Predictors for influenza vaccination among Thai pregnant woman: The role of physicians in increasing vaccine uptake.

BACKGROUND: Physician recommendation and attitudes and beliefs of pregnant women toward influenza and vaccination may influence vaccine uptake during pregnancy. We examined how physician recommendation and health beliefs of pregnant women may jointly affect influenza vaccination during pregnancy. METHODS: Thai pregnant women aged ≥18 years and >13 gestational weeks attending antenatal care (ANC) clinics, and ANC physicians were recruited during May-August 2015. Women and physicians, linked using unique identifiers, provided data on demographic, health and work history, knowledge, attitudes, and beliefs toward influenza and vaccination, based on Health Belief Model constructs. Physicians also provided data on their practices in recommending influenza vaccination during pregnancy. Prevalence ratios for the association between knowledge, attitudes and beliefs of pregnant women, physician recommendation and documented receipt of vaccination within 30 days of the visit were calculated. RESULTS: Among 610 women, the median age was 27 years; 266 (44%) and 344 (56%) were in the second and third trimesters, respectively. Twenty-one (3%) had pre-existing conditions. Of 60 physicians with the median years of practice of 5; 17 (28%) reported frequently/usually/always recommending influenza vaccine to their pregnant patients, while 43 (72%) reported never/rarely/sometimes recommending the vaccine. Controlling for the pregnant women's knowledge and beliefs, pregnant women whose physician recommended influenza vaccination were 2.3 times (95% confidence interval 1.4-3.8) more likely to get vaccinated. CONCLUSIONS: In this study, physician recommendation was the only significant factor associated with influenza vaccine uptake among Thai pregnant women. Understanding physicians' motivation/barrier to recommending influenza vaccination to pregnant women may increase coverage.

Tolerability of trivalent inactivated influenza vaccine among pregnant women, 2015.

BACKGROUND: Thailand recommends influenza vaccination among pregnant women. We conducted a cohort study to determine if the prevalence of adverse events following immunization (AEFIs) with influenza vaccine among Thai pregnant women was similar to that often cited among healthy adults. METHODS: Women who were ≥17 gestational weeks and ≥18 years of age were recruited. Demographic and health history data were collected using structured questionnaires. Women were provided with symptom diary, ruler to measure local reaction(s), and thermometer to measure body temperature. AEFIs were defined as any new symptom/abnormality occurring within four weeks after vaccination. The diaries were abstracted for frequency, duration, and level of discomfort/inconvenience of the AEFIs. Serious adverse events (SAEs) and the likelihood of AEFIs being associated with vaccination were determined using standard definitions. RESULTS: Among 305 women enrolled between July-November 2015, median age was 29 years. Of these, 223 (73%) were in their third trimester, 271 (89%) had completed secondary school or higher, and 20 (7%) reported ≥1 pre-existing conditions. AEFIs were reported in 134 women (44%; 95% confidence interval [CI] 38-50%). Soreness at the injection site (74, 24%; CI 19-29%), general weakness (50, 16%; CI 12-21%), muscle ache (49, 16%; CI 12-21%), and headache (45, 15%; CI 1-19%) were most common. Of those with AEFIs, 120 (89%) reported symptom/abnormality occurred on day 0 or day 1 following vaccination. Ten women (7%) reported the AEFIs affected daily activities. The AEFIs generally spontaneously resolved within 24 h of onset. There were two vaccine-unrelated SAEs. Of 294 women with complete follow-up, 279 (95%) had term deliveries, 12 (4%) had preterm deliveries, and 3 (1%) had miscarriage or stillbirth. CONCLUSION: In our cohort, AEFIs with influenza vaccine occurred with similar frequency to those reported among healthy adults in other studies, and were generally mild and self-limited. No influenza vaccine-associated SAEs were identified.

Implementation and assessment of a prevention with positives intervention among people living with HIV at five hospitals in Thailand.

