Dapsone has potent anti-inflammatory effects, and is used in the treatment of leprosy, cutaneous vasculitis, neutrophilic dermatoses, and dermatitis herpetiformis and other blistering disorders. However, it may cause severe adverse reactions such as hypersensitivity syndrome, which is characterized by fever, skin rash, hepatitis and lymphadenopathy. We report a 44-year-old female Korean patient with dapsone hypersensitivity syndrome (DHS) that presented as a bullous skin eruption. The patient had a 1-year history of urticarial vasculitis, treated with antihistamines, prednisolone and dapsone. Although the skin lesions improved, she reported fever, nausea, abdominal pain, jaundice, fatigue and skin rashes. On physical examination, there were generalized erythematous macules and purpura with facial oedema that developed into vesicles on the upper limbs. Histological examination of a skin biopsy of a vesicular lesion found subepidermal oedema with a mixed inflammatory cell infiltrate, including eosinophils in the dermis. Indirect immunofluorescence testing using normal foreskin as substrate revealed IgG deposits in the basement membrane zone. Circulating autoantibodies against antigens of 190 and 230 kDa were found by immunoblotting analysis using epidermal extracts. This case illustrates DHS with the formation of circulating autoantibodies.
Background
Although vaccination of nursing students in clinical practice is important due to the possibility of COVID-19 infection and subsequent transmission to patients, some nursing students are hesitant to get vaccinated. Thus, it is necessary to identify the actual intentions and motivations of nursing students who have been vaccinated for COVID-19, even if their decisions were driven by clinical practice policy. The purpose of this study was to understand the nature of COVID-19 vaccine hesitancy among vaccinated nursing students in clinical practice and to examine their reasons for getting vaccinated despite such hesitancy.
Method
A cross-sectional, descriptive study was conducted at two tertiary hospitals in South Korea from November 20, 2021, to December 17, 2021. The study recruited a convenience sample of 125 nursing students who were vaccinated for COVID-19. Data were analyzed using the chi-square test, Fisher’s exact test, and independent t-test.
Results
Of the 125 nursing students, 51 (40.8%) reported vaccine hesitancy, among whom 88.2% reported that their hesitancy was due to the adverse effects and instability of the vaccine. It was also found that 70.6% of nursing students in the vaccine-hesitant group were eventually vaccinated due to clinical practice policy, whereas 67.6% of nursing students in the non-hesitant group were vaccinated to protect their health.
Conclusions
COVID-19 vaccine hesitancy is prevalent among nursing students. Therefore, specific efforts should be made to provide education focusing on the safety, benefits, and efficacy of COVID-19 vaccines, implement mandatory vaccination policies for clinical practice, and give priority to vaccination opportunities to nursing students in order to reduce the hesitancy of nursing students to vaccines.
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