New Delhi, May 23
On Friday, a revised government notice recommended the use of hydroxychloroquine as a preventive medication for asymptomatic healthcare workers working in non-COVID-19 hospitals, front line staff on duty in containment areas and paramilitary / police personnel involved in activities related to coronavirus infection.
As mentioned in the previous review, the infection medication is also recommended for all asymptomatic healthcare workers involved in the containment and treatment of COVID-19 and family contacts of laboratory confirmed cases.
The revised ICMR opinion, however, warned that taking the drug should not instill a sense of false security.
The recommendation was made after the Joint Monitoring Group chaired by the Directorate General of Health Services (DGHS) and comprising representatives of AIIMS, ICMR, National Center for Disease Control, National Disaster Management Authority, WHO and experts from central government hospitals examined the prophylactic use of hydroxychloroquine (HCQ) in the context of its extension to health care and other frontline workers deployed in non-areas COVID-19 and COVID-19.
Three new categories – all asymptomatic health care workers working in non-COVID hospitals / hospital areas / COVID blocks, asymptomatic front-line workers such as surveillance officers deployed in containment areas and paramilitary / police personnel involved in activities related to COVID-19 – are now included.
According to the revised opinion, “At NIV, Pune, the HCQ in vitro test report for antiviral efficacy showed a reduction in infectivity and a logarithmic reduction in the viral RNA copy of SARs-CoV2”.
“The drug is contraindicated in people with known cases of retinopathy, hypersensitivity to HCQ and heart rhythm disorders,” said the report.
The drug is not recommended for prophylaxis in children under the age of 15 and during pregnancy and lactation, the review said.
It is rare for the drug to cause cardiovascular side effects such as cardiomyopathy and arrhythmia (heart rate).
“In this situation, the drug must be stopped. The drug can rarely cause visual disturbances, including a vision disorder that is generally self-limiting and improves drug discontinuation, “said the revised opinion.
The drug should be administered under strict medical supervision with informed consent, he said.
The National Working Group (NTF) for COVID-19 established by the ICMR examined the use of HCQ for the prophylaxis of SARS-CoV-2 infection for the high-risk population based on the evidence emerging on its safety and efficacy.
Data on the evaluation of HCQ prophylaxis in 1,323 healthcare workers indicated mild adverse effects such as nausea (8.9%), abdominal pain (7.3%), vomiting (1.5%), hypoglycemia (1.7%) and cardiovascular effects. (1.9%), said the advisor.
However, according to data from Pharma’s pharmacovigilance program in India, there have been 214 reported cases of adverse drug reactions associated with the prophylactic use of HCQ, he said.
Of these, seven were safety reports of serious individual cases with QT interval prolongation on the ECG in three cases, he added.
Highlighting the studies on the prophylaxis of SARS-CoV-2 infection, the opinion stated that a retrospective case-control analysis at the ICMR revealed that there is a significant dose-response relationship between the number prophylactic doses taken and the frequency of occurrence of SARSCoV-2 infection in symptomatic healthcare workers who have been tested for coronavirus infection.
Another survey of three central government hospitals in New Delhi indicates that among healthcare workers involved in COVID-19 care, those on HCQ prophylaxis were less likely to develop SARS-CoV-2 infection, than those who weren’t there.
The benefit was less pronounced among healthcare workers caring for a general patient population.
In addition, a prospective observational study of 334 health workers at AIIMS, including 248 on HCQ prophylaxis in New Delhi, also found that those taking HCQ prophylaxis had a lower incidence of SARS-CoV infection -2 than those who did not take it.
According to the opinion, the drug should only be administered on the prescription of a licensed doctor and it is advisable to consult a doctor for any adverse event or potential drug interaction before initiating the drug, according to the report.
Frontline workers should use PPE in accordance with guidelines issued by the Ministry of Health and should be advised to consult their physician (within their hospital / surveillance team / safety organization) for any adverse event or potential drug interaction before starting treatment, says the lawyer.
If someone becomes symptomatic during prophylaxis, he / she should immediately contact the health facility, get tested according to national guidelines, and follow the standard treatment protocol, he said.
In addition to the symptoms of COVID-19 (fever, cough, difficulty breathing), if the person on chemoprophylaxis develops other symptoms, they should immediately seek medical attention, she said.
All asymptomatic contacts of laboratory-confirmed cases should remain quarantined at home in accordance with national guidelines, even if they are on prophylaxis, the notice added.