BACKGROUND: We implemented a hospital-based prevention with positives (PwP) intervention among people living with HIV (PLHIV) that included HIV transmission risk screening, short HIV prevention messages, family planning, HIV disclosure counseling, and partner HIV testing at five hospitals in Thailand. We assessed changes in sexual risk behaviors among PLHIV who received the PwP services at the hospitals. METHODS: From January 2008-March 2009, we systematically selected a subset of PLHIV receiving care at the five hospitals to offer participation in the PwP intervention. We collected demographic, risk behavior, and laboratory data using a standardized questionnaire. We analyzed data from PLHIV who completed at least four visits, using generalized estimating equations to identify baseline participant characteristics that were associated with adopting sexual practices less likely to be associated with HIV transmission during follow-up. RESULTS: A total of 830 PLHIV were interviewed and 756 (91.1%) completed four visits. The median age of these 756 participants was 37 years, 400 (52.9%) were women, and 475 (62.8%) had a steady partner. At baseline, 353 (74.3%) of the steady partners had been tested for HIV and 132 (37.4%) had tested negative. Among the 756 PLHIV, 427 (56.5%) reported having sex in the 3 months before enrollment and 413 (54.6%) in the 3 months before the fourth visit. The proportion reporting having vaginal or anal sex without a condom decreased from 20.8% at baseline to 5.1% at the fourth visit (p<0.001). Factors associated (p<0.05) with abstinence or 100% condom use at follow-up visits included: completing ≥ two visits, being diagnosed with HIV for longer than 3 months, and receiving HIV prevention messages from a doctor (versus a nurse or counselor). CONCLUSION: Safe sex behaviors increased among PLHIV receiving PwP services, suggesting that expansion of hospital-based PwP services may reduce the number of new HIV infections in Thailand.

Prevalence of Sexually Transmitted Infection in Teenage Pregnancy in Rajavithi Hospital, Thailand.

BACKGROUND: Behavioral and social changes in the modern era have triggered an increase in the incidence of early sexual contact and teenage pregnancy. Since there is no routine Gonococcal & Chlamydial (GC & CT) screening in teens in antenatal clinics in Thailand, the present study was performed to find the prevalence of STI, especially Chlamydial infection, in teenage pregnancy. OBJECTIVE: To evaluate the prevalence of sexually transmitted infections (STIs), especially Chlamydial infection (CT), in teenage pregnancy and its related factors. MATERIAL AND METHOD: One hundred and twenty-one teenage pregnancies were recruited at the ANC in Rajavithi Hospital from October 2006 to May 2007. After signing informed consent forms, they were asked to answer questionnaires about baseline data, sexual information and risk factors, after which urine specimens were collected for screening for GC and CT using the PCR technique (AMPLICOR by Roche). Later, pelvic examination was per formed by the gynecologist at the STD (sexually transmitted disease) clinic. All the data and LAB results were recorded and analyzed by the SPSS program. Numbers, percentages, means with SD, Chi-squared test, Fisher's exact test and odds ratio were used. Potential risk factors were analyzed using binary logistic regression. RESULTS: The prevalence of STI in pregnant teenagers was 28.1% (CT = 19.8%, GC = 1.7%, hepatitis B = 3.3%, trichomoniasis 1.7%, Herpes simplex = 0.8% and condyloma acuminata = 0.8%). No Syphilis, chancroid or HIV were found in the present study Other non-STI like candidiasis and bacterial vaginosis were found in 45.5% of participants (candidiasis and bacterial vaginosis at 19.0% and 24.8%, respectively). The risk of CT infection was significantly related (6.9 times higher) to having previous sexual contact before the current partner (95% CI, 1.8-27.0). CONCLUSION: STI, especially Chlamydial infection, was found in a significant number of teenage pregnancies. Measures should be taken to prevent this resulting in complicated outcomes in the future.

Dual contraceptive method use and pregnancy intention among people living with HIV receiving HIV care at six hospitals in Thailand.

