the significant negative influence on chronic hepatitis C therapy outcome. Because of the risk of TOA developing during IFN therapy gynecological care is needed in chronic hepatitis C management.

The role of mechanisms of buffering anxiety in HIV carriers. A study within the terror management theory paradigm.

INTRODUCTION: The paper concerns definition of the level of posttraumatic growth (PTG), the psychological adaptation mechanism occurring after extreme experiences in life, such as being informed of having HIV infection. AIM: The study is experimental, aiming to assess whether correlations between exposure to thoughts of stressful experiences and their psychological consequences are mediated by an efficient mechanism of buffering anxiety MATERIAL/METHODS: Fifty-four men and 26 women infected with HIV who underwent manipulated exposure to mortality according to the hypotheses of the terror management theory (TMT) were included. Subjects were randomly assigned to the control group (dental anxiety) or the experimental group (fear of dying). RESULTS: The results confirmed the assumptions of the terror management theory. The subjects had an efficient mechanism of alleviating the fear of dying, the so-called "anxiety buffer." The analysis revealed a high level of posttraumatic growth and advantages derived from the disease. The paper additionally characterizes the specific group of HIV-positive people, their functioning in society and the family. It touches on such issues as professional work, relations with relatives and friends, social life, and adherence. CONCLUSIONS: The study has shown that the specific group of people infected with HIV managed very well to adapt to the circumstances. One may say that as a consequence of acquiring the infection, the subjects have experienced significant changes of personality, which have ultimately led to an improvement of their lives and offered new possibilities for personal and social development to them. All the recorded changes fit into the TMT paradigm.

[Renaissance of infectious diseases]. / Renesans chorób zakaznych.

According to the report of the National Institutes of Health (NIH) in Bethesda, Maryland, USA, infectious diseases are one of the eight most common causes of illness since 1990. Due to breaking down barriers of interspecies, the state of immunosuppression, widespread use of antibiotics, there are still new threats, and earlier known to cause disease of a different course, resistant to previously effective therapies. The evolution of infectious diseases directs our attention primarily on the validity of the principles of rational antibiotic use to the increasing resistance of microorganisms. The movements of the opponents of vaccination appear to be more effective than the planned education of doctors and their patients, and the absence of sufficient administrative control performance of vaccination, raises a serious problem in contemporary clinical researcher. Infectious diseases will continue to exist as long as host organisms. It is important to the fight against them, making the best use of expertise and funds. In such a situation, the balance may move to benefit us--humans.

[Antiviral treatment of chronic B hepatitis; 2010 - therapeutic recommendations]. / Leczenie przeciwwirusowe przewleklego zapalenia watroby typu B--zalecenia terapeutyczne 2010.

The drugs currently approved for treatment of HBV infections are: interferon alpha2a and alpha2b, pegylated interferon (PeglFN-al-pha2a) natural interferons and nucleos(t)ide analogues (NA): adefovir, entecavir, lamivudine, telbivudine (currently not available in Poland) and tenofovir. The following questions are described: the primary goal of antiviral treatment, criteria in therapeutic decision-making (including extrahepatic manifestations, compensated and decompensated cirrhosis of the liver), treatment failure (including: drug resistance), management of patients with HBV-positive markers, in whom chemotherapy or other immunosuppressive therapy is planned. In treatment-naive patients with chronic hepatitis B the first line therapy should be PeglFN-alpha2a monotherapy, and the first-line should be entecavir or tenofovir (highest potential for HBV replication suppression and high genetic barrier to resistance). In drug resistance the patient should be switched to another, preferably high-potency NA (entecavir or tenofovir) or start PeglFN-alpha2a therapy.

Analysis of metabolic changes of brain in HIV-1 seropositive patients with proton magnetic resonance spectroscopy.

