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BACKGROUND The efficacy and safety of hydroxychloroquine (HCQ) for COVID-19 prophylaxis remains highly controversial. OBJECTIVE This study aimed to evaluate the efficacy and safety of HCQ to prevent COVID-19. METHODS Electronic searches were conducted up to December 21, 2022 in Pubmed/MEDLINE, Embase, medRxiv, the Cochrane COVID-19 Register of Controlled Trials, clinicaltrials.gov, and the WHO International Clinical Trials Registry Platform. The primary outcomes included COVID-19 transmission, and mortality. Treatment effects were reported as relative risk (RR) for dichotomous variables with 95% confidence intervals (CI). We performed either a fixed- or random-effects model to pool the results of individual studies depending on the presence of heterogeneity. RESULTS Fifteen randomized trials were included: 10 pre-exposure prophylaxis trials and 5 post-exposure prophylaxis trials. The pooled RR of COVID-19 transmission in the pre-exposure prophylaxis trials was 0.73 (95% CI 0.66-0.81) when using either a fixed-effect model. The pooled RR of COVID-19 transmission in the post-exposure prophylaxis trials was 0.93 (95% CI 0.76-1.15). The final pooled RR, including all pre- and post-exposure trials, was 0.78 (95% CI 0.74-0.86). CONCLUSIONS Available evidence suggested that prophylactic HCQ for people at risk of exposure to SARS-CoV-2 was safe and effective. Therefore, HCQ as prophylaxis (especially as pre-exposure prophylaxis) for COVID-19 is recommended. CLINICALTRIAL PROSPERO (Prospective International Register of Systematic Reviews) CRD42022357880; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=257299
BACKGROUND The efficacy and safety of hydroxychloroquine (HCQ) for COVID-19 prophylaxis remains highly controversial. OBJECTIVE This study aimed to evaluate the efficacy and safety of HCQ to prevent COVID-19. METHODS Electronic searches were conducted up to December 21, 2022 in Pubmed/MEDLINE, Embase, medRxiv, the Cochrane COVID-19 Register of Controlled Trials, clinicaltrials.gov, and the WHO International Clinical Trials Registry Platform. The primary outcomes included COVID-19 transmission, and mortality. Treatment effects were reported as relative risk (RR) for dichotomous variables with 95% confidence intervals (CI). We performed either a fixed- or random-effects model to pool the results of individual studies depending on the presence of heterogeneity. RESULTS Fifteen randomized trials were included: 10 pre-exposure prophylaxis trials and 5 post-exposure prophylaxis trials. The pooled RR of COVID-19 transmission in the pre-exposure prophylaxis trials was 0.73 (95% CI 0.66-0.81) when using either a fixed-effect model. The pooled RR of COVID-19 transmission in the post-exposure prophylaxis trials was 0.93 (95% CI 0.76-1.15). The final pooled RR, including all pre- and post-exposure trials, was 0.78 (95% CI 0.74-0.86). CONCLUSIONS Available evidence suggested that prophylactic HCQ for people at risk of exposure to SARS-CoV-2 was safe and effective. Therefore, HCQ as prophylaxis (especially as pre-exposure prophylaxis) for COVID-19 is recommended. CLINICALTRIAL PROSPERO (Prospective International Register of Systematic Reviews) CRD42022357880; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=257299
Despite the outstanding progress that has been made in the prevention, detection, and management of hepatitis B during the past decades, hepatitis B remains a problem among healthcare personnel (HCP) in many countries. We reviewed studies on all aspects of hepatitis B in HCP published from 2017 through April 2023. They revealed wide variations on the prevalence of infection among HCP, ranging from 0.6% in Europe to >8.7% in Africa, almost always in association with very low vaccination rates. Many studies found a significant association between HCP’s knowledge about hepatitis B and hepatitis B vaccines, their vaccination status, and practices. This research also discloses global inequities regarding vaccination policies against hepatitis B, free-of-charge vaccinations, and access to post-exposure prophylaxis (PEP). Strategies to prevent and manage accidental exposures are needed in order to reduce the burden of hepatitis B on HCP, while written policies for all aspects of infection prevention, protective equipment, and PEP should be available. Lastly, HCP should be accordingly educated. These are all imperative given the decline of routine vaccinations in the COVID-19 era, particularly in countries with fragile vaccination programs, and the disruptions of interventions for hepatitis B that are expected to provide a pool of virus transmission to future generations.
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