Favipiravir-induced cutaneous adverse reactions in patients infected with COVID-19.

Favipiravir (FVP) has been used for treatment of COVID-19 in many countries. We analysed the incidence of FVP-induced cutaneous adverse reactions (CARs) in patients infected with COVID-19 who were hospitalized at Bamrasnaradura Infectious Diseases Institute, a principal centre of emerging infectious disease in Thailand, and who presented with cutaneous eruption following FVP prescription. We identified five cases of FVP-induced CARs: two patients with maculopapular rash, two with urticarial rash, and one with Stevens-Johnson syndrome. The median interval between FVP treatment and rash occurrence was 7 days and the mean duration of the rash was 5 days. This report highlights that FVP can induce CARs, particularly eruptions, in COVID-19-infected patients. Clinicians should be aware of this possible drug-related allergy, and it should be excluded as a cause of rash during FVP treatment of COVID-19.

Acute urticaria alone after CoronaVac COVID-19 vaccination should not be a contraindication for revaccination.

Patients who develop an immediate allergic reaction within the first 4 h of COVID-19 vaccine injection are recommended not to receive the same vaccine again. This recommendation mainly focuses on the mRNA and adenoviral vector COVID-19 vaccines, but data for whole virus vaccines are unknown. We report seven patients who developed an immediate reaction within 4 h (six had generalized urticaria, one had localized urticaria) after the first vaccination with CoronaVac, the inactivated SARS-CoV-2 vaccine. The results of skin tests and basophil activation tests suggested that spike peptides play a role in exacerbating urticaria in some patients. However, all subjects who developed urticaria within 4 h after CoronaVac vaccination were successfully revaccinated without graded challenge, although recurrent urticaria was common. This preliminary result indicates that acute urticaria alone should not be a contraindication for the second dose of CoronaVac if the supply of alternative vaccines is limited.

Risk factors for childhood diarrhea in an urban community, Bangkok, Thailand.

A follow-up study for diarrheal disease was carried out for a period of one year in children aged 0-5 yrs who lived in a government housing project in Din Daeng community of Bangkok metropolitan area during 1988-1989. The overall incidence was 0.9 episode per child per year with the higher episode of 2 per child per year in children less than 2 yrs. The risk factors of diarrheal occurrence were studies within different age groups. For children less than 6 months the major risk factors were low family income, low education level and unemployed parents. In children 6-11 months the other risk factors added to low income and education in mothers were children who did not live with parents. The risk factors for children 1-2 yrs were non-working mothers, and unhygienic behavior of the child care takers such as no hand washing after toilet use and the method of cleaning milk bottles for children 2-5 yrs. Method of faecal disposal, handwashing, day care and food protection were major sources of diarrheal risk.

Impact of an educational program on the treatment practices of diarrheal diseases among pharmacists and drugsellers.

The impact of an intervention program, measured by changes in the prescription of ORS, antibiotics and antidiarrheal drugs by those pharmacists and drugsellers after administering the proposed educational package was assessed. The results of the study indicated that, before the educational program started, ORS was prescribed by pharmacists for 31.4% and 15.7% of watery diarrhea and dysentery episodes, respectively. Only 18.9% and 13.3% of drugsellers gave ORS to assessors in case of watery diarrhea and dysentery. Antibiotics and antidiarrheal agents were prescribed extensively, watery and dysenteric diarrhea (84% and 56% for watery diarrhea by pharmacists and drugsellers; 92% and 60% for dysentery). Antidiarrheal drugs were used as frequently. After the educational program, the assessment of the prescription behavior of the pharmacists showed no change in ORS, antibiotics and antidiarrheal drugs prescribed to treat watery diarrhea. In dysentery, the effective percent change in prescribing ORS between pre- and post- intervention program was much higher in intervention group than the control group. For drugsellers, effective percent change in ORS usage in treatment of watery diarrhea was 11.8% compared with -7.7% in the control group. No such change was observed in treatment of dysentery. There was a slight significant change in behavior concerning use of antibiotics among subjects getting information by mail, compared to those who got full intervention, when the pre-intervention behavior, store type and treatment type was taken into account.

Childhood diarrhoea in a low-income urban community in Bangkok: incidence, clinical features, and child caretaker's behaviours.

A one-year surveillance study of childhood diarrhoea in a low-income urban community in Bangkok revealed an annual incidence of 2.2 episodes per child among infants, and that the overall annual incidence among children under five years of age was 0.9 per child. Rotavirus, Salmonella and Campylobacter jejuni were common aetiologic agents. In children less than one year, diarrhoea was caused mostly by rotavirus and Salmonella. In 1-2 year old children, the major causative agent was rotavirus while E. coli, Campylobacter jejuni and Shigella were subsequent aetiologic agents. In grown up children (aged 2-5 years), the more common diarrhoeal pathogens were Shigella and E. coli. The clinical characteristics of diarrhoeal illness due to different pathogens were shown. The sources of drugs and the usage of available facilities in treating diarrhoea are also described. Caretakers treated childhood diarrhoea with ORS (53%), antibiotics (10%), and a combination of these in 15% of cases. These findings imply that the available facilities in this community can be better utilised to obtain more effective control of diarrhoeal morbidity and mortality.