BACKGROUND: Asymptomatic central nervous system involvement may occur in the early stages of the HIV infection. The aim of the study was to evaluate early brain metabolic changes by means of proton MR spectroscopy (H1MRS) in the HIV-1 seropositive patients without neurological deficits or significant abnormalities in the plain MR study. MATERIAL/METHODS: The H1MRS examinations were performed with the use of a MR GE Signa 1,5T system. There were 39 subjects examined, aged 21 to 57 years (mean age 35 years) were examined, including 25 patients infected with HIV-1 and 14 healthy volunteers who constituted a control group. The examinations were performed using the Single Voxel Spectroscopy technique with the PRESS sequence, with following parameters: TR=1500 ms, TE=35 ms, number of acquisitions =128, time of acquisition =3 min. 43 sec. Voxels of 8 cm(3) (20×20×20 mm) in size were located in the following 5 regions: posterior cingulate gyrus, grey matter of the frontal area, left basal ganglia, white matter of the left parietal area and white matter of the frontal area. The NAA/Cr, Cho/Cr, mI/Cr ratios in the defined regions of interest were statistically analyzed. RESULTS: There was a statistically significant decrease (p<0.05) in the NAA/Cr ratios in the posterior cingulate area and white matter of the left parietal area in HIV-1 seropositive patients, as compared to the control group. Other metabolite ratios in all the above mentioned locations showed no statistically significant differences, as was also the case for NAA/Cr ratios in grey matter of the frontal area, left basal ganglia and white matter of the frontal area. CONCLUSIONS: The reduction of NAA/Cr values revealed in H1MRS studies suggests loss of neurons/neuronal activity in the posterior cingulate area and white matter of the left parietal area, in patients with HIV-1 at the stage before clinical manifestations of retroviral infection and structural changes in the plain MR study. This may reflect a direct neurotropic activity of HIV.

Prognostic factors for virological response in antiretroviral therapy-naive patients in the MONARK Trial randomized to ritonavir-boosted lopinavir alone.

BACKGROUND: MONARK is a pilot randomized trial comparing the safety and efficacy of lopinavir/ritonavir (LPV/r) monotherapy to a standard triple-drug regimen as initial therapy. The primary endpoint was virological response (VR) defined as viral load (VL)<400 copies/ml at week 24 and VL<50 copies/ml at week 48. The objective of this study was to determine prognostic factors of VR in patients receiving LPV/r monotherapy. METHODS: Baseline characteristics, including demographics, HIV type-1 (HIV-1) subtype (B versus non-B), early VR up to week 4, LPV trough concentrations and compliance were investigated as prognostic factors for VR in patients receiving LPV/r monotherapy. Logistic regression was used to search for variables significantly associated with the occurrence of VR. RESULTS: VR was achieved in 53 out of 83 patients randomized to the LPV/r arm. The on-treatment analysis, using a multivariate model, indicated that having VL<400 copies/ml at week 4 and harbouring HIV-1 subtype B were independently associated with an increased probability of VR. No difference in early VL reduction was evidenced between patients harbouring B or non-B subtypes. The latter patients had more difficulty in adherence to therapy than the former patients. The intention-to-treat analysis showed similar results. CONCLUSIONS: HIV-1 RNA measured at baseline or at week 4 and HIV-1 subtype (B versus non-B) were independent predictive factors of VR in patients starting therapy with LPV/r alone. Although based on a small sample size, results of this study showed that adherence to therapy is lower in patients harbouring non-B subtypes and appears to be a key factor of VR in the context of protease inhibitor monotherapy.

Cutaneous cryptococcosis as a rare manifestation of the immune reconstitution syndrome in an HIV-1-infected patient.

Immune reconstitution syndromes (IRS) in HIV-1-infected patients are associated with an exaggerated infl ammatory response against an opportunistic infection during highly active antiretroviral therapy (HAART). The most commonly described cases of this phenomenon concern mycobacterial (Mycobacterium avium and M. tuberculosis) infections, pneumocystodosis, cryptoccoccal meningitis, and CMV infections. Cutaneous cryptococcosis as IRS is less commonly observed. The case of a 45-year-old HIV-1-positive male is reported who developed subcutaneous abscesses due to Cryptococcus neoformans infection after four weeks of effective HAART following profound immune defi ciency.

