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SIGNpost 00644


Post00644 Call 4 Devices+ 9th + Abstracts + Waste + News 18 April 2012


1. Call for needle-free intradermal delivery devices for upcoming clinical
2. Design New Approaches to Optimize Immunization Systems: Round 9 Gates
Grand Challenge funding
3. Improving safety in maternity services: A toolkit for teams
4. Abstract: Health Care-Associated Hepatitis C Virus Infections Attributed
to Narcotic Diversion
5. Abstract: Redesigning the AIDS response for long-term impact
6. Abstract: Needlestick injuries, short peripheral catheters, and health
care worker risks
7. Abstract: Case Report: Risk of virus infection after accidental blood
inoculation from a multi-infected AIDS patient
8. Abstract: Using high-technology to enforce low-technology safety
measures: the use of third-party remote video auditing and real-time
feedback in healthcare
9. Abstract: Standardization the process of intravitreal injection to
prevent the risk of endophthalmitis
10. Abstract: A Memory Retrieval-Extinction Procedure to Prevent Drug
Craving and Relapse
11. Abstract: Enrollment characteristics and risk behaviors of injection
drug users participating in the Bangkok Tenofovir Study, Thailand
12. Abstract: Clinical and virological characteristics of hepatitis B or C
virus co-infection with HIV in Indonesian patients
13. Abstract: Towards combination HIV prevention for injection drug users:
addressing addictophobia, apathy and inattention
14. Abstract: Aerosolized MMR vaccine: Evaluating potential transmission of
components to vaccine administrators and contacts of vaccines
15. Abstract: Limited efficacy of steam sterilization to inactivate vCJD
16. Abstract: Crimean-Congo hemorrhagic fever virus: new outbreaks, new
17. Abstract: Subcutaneous Drug Delivery: A Route to Increased Safety,
Patient Satisfaction, and Reduced Costs
18. No Abstract: Infection control among health care assistants
19. No Abstract: On the Safety and Benefits of Repeated Intravenous
Injections of Ketamine For Depression
20. News
– Spinal injections may not aid lower back pain
– UK: Park Primary clean-up finds used needle
– Pakistan: Hospital waste
– Russia: No Clean Needles for Russian Addicts – Drug Official
– Canada: Quebec waiting for community groups to apply for safe-injection
– India: BD trains healthcare workers on Blood Collection Practices
– Canada: Ontario rejects safe injection sites
– Kenya: Nema raises the red flag over risks of dumping toxic waste
– Australia: Demand Drives Needle Exchange Need
– Memory ‘trick’ relieves drug cravings
– Injectable contraceptive doubles risk of breast cancer, study shows

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1. Call for needle-free intradermal delivery devices for upcoming clinical

Kindly SIGNposted by Emily Griswold at PATH

Call for needle-free intradermal delivery devices for upcoming clinical

In collaboration with the Bill & Melinda Gates Foundation, PATH invites
letters of interest and applications from technology manufacturers willing
to provide eligible needle-free intradermal (ID) delivery devices for usein
a clinical trial of reduced-dose inactivated polio vaccine (IPV) scheduled
for 2013 in China.


Ensuring wide-scale access to IPV is a key goal of polio eradication
efforts and post-eradication planning. The Bill & Melinda Gates Foundation
plans to support a clinical trial to evaluate the dose-saving potential
ofIPV when it is delivered intradermally, which could extend vaccine supply
and make IPV more affordable for immunization programs in developing
countries. Needle-free delivery devices that facilitate safer, easier, and
more consistent ID delivery of vaccinecould also enable ID delivery of IPV
by less-experienced health workers or trained volunteers.


To be eligible, devices must be needle free with a disposable,
autodisabling fluid path and capable of delivering 0.1 ml of IPV
intradermally in infants and children. Manually powered devices suitable
for use either ina clinic or in a mobile campaign setting are preferred.
Multiple devices that meet these requirements may be included in the trial.

Final device selections will be made by the Bill & Melinda Gates
Foundation. Please also note that the Bill & Melinda Gates Foundation
reserves the right to withdraw this request for applications and/or cancel
the plannedtrial at any time.

How to apply

Letters of interest are requested by April 27, 2012.
Full applications and supporting materials are due May 14, 2012.

Applications should include:

A cover letter with a description of the materials enclosed.
Instructions for use for the device.
A completed response questionnaire (see Annex 1 [317 KB PDF]).
Supporting documentation, where appropriate.

Please email the letter of interest and full application to

Relevant materials can also be mailed to:

Emily Griswold
PO Box 900922
Seattle, WA 98109

For questions and guidance on this opportunity, please contact PATH
(primary) at or Linda Venczel at

More information
New vaccine tools for polio from PATH

Vaccine technologies at PATH


2. Design New Approaches to Optimize Immunization Systems: Round 9 Gates
Grand Challenge funding
Robertson, Joanie jrobertson[at]
Sign Moderator <sign.moderator[at]>

Hello SIGN moderator,

I wanted to share the following announcement of the Round 9 Gates Grand
Challenge funding. Please note that there is a topic on immunization
medical waste under the “Environmental Impact” heading.


Joanie Robertson

Joanie Robertson, Technical Officer
PATH Hanoi office
2nd Floor, Hanoi Towers
49 Hai Ba Trung St. Hoan Kiem District
Hanoi, Vietnam
p:+84 4 3936 2215 x131
c:+84 904 983 799

3. Improving safety in maternity services: A toolkit for teams

Crossposted with thanks from the EQUIDAD listserve at
Improving safety in maternity services: A toolkit for teams

Available online at:

Vinice Thomas, Anna Dixon
UK – The King’s Fund – April 2012

“…..The safety of maternity services is of paramount importance.
Maternity teams face many challenges in delivering safe care to mothers,
babies and families.

Building on the recommendations in partnership with the Royal College of
Obstetricians and Gynaecologists, the Royal College of Midwives, the NHS
Litigation Authority, Centre for Maternal And Child Enquiries and the
National Patient Safety Agency, The King’s Fund launched the Safer Births
Improvement Programme, providing customised support to 12 multidisciplinary
maternity teams in England.

This toolkit shares the experiences and lessons from those teams.

Improving Safety in Maternity Services:

a toolkit for teams is organised around five key areas for improvement in
maternity care on which the teams focused:

– teamworking
– communication
– training
– information and guidance
– staffing and leadership

Each section begins with a brief explanation on how focusing on
improvements in each area can contribute to improved safety. It then
highlights some of the experiences of the maternity teams who focused on
this issue and their key learning points.

There are also short summaries of tools that can be used to improve safety.
These provide a brief guide to how to use the tool and signpost further
resources. Where available we have included examples or templates that can
be used or adapted for local use.

Finally, we provide more information about service improvement and the
tools and techniques that can be used.

The challenges facing maternity teams are likely to increase with the
financial pressures on the NHS. However, many of the changes described here
do not need additional funding. They need time and commitment, leadership
and some knowledge. The tips and tools in this resource will help maternity
teams to implement changes that will deliver benefits to women and

4. Abstract: Health Care-Associated Hepatitis C Virus Infections Attributed
to Narcotic Diversion

Health Care-Associated Hepatitis C Virus Infections Attributed to Narcotic

Walter C. Hellinger, MD; Laura P. Bacalis, RN; Robyn S. Kay, MPH; Nicola D.
Thompson, PhD, MS; Guo-Liang Xia, MD, MPH; Yulin Lin, MD; Yury E.
Khudyakov, PhD; and Joseph F. Perz, DrPH

+ Author Affiliations

From Mayo Clinic, Jacksonville, Florida; Florida Department of Health,
Tallahassee, Florida; and the Centers for Disease Control and Prevention,
Atlanta, Georgia.

Background: Three cases of genetically related hepatitis C virus (HCV)
infection that were unattributable to infection control breaches were
identified at a health care facility.

Objective: To investigate HCV transmission from an HCV-infected health care
worker to patients through drug diversion.

Design: Cluster and look-back investigations.

Setting: Acute care hospital and affiliated multispecialty clinic.

Patients: Inpatients and outpatients during the period of HCV transmission.

Measurements: Employee work and narcotic dispensing records, blood testing
for HCV antibody and RNA, and sequencing of the NS5B gene and the
hypervariable region 1 of the E2 gene.

Results: 21 employees were recorded as being at work or as retrieving a
narcotic from an automated dispensing cabinet in an area where a narcotic
was administered to each of the 3 case patients; all employees provided
blood samples for HCV testing.

