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SIGNpost 00653


Post00653 Yves Chartier + Webinars + Abstracts + Rio20+ + News 13 June 2012


1. A Tribute to Yves Chartier
2. Editorial of the International Journal of People’s Health to pay tribute
to Yves Chartier
3. Waste Management: Free Online Green Healthcare Webinar Series
4. Abstract: Needlestick and sharps injuries among housekeeping workers in
hospitals of Shiraz, Iran
5. Abstract: Implementation of intravenous to oral antibiotic switch
therapy guidelines in the general medical wards of a tertiary-level
hospital in South Africa
6. Abstract: Risk factors for infection with different hepatitis C virus
genotypes in southern Brazil
7. Abstract: Effect of an Educational Course at an Iranian Dental School on
Students’ Knowledge of and Attitudes About HIV/AIDS
8. Abstract: A Population-Based Study of the Epidemiology of Hepatitis C in
a North American Population
9. Abstract: Life after the ban: an assessment of US syringe exchange
programs’ attitudes about and early experiences with federal funding
10. Abstract: HIV development assistance and adult mortality in Africa
11. Abstract: Analysis of Event Logs from Syringe Pumps: A Retrospective
Pilot Study to Assess Possible Effects of Syringe Pumps on Safety in a
University Hospital Critical Care Unit in Germany
12. Abstract: Sublingual allergen immunotherapy: mode of action and its
relationship with the safety profile
13. Abstract: Acellular vaccines for preventing whooping cough in children
14. Abstract: Priority medicines for maternal and child health: a global
survey of national essential medicines lists
15. No Abstract: Minimum impact. Reducing the detrimental effects of
hospital waste
16. LIVE from Rio Plus 20: on 13 June – In English with simultaneous
translation to Spanish
17. News
– Canada: Students screened after blood-test incident; followup due
– USA: 14 diagnosed with hepatitis C in outbreak at New Hampshire hospital
– Injections ineffective for knee arthritis: study
– Philippines: HIV spreading via needles
– Ireland: Tests for hospital patients where worker has HIV: HSE says 63
to get ‘precautionary’ screenings
– Russia: Injection Drug Use, Sexual Risk, Violence and STI/HIV Among
Moscow Female Sex Workers
– USA: Official Says Shared Syringe Eyed as Possibility in Hepatitis
– Kenya: Mung’aro vows to block needles for drug addicts
– Kenya: Needles to be distributed to injecting drug users
– USA: Vaccines for U.S. children may not be properly stored: study

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1. A Tribute to Yves Chartier

Garance Upham, Peoples Health, France kindly posts notes from the Tribute
to Yves Chartier – a satellite event at the 65th World Health Assembly at
WHO Headquarters in Geneva Switzerland on 22 May 2012.

A Tribute to Yves Chartier

On May 22, a satellite event dedicated to honor the work of Yves Chartier
took place in the Geneva United Nations ‘Palais’ where the World Health
Assembly was being held.

Besides high level government officials from France and Benin, the event
included NGOs and many WHO staff.

The subjects were: Water- Sanitation- Hygiene- Injection Safety- Natural
Ventilation- Waste management- Infection control : An ecological approach
to HIV/AIDS and Antibiotic Resistance.

An “International Journal of People’s Health” was put together to honor the
Memory of Yves and remind everyone how his contributions were unique and
essential for today’s health of all people. (see link)

The organizers are today considering the possibility of setting up a “Prize
Yves Chartier”.

The Journal and event were made possible thanks to the support of the
French Ministry in charge of Health, and the organizing of People’s Health

English and French versions of the International Journal of People’s Health
is at

Garance Upham, Chief Editor,

2. Editorial of the International Journal of People’s Health to pay tribute
to Yves Chartier

Garance Upham, Peoples Health, France kindly posts the editorial paying
tribute to Yves Chartier for his life of working in public health.

The Journal is available for download at:
Editorial of the International Journal of People’s Health to pay tribute to
Yves Chartier.

The vision and the work of those who can see from the individual to the
collective needs of society is most critical. Rare is that person, and in
our common struggle, the loss of one such individual is missed by the
collective movement for global health. Pr Anthony So.