Review of patients with hepatosteatosis and chronic hepatitis C.

We analysed a HCV RNA positive population with varied steatosis index admitted at Infectious Diseases and Hepatology Department, Medical University of Wroclaw in terms of existing abnormalities in biochemistry parameters, anthropometric differences as well as the antiviral therapy outcomes.

[Cytokine assessment in untreated hepatitis C virus infected patients and during interferon alpha +ribavirine therapy]. / Badanie wybranych cytokin w surowicy krwi pacjentów z przewleklym zapaleniem watroby typu C nieleczonych oraz leczonych interferonem alfa i rybawiryna.

UNLABELLED: Many articles concerning the hepatitis C virus (HCV) infection emphasize the role of cytokines Th1- and Th2-dependent. The aim of our study was to assess the changes in the concentration of cytokines (IL-2, IFN-gamma, IL-4, IL-10) determined by ELISA test in serum of HCV infected patients treated with interferon alpha (IFN-alpha) and ribavirine. RESULTS: The cytokine levels in HCV patients (n = 40) were similar to levels observed in healthy volunteers (p > 0.05). During IFN-alpha and ribavirine therapy no statistically significant changes in cytokine levels were observed in patients who achieved sustained virological response (SVR) compared to unsuccessfully treated patients (p > 0.05). CONCLUSIONS: 1. Serum is not useful compartment to determinate level of cytokines by ELISA method in chronic hepatitis C. 2. The measurement of cytokine levels using ELISA test was not confirmed to be useful in monitoring and assessment of the therapy results in HCV infected patients.

Immune reconstitution diseases: is it possible to establish recommendations?

The introduction of combination antiretroviral therapy (cART) has attracted the attention of scientists and physicians all over the world to the phenomenon known as IRD, immune restoration disease. The management of IRD depends on the correct diagnosis of the syndrome, which can be difficult to establish. The atypical presentation and unpredictable course of the disease may require individual decisions regarding a delay of cART or its interruption as well as the use of corticosteroids. Thus the frequent need for individualized management of IRD can make it difficult to obtain enough results from prospective randomized trials to establish strict recommendations. However, they should be initiated as soon as possible.

[Chronic hepatitis C in patients with HIV/HCV coinfection with high CD4+ lymphocytes count]. / Obraz przewleklego zapalenia watroby typu C u pacjentów zakazonych HIV z wysoka liczba limfocytów CD4+.

AIM: analysis of data characterizing HCV infection in patients infected with HIV. MATERIAL AND METHODS: 37 persons (29 male and 8 female) aged 23-49 years (mediana 34), with HIV/HCV coinfection, treated (n=25) and untreated (n=12) with antiretroviral therapy. HAART was effective in treated patients; CD4+ count >350 cells/microl. Viral load of HIV and HCV, HCV genotypes, CD4/CD8, biochemical tests, histopathological examination were measured. Results were analyzed statistically. RESULTS: the majority of patients were former IVDUs (n=31.84%), 3 persons (8%)--MSM, 3 (8%)--route of infection unknown. Duration of HCV infection 1-10 years, mediana 5. All patients were in A1 or A2 stage of HIV infection. Among patients treated with HAART (n=25) mediana of CD4+ count before treatment was 263 (69-595) cells/micro, mediana of HIV viral load 75000 copies/ml (n=7); 2040-263414 copies/ml. 17 patients were currently treated with PI, 17 with NNRTI, and 2 patients with NRTI only. HCV genotype was determined in 32 patients: 3a--n=19 (59%), 1--n= 9 (28%) 4--n=4 (13%). HCV viral load: 2.4 x 10(5)-7.73 x 10(6) IU/ml, mediana 1.6 x 10(6). Levels of ALT: 21-358 IU/ml, mediana 102, AST: 20-195 IU/ml, mediana 62, GGTP--9-463 IU/ml, mediana 58. ALT level was significantly higher in HCV genotype 3a infection (p=0.0214). Fibrosis stage above 2 was revealed in 3 patients and in majority (62%) was below 2. None patient had liver cirrhosis. Fibrosis was significantly higher in patients with low CD4+ nadir (p=0.03). CONCLUSIONS: Progression of liver fibrosis is slow in patients coinfected with HIV/HCV with high CD4+ count. High percentage of HCV genotype 3 and mild fibrosis are good prognostic factors for effectiveness of HCV infection treatment in HIV infected persons.