One employee was infected with HCV that had more than 95% NS5B sequence
homology with the HCV strains of the 3 case patients. Quasi-species
analysis showed close genetic relatedness with variants from each of the
case patients and more than 97.9% nucleotide identity.

The employee acknowledged parenteral opiate diversion. An investigation
identified 6132 patients at risk for exposure to HCV because of the drug

Of the 3929 living patients, 3444 (87.7%) were screened for infection. Two
additional cases of genetically related HCV infection attributable to the
employee were identified.

Limitation: Of the living patients at risk for HCV exposure, 12.3% were not

Conclusion: Five cases of HCV infection occurring over 3 to 4 years were
attributed to drug diversion by an HCV-infected health care worker. Studies
of drug diversion and assessments of strategies to prevent narcotics
tampering in all health care settings are needed.

Primary Funding Source: None.

Open access free article at:

5. Abstract: Redesigning the AIDS response for long-term impact
Bull World Health Organ. 2011 Nov 1;89(11):846-52.

Redesigning the AIDS response for long-term impact.

Larson HJ, Bertozzi S, Piot P.

London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E
7HT, England.

Three decades since the human immunodeficiency virus (HIV) was identified,
the pandemic of acquired immunodeficiency syndrome (AIDS) has developed
into diverse epidemics around the world. In many populations, HIV infection
has become endemic.

While there is good progress on expanding access to treatment, with an
estimated 6.6 million people on antiretroviral therapy at the end of 2010,
* prevention efforts are still highly inadequate with 2.6 million new
infections occurring in 2009. Demand for treatment is increasing while
funding is becoming more scarce and activism is waning. In 2007, the Joint
United Nations Programme on HIV/AIDS (UNAIDS) established an independent
forum called aids2031 to take a critical look at the global HIV/AIDS

This paper outlines four key areas for a re-designed AIDS response based on
the deliberations of this initiative and on the learning and experience of
the first three decades of the epidemic: (i) a new culture of knowledge
generation and utilization; (ii) transformed prevention and treatment to
increase effectiveness; (iii) increased efficiency through better
management and maximizing synergies with other programmes; and (iv)
investment for the long term. Across all these areas is a strong emphasis
on local capacity building, leadership, programme priorities and budgets.

Free PMC Article

6. Abstract: Needlestick injuries, short peripheral catheters, and health
care worker risks

J Infus Nurs. 2012 May;35(3):164-78.

Needlestick injuries, short peripheral catheters, and health care worker

Hadaway L.

Author Affiliations: Lynn Hadaway Associates, Inc. Lynn Hadaway, MEd, RN,
BC, CRNI®, has more than 35 years of experience as an infusion nurse,
educator, and consultant. She holds a master’s degree in education along
with certification in professional staff development and infusion nursing
and has published extensively on infusion topics in numerous journals.

Percutaneous exposure (PCE) and mucocutaneous exposure (MCE) to blood and
blood-containing body fluids pose risks to health care workers worldwide.
Although PCEs have been greatly reduced in the United States, they have not
been eliminated and continue to be a significant problem worldwide. MCE
seems to be a much smaller problem than PCE; however, the data are limited
and confusing.

Venipuncture procedures can easily be associated with PCE, but there are no
published reports of MCE occurring during insertion, use, and removal of
peripheral catheters.

This integrative, systematic literature review identifies the risks
associated with venipuncture and the insertion of short peripheral

7. Abstract: Case Report: Risk of virus infection after accidental blood
inoculation from a multi-infected AIDS patient

J Med Virol. 2012 Jun;84(6):897-900.

Case Report: Risk of virus infection after accidental blood inoculation
from a multi-infected AIDS patient.

Berger A, Stürmer M, Doerr HW.

Institute of Medical Virology, Hospital of Johann-Wolfgang-Goethe
University, Frankfurt/M, Germany.

Infections caused by blood-borne viruses such as hepatitis B and C and the
human immunodeficiency virus (HIV) are associated commonly with needlestick
injuries, especially in a hospital setting. A prospective investigation was
conducted on a medical doctor who suffered an accidental needlestick injury
during blood collection from a patient with AIDS.

The patient’s blood
contained 195,000 copies of HIV RNA, 1?×?10(6) IU hepatitis C virus (HCV)
RNA, and >10(7) copies of parvovirus B19 DNA per 1?ml plasma. It was
positive for cytomegalovirus virus and evidence of a resolved hepatitis B
virus (HBV) infection was found. HCV viremia was detected in the physician
15 days later and was not resolved by seroconversion after 57 days. HIV
infection was not transmitted, possibly because of the immediate use of
anti-HIV prophylactic drugs after exposure. Parvovirus B19 infection was
presumably prevented by pre-existing specific antibodies in the patient.

Considering that many HIV carriers are coinfected with hepatitis B and C
viruses, this case report support the knowledge that the risk of HCV
transmission from a patient with AIDS is greater than that of HIV.

© 2012 Wiley Periodicals, Inc.

8. Abstract: Using high-technology to enforce low-technology safety
measures: the use of third-party remote video auditing and real-time
feedback in healthcare

Clin Infect Dis. 2012 Jan 1;54(1):1-7.

Using high-technology to enforce low-technology safety measures: the use of
third-party remote video auditing and real-time feedback in healthcare.

Armellino D, Hussain E, Schilling ME, Senicola W, Eichorn A, Dlugacz Y,
Farber BF.

Department of Epidemiology, North Shore University Hospital, Manhasset, NY,

BACKGROUND: Hand hygiene is a key measure in preventing infections. We
evaluated healthcare worker (HCW) hand hygiene with the use of remote video
auditing with and without feedback.

METHODS: The study was conducted in an 17-bed intensive care unit from June
2008 through June 2010. We placed cameras with views of every sink and hand
sanitizer dispenser to record hand hygiene of HCWs. Sensors in doorways
identified when an individual(s) entered/exited. When video auditors
observed a HCW performing hand hygiene upon entering/exiting, they assigned
a pass; if not, a fail was assigned. Hand hygiene was measured during a 16-
week period of remote video auditing without feedback and a 91-week period
with feedback of data. Performance feedback was continuously displayed on
electronic boards mounted within the hallways, and summary reports were
delivered to supervisors by electronic mail.

RESULTS: During the 16-week prefeedback period, hand hygiene rates were
less than 10% (3933/60?542) and in the 16-week postfeedback period it was
81.6% (59?627/73?080). The increase was maintained through 75 weeks at
87.9% (262?826/298?860).

CONCLUSIONS: The data suggest that remote video auditing combined with
feedback produced a significant and sustained improvement in hand hygiene.

Comment in

Clin Infect Dis. 2012 Jan 1;54(1):8-9.

Big brother is washing…Video surveillance for hand hygiene adherence,
through the lenses of efficacy and privacy.

Palmore TN, Henderson DK.

Comment on Clin Infect Dis. 2012 Jan 1;54(1):1-7.

9. Abstract: Standardization the process of intravitreal injection to
prevent the risk of endophthalmitis

Zhonghua Yan Ke Za Zhi. 2012 Feb;48(2):100-2.

[Standardization the process of intravitreal injection to prevent the risk
of endophthalmitis].

[Article in Chinese]
Sun XD, Wang FH.

Department of Ophthalmology, First People’s Hospital Affiliated to Shanghai
Jiaotong University, Shanghai 200080, China. Email:

Millions of intravitreal injections were performed for the patients with
neovascular eye diseases each year. The intravitreal injection has become a
routine medical procedure in daily practice of ophthalmologist.

Although the risk of post-injection endophthalmitis is low, the prevalence
is increasing as more patients received injections. Once occurred,
endophthalmitis can lead to irreversible vision loss.

To reduce the potential rising risk of post-injection endophthalmitis,
establishing guidelines for intravitreal injection is urgent.