Yves Chartier was of that long tradition of French public health, which
embraced an ecological approach to people’s health: Drinking water –
sanitation – hygiene – waste management – Injection safety – natural
ventilation – the prevention of nosocomial infection, were the major themes
of his work at the World Health Organization.

The protection of people in a disease carrying environment, patient safety
in health systems, are at the heart of the pastorian enterprise of Yves
Chartier which we humbly wish to honor by this publication. Yves died in a
mountain accident last January 8.

Devoid of any spirit of competition, neither within the World Health
Organization, nor in the world, he had no ambition other than to trace the
shortest path for a better protection of people against disease.

The lack of clean drinking water is the leading cause of potentially fatal
diarrhea in young children and in the immuno-compromised?

Yves writes how to integrate clean water and sanitation for schools
planning in poor communities.

He works with USAID on the elaboration of programs to integrate WASH
(WAter, Sanitation and Hygiene) in AIDS programs, Merri Weinger says he was
“the best of the best” (p 9-11).

“Water quality, especially the lack of harmful bacteria, viruses and
parasites, is known to be very important in preventing infection in people
with full immune systems. A great irony exists in advanced giving, costly
life-saving ART to PLHIV with a glass of water that could infect them with
a life – threatening illness.”

Yves strives for appropriate technical assistance in water emergencies,
with Doctors without Borders and other partners.

* Billions of dirty injections in health care annually and poor waste
management, transmit bloodborne pathogens, such as bloodborne viruses:
hepatitis and HIV.

* Yves spent constant energy in WHO’s SIGN (Safe Injection Global Network)
and with country partners to protect patients and caregivers, as in Namibia
where Dr. Azizi Abdullah drastically improved the situation with Yves’
input (p14-15). Today, in a region of Mali, Dr M. C. Kone finds 85% of
health workers unaware of HIV, hepatitis risks (p16).

The control and prevention of nosocomial infections cannot be held a luxury
in health systems, but rather a pillar, as Dr. Georges Ducel reminds us
reviewing the works of Yves (p12). For too long basic hygiene has been
neglected and magic bullet antibiotics over-used in prophylaxis,
participating in increase of resistance to drugs by bacteria and
endangering patients in the process.

Today, facing the rising phenomena of resistance as described in the just
published WHO document, when pipelines are ‘dry’, it is important to react,
as Dr Jean Carlet (president of the NGO ACdeBMR) tell us, by placing
emphasis on a more responsible and regulatory attitude on the part of all
sectors of society, without forgetting prevention through proper and
specific waste treatment and water management (p7-8), because we have to
delay the arrival of a ‘world without antibiotics’ and give time for new
thinking in approaching fundamental research, as Anthony So (Duke
University, one of the reputed expert on BMR (p5), and John-Arne Røttingen
(president of the CEWG, the Working Group on financing for R&D (p6) speak
of about the issue.

Negligence in prevention of airborne transmission represents a great
opportunity for tuberculosis to spread. Without great expenditures,
understanding the techniques of ‘natural ventilation’ developed by Yves,
provides effective protection for patient and caregiver alike. Pr Babacar
N’Doye (head of HAI prevention group- Pronalin) uses this technical work in
Senegal (p17).

The entirety of the work of Yves Chartier defines what our priorities ought
to be: development of drinking water systems in all countries, large
investments in waste management, and functional systems of sewage in major
cities of emerging countries, taking the likelihood of weather storms and
water flooding into account.

At the World Water Forum in Marseilles, France, governments of the world
issued resolutions. Yet public health priorities tend to focus on
‘deliverables’ and monitoring, and horizontal public approaches for
universal access to drinking water, proper waste management, sewage, remain
low on the list of world health priorities, notwithstanding Resolution
WHA64.14 on Drinking Water, Sanitation and Health.

Understanding and applying the contributions and recommendations from Yves
Chartier is our way of paying him everlasting tribute. His great
achievements are all essentials to face the challenges of today and

On the covers: water, nature, mountains and the shadow of Yves’ bike :
always looking to new heights. Yves, for those of us who have known you,
you will always be present. And through your work, you will remain one of
the best in public health ‘à la française’, work to be continued for the
health of all the people!

Garance Upham

Chief Editor: Garance Upham
Contact publication:

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4. Abstract: Needlestick and sharps injuries among housekeeping workers in
hospitals of Shiraz, Iran

BMC Res Notes. 2012 Jun 7;5(1):276.