[Diagnostics of Lyme disease]. / Diagnostyka boreliozy.

Although many years have passed since Borrelia burgdorferi was first identified, advances in understanding biology and clinical course of infection made and new diagnostic procedures developed, Lyme disease is still difficult to diagnose. Therefore, it is often wrongly diagnosed and unnecessarily treated. In this paper we analyzed the latest data on Lyme disease diagnostic methods, paying much attention to their limitations and correct interpretation of results. In routine diagnosis of this diseases, indirect tests, based on the detection of specific IgM and IgG antibodies, are most useful. The Lyme disease diagnosis should begin with screening tests, which are highly sensitive but not specific enough and sometimes yield false positive results, then all positive results should be verified by confirmation tests, which allow to distinguish between true positive results and healthy individuals with false positive ones.

Graves' disease as an immune reconstitution syndrome in an HIV-1-positive patient commencing effective antiretroviral therapy: case report and literature review.

Combination antiretroviral therapy (cART) reduces morbidity and mortality in human immunodeficiency virus (HIV) infection, but it may also alter the clinical course of subclinical opportunistic infections and can even induce autoimmune disease. These atypical presentations are known as immune restoration disease (IRD), immune reconstitution syndrome/immune recovery syndrome (IRS), or immune restoration inflammatory syndrome (IRIS). We report the case of a 27-year-old, HIV-1-positive woman who developed hyperthyroidism attributable to Graves' disease (GD) after commencing potent cART. At the initiation of cART, her CD4 T cell count was 15 cells/microL and plasma HIV RNA 35 000 copies/mL. Her commencement of cART resulted in complete viral suppression and subsequent improvement of the CD4 T-cell count. Three years later, the diagnosis of GD was established based on a typical clinical picture and the results of hormonal and immunological analyses. It coincided with a 58-fold rise of the CD4 T cells. Retrospective analysis of serum samples revealed normal thyroid function and lack of anti-thyroid peroxidase (anti-TPO), anti- thyroid-stimulating hormone receptor (anti-TSHR), and anti-thyroglobulin (anti-TG) autoantibodies at the beginning of cART. HLA class II gene examination did not reveal susceptibility for the GD development in this patient. We suggest that GD in our patient was an IRD, and advise this as a possible differential diagnosis in patients presenting with hyperthyroidism on cART. To provide further details relevant to this case, we also review the literature concerning IRD-GD.

Long-term (120-Week) antiviral efficacy and tolerability of fosamprenavir/ritonavir once daily in therapy-naive patients with HIV-1 infection: an uncontrolled, open-label, single-arm follow-on study.