We reviewed the clinical research evidences on the causes and characters of
post-injection endophthalmitis as well as the preventive actions. A
standard operation pattern on intravitreal injection is also introduced

10. Abstract: A Memory Retrieval-Extinction Procedure to Prevent Drug
Craving and Relapse
Science 13 April 2012: Vol. 336 no. 6078 pp. 241-245

A Memory Retrieval-Extinction Procedure to Prevent Drug Craving and Relapse

Yan-Xue Xue1,*, Yi-Xiao Luo1,*, Ping Wu1,*, Hai-Shui Shi1,2, Li-Fen Xue1,
Chen Chen1, Wei-Li Zhu1, Zeng-Bo Ding1, Yan-ping Bao1, Jie Shi1, David H.
Epstein3, Yavin Shaham3, Lin Lu1,†

+ Author Affiliations
1National Institute on Drug Dependence, Peking University, Beijing 100191,
2Department of Biochemistry and Molecular Biology, Basic Medical College,
Hebei Medical University, Shijiazhuang 050017, China.
3Intramural Research Program, National Institute on Drug Abuse, National
Institutes of Health, Baltimore, MD 21224, USA.
To whom correspondence should be addressed. E-mail:
* These authors contributed equally to this work.

Drug use and relapse involve learned associations between drug-associated
environmental cues and drug effects. Extinction procedures in the clinic
can suppress conditioned responses to drug cues, but the extinguished
responses typically reemerge after exposure to the drug itself
(reinstatement), the drug-associated environment (renewal), or the passage
of time (spontaneous recovery).

We describe a memory retrieval-extinction procedure that decreases
conditioned drug effects and drug seeking in rat models of relapse, and
drug craving in abstinent heroin addicts. In rats, daily retrieval of drug-
associated memories 10 minutes or 1 hour but not 6 hours before extinction
sessions attenuated drug-induced reinstatement, spontaneous recovery, and
renewal of conditioned drug effects and drug seeking. In heroin addicts,
retrieval of drug-associated memories 10 minutes before extinction sessions
attenuated cue-induced heroin craving 1, 30, and 180 days later.

The memory retrieval-extinction procedure is a promising nonpharmacological
method for decreasing drug craving and relapse during abstinence.

11. Abstract: Enrollment characteristics and risk behaviors of injection
drug users participating in the Bangkok Tenofovir Study, Thailand

PLoS One. 2011;6(9):e25127.

Enrollment characteristics and risk behaviors of injection drug users
participating in the Bangkok Tenofovir Study, Thailand.

Martin M, Vanichseni S, Suntharasamai P, Sangkum U, Chuachoowong R, Mock
PA, Leethochawalit M, Chiamwongpaet S, Kittimunkong S, van Griensven F,
McNicholl JM, Paxton L, Choopanya K; Bangkok Tenofovir Study Group.
Collaborators (34)

Thailand Ministry of Public Health – US Centers for Disease Control and
Prevention Collaboration, Nonthaburi, Thailand.

BACKGROUND: The Bangkok Tenofovir Study was launched in 2005 to determine
if pre- exposure prophylaxis with tenofovir will reduce the risk of HIV
infection among injecting drug users (IDUs). We describe recruitment,
screening, enrollment, and baseline characteristics of study participants
and contrast risk behavior of Tenofovir Study participants with
participants in the 1999-2003 AIDSVAX B/E Vaccine Trial.

METHODS: The Bangkok Tenofovir Study is an ongoing, phase-3, randomized,
double- blind, placebo-controlled, HIV pre-exposure prophylaxis trial of
daily oral tenofovir. The Tenofovir Study and the Vaccine Trial were
conducted among IDUs at 17 drug-treatment clinics in Bangkok. Tenofovir
Study sample size was based on HIV incidence in the Vaccine Trial.
Standardized questionnaires were used to collect demographic, risk
behavior, and incarceration data. The Tenofovir Study is registered with, number–NCT00119106.

RESULTS: From June 2005 through July 2010, 4094 IDUs were screened and 2413
enrolled in the Bangkok Tenofovir Study. The median age of enrolled
participants was 31 years (range, 20-59), 80% were male, and 63% reported
they injected drugs during the 3 months before enrollment. Among those who
injected, 53% injected methamphetamine, 37% midazolam, and 35% heroin.
Tenofovir Study participants were less likely to inject drugs, inject
daily, or share needles (all, p<0.001) than Vaccine Trial participants.

DISCUSSION: The Bangkok Tenofovir Study has been successfully launched and
is fully enrolled. Study participants are significantly less likely to
report injecting drugs and sharing needles than participants in the
1999-2003 AIDSVAX B/E Vaccine Trial suggesting HIV incidence will be lower
than expected. In response, the Bangkok Tenofovir Study enrollment was
increased from 1600 to 2400 and the study design was changed from a defined
1-year follow-up period to an endpoint-driven design. Trial results
demonstrating whether or not daily oral tenofovir reduces the risk of HIV
infection among IDUs are expected in 2012.

Free Article:

12. Abstract: Clinical and virological characteristics of hepatitis B or C
virus co-infection with HIV in Indonesian patients
J Med Virol. 2012 Jun;84(6):857-65.

Clinical and virological characteristics of hepatitis B or C virus co-
infection with HIV in Indonesian patients.

Anggorowati N, Yano Y, Heriyanto DS, Rinonce HT, Utsumi T, Mulya DP,
Subronto YW, Hayashi Y.

Center for Infectious Diseases, Graduate School of Medicine, Kobe
University, Kobe, Japan; Department of Anatomical Pathology, Faculty of
Medicine, Dr. Sardjito Hospital, Gadjah Mada University, Yogyakarta,

Hepatitis virus-related liver disease increases substantially the mortality
rate of patients with HIV on highly active antiretroviral therapy (HAART).
Therefore, early diagnosis of hepatitis B virus (HBV) and hepatitis C virus
(HCV) is important. However, the prevalence of HBV and HCV infection in
Indonesian patients infected with HIV is unknown. Therefore, this study
examined the molecular and clinical characteristics of HBV and HCV in 126
patients infected with HIV, mostly on HAART, at Dr. Sardjito Hospital,
Yogyakarta, Indonesia.

The rates of triple infection, HIV/HCV co-infection, HIV/HBV co-infection,
and mono-infection were 4.8%, 34.1%, 3.2%, and 57.9%, respectively. Seven
HCV genotypes were detected, with genotypes 1a, 1b, 1c, 3a, 3k, 4a, and 6n
found in 23 (52%), 1 (2%), 4 (9%), 5 (11%), 7 (16%), 3 (6%), and 1 (2%)
patients, respectively, indicating multiple modes of transmission. HBV-DNA
was detected in 2/10 patients with hepatitis B surface antigen; both
patients were HAART naive. Univariate analysis revealed that male sex,
higher education level, injection drug use, sexual contact, alanine
aminotransferase =40?IU/L, and aspartate aminotransferase- to-platelet
ratio index?>?0.5 were associated with HCV co-infection. In multivariate
analysis, injection drug use (OR: 26.52; 95% CI: 3.52-199.54) and alanine
aminotransferase =40?IU/L (OR: 6.36; 95% CI: 1.23-32.89) were independently
associated with HCV co-infection.

HCV co-infection was common among Indonesian patients infected with HIV,
particularly among injecting drug users, and was a risk factor for disease
progression of HIV.

Copyright © 2012 Wiley Periodicals, Inc.

13. Abstract: Towards combination HIV prevention for injection drug users:
addressing addictophobia, apathy and inattention

Curr Opin HIV AIDS. 2012 Apr 11.

Towards combination HIV prevention for injection drug users: addressing
addictophobia, apathy and inattention.

Strathdee SA, Shoptaw S, Dyer TP, Quan VM, Aramrattana A; for the Substance
Use Scientific Committee of the HIV Prevention Trials Network.

aUC San Diego Division of Global Public Health, Department of Medicine
bUCLA Departments of Family Medicine and Psychiatry and Biobehavioral
Sciences cDepartment of Epidemiology and Biostatistics University of
Maryland College Park dThe Johns Hopkins University Bloomberg School of
Public Health, Maryland, USA eThe Department of Family Medicine and Center
for Substance Abuse Research, Research Institute for Health Sciences,
Chiang Mai University, Thailand.

PURPOSE OF REVIEW: Recent breakthroughs in HIV-prevention science led us to
evaluate the current state of combination HIV prevention for injection drug
users (IDUs). We review the recent literature focusing on possible reasons
why coverage of prevention interventions for HIV, hepatitis C virus (HCV)
and tuberculosis among IDUs remains dismal. We make recommendations for
future HIV research and policy.

RECENT FINDINGS: IDUs disproportionately under-utilize voluntary HIV
counseling and testing (VCT), primary care and antiretroviral therapy
(ART), especially in countries that have the largest burden of HIV among
IDUs. IDUs present later in the course of HIV infection and experience
greater morbidity and mortality. Why are IDUs under-represented in HIV-
prevention research, access to treatment for both HIV and addiction, and
access to HIV combination prevention? Possible explanations include
addictophobia, apathy, and inattention, which we describe in the context of
recent literature and events.