Importance of salmonellae and Campylobacter jejuni in the etiology of diarrheal disease among children less than 5 years of age in a community in Bangkok, Thailand.

The etiology of diarrhea in children less than 5 years of age in a low-income housing project in Bangkok, Thailand, was determined over 1 year. Nontyphoidal salmonellae (13%), Campylobacter jejuni (12%), rotavirus (12%), enterotoxigenic Escherichia coli (7%), shigellae (6%), E. coli that hybridized with the enteropathogenic E. coli adherence factor probe (3%), and enteroinvasive E. coli (1%) were identified in 345 episodes of diarrhea in children less than 5 years of age. Salmonellae were identified in 17% and C. jejuni was identified in 15% of 54 children less than 6 months of age with diarrhea. Shigellae, enteroinvasive E. coli, enteropathogenic E. coli adherence factor, and enterotoxigenic E. coli were not isolated from children less than 6 months of age. Since salmonellae and C. jejuni were the most common bacterial pathogens identified in children less than 6 months of age, efforts to prevent transmission of salmonellae and campylobacter to young children should be a public health priority in Bangkok.

Purified equine rabies immune globulin: a safe and affordable alternative to human rabies immune globulin.

Reported are the results of a retrospective study of 3156 patients who were treated at the Queen Saovabha Memorial Institute, Bangkok, with equine rabies immune globulin (ERIG). Only 51 patients (1.6%) exhibited serum-sickness-like reactions, none of which persisted for more than a week, and only 8 of these patients (15%) were treated with a short course of steroids. One patient, whose skin test was negative, had an immediate anaphylactic reaction to ERIG that responded to parenteral therapy with epinephrine and hydrocortisone sodium succinate. Serum-sickness-like reactions were more frequent among females and over 21-year-olds but were exceedingly rare (0.086%) among children under 10 years of age.

Purified equine rabies immune globulin: a safe and affordable alterntaive to human rabies immune globulin

Reported are the results of a retrospective study of 3,156 patients who were treated at the Queen Saovabha Memorial Institute, Bangkok, with equine rabies immune globulin (ERIG). Only 51 patients (1.6 percent) exhibited serum-sickness-like reactions, none of which persisted for more than a week, and only 8 of these patients (15 percent) were treated with a short course of steroids. One patient, whose skin test was negative, had an immediate anaphylactic reaction to ERIG that responded to parenteral therapy with epinephrine and hydrocortisone sodium succinate

Serum-sickness-like reactions were more frequent among females and over 21-year-olds but were exceedingly rare (0.086 percent) among children under 10 years of age(AU)

Epidemiologic study of risk factors in cancer of the cervix uteri in Thai women.

PIP: A case control study was conducted to identify various environmental factors associated with cervical cancer and the extent or degree of association of those factors with the disease. The cases were 212 histologically confirmed cervical cancer patients admitted to the gynecological ward in 4 Thailand hospitals. The controls were 212 patients diagnosed with other gynecological conditions except cancer (confirmed by pelvic examination and papanicolaou smear) who were admitted to those hospitals during the same period as the cases. The cases and controls were matched by age, using 5 year intervals. Questionnaires containing information such as sociodemographic data, marital status, pregnancy and delivery history, past history of illness, especially with genital tract infections, and husband's illness history including venereal diseases were distributed. Questionnaires were the same for case and control. Cases and controls were similar in demographic and social characteristics. All cases were younger at 1st intercourse and had a higher number of pregnancies and parity than controls. Various factors presented significantly more in the cases than the controls. The suspected risk factors in cervical cancer were: parity, with cases showing higher parity than control; positive history of vaginal infections; higher number of marriages; younger age at 1st intercourse and history of husband's sexually transmitted disease. Circumcision in the husband indicated a protective factor to this disease, although the number of husbands who had circumcision in this study were very few. The risk factor of highest relative risk value was the marriage factor, followed by factors of high parity. Women who had 3 or more live births were 3 times more prone to cervical cancer than women with lower fertility. Women who had multiple marriages also ran a higher risk to this disease, as did those who had history of vaginal infection and husband's history of sexually transmitted disease. Women with a history of irregular menstruation both of amount and frequency were twice as prone to cervical cancer than normal women. The degree of association between risk factors and cervical cancer as expressed by odd ration was shown by various combinations of the risk factors, such as high parity and positive history of vaginal infection. These 2 characteristics were about 9 times more prone to cervical cancer than women without these characteristics. Women with 4 risk factors combined had the greatest risk compared to those who did not have those factors.^ieng