BACKGROUND: In the SOLO study (APV30002), once-daily antiretroviral treatment with the protease inhibitor fosamprenavir (FPV) 1,400 mg boosted by ritonavir (r) 200 mg plus abacavir/lamivudine (ABC/3TC) was found to be noninferior to nelfinavir plus ABC/3TC over 48 weeks in treatment-naive patients with HIV -1 infection. OBJECTIVE: This interim report presents antiviral efficacy and tolerability data from 211 patients who received FPV/r QD for at least 48 weeks in SOLO and continued this treatment in the follow-on study (APV30005) for up to 120 weeks. METHODS: APV30005 is an international, multicenter, uncontrolled, open-label, follow-on study conducted to provide continued access to FPV in patients with HIV-1 infection who had participated in previous FPV studies, including SOLO, and to obtain longer-term data on the antiviral response and tolerability of an FPV-containing regimen. Patients who had completed at least 48 weeks of FPV/r therapy in the SOLO study were eligible to enter the follow-on study and continue receiving FPV/r 1,400/200 QD, with study visits every 12 weeks. Their background regimens were chosen at the investigators' discretion and could be changed at any time. Antiviral response end points included plasma HIV-1 RNA levels <400 and <50 copies/mL, median plasma HIV-1 RNA levels, median and absolute changes from baseline in the CD4 cell count, and the frequency of HIV disease progression. Genotype and phenotype analyses were performed for patients meeting the criterion for virologic failure (defined as plasma HIV -1 RNA >1,000 copies/mL on 2 consecutive occasions on or after week 12). Tolerability was assessed in terms of adverse-event reports evaluated by the primary investigator and changes in laboratory values. Assessments were conducted at 12-week intervals during the follow-on study. Data from the baseline visit (day 1 of SOLO) were compared with data from the follow-on study through March 31, 2004, when all patients had completed at least 120 weeks of therapy with FPV/r QD. Because this was a rollover study, no significance testing was performed and all reported results are descriptive. RESULTS: The demographic and baseline characteristics of the patients who received FPV/r QD in this follow on study (N = 211) were similar to those of the 322 patients randomized to receive FPV/r QD in the SOLO study. Their median age was 36 years, 72% were male, 49% were white, and 39% were black. The median baseline plasma HIV 1 RNA level was 4.82 log(10) copies/ mL, and the median baseline CD4+ cell count was 168 cells/mm(3). The median duration of exposure to FPV/r QD from SOLO baseline through the cutoff date was 996 days (142 weeks), ranging from 372 to 1,226 days (53-175 weeks). At week 120, plasma HIV-1 RNA levels <400 and <50 copies/mL were achieved and maintained in 75% (159) and 66% (139) of patients, respectively, when missing data and discontinuations were counted as failures. The median CD4+ cell count at week 120 was 451 cells/mm(3), a median change from baseline of 292 cells/mm(3). In 14 patients with no baseline resistance who met the criterion for virologic failure, no viral protease resistance mutations were detected. Extended treatment was generally well tolerated. The most frequently reported drug-related grade 2-4 adverse events were diarrhea (22 [10%]), nausea (17 [8%]), drug hypersensitivity (14 [7%], all cases attributed to ABC, which was a study drug in SOLO), and increased triglycerides (14 [7%]). The nature of adverse events reported after 48 weeks of therapy was comparable to that reported before week 48. Adverse events occurred at a similar or lower frequency between weeks 48 and 120 compared with before week 48. Similarly, laboratory abnormalities seen by week 120 were comparable to those seen by week 48, although they were less frequent. CONCLUSIONS: Extended treatment (120 weeks) with FPV/r QD in these antiretroviral therapy-naive, HIV-1-infected patients was associated with sustained antiviral response and immunologic improvement. Adverse events had generally developed by 48 weeks of therapy and did not occur at a higher frequency through 120 weeks of treatment.

Lung cancer as an immune reconstitution disease in an HIV-1 positive man receiving HAART.

A case of small-cell lung cancer with prompt worsening of the clinical course was observed in a patient with significant immune restoration after receiving effective highly active antiretroviral therapy (HAART) for seven months. Rapid and enormous enlargement of metastatic liver was the main symptom. Chest x-ray showed an enlargement of the left hilus. The patient died 22 days after the onset of the fulminant disease. We suggest that the occurrence and aggressive course of the lung cancer resulted from the development of immune reconstitution syndrome.

Non-Hodgkin's lymphoma as a rare manifestation of immune reconstitution disease in HIV-1 positive patients.