SUMMARY: This commentary discusses the current state of HIV-prevention
interventions for IDUs including VCT, needle and syringe program (NSP),
opioid substitution therapy (OST), ART and pre-exposure chemoprophylaxis
(PrEP), and discusses ways to work towards true combination HIV prevention
for IDU populations. Communities need to overcome tacit assumptions that
IDUs can navigate through systems that are maintained as separate silos,
and begin to take a rights-based approach to HIV prevention to ensure that
IDUs have equitable access to life-saving prevention and treatments.

14. Abstract: Aerosolized MMR vaccine: Evaluating potential transmission of
components to vaccine administrators and contacts of vaccines

Biologicals. 2012 Apr 9.

Aerosolized MMR vaccine: Evaluating potential transmission of components to
vaccine administrators and contacts of vaccines.

Diaz-Ortega JL, Bennett JV, Castaneda D, Martinez D, Fernandez de Castro J.

Instituto Nacional de Salud Pública, Mexico.

Although numerous operative and immunological advantages accompany aerosol
immunization, potential vaccine virus transmission from the aerosol device
to vaccine administrators or from aerosol vaccinees to their contacts
requires further study.

We conducted a clinical and serological follow-up study of vaccine
administrators and matched classroom or household contacts of young adults
who received the MMR vaccines by aerosol or injection. Differences in
incidence of clinical adverse events between vaccinees and contacts were
not statistically significant.

No seroresponses to any components of MMR vaccine were noted among 25
matched contacts of persons receiving injected vaccines, and only one
equivocal seroresponse was noted among 25 matched contacts of aerosol
recipients. No seroresponses were observed in 3 persons who administered
aerosol vaccine.

The composite findings of this study provide additional evidence of the
safety of this approach.

Copyright © 2012 The International Alliance for Biological Standardization.
Published by Elsevier Ltd. All rights reserved.

15. Abstract: Limited efficacy of steam sterilization to inactivate vCJD

J Hosp Infect. 2012 Jan;80(1):46-51. Epub 2011 Nov 17.

Limited efficacy of steam sterilization to inactivate vCJD infectivity.

Fernie K, Hamilton S, Somerville RA.

Neurobiology Division, The Roslin Institute and R(D)SVS, University of
Edinburgh, Easter Bush, Midlothian, UK.

BACKGROUND: The transmission of bovine spongiform encephalopathy (BSE) to
humans as variant Creutzfeldt-Jakob Disease (vCJD) raised concerns about
potential secondary transmissions due to the resistance of the agents
causing transmissible spongiform encephalopathies (TSEs), sometimes known
as prions, to commonly used methods of sterilization, notably steam
sterilization (or autoclaving). It has been suggested that surgical
instruments and other medical devices might retain sufficient infected
tissue debris after cleaning and steam sterilization to infect patients on
whom they are subsequently used.

AIM: To determine whether concerns about the lack of efficacy of steam
sterilization of vCJD were justified.

METHODS: The reduction in infectivity of brain macerates of vCJD brain
after steam sterilization using the standard temperatures and time
recommended for autoclaving in UK hospitals (134-137°C for 3 min) was

FINDINGS: Reductions in titre of 10(2.3) to >10(3.6) ID(50) were found. In
three of four samples, infectivity was recovered after steam sterilization.

CONCLUSION: As noted previously, TSE strains derived from BSE sources
appear to be more resistant to steam sterilization and other forms of heat
inactivation than other TSE sources.

Copyright © 2011 The Healthcare Infection Society. Published by Elsevier
Ltd. All rights reserved.

16. Abstract: Crimean-Congo hemorrhagic fever virus: new outbreaks, new

Curr Opin Virol. 2012 Apr;2(2):215-20.

Crimean-Congo hemorrhagic fever virus: new outbreaks, new discoveries.

Ergonul O.

Koç University, School of Medicine, Infectious Diseases Department,
Istanbul, Turkey.

Crimean-Congo hemorrhagic fever (CCHF) is a fatal viral infection described
in Asia, Africa and Europe. Humans become infected through the bites of
ticks, by contact with a patient with CCHF during the acute phase of
infection, or by contact with blood or tissues from viremic livestock.

The occurrence of CCHF closely approximates the known world distribution of
Hyalomma spp. ticks. The novel studies of phylogenetic analyses reveal the
interesting relations between the strains from distant outbreaks.

The clinical features show common dramatic progress characterized by
hemorrhage, myalgia, and fever. Besides the direct infection of
endothelium, indirect damage by viral or virus mediated host-derived
soluble factors that cause endothelial activations and dysfunction occur.
In diagnosis, enzyme linked immunoassay and real-time reverse
transcription-polymerase chain reaction are used.

Early diagnosis is critical for the patient and potential nosocomial
infections. Supportive therapy is the essential part of the case
management. Ribavirin was suggested as an effective drug in recent studies,
and it was found to be beneficial.

The health care workers are under serious risk of transmission of the
infection, particularly during the follow-up of the patient, with
hemorrhages from the nose, mouth, gums, vagina, and * injection sites.

Copyright © 2012. Published by Elsevier B.V.


17. Abstract: Subcutaneous Drug Delivery: A Route to Increased Safety,
Patient Satisfaction, and Reduced Costs

J Infus Nurs. 2012 May;35(3):154-160.

Subcutaneous Drug Delivery: A Route to Increased Safety, Patient
Satisfaction, and Reduced Costs.

Dychter SS, Gold DA, Haller MF.

Author Affiliations: Halozyme Therapeutics, Inc, San Diego, California (Drs
Dychter and Gold); and Anaphore, La Jolla, California (Dr Haller). Samuel
S. Dychter, MD, is executive medical director at Halozyme Therapeutics. He
received his university and medical training at the National Autonomous
University of Mexico and completed his medical clerkships at the Mexican
Institute for Social Security in Mexico City. David A. Gold, PhD, is senior
project manager at Halozyme Therapeutics. Dr Gold earned his PhD in
biomedical sciences at the University of California, San Diego, and was a
postdoctoral fellow at the Salk Institute for Biological Studies. Michael
F. Haller, PhD, works at Anaphore and was previously at Halozyme as head of
drug delivery. Dr Haller earned his PhD in biomedical engineering from the
Johns Hopkins University School of Medicine and his MS from Cornell

The subcutaneous (SC) route of administration is generally preferred over
intravenous administration because it enables at-home injection, improves
quality of life, and reduces health care costs. In general, a volume of no
greater than 1 to 2 mL is injected SC; however, for high-dose agents with
limited solubility, such as monoclonal antibodies, larger volumes must be
administered, which requires divided doses, smaller volumes, or more
frequent dose administration. Therapeutics are being formulated with an
enzyme, recombinant human hyaluronidase, to enhance the dispersion and
absorption of SC administered therapeutics by transiently depolymerizing
hyaluronan, a major component of the interstitial matrix.

18. No Abstract: Infection control among health care assistants

Nurs J India. 2011 Apr;102(4):74-6.

Infection control among health care assistants.

Saini R, Singh S, Singh JI, Jairus R.

Gian Sagar College of Nursing, Ramangar, Banur.

19. No Abstract: On the Safety and Benefits of Repeated Intravenous
Injections of Ketamine For Depression

Biol Psychiatry. 2012 Apr 11.

On the Safety and Benefits of Repeated Intravenous Injections of Ketamine
For Depression.

Blier P, Zigman D, Blier J.

University of Ottawa Institute of Mental Health Research, Ottawa, Canada.

20. News

– Spinal injections may not aid lower back pain
– UK: Park Primary clean-up finds used needle
– Pakistan: Hospital waste
– Russia: No Clean Needles for Russian Addicts – Drug Official
– Canada: Quebec waiting for community groups to apply for safe-injection
– India: BD trains healthcare workers on Blood Collection Practices
– Canada: Ontario rejects safe injection sites
– Kenya: Nema raises the red flag over risks of dumping toxic waste
– Australia: Demand Drives Needle Exchange Need
– Memory ‘trick’ relieves drug cravings
– Injectable contraceptive doubles risk of breast cancer, study shows

Selected news items reprinted under the fair use doctrine of international
copyright law:
Spinal injections may not aid lower back pain
By Genevra Pittman, Reuters Health (16.04.12)

NEW YORK (Reuters Health) – A new study suggests that injections of
steroids or arthritis drugs in the spine may not provide much extra relief
for people with chronic back and leg pain due to nerve damage.