BACKGROUND: Describe dual contraceptive method use and the intention to become pregnant of people living with HIV (PLHIV) and their partners in Thailand. METHODS: From January 2008-March 2009, we systematically selected a cohort of PLHIV from PLHIV seeking care at five tertiary care hospitals and one community hospital to complete a questionnaire assessing sexual activity, intention to become pregnant, and contraceptive practices at baseline and 12 months after enrollment. Participants received short family planning messages every 2-3 months to promote the use of dual contraceptives and were offered family planning services. RESULTS: A total of 1,388 PLHIV enrolled, their median age was 37 years (IQR 33-43), 898 (64.7%) had a steady partner, and 737 (53.1%) were male. Among those with a steady partner, 862 (96.0%) did not intend to become pregnant; 709 (82.3%) had sex during the previous 3 months, 683 (96.3%) used at least one contraceptive method, and 202 (29.6%) used dual contraceptive methods. Of the 317 PLHIV who used a single contraceptive method at baseline, 66 (20.8%) reported using dual methods at 12 months. Participants at two tertiary care hospitals where coordinators facilitated PLHIV referral between HIV and OB/GYN clinics were more likely than participants at the other hospitals to change from single method to dual method (p ≤ 0.03). CONCLUSION: Few PLHIV in this study intended to become pregnant; however, only one-fourth used dual contraceptive methods. Integrating an assessment of the intention to become pregnant and strengthening the PLHIV referral systems in family planning services may contribute to higher rates of dual contraceptive use.

Sexually transmitted infections among HIV-infected women in Thailand.

BACKGROUND: Data on sexually transmitted infections (STI) prevalence among HIV-infected women in Thailand are limited. We studied, among HIV-infected women, prevalence of STI symptoms and signs; prevalence and correlates of having any STI; prevalence and correlates of Chlamydia trachomatis (CT) or Neisseria gonorrhoeae (GC) among women without CT and/or GC symptoms or signs; and number of women without CT and/or GC symptoms or signs needed to screen (NNS) to detect one woman with CT and/or GC overall, among pregnant women, and among women ≤25 years. METHODS: During October 2004-September 2006, HIV-infected women at 3 obstetrics and gynecology clinics were asked about sexual behaviors and STI symptoms, physically examined, and screened for chlamydia, gonorrhea, trichomoniasis, and syphilis. Multivariate logistic regression was used to identify correlates of infections. NNS was calculated using standard methods. RESULTS: Among 1,124 women, 526 (47.0%) had STI symptoms or signs, 469 (41.7%) had CT and/or GC symptoms or signs, and 133 (11.8%) had an STI. Correlates of having an STI included pregnancy and having STI signs. Among 469 women and 655 women with vs. without CT and/or GC symptoms or signs, respectively, 43 (9.2%) vs. 31 (4.7%), 2 (0.4%) vs. 9 (1.4%), and 45 (9.6%) vs. 38 (5.8%) had CT, GC, or "CT or GC", respectively; correlates included receiving care at university hospitals and having sex with a casual partner within 3 months. NNS for women overall and women ≤25 years old were 18 (95% CI, 13-25) and 11 (95% CI, 6-23), respectively; and for pregnant and non-pregnant women, 8 (95% CI, 4-24) and 19 (95% CI, 14-27), respectively. CONCLUSIONS: STI prevalence among HIV-infected women, including CT and GC among those without symptoms or signs, was substantial. Screening for CT and GC, particularly for pregnant women, should be considered.

Prevalence of low birthweight infants in HIV-infected women delivered in Rajavithi Hospital.

OBJECTIVE: To determine the prevalence of low birthweight infants in HIV-infected pregnant women delivered in Rajavithi Hospital and the relationship between antiretroviral drugs and low birthweight infants. MATERIAL AND METHOD: All numbers of low birthweight (LBW) infants and pregnant women with or without HIV infection delivered in Rajavithi Hospital during 2004-2008 from medical records were used. Two hundred HIV-infected pregnant women who delivered their infants at the same period were random for description and analysis. RESULTS: The prevalence of low birthweight infants delivered by HIV and non HIV-infected pregnant women were 12.6% (53/ 420) and 13.3% (4,249/31,975), respectively. There was no significant association between HIV infection and low birthweight (p = 0.688). Low birthweight infants delivered from HIV-infected pregnant women with and without antiretroviral therapy were 9.9% (7/41) and 13.6% (19/159), respectively. Various types of antiretroviral (ARV) drug including no ARV were significantly associated with LBW (p = 0.021). The one who received highly active antiretroviral therapy (HAART) had 2.27 times higher risk in having LBW. CONCLUSION: The prevalence of low birthweight infants among HIV-infected pregnant women was 12.6%. There was no association between HIV infection and LBW. HAART might be a risk of LBW.