Combination antiretroviral therapy (cART) can improve immune system function through suppression of HIV-1 replication. However, paradoxical immune response may develop in some patients as a result of effective therapy followed by immune restoration. The phenomena is known as IRS, immune reconstitution syndrome/immune recovery syndrome. IRS can develop within weeks to months after cART is commenced and the time is related to the type of the disease. There are but scant reports concerning IRS-NHL (non-Hodgkin's lymphoma) in HIV-1 positive subjects. We observed 4 (33%) cases of IRS-NHL out of 12 patients in whom NHL was diagnosed. As a result of potent cART they reached viral suppression in a mean time of 15 weeks followed by a rise in CD4(+) T cells within 16.5 weeks. The diagnosis of NHL was established at a mean time of 36 weeks after cART was introduced and 20 weeks after the CD4 T cell increase was achieved. This may indicate that the immune reconstitution as a result of cART was a predisposing factor for the development of NHL in our patients. There was prompt progression of the disease and the outcome was fatal in all cases. IRS-NHL should be suspected in any case of lymphadenopathy, generalized or limited to the abdomen or periphery, which develops after immune recovery due to potent cART within a few months.

[Critical evaluation of reporting on postexposure skin damage incidents and its consequences for Polish health workers]. / Krytyczna ocena rejestracji ekspozycji zawodowych zwiazanych z naruszeniem ciaglosci tkanek oraz wynikajacych z tego konsekwencji--wsród pracowników polskiej sluzby zdrowia.

BACKGROUND: The principles of uniform reports on infections with HBV, HCV, HIV due to occupational exposure have not yet been established in Poland. Usually, reporting on such incidents is governed by internal rules of individual health care institutions. The aim of the study was to assess the possibility of obtaining data on postexposure incidents among health care workers in different voivodeships (regions) and to identify a group of persons who most frequently reported such cases in a given calendar year. MATERIAL AND METHODS: Nineteen medical centers from all 16 voivodeships were invited to participate in the study. The main condition to be enrolled in the study was to provide full postexposure prophylaxis log. RESULTS AND CONCLUSIONS: In all, 8 centers from 8 voivodeships were enrolled in the final study. Only in 4 voivodehips, completely centralized postexposure prophylaxis logs were in operation. Women with secondary education (nurses) formed the major group of exposed persons. Exposure incidents occurred most frequently in wards or operation rooms while performing medical procedures or immediately after. Blood collection predominated among various kinds of exposure. The majority (75.7%) of health workers underwent full vaccination program against HBV. The analysis revealed large differences in exposure reporting between individual voivodeships. Sometimes they made it even difficult to complete full demographic data concerning exposed persons. Therefore, a universal tool of nationwide system should be elaborated. Such a system (an example is presented by the authors), regularly verified, might provide grounds for a wider analysis of postexposure prophylaxis efficacy, details concerning exposure incidents and their consequences in the future. This may greatly contribute to the reduction of exposure rates among health care workers.

[Underestimation of exposure incidence rates in Polish health workers: a prospective study]. / Ocena niedoszacowania czestosci ekspozycji na material biologiczny wsród pracowników polskiej sluzby zdrowia--analiza prospektywna.

BACKGROUND: Analyses of exposure rates among health care workers comprise both risk and epidemiology of blood borne pathogenic factors. In Poland, a possible extent of underestimation of such incidents has not yet been widely studied in the population of this group of employees. The aim of the study was to observe a group of population chosen as an example to assess the actual exposure incidence rates, especially those not subjected to registration. MATERIALS AND METHODS: A prospective six-month survey covered 319 Lower Silesia health care workers: physicians, nurses and auxiliary staff. Statistical methods were used to analyze the obtained data, especially those concerning the job performance, the number of medical procedures performed and frequency of exposures, both registered in each case and not registered in the post-exposure prophylaxis log. RESULTS AND CONCLUSIONS: Finally, 269 persons were under observation. Actual exposure incidence rate was several fold higher than that officially registered and differed depending on the department and subgroup of health care workers. In summary, the ratio of all the registered cases to those not registered was 1: 6. An overall proportion of not registered cases of exposure was as high as 86%. Most frequent job activities of exposed health care workers comprised preparatory procedures like parenteral drug administration or injections. Post-procedure activities were less frequently the cause of exposure. Non-registration of such exposures were motivated by a self-assessment of a low infection risk or a conviction that self-protection on the incidence site was optimal. Lack of current knowledge was rather rarely admitted as a reason for underreporting.