The drug injections also didn’t increase the risk of infection and other
complications, despite some previous safety concerns.

It’s possible, researchers said, that higher doses of steroids or the anti-
arthritis drug etanercept (marketed as Enbrel) may do a better job of
easing pain in this notoriously hard-to-treat group of patients. Or people
might get more pain relief if the shots are given as-needed, instead of at
set intervals.

So the findings can’t say definitively whether or not either type of
injection might help some people with nerve-related chronic pain,
researchers report in the Annals of Internal Medicine.

“This kind of pain is very challenging to treat. There’s no reliable
treatment that works in everyone,” said Dr. Steven Cohen from the Johns
Hopkins University School of Medicine in Baltimore, who worked on the

Medications tend not to work very well, he told Reuters Health. And
although surgery may help in the short term, studies haven’t found an
effect in people who did or didn’t have an operation a couple of years down
the line.

Most people with lower back and leg pain due to nerve damage — also known
as sciatica — are treated with epidural steroid injections, Cohen said.
But recently, there’s been more interest in injections of immune-
suppressing drugs like etanercept.

“People are looking for something more effective and something safer,” he
said. “The findings are disappointing, but by no means is this the end of
the story.”


Cohen’s study involved 81 people who’d had sciatica for at least a month.
The patients were in their early 40s, on average, and treated at one of
four military medical centers and two civilian hospitals.

Study participants were split into three treatment groups. They were given
two spinal injections, two weeks apart, of the steroid methylprednisolone,
etanercept, or normal salty water, called saline. Neither the patients
themselves nor the doctors treating them knew who got which type of

At check-ins one month later, patients’ back and leg pain was reduced by a
similar amount, regardless of which treatment they’d received. Their back
pain scores fell by average of one to two points, and leg pain by two to
four points, on a 10-point scale.

People who had gotten steroid or saline injections reported bigger
improvements in how well they could get around and perform usual activities
compared to those in the etanercept-injection group.

The lack of any significant benefit with etanercept, compared to normal
saline, was “disappointing,” according to Cohen. “These drugs are
expensive, and even though they may be safer than steroids, they’re not
devoid of risk,” he said.

Steroid or etanercept injections cost about $500 to $700 each, Cohen said.
The biggest concern with etanercept is immune system side effects, he
added, while steroids can cause stomach problems and alter blood sugar

Between one and six patients in each group had side effects related to the
injections, including worsening pain, a rash or infection, but none were

It’s possible that patients treated with regular saline got some relief
because the injection washed out the spine and increased blood flow to
nerve roots, researchers said.

In the end, whether or not patients’ sciatica pain improves may be more up
to their own behavior than what type of injections they get, if any, Cohen

“The treatment that has the strongest evidence behind it is actually
exercise programs,” he said — as well as losing weight, for people who are
too heavy.

“It’s kind of a long, slow process. People have to have realistic

SOURCE: Annals of Internal Medicine, online April 16, 2012.
© Thomson Reuters 2011. All rights reserved.
UK: Park Primary clean-up finds used needle
BBC News South Scotland, UK (16.04.12)

Police urged anyone using needles to dispose of them safely
A used needle and syringe “heavily contaminated” with blood were discovered
while about 100 children took part in a community litter-pick.

They were found near Park Primary School in Stranraer.

The discovery came during an annual litter-pick organised by Keep Scotland
Beautiful as part of its National Spring Clean campaign.

Police said the incident was “very concerning” and urged anyone using
needles to dispose of them safely.

Dumfries and Galloway Constabulary said about 100 children and 50 adults
had been taking part in the clean-up earlier this month when the items were

A community engagement worker and a local warden found them and they were
disposed of safely.

‘Totally unacceptable’
Community safety constable Siobhan Pellet said: “We would like to ask those
people who do use needles to take care using them and to make sure that
they dispose of them safely and in the appropriate manner.

“It is totally unacceptable that they are left lying where children can
find them.

“The dangers of injury and infection through needle stick injuries are

“It must be reiterated that if you see a needle or syringe lying in the
street do not touch it but report it so it can be safely removed.”

Pakistan: Hospital waste
Israr Ahmed, Business Recorder, Pakistan (14.04.12)

Hospital or healthcare waste is the by-product of health services rendered
to the population by healthcare providers like public and private
hospitals, general medical practitioners, academic and research
institutions, medical laboratories, blood banks and blood collection
services and other associated establishments.

Waste generated by healthcare activities includes a broad range of
materials, from used needles and syringes to soiled dressings, body parts,
diagnostic samples, blood, chemicals, pharmaceuticals, run-down medical
devices and radioactive materials.

The considerable amount of this waste generated during the process of
healthcare services’ delivery is hazardous both for human health and
environment, as it causes environmental pollution, hence need to be
disposed of properly and in a specified way. The World Health Organisation
has classified medical waste into different categories, which are,
infectious, sharps, pathological, pharmaceutical and radioactives.

According to Dr Imran Khan (Indus Hospital), an expert in hospital waste
management, there are several categories of infectious waste produced
during the delivery of healthcare services, such as human tissues and body
parts, animal carcass, syringes, blades, saws, drugs, vomits, urine,
chemicals and fluid from laboratories. He says that this kind of infectious
waste of the hospitals/healthcare establishments is needed to be segregated
from the solid waste and stored in special containers so that it could be
disposed of in the specified way.

Poor management of healthcare waste potentially exposes healthcare workers,
waste handlers, patients and the community at large to infection, toxic
effects and injuries, and risks polluting the environment.

It is essential that all medical waste materials are segregated at the
point of generation, appropriately treated and disposed of safely.

But the situation at health facilities of the largest city of the country
is pathetic as far as the management and disposal of the healthcare waste
is concerned.

Even the major public sector healthcare facilities have either no proper
system of management and disposal of the waste or whatever system they have
is non-functional.

No proper and modern waste management system is in place in the public and
private sector hospitals except one or two. Dr Qaiser Sajjad, Central
Finance Secretary and former President Pakistan Medical Association (PMA)
Karachi chapter, says that there was not a single hospital in the public
sector and even in private sector (with the exception of one) in Karachi
where the hospitals wastes were segregated or disposed of as per the
international standard and Hospital Management Rules 2005 or a modern and
scientific waste management system was in place. Usually two methods are
being used to dispose of the hospital waste ie landfills and incineration.

In landfill method, hospital waste is buried underground but according to
health experts overwhelming majority of the landfill sites are not
constructed on scientific lines.

Incinerators installed at various places also do not have proper filters
and scrubbers and when hospital waste is burnt, toxic gases like dioxin and
chemicals are discharged in the air which can be potential carcinogen.
According to Dr Imran, only Agha Khan Hospital Karachi has a proper waste
management system and functional incinerators to burn the infectious waste.

Health experts recommend that the hospital waste should be segregated from
the solid waste and stored in special containers.

Proper landfills should be constructed and all incinerators working without
filters and scrubbers should be immediately shut down. A visit to three
major public sector hospitals of the city, Jinnah Post Graduate Medical
Centre (JPMC), Civil Hospital Karachi (CHK) and Abbasi Shaheed Hospital
(ASH) revealed that there was no proper and functional waste management

The incinerators of CHK, and Abbasi Shaheed hospital are closed for a long
time. There is no proper monitoring of the waste disposal process in these
public sector health facilities, as one can find even the
hazardous/infectious waste in the premises or adjoining areas of these

A detailed visit to and adjoining areas of JPMC, CHK and ASH revealed that
the hospital waste is thrown out in the dustbin/collection points of
municipal waste, as there were used syringes, blades, saws and other
materials mixed with the municipal waste. At a collection point of a
municipal waste in Bazerta Lane, a locality adjacent to JPMC, children were
playing with used syringes.

The situation at other hospitals is also the same.

When Medical Superintendent (MS) Civil Hospital Saeed Qureshi was
contacted, he said that due to construction work, the incinerator of the
hospital was closed.

He said that healthcare waste generated at CHK was given to Karachi
Municipal Corporation for burning out at its incinerator, for which it has
been paid.

But the hospital sources said that large portion of the waste, which can be
recycled or reused, is sold out.