Outcome of teenage pregnancy in Rajavithi Hospital.

OBJECTIVE: To compare maternal and neonatal outcomes between pregnant teenage girls (age <20 yrs) and pregnant adults (age 20-34 yrs). MATERIAL AND METHOD: Seven hundred and fifty pregnant teenagers admitted and delivered at Rajavithi Hospital during November 8, 2006 and December 22, 2007 were enrolled in the study. A control group included 750 pregnant adults delivered during the same period. RESULTS: Preterm labor was the significant antepartum complication in the teenage mothers while diabetes mellitus was the significant one in the adult mothers as compared to those in the other groups. Teenage mothers had significantly higher incidence of cesarean delivery than that in the adult mothers. The neonates of the teenage mothers showed higher number of complications than those of the adult mothers. CONCLUSION: Pregnant teenage girls had more maternal and neonatal complications than those of pregnant adults.

Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae in HIV-seropositive patients and gonococcal antimicrobial susceptibility: an update in Thailand.

We surveyed the rate of chlamydial and gonococcal infections among human immunodeficiency virus (HIV)-seropositive patients in Thailand as well as the current status of antimicrobial resistance of Neisseria gonorrhoeae and determined the prevalence of penicillinase-producing N. gonorrhoeae (PPNG) in Thailand. A total of 1,158 endocervical swabs from 824 HIV-seropositive patients were collected to detect both organisms by Gen-Probe. The prevalences of chlamydial and gonococcal infection were 9.7 and 1.3%, respectively. Susceptibility of 122 gonococcal isolates to 6 drugs was determined by the disk diffusion method. None of the isolates was susceptible to penicillin or tetracycline. With respect to fluoroquinolones, more than 90% of the isolates were resistant to ciprofloxacin and ofloxacin. No gonococcal isolate with resistance to cefotaxime and ceftriaxone was detected. Among the 122 isolates, 83.6% or 102 isolates were PPNG, and most (79.5%) of these 122 isolates were further identified as PPNG plus tetracycline-resistant N. gonorrhoeae, with only 4.1% being PPNG alone. All of the 102 isolates identified as PPNG contained the bla(TEM) gene. We then performed a preliminary molecular study and identified, for the first time in Thailand, a PPNG isolate producing beta-lactamase and containing the bla(TEM) gene which was identical to the beta-lactamase TEM protein of Salmonella enterica identified as TEM-135.

Antiretroviral resistance patterns and HIV-1 subtype in mother-infant pairs after the administration of combination short-course zidovudine plus single-dose nevirapine for the prevention of mother-to-child transmission of HIV.

BACKGROUND: World Health Organization guidelines for prevention of mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) recommend administration of zidovudine and single-dose nevirapine (NVP) for HIV-1-infected women who are not receiving treatment for their own health or if complex regimens are not available. This study assessed antiretroviral resistance patterns among HIV-infected women and infants receiving single-dose NVP in Thailand, where the predominant circulating HIV-1 strains are CRF01_AE recombinants and where the minority are subtype B. METHODS: Venous blood samples were obtained from (1) HIV-infected women who received zidovudine from 34 weeks' gestation and single-dose NVP plus oral zidovudine during labor and (2) HIV-infected infants who received single-dose NVP after birth plus zidovudine for 4 weeks after delivery. HIV-1 drug resistance testing was performed using the TruGene assay (Bayer HealthCare). RESULTS: Most mothers and infants were infected with CRF01_AE. NVP resistance was detected in 34 (18%) of 190 women and 2 (20%) of 10 infants. There was a significantly higher proportion of NVP mutations in women with delivery viral loads of >50,000 copies/mL (adjusted odds ratio, 8.5; 95% confidence interval, 2.2-32.8, P = .002 for linear trend) and in those with subtype B rather than CRF01_AE infections (38% vs. 16%; adjusted odds ratio, 3.6; 95% confidence interval, 1.1-11.8; P = .038). CONCLUSIONS: The lower frequency of NVP mutations among mothers infected with subtype CRF01_AE, compared with mothers infected with subtype B, suggests that individuals infected with subtype CRF01_AE may be less susceptible to the induction of NVP resistance than are individuals infected with subtype B.