Needlestick and sharps injuries among housekeeping workers in hospitals of
Shiraz, Iran.

Lakbala P, Ebadi Azar F, Kamali H.

BACKGROUND: Needlestick and sharps injuries (NSSIs) are one of the major
risk factors for blood-borne infections (BBPs) at healthcare facilities.
This study examines the current prevalence of NSSIs among housekeeping
workers engaged in the handling and disposal of biomedical waste (BMW) at
government and private hospitals in Shiraz, Iran, and furthermore, explores
strategies for preventing these injuries

FINDINGS: Using a cross-sectional study design, NSSI’s and associated
protective measures for housekeeping workers throughout hospitals in Shiraz
were evaluated from 2009 onwards. Using a questionnaire, data was collected
for 92 workers who had engaged directly with BMW. Data was analyzed using
Chi- square, student t-test and where appropriate, SPSS version 12. 90.2 %
of housekeeping workers were warned of the dangers associated with waste,
87.5 % in government and 93.2 % in private hospitals (P = 0.0444). 83.7 %
had attended educational programs on biomedical waste (BMW) management and
injury prevention at their hospital in the preceding year. 16.3 % had not
been trained in biomedical waste management (P = 0.0379) and 88.9 % had a
sufficient supply of safety wear.

CONCLUSIONS: NSSIs are a common risk factor for infection among health care
workers within hospitals in Iran. For the effective prevention of these
injuries, health boards and hospital trusts need to formulate strategies to
improve the working conditions of health care workers, discourage the
excessive use of injections, and increase their adherence to universal

Free full text

5. Abstract: Implementation of intravenous to oral antibiotic switch
therapy guidelines in the general medical wards of a tertiary-level
hospital in South Africa

J Antimicrob Chemother. 2012 Mar;67(3):756-62.

Implementation of intravenous to oral antibiotic switch therapy guidelines
in the general medical wards of a tertiary-level hospital in South Africa.

van Niekerk AC, Venter DJ, Boschmans SA.

Department of Pharmacy, Nelson Mandela Metropolitan University,
Summerstrand, Port Elizabeth, South Africa.

OBJECTIVES: The design and implementation of an antibiotic intravenous (iv)
to oral switch therapy (IVOST) guideline in a Third World health setting.

METHODS: The guideline was developed and integrated into daily practice by
a ward pharmacist over a period of 7 weeks. Patients were switched once
they were deemed clinically stable according to IVOST criteria. The final
decision to switch was left to the attending physician. One pre- and two
post- implementation audits (150 patient medical records per audit) were

RESULTS: Implementation of the IVOST guideline was successful in increasing
(P<0.0005) the number of patients switched from 16% (19/119) pre-
implementation to 43.9% (47/107) immediately after implementation; however,
the change was not sustained 3 months after implementation (20.8%; 25/120).
The intervention was also successful in decreasing the overall duration of
iv therapy (P<0.0005) from 7.2 ± 3.5 days pre-implementation to 5.2 ± 3.0
days immediately post-implementation. The change was not sustained 3 months
after implementation (6.5 ± 3.5 days).

CONCLUSIONS: Despite the challenges encountered in a Third World
environment, an antibiotic IVOST guideline can be successfully implemented.
Continual, active integration of the guideline into daily practice by a
ward pharmacist is essential if positive IVOST outcomes are to be

6. Abstract: Risk factors for infection with different hepatitis C virus
genotypes in southern Brazil

ScientificWorldJournal. 2012;2012:946954.

Risk factors for infection with different hepatitis C virus genotypes in
southern Brazil.

Paraboni ML, Sbeghen MD, Wolff FH, Moreira LB.

Universidade Regional Integrada Campus Erechim, Erechim, Brazil.

Objectives. To investigate the proportion of different genotypes in
countryside microregions in southern Brazil, and their association with
risk factors.

Methods. Cross-sectional study including a convenience sample of patients
who tested positive for HCV-RNA and were referred to a regional health
center for genotyping, from December 2003 to January 2008. Data were
obtained through the National Disease Surveillance Data System, from
laboratory registers and from patient charts. Identification of genotypes
was carried out using the Restriction Fragment Length Polymorphism “in
house” technique. Independent associations with genotypes were evaluated in