Sources said that the incinerator at JPMC was also non-functional, but the
management said that the incinerator was operating and hazardous waste was
being burnt safely.

Director Administration JPMC Chaudhry Ikram says that the incinerator is
being run for about eight hours daily.

Over 100kg of infectious waste is being brunt safely on the scientific
lines at the incinerator. The infectious healthcare waste is a major cause
of HIV/AIDS, hepatitis B and C and viral infections.

These viruses are generally transmitted through injuries from needles and
sharp objects, which are contaminated with human blood, said Dr Qaiser

There are, however, numerous other diseases which could be transmitted by
contact with healthcare wastes.

These are urinary tract infections, respiratory tract infections, wound
infections, bacteraemia, and skin infections etc, he added. He maintained
that major portion of the hospital waste is thrown out in the municipal
waste collection points.

“There are more than three thousands scavengers in the city who can be seen
searching for recyclable waste items in garbage bins in various city
localities. As infectious waste such as needles and other chemical
materials thrown at these garbage bins, scavengers get injured due to
needles and contract Hepatitis and other infectious diseases unknowingly,”
he added.

Dr Imran pointed out to another aspect of the issue.

According to him, unsafe disposal of used syringes, blades etc leads to
their reuse enhancing the risk of disease transmission. “Unsafe disposal of
the hospital waste is said to be one of the major reasons that we have high
prevalence of hepatitis B and C infections, particularly among healthcare
workers,” he added.

Sources said that there was a potential market of healthcare waste in
recycling business.

Plastic ware industry is the biggest buyer of used syringes, infusion and
blood bags.

Sources said that handlers of waste at healthcare facilities are involved
in selling the waste to people engaged in recycling business. They said
that there are about 300 units in New Karachi and other areas of the city,
which are involved in recycling of hospital waste especially plastic and
syringes, blood bags infusions.

A worker of one such unit told Business Recorder that even water coolers,
hot pots and other plastic utensils were made of hospitals’ plastic waste.
Any healthcare waste left by scavengers is either taken for final disposal
by municipal authorities in open trucks or burned in a smoldering fire,
polluting the environment.

Even before this process takes place, dogs, cats and birds flock the
community waste sites in search of food, contribute to further spread of
infectious materials in the locality. It is an irony that Karachi Municipal
Corporation (KMC), which has a major incineration plant, but most of the
private and public sector hospitals dumped their waste in open spaces or
dispose of it with municipal waste.

Dr Shaukat Malik, member PMA’s executive committee, said that there were
guidelines for hospital waste management in Pakistan in the form of
Hospital Management Rules 2005, prepared by the Ministry of Environment in
consultation with the Environmental Health Unit of the Ministry of Health,
and other stakeholders covering all aspects of safe hospital waste
management, including the risk associated with the waste, formulation of
waste management teams, their responsibilities, collection, segregation,
transportation, storage and disposal methods.

But, he deplored, these rules are not followed by healthcare facilities
providers. The situation is alarming which needs immediate action on part
of the government, concerned authorities and health facilities’ providers.

Though the major hospitals and healthcare facilities could have their own
waste management and disposal systems, but small hospital, clinics,
laboratories, blood banks and others could not afford such a facility,
hence the government needs to set up centralised disposal points for
hospital waste in 18 towns of Karachi.

Though the KMC provides a disposal service that collects and incinerates
waste from hospitals for a fee.

Despite this, most hospitals prefer to dump their waste in the open.

The practice is highly hazardous.

There is a need for awareness about hazards of such waste among all high-
risk groups.

The government and concerned authorities are required to launch crackdown
on the trade of recycled syringes and other waste.
Copyright Business Recorder, 2012

Russia: No Clean Needles for Russian Addicts – Drug Official
Marc Bennetts, RIA Novosti, Russia (13.04.12)

MOSCOW: Russia’s chief specialist on tackling drug abuse reiterated on
Friday the country’s reluctance to introduce a Western-style system of
needle exchanges for heroin addicts, saying it would do nothing to combat
high HIV infection rates.

“We tried this,” health ministry specialist Yevgeny Bryun told journalists
in downtown Moscow. “And, strangely enough, we saw a spike in drug use and
HIV infections.”

“Russia is very frightened of this system,” he said.

Russia’s Health Ministry said last year that HIV infection rates had
tripled in areas where foreign-run needle exchange programs were in place.
But non-governmental organizations say the increases are “logical.”

“Of course they discover more addicts and infections in regions with these
programs,” Ivan Varentsov, a spokesperson for the Andrey Rylkov Foundation,
which provides health information to intravenous drug users, told RIA
Novosti. “They come in for testing and treatment.”

“It’s hard to understand the logic sometimes behind Russia’s drug
policies,” he added, calling them among the most “repressive in the world.”
Some 30,000 Russians die from heroin abuse every year, according to
official statistics. That figure is around one-third of all heroin-related
deaths worldwide. Non-govermental organizations estimate that there are up
to three million heroin addicts in the country.

Parallel to this, over 100,000 people died from AIDS-related illnesses in
Russia in 2011 and the number of new HIV infections jumped 10 percent. The
United Nations says there are now around a million people living with HIV
in Russia.

Bryun also criticized the Western model of methadone distribution to
addicts. Methadone is a synthetic form of opium used to wean addicts off
heroin. Its use in treating heroin addicts is endorsed by the United
Nations and scores of countries, including all but three of the 15 former
Soviet republics. The other two former Soviet countries without methadone
programs in place are Turkmenistan and Uzbekistan.

“This is not treatment,” Bryun said, also arguing that the system had been
adopted in the United States as a “cheap option” for addicts lacking
medical insurance. “We can get the same results without methadone – so why
use it?”

He also argued that addicts were likely to simply sell methadone and use
the money to buy heroin.

Russia has also cracked down on organizations that advocate the adoption of
methadone as treatment.

The website of the Andrey Rylkov Foundation was closed down by order of the
Federal Drug Control Service on February 3 over the site’s alleged
“promotion of the use of drugs.”

“They accused us of promoting drug use and selling methadone,” Varentsov
said. “This is nonsense.”

The vast majority of the heroin injected in Russia is from Afghanistan. The
United Nations says twenty-one percent of the 375 tons of heroin produced
annually in the war-ravaged state travel through central Asia before
hitting the already glutted Russian market.

Russia’s government estimates that some $17 billion was spent on street
heroin last year nationwide.

Russia’s federal drug control chief, Viktor Ivanov, said in February that
opium production in Afghanistan went up 61 percent in 2011.

He also said NATO’s efforts to encourage Afghan farmers to give up their
poppy fields in favor of wheat production had “failed,” as farmers “gladly
take the wheat and continue cultivating opium poppy.”
Canada: Quebec waiting for community groups to apply for safe-injection
Montreal Gazette, Montreal Canada (12.04.12)

MONTREAL – Quebec Health Minister Yves Bolduc is waiting for plans from
community groups before deciding whether to go ahead with supervised
injection sites (SIS) in areas where intravenous drug use is rampant, his
press attaché said Wednesday.

“The minister has said he supports these sites in conformity with the
Supreme Court judgment,” Natacha Joncas Boudreau SAID.

She was alluding to the ruling in September by the Supreme Court of Canada
that an attempt by the federal government to shut down Vancouver’s Insite
clinic – North America’s only nurse-supervised injection site – violated
the Charter of Rights and Freedoms.

On Wednesday, researchers at the University of Toronto recommended the
creation of two supervised injection facilities in Ottawa and three in

They concluded that such “facilities are likely to represent good
investments in health-care dollars” because they would improve the health
of drug users and reduce the risk that they might contract HIV and
hepatitis by using dirty needles.

In December, Montreal’s public health department released a report strongly
in favour of establishing three supervised-injection sites and a mobile one
this year.

The report recommended that fixed sites be set up in Hochelaga-Maisonneuve,
downtown and in an area near St. Urbain and Prince Arthur Sts.

The mobile unit would move around St. Henri and the city’s southwest

“The minister has met with community groups and public health,” Joncas
Boudreau said.

“It’s the community groups that must submit their projects to the minister,
who will decide whether they are in conformity with the Supreme Court
ruling,” she said.

Montreal Mayor Gérald Tremblay has repeatedly stated that any downtown site
should be located in an existing medical facility, but residents have
complained that it would add to the number of people seeking help for

In a city meeting in February, representatives of Cactus, a free needle-
exchange service, argued that an SIS be set up at Cactus’s current address
on Sanguinet St.