Maternal herpes simplex virus type 2 coinfection increases the risk of perinatal HIV transmission: possibility to further decrease transmission?

OBJECTIVES: To evaluate the association between maternal herpes simplex virus type 2 seropositivity and genital herpes simplex virus type 2 shedding with perinatal HIV transmission. STUDY DESIGN: Evaluation of women who participated in a 1996-1997 perinatal HIV transmission prevention trial in Thailand. METHODS: In this nonbreastfeeding population, women were randomized to zidovudine or placebo from 36 weeks gestation through delivery; maternal plasma and cervicovaginal HIV viral load and infant HIV status were determined for the original study. Stored maternal plasma and cervicovaginal samples were tested for herpes simplex virus type 2 antibodies by enzyme-linked immunoassay and for herpes simplex virus type 2 DNA by real-time PCR, respectively. RESULTS: Among 307 HIV-positive women with available samples, 228 (74.3%) were herpes simplex virus type 2 seropositive and 24 (7.8%) were shedding herpes simplex virus type 2. Herpes simplex virus type 2 seropositivity was associated with overall perinatal HIV transmission [adjusted odds ratio, 2.6; 95% confidence interval, 1.0-6.7)], and herpes simplex virus type 2 shedding was associated with intrapartum transmission (adjusted odds ratio, 2.9; 95% confidence interval, 1.0-8.5) independent of plasma and cervicovaginal HIV viral load, and zidovudine treatment. Median plasma HIV viral load was higher among herpes simplex virus type 2 shedders (4.2 vs. 4.1 log(10)copies/ml; P = 0.05), and more shedders had quantifiable levels of HIV in cervicovaginal samples, compared with women not shedding herpes simplex virus type 2 (62.5 vs. 34.3%; P = 0.005). CONCLUSION: We found an increased risk of perinatal HIV transmission among herpes simplex virus type 2 seropositive women and an increased risk of intrapartum HIV transmission among women shedding herpes simplex virus type 2. These novel findings suggest that interventions to control herpes simplex virus type 2 infection could further reduce perinatal HIV transmission.

Treatment failure following large loop excision of the transformation zone for the treatment of cervical intraepithelial neoplasia at Rajavithi Hospital.

OBJECTIVE: To evaluate the treatment failure rate of large loop excision of the transformation zone (LLETZ) in the treatment of cervical intraepithelial neoplasia (CIN) and the risk of persistence or recurrence depending on the clinicopathologic factors. MATERIAL AND METHOD: Retrospective case-record review of 250 women who had a final diagnosis of CIN and underwent LLETZ in Rajavithi Hospitalfrom June 1st, 1998 to December 31st, 2003. Computerized files of these patients were then reviewed for clinicopathological follow-up results. RESULTS: Success rate of 86.8% was obtained. The incidence of treatment failure was 13.2%. The clinicopathologic factor associated with the persistence or recurrence was the presence of CIN at the margin of excision. Of 69 cases with incomplete excision (positive margin), treatment failure developed in 29.0%, compared to 5.2% in patients with complete excision (negative margins) (p < 0.001). Using multivariate analysis, incomplete excision and endocervical margin involvement of specimen were independent risk factors for the treatment failure of CIN. CONCLUSION: LLETZ is an effective treatment for CIN. Treatment failure rate is low. Positive surgical margin is a predictor of persistence or recurrence after LLETZ. Incomplete excision and endocervical margin involvement of specimen are significant independent risk factors.

Human papillomavirus (HPV) detection among human immunodeficiency virus-infected pregnant Thai women: implications for future HPV immunization.

