Efficacy of hydroxychloroquine in pre-exposure severe acute respiratory syndrome coronavirus 2 prophylaxis among high-risk healthcare workers: A multicenter study

Nasri, Elahe; Fakhim, Hamed; Salahi, Mehrdad; Ghafel, Safiyeh; Pourajam, Samane; Darakhshandeh, Ali; Kassaian, Nazila; Sadeghi, Somayeh; Ataei, Behrooz; Haghjooy Javanmard, Shaghayegh; Vaezi, Afsane

Efficacy of hydroxychloroquine in pre-exposure severe acute respiratory syndrome coronavirus 2 prophylaxis among high-risk healthcare workers: A multicenter study

Authors

¹ Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

² Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences; Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

³ Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

⁴ Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

⁵ Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Science, Isfahan, Iran

⁶ Department of Medical Laboratory Science, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran

Abstract

Background: Prophylaxis could be an established strategy to potentially prevent and control infectious diseases and should be considered in the coronavirus disease 2019 (COVID-19) pandemic. The present study aimed to assess the effectiveness of hydroxychloroquine as a prophylaxis treatment strategy in the reduction of the risk of COVID-19 among health professionals.
Materials and Methods: The health professionals were randomly assigned (1:1) to the control group without receiving any hydroxychloroquine as prophylaxis and the hydroxychloroquine group receiving a weekly hydroxychloroquine dose of 400 mg up to 12 weeks.
Results: A total of 146 health professionals were randomly enrolled in this study between August 11 and November 11 in 2020. Among the screened health professionals, 21 (14.6%) were infected with COVID-19 during the 12 weeks, and 14 (66.6%) out of the 21 health professionals were in the control group. Most participants with COVID-19 had mild symptoms (62%). In addition, 9.5% (n = 2) of the participants suffered from moderate disease and 28.5% were diagnosed with severe symptoms. In the hydroxychloroquine group, 5 (7.1%) and 2 (2.8%) participants were reported with mild and moderate symptoms of COVID-19, respectively, and 2 participants had moderate, 8 (10.9%) participants had mild symptoms, and 6 (8.2%) participants had severe symptoms in the control group, within 3 months. Severe symptoms of COVID-19 were not observed in the hydroxychloroquine group.
Conclusion: This study addressed the effect and benefit of hydroxychloroquine administration for the prevention of COVID-19 among health professionals. The improved perception of prophylaxis might highlight its important role in future COVID-19 outbreaks to prevent hospital transmission, which is a major route of spread.

Keywords

References

1.	Chang MC, Park YK, Kim BO, Park D. Risk factors for disease progression in COVID-19 patients. BMC Infect Dis 2020;20:445.
2.	Fegert JM, Vitiello B, Plener PL, Clemens V. Challenges and burden of the coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: A narrative review to highlight clinical and research needs in the acute phase and the long return to normality. Child Adolesc Psychiatry Ment Health 2020;14:20.
3.	Hu Z, Song C, Xu C, Jin G, Chen Y, Xu X, et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Sci China Life Sci 2020;63:706-11.
4.	Sahu AK, Amrithanand VT, Mathew R, Aggarwal P, Nayer J, Bhoi S. COVID-19 in health care workers – A systematic review and meta-analysis. Am J Emerg Med 2020;38:1727-31.
5.	Winzeler EA. Malaria research in the post-genomic era. Nature 2008;455:751-6.
6.	Parhizgar AR, Tahghighi A. Introducing new antimalarial analogues of chloroquine and amodiaquine: A narrative review. Iran J Med Sci 2017;42:115-28.
7.	Liu J, Cao R, Xu M, Wang X, Zhang H, Hu H, et al. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discov 2020;6:16.
8.	Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res 2020;30:269-71.
9.	Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe M, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: Results of an open-label non-randomized clinical trial. Int J Antimicrob Agents 2020;56:105949.
10.	Lee SH, Son H, Peck KR. Can post-exposure prophylaxis for COVID-19 be considered as one of outbreak response strategies in long-term care hospitals? Int J Antimicrob Agents 2020;55:105988.
11.	Boulware DR, Pullen MF, Bangdiwala AS, Pastick KA, Lofgren SM, Okafor EC, et al. A randomized trial of hydroxychloroquine as postexposure prophylaxis for covid-19. N Engl J Med 2020;383:517-25.
12.	Guitti P, Parnaz P, Parichehr P, Fariba G. Prophylactic recommendation for healthcare workers in COVID-19 pandemic. Adv J Emerg Med 2020;4.
13.	Pereira BB. Challenges and cares to promote rational use of chloroquine and hydroxychloroquine in the management of coronavirus disease 2019 (COVID-19) pandemic: A timely review. J Toxicol Environ Health B Crit Rev 2020;23:177-81.
14.	Rosenberg ES, Dufort EM, Udo T, Wilberschied LA, Kumar J, Tesoriero J, et al. Association of treatment with hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID-19 in New York State. JAMA 2020;323:2493-502.
15.	Keshavan M. Hospital Workers Across the U.S. Present Sharply Different Pictures of their Preparedness for the Coronavirus. STAT. Available from: https://www.statnews.com/2020/03/. [Last accessed on 2020 Mar 14].
16.	Tahiri Joutei Hassani R, Bennis A. Hydroxychloroquine as antiviral prophylaxis for exposed caregivers to Covid-19: An urgent appraisal is needed. J Infect Public Health 2020;13:865-7.
17.	World Health Organization. Diagnostic Detection of 2019-nCoV by Real-Time RT-PCR. Available from: https://www.who.int/docs/default-source/coronaviruse/protocol-v2-1.pdf?sfvrsn=a9ef618c_2. [Last accessed 2020 Dec 10].
18.	Cheng SH, Taiwan HCQ Study Group. A multicenter, randomized, open-label, controlled trial to evaluate the efficacy and tolerability of hydroxychloroquine and a retrospective study in adult patients with mild to moderate coronavirus disease 2019 (COVID-19). PLoS One 2020;15:e0242763.
19.	Mohammadi F, Pourzamani H, Karimi H, Mohammadi M, Mohammadi M, Ardalan N, et al. Artificial neural network and logistic regression modelling to characterize COVID-19 infected patients in local areas of Iran. Biomed J 2021;44:304-16.
20.	Jorge A. Hydroxychloroquine in the prevention of COVID-19 mortality. Lancet Rheumatol 2021;3:e2-3.
21.	Abella BS, Jolkovsky EL, Biney BT, Uspal JE, Hyman MC, Frank I, et al. Efficacy and safety of hydroxychloroquine vs. placebo for pre-exposure SARS-CoV-2 prophylaxis among health care workers: A randomized clinical trial. JAMA Intern Med 2021;181:195-202.
22.	Rajasingham R, Bangdiwala AS, Nicol MR, Skipper CP, Pastick KA, Axelrod ML, et al. Hydroxychloroquine as pre-exposure prophylaxis for COVID-19 in healthcare workers: A randomized trial. medRxiv 2020; 2020.09.18.20197327.
23.	Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
24.	Marmor MF, Carr RE, Easterbrook M, Farjo AA, Mieler WF, American Academy of Ophthalmology. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy: A report by the American Academy of Ophthalmology. Ophthalmology 2002;109:1377-82.
25.	Chang R, Sun WZ. Repositioning chloroquine as ideal antiviral prophylactic against COVID-19-time is now. Drug Discov Today 2020;25:1786-92.

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