Louis Letellier de St. Just, president of Cactus, said his centre has plans
for six cubicles to provide as many as 100 nurse-supervised injections a

It’s not clear whether Cactus has submitted its plans yet to the Health

De St. Just was unavailable for comment.

Postmedia News contributed to this report.
© Copyright (c) The Montreal Gazette
India: BD trains healthcare workers on Blood Collection Practices, India (12.04.12)

Our Bureau, Bengaluru, Thursday, April 12, 2012, 13:30 Hrs [IST]
BD (Becton, Dickinson and Company) is now increasing focusing on the safe
blood collection practices. Paramedical workers are subject to the largest
number of blood exposures. Percutaneous injury from blood-filled needles is
the primary route through which healthcare workers are exposed to
bloodborne pathogens and potentially fatal diseases, including hepatitis B
virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus
(HIV), which pose serious health and safety risks to healthcare workers.

The company which organized a seminar at New Delhi recently stated that
while developing a strong laboratory system is crucial to supporting the
prevention, treatment of infections diseases, it is also critical to
protect healthcare workers from exposure to blood-borne pathogens through
accidental needlestick injuries (NSIs).

“As part of our efforts to strengthen laboratory systems, BD works with
labs to reduce diagnostic errors. However, we believe that it is also of
vital importance to help protect healthcare workers who are at risk of
contracting life threatening infections via NSIs during the process of
blood collection. BD is committed to advancing the cause of healthcare
worker safety and continues to actively support hospitals’ efforts to train
and educate their employees in this domain,” said Dr Sanjay Sarin,
director, BD Diagnostics – Preanalytical Systems – India.

At a seminar organized by BD Dr Arvind Lal, chairman and managing director,
Dr Lal PathLabs, said, “The safety of healthcare workers should be an
integral part and priority of any organization. We all need to create
systems in our organizations that help ensure the safety of our employees.”

Dr Ana Stankovic, vice president, Medical and Scientific Affairs and
Clinical Operations, BD Diagnostics – Preanalytical Systems said,
“Extensive experience accumulated for the past 12 years across the world
clearly shows that NSIs are radically reduced once safety devices are
adopted. It is very important that healthcare workers everywhere have the
same opportunity to do their jobs in the safest environment possible by
using blood collection devices with safety features.”

To strengthen healthcare systems, BD provides training for laboratory staff
and clinicians who can then help educate other healthcare workers at their
facilities. The company also conducts Pre-analytical Audits across
laboratories and delivers specific modules that allow laboratory managers
to improve their processes. Its phlebotomy training programs are certified
by the Association of Clinical Biochemists of India (ACBI). Worldwide, BD
has conducted Good Laboratory Practice (GLP) training programs in more than
60 countries, reaching nearly 5,600 participants in 623 sessions since
August 2004.
Canada: Ontario rejects safe injection sites
By Tom Blackwell and Natalie Alcoba, National Post, Canada (11.04.12)

Public-health experts had barely released a hefty report Wednesday urging
Ontario to open five safe-injection sites for drug addicts when the
province’s Health Minister weighed in.

Deb Matthews stressed that the province has no plans to implement the
experts’ recommendations, as once again the forces of politics and science
collide over the contentious idea of giving narcotic users a legal place to
shoot up.

“We are always prepared to listen to good advice, and we make our decisions
based on evidence,” Ms. Matthews said in a terse statement issued by her
office less than half an hour after a press conference releasing the
report. “[But] experts continue to be divided on the value of the sites.”

Toronto and Ottawa should open multiple safe-injection sites: study
Dan Gardner: The political benefits of ignoring facts
The report issued by Doctors Ahmed Bayoumi and Carol Strike on Wednesday
has been billed as the most comprehensive yet produced on the topic. It
calls for three sites in Toronto and two in Ottawa, predicting they could
curb the incidence of HIV and hepatitis infections, the number of overdose
deaths and the scope of needle use in public places.

“Toronto and Ottawa each have a significant number of people who use
drugs,” said the report. “Supervised consumption facilities would be
beneficial in both cities.”

Safe injection sites are based on the concept of “harm reduction.” Rather
than just punishing wrongdoers, the philosophy focuses on lessening the
nasty side effects of illicit activity like drug use.

The original Insite facility, located in Vancouver’s Downtown Eastside, was
given an exemption from the Criminal Code in 2003 by the then Liberal
government, backed by local and provincial governments in B.C. The Harper
government, arguing that it was a “failed experiment” and committed to a
get-tough “war” on drug abuse, tried to shut down Insite, only to be
challenged all the way to the Supreme Court of Canada.

The top court ruled unanimously last October that closing the clinic would
threaten the drug users’ health and lives, contravening their
constitutional right to life, liberty and security of the person.

In Montreal, recent discussion of opening sites there has become bogged
down in a debate over where to locate them, with residents of some proposed
locations worried about possible harms.

Wednesday’s report suggests why politicians might balk in the face of both
scientific and judicial approval. The authors stressed that opinion polling
indicates that “more than 50%” of Ontarians support the idea, yet just 37%
said in a 2009 survey they strongly back it, while 53% had mixed opinions
and 19% were opposed.

And police surveyed by the researchers were almost universally against the
idea, feeling it would fuel more crime and tacitly legitimize narcotic

By contrast, the injection drug problem in Vancouver has always been more
visible, leading even the city’s police to back the idea of a safe-
injection facility, noted Nelson Wiseman, a political scientist at the
University of Toronto. Without that kind of groundswell of support here, it
is not surprising the government would hesitate to embrace the concept, he

“In Vancouver, the problem is much more obvious, more apparent, more in
your face,” said Prof. Wiseman. “If you’re political [in Ontario], why
would you get into this?”

A government source suggested that there is nothing preventing either
Toronto or Ottawa from bypassing the province and asking the federal
government for approval to open a site.

At Toronto City Hall, the reviews were relatively positive. George
Mammoliti, a councillor allied to Rob Ford, the conservative Mayor,
suggested safe-injection sites might work, so long as they were not forced
on any neighbourhood.

“There are communities that are suffering from drug addiction and they are
the best communities to put them in.”

The report was funded chiefly by the Ontario HIV Treatment Network and the
federal Canadian Institutes of Health Research.

The researchers reviewed studies conducted on the Vancouver facility and
dozens in Europe and Australia, and extensively examined the injection-drug
population in Toronto and Ottawa, surveying users, health workers, police,
business people and others.

They estimated about 9,000 drug users in Toronto and 3,000 in Ottawa are
injecting both cocaine and opiates like heroin. As many as 18% of those
surveyed said they share needles and up to 54% said they shot up in public.

The report recommends injection sites that would allow supervised drug use,
and ideally be connected to a health facility that already treats users.

Each of the three Toronto locations could potentially prevent two to three
HIV infections per year, and as many as 20 hepatitis C cases, while each
Ottawa site could prevent as many as 10 HIV and 35 hep-C infections, the
report’s authors calculated.

They estimated the yearly cost of each site at about $1.5-million, but
concluded the potential for disease prevention made them cost-effective.
Kenya: Nema raises the red flag over risks of dumping toxic waste
By Dave Opiyo, Daily Nation, Nairobi Kenya (10.04.12) [Edited]

The country’s environmental watchdog has raised the red flag over the
manner in which medical and electronic waste in the country is disposed.

The National Environmental Management Authority in a report says poor
disposal of used needles, syringes and other toxic waste on uncontrolled
dumping sites have become a major threat to the public health.

With regard to medical waste, the World Health Organisation has already
warned that injections given with contaminated syringes cause about 23
million infections of hepatitis B, Hepatitis C and HIV worldwide.

According to its latest report on the state of the country’s environment,
Nema says the key driver for indiscriminate dumping of medical waste from
hospitals in the country is the lack of proper disposal facilities,
particularly incinerators.

Incineration centres, reveals the report, are limited and where available,
are either broken down or improperly used.

“It is known that incineration as a waste treatment technique releases
toxic gases produced by combustion of the by product or other materials,
and this can affect the environment and human health,” reads the report.

Some of the health institutions licensed to operate incinerators, according
to the report, include Tenwek Hospital in Bomet, Aga Khan Hospital both in
Kisumu and Mombasa, Lions Sight First Eye Hospital and Aga Khan University
Hospital all in Nairobi.

Others are Franciscan Sisters of St Joseph’s in Kisii, Muthale Mission
Hospital in Kitui and Moi Teaching and Referral Hospital.

