Background: Prisons are known to be high-risk environments for the spread of bloodborne and sexually transmitted infections. Prison officers are considered to have an intermittent exposure potential to bloodborne infectious diseases on the job, however there has been no studies on the prevalence of these infections in prison officers in Ghana.

Background: Human herpesvirus 8 (HHV-8), cytomegalovirus (CMV) and Epstein-Barr virus (EBV) are prevalent in Africa, but less common elsewhere and the modes of transmission are still subject to debate. Generally, they rarely cause disease in the immunocompetent host but are highly oncogenic when associated with immunosuppression. Although the high prevalence of HHV-8, CMV and EBV has been well documented in Africa, such data are sparse from Ghana.

The goal of this study was to determine the effect of CYP2B6 genetic variation on the steady-state pharmacokinetics of efavirenz (600 mg/day) in TB/HIV co-infected patients receiving concomitant rifampin, a potent CYP inducer. In the 26 patients studied, CYP2B6 c.516GG, GT and TT genotype frequencies were 0.27, 0.50 and 0.23, respectively. Mean plasma efavirenz area-under-the-curve was significantly higher in patients with CYP2B6 c.516TT than in those with GT (107 vs. 27.6 μg.h/mL, P < 0.0001), or GG genotype (107 vs. 23.0 μg.h/mL, P < 0.0001). Apparent oral clearance (CL/F) was significantly lower in patients with CYP2B6 c.516TT than in those with GT genotype (2.1 vs. 8.4 mL/min/kg, P < 0.0001), and GG genotype (2.1 vs. 9.9 mL/min/kg, P < 0.0001). No differences in efavirenz exposure or CL/F existed between patients with CYP2B6 c.516GT and GG genotypes. Our results indicate that CYP2B6 c.516TT genotype can be used to identify efavirenz poor metabolizers in patients co-treated with rifampin. KeywordsCytochrome P450 2B6; genetic polymorphisms; efavirenz exposure; rifampin Tuberculosis (TB) is the most common complication of human immunodeficiency virus (HIV) infection and is associated with high fatality rates. 1,2 While highly active antiretroviral therapy (HAART) improves survival in co-infected patients, 3-5 potential overlapping drug toxicities, and cytochrome P450 (CYP)-mediated drug-drug interactions constitute major challenges to early initiation of HAART. The magnitude of drug-drug interactions due to rifampin is a major factor in selecting an effective HAART regimen. 6-8 Rifampin is a critical component of TB therapy, 9 but is also a potent inducer of CYP enzyme activity, 10-12 as well as the Pglycoprotein (P-gp) transport system. 13 As a result, the exposure to the HIV protease inhibitors (PIs) and nonnucleoside reverse transcriptase inhibitors (NNRTIs) is reduced during Currently, it is not known whether CYP induction by rifampin will affect the relationship between CYP2B6 c.516G>T genotype and efavirenz exposure. The reported magnitude of induction of CYP2B6 activity by rifampin in primary human hepatocytes varies. While some authors reported a 7 − 13-fold induction, 10,11 others found only 2.5-fold increase in activity. 12 In one in vivo study, CYP2B6 activity in the presence of rifampin was only 2.1 times that in the absence of rifampin. 23 Co-administration of rifampin with efavirenz 600 mg daily caused a 22% reduction in efavirenz area under the curve (AUC) in HIV/TB co-infected patients, which was overcome by increasing the dose to 800 mg/day. 24 This finding led some experts to recommend an increased efavirenz dose when co-administered with rifampin. 6,7,25 Although an increased efavirenz dose might be appropriate for some persons, it does not take into consideration the variable effect of rifampin on CYP2B6 activity. In the aforementioned pharmacokinetic study, the change in efavirenz AUC with concomitant rifampin ranged from a decrease of 65% to an increase of 37%. 24 Furthermore, vari...

Cockroaches are common in the environment of many hospitals in Ghana; however, little is known about their public health risks. To evaluate potential risks, we investigated the external and internal microbial flora of 61 cockroaches from a tertiary hospital in Ghana and evaluated the antibiotic resistance profiles of the common bacterial species. Standard methods were used in all the microbiological investigations and antibiotic susceptibility testing. A rotavirus carriage rate of 19.7% was observed among the cockroaches. Four types of intestinal parasites were carried externally by the cockroaches, and the most prevalent was Hookworm (4.9%). Eight nosocomial bacteria were isolated from the cockroaches, and the most prevalent was Klebsiella pneumoniae, which occurred internally in 29.5% of the cockroaches and 26.2% externally. Multiple drug resistance among common bacteria isolated from the cockroaches ranged from 13.8% (Escherichia coli) to 41.1% (Klebsiella pneumoniae). Cockroaches constitute an important reservoir for pathogenic microorganisms, and may be important vectors of multiple resistant nosocomial pathogens in the studied hospital.

BackgroundAlmost all diarrhea deaths in young children occur in developing countries. Immunization against rotavirus, the leading cause of childhood severe dehydrating acute diarrhea may reduce the burden of severe diarrhea in developing countries. Ghana introduced rotavirus and pneumococcal vaccination in the national expanded program on immunization in May 2012.MethodsReview of all-cause diarrheal hospitalization data for children aged 59 months and younger at 2 pediatric referral hospitals in southern Ghana from 2008 to 2014. The proportion of acute diarrhea (defined as 3 or more watery, non-bloody stools within 24 hours that has lasted for less than 7 days) cases caused by rotavirus was determined. Temporal trend and age group distribution of all-cause diarrhea and rotavirus gastroenteritis before and after introduction of the new vaccines were compared.ResultsOf the 5847 children hospitalized with all-cause diarrhea during the 74 months (January 2008 – February 2014), 3963 (67.8%) children were recruited for rotavirus surveillance and stool specimens were tested for rotavirus in 3160/3963 (79.7%). Median monthly hospitalization for all-cause diarrhea reduced from 84 [interquartile range (IQR) 62 – 105] during the 52 months pre-vaccination introduction to 46 (IQR 42 - 57) in the 22 months after implementation of vaccination. Significant decline in all-cause diarrhea hospitalization occurred in children aged 0 - 11 months: 56.3% (2711/4817) vs. 47.2% 486/1030 [p = 0.0001, 95% confidence interval (CI) 0.77 – 0.88] and there was significant reduction of rotavirus gastroenteritis hospitalization: 49.7% (1246/2505) vs. 27.8% (182/655) [p = 0.0001, 95% CI 0.32 - 0.47] before and after vaccine introduction respectively.ConclusionsImplementation of rotavirus vaccination program may have resulted in significant reduction of severe diarrhea hospitalization even though this observational study could not exclude the effect of other confounding factors. Continued surveillance is recommended to monitor the progress of this program.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-431) contains supplementary material, which is available to authorized users.