BACKGROUND: Human immunodeficiency virus (HIV)-infected women are at increased risk for developing cervical cancer and for infection with human papillomavirus (HPV). Prophylactic vaccines targeting HPV types 16 and 18 are being evaluated for efficacy among young women. GOAL: The goal was to assess the prevalence of HPV among HIV-infected pregnant women in Bangkok and to evaluate the need for prophylactic HPV vaccines studies in this population. STUDY DESIGN: The study population consisted of 256 HIV-infected pregnant women who participated in a mother-to-child HIV transmission trial. Stored cervicovaginal lavage samples were tested for the presence of HPV DNA by polymerase chain reaction with PGMY09/11 primers and reverse line-blot hybridization for determination of anogenital HPV types. RESULTS: HPV prevalence was 35.5% (91/256); high-risk HPV prevalence was 23.4% (60/256). HPV type 16 or 18 was present in 8.2% (21/256). Almost half of all infections were multiple. Furthermore, overall HPV detection was associated with abnormal cervical cytology (P<0.001) and higher HIV-plasma viral load (P=0.007). CONCLUSIONS: Only one-quarter of HIV-infected pregnant women in Bangkok had high-risk HPV types; less than 10% had HPV types 16 or 18. As the HPV prevalence is expected to increase during HIV disease, prophylactic vaccines targeting HPV types 16 and 18 should be studied among HIV-infected women not yet infected with these HPV types and not previously exposed.

Evaluating programs to prevent mother-to-child HIV transmission in two large Bangkok hospitals, 1999-2001.

The 2 largest maternity hospitals in Bangkok implemented comprehensive programs to prevent mother-to-child HIV transmission in 1998. We conducted a cross-sectional survey of post-partum HIV-infected women in 1999 through 2001 to evaluate these programs. Women were given structured interviews at 0 to 3 days, 1 month, and 2 months postpartum. Medical records of women and their newborns were reviewed. Of 488 enrolled women, 443 (91%) had antenatal care: 391 (88%) at study hospitals and 52 (12%) elsewhere. The HIV diagnosis was first known before pregnancy for 61 (13%) women, during pregnancy for 357 (73%) women, during labor for 22 (5%) women, and shortly after delivery for 48 (10%) women. Antenatal zidovudine (ZDV) was used by 347 (71%) women, and intrapartum ZDV was used by 372 (76%) women. Twelve (55%) of the 22 women who first learned of their HIV infection during labor took intrapartum ZDV. All 495 newborn infants started prophylactic ZDV; the first dose was given within 12 hours for 491 (99%) children. Ten (2%) children were breast-fed at least once by their mother, and 10 (2%) were breast-fed at least once by someone else. Although uptake of services was high, inconsistent antenatal care, fear of stigmatization, and difficulty in disclosing HIV status prevented some women from using services.

Satisfaction and tolerability of combination of lactoserum and lactic acid on the external genitalia in Thai women.

OBJECTIVE: The aims of this study were to assess the user satisfaction and tolerability of a combination of lactoserum and lactic acid on the external genitalia of Thai women. MATERIAL AND METHOD: Women who were over 18 years of age who came to gynecologic outpatient unit at Rajavithi Hospital from November 2004 to January 2005, without clinical manifestations of vulvovaginal irritation or infection were included. The exclusion criteria were women who had allergy to a combination of lactoserum and lactic acid, or any of the components of this product. Clinical history was taken and gynaecological examination was performed. Those who met the eligible criteria were assigned to use one bottle of 150 ml combination of lactoserum and lactic acid on the external genitalia. Fisher's Exact test was used to compare the satisfaction between each group. RESULTS: There were 300 patients equally dividing in 3 groups. Average age was 42.2 +/- 9.8 years. The satisfaction percentage was more than 90 percent according to the evaluation criteria. There was no statistically significant difference between products. The tolerability were high percentage, only 3.3% of the patients used these products less than 7 days. 6 patients (2%) experienced discomfort resulting from these products and no statistically significant difference between products. CONCLUSION: The combination of lactoserum and lactic acid demonstrated the high percentage of satisfaction and tolerability. Only 2% of patients experienced discomfort without any serious discomfort effects.