In addition to this, other organisations that have been licensed to
incinerate an assortment of hazardous waste according to the report include
Oserian Development Corporation, Environment and Combustion, Green City
Incinerator, Mabati Rolling Mills, Enviro-Safe, East African Portland
Cement, Standard Rolling Mills, Agro Chemical and Food Company, James
Finlay Kenya Limited, Homegrown Kenya and Envirowaste.

The environmental watchdog says that the low number of licensed
incinerators indicates that a large number of Kenyans are exposed to

“Whereas the opportunity exists for medical facilities to transport waste
to commercial incinerators for disposal, there is no evidence to support
this practice on the ground,” reads the report.

“It is a common practice for most of the hazardous medical waste to be
dumped in shallow pits within the precincts of the medical institutions,”
it goes on.

“These pits are easily accessible by scavenging birds and rodents. These
then serve as reservoirs for disease transmission. In addition, these pits
are not properly lined and there is a real risk of contaminating
underground water sources,” adds the report.

Further, the watchdog points out, many jobless people forage in these pits
in search of salvageable items for sale.

“These people are exposed to the risk of contact with contaminated material
or being pricked by the sharp objects. The attempt to dispose of the waste
by periodic burning only exacerbates the problem as it exposes the
surrounding communities to dangerous fumes,” says the report.

Nema also says that proper quantification of waste in the country has not
been done.

Medical waste

Because of this data gap, they say, it has been difficult to formulate
effective strategies to deal with medical waste management.

“Moreover, a number of agricultural and veterinary labs might be disposing
of waste that could fall within the biomedical category in an unhygienic
manner as none of the latter facilities have been licensed by Nema,” they
Australia: Demand Drives Needle Exchange Need (13.04.12)

The Western Australia Substance Users Association has opened the region’s
first permanent needle-exchange facility. WASUA said the site, located in
Bunbury, was launched due to high demand: The organization’s van-based
needle-exchange program distributed more than 200,000 clean needles in the
region during the past year. NEPs have played a vital role in helping
prevent the spread of blood-borne illnesses in Australia, according to Paul
Dessaur of WASUA.

“In Australia, for instance, the rate of HIV amongst injecting drug users
is less than 1 percent, and that is unheard of, and it’s purely because we
introduced these programs way back in 1986,” he said.

More people are accessing the NEP now that it has a fixed location, Dessaur
said. “More than 33 percent of the people who visited the site in the last
two weeks are actually new to the service,” he said. For more information,
Memory ‘trick’ relieves drug cravings
Altering memories of drug use could stop ex-addicts from relapsing.

Mo Costandi, Nature News, doi:10.1038/nature.2012.10442 (12.04.12)

Researchers have come up with a way to help prevent recovering drug addicts
from relapsing — without using other pharmaceuticals to help. The approach
involves modifying addicts’ behaviour by weakening their memory of drug
taking, which relieves their cravings and might help to prevent relapse.

Addicts tend to associate a drug’s effects with drug-taking equipment and a
certain environment, which can make them vulnerable to relapse if they
encounter those conditions. The technique, studied by Lin Lu of the
National Institute of Drug Dependence at Peking University in Beijing and
his colleagues, aims to break that link by briefly reactivating the memory
of drug taking and following it with an ‘extinction session’ of repeated
exposure to the same memory cues.

The short reminder of drug-taking seems to take the memory out of storage
and make it easier to overwrite.

Existing therapies try to help addicts to unlearn their habit by, for
example, showing them videos of people injecting, and having them handle
syringes while not under the influence of the drug. This reduces cravings
in the clinic, but not when addicts return to their usual surroundings.
Other approaches tested in rats involved using memory-blocking drugs to
change memories of past drug use, but these are not approved for use in

To boost the technique’s effectiveness, Lu and his team combined the
approach with a process called memory reconsolidation. During
reconsolidation, information is retrieved from long-term storage and
reactivated to strengthen the memory. After retrieval, however, the
information becomes temporarily unstable and thus prone to alteration.
Their work is published today in Science1.

A cure for craving?

To use reconsolidation to wipe out drug memories, Lu and his team first
taught rats to self-administer cocaine and heroin, so that they learnt to
associate a particular environment with a drug high. The researchers then
put the rats in the same environment, but without the drug being available.

Rats showed the least drug-seeking behaviour if they were put in the drug-
taking environment for 15 minutes, removed from it for 10 minutes and then
returned for 3 hours.

Next, the researchers applied the procedure to humans. They showed heroin
addicts a 5-minute video of images of heroin use and drug paraphernalia,
either 10 minutes or 6 hours before an hour-long extinction session, in
which they were repeatedly exposed to the same images.

Addicts who were shown the video 10 minutes before the extinction session
showed decreased drug cravings both during the session and up to six months
later, says Lu. There was no noticeable effect on cravings in those who
watched the video 6 hours before the session.

Neuroscientists think that the brief exposure beforehand reactivates the
memory of drug taking, making it easier to erase the link between the cues
of drug taking and getting high, and to replace it with a memory in which
no such link is formed.

Participants were hospitalized throughout the study. Whether the procedure
would prevent relapse for addicts in their usual environment remains to be

A distant memory

“It’s a fantastic and fascinating study, involving very well controlled
experiments in both rats and humans, and they got such dramatic results,”
says neuroscientist Liz Phelps of New York University, who was not involved
in the work.

In 2010, Phelps and her colleagues showed that memory reconsolidation could
be used to extinguish fearful memories[2]. In their experiment,
participants were repeatedly shown a blue square while receiving mild
electric shocks on the wrist, and learned to associate the two stimuli, so
that afterwards they responded to the square with fear.

The participants were then shown the square again without receiving shocks.
Some were briefly shown the square 10 minutes before this second phase.
This triggered reconsolidation, which interfered with and weakened the
fearful memories. Again, the procedure only worked if there was a
relatively brief interval between the two stages.

“I wasn’t convinced that the technique would be effective in a clinical
setting or in complex, real-life situations,” says Phelps, adding that she
was “pleasantly surprised” by Lu’s results.

Lu says that repeating the procedure regularly might prevent addicts from
relapsing in the long term. He and his team would like to investigate the
underlying neural mechanisms, and to see if the approach is applicable to
other drugs such as alcohol and nicotine.

The procedure may also be effective for treating conditions such as post-
traumatic stress disorder, but must be tested for potential side effects
before it can be approved for wider use.

It would be simple to combine the new technique with existing therapies,
says Phelps. “It’s a very subtle manipulation that could have a big
Injectable contraceptive doubles risk of breast cancer, study shows
By Monica DyBuncio CBS News, USA (05.04.12)

(CBS News) An injectable form of birth control doubles breast cancer risk
among young women, according to a new study.

The study examined younger women, ages 20 to 44, and confirmed a link
between depo-medroxyprogesterone acetate (DMPA) – the main ingredient in
the contraceptive sold under the brand name Depo-Provera – and breast
cancer risk. The contraceptive shot is usually injected into the buttocks
or upper arm once every 3 months, or just under the skin once every 12 to
14 weeks.

The contraceptive contains progestin, the same hormone used in a menopausal
therapy that has previously been found to increase risk for breast cancer.
But researchers say few studies have examined the link between DMPA and
breast cancer risk, and this is the first large scale U.S. study to do so.

The study, led by researchers at the Fred Hutchinson Cancer Research Center
in Seattle, is published in the April 15 issue of Cancer Research.

The research involved over 1,000 young women diagnosed with breast cancer.
About 10 percent of those women reported using DMPA, which study authors
say is consistent with nationwide usage patterns.

What did the results show? Women who had used DMPA for at least one year
had a risk for breast cancer 2.2 times greater than those who did not use
the injectable birth control. Women who had used DMPA for less than a year
or had stopped using it more than a year ago did not have an increased
risk, meaning discontinuing use may be effective.

“Although breast cancer is rare among young women and the elevated risk of
breast cancer associated with DMPA appears to dissipate after
discontinuation of use, our findings emphasize the importance of
identifying the potential risks associated with specific forms of
contraceptives given the number of available alternatives,” the authors
wrote in a news release.

Lead author Dr. Christopher Li of Fred Hutchinson Cancer Research Center in
Seattle, Wash. said in a statement, “In the United States many women have
numerous options for contraception, and so it is important to balance their
risks and benefits when making contraceptive choices.”

The CDC has more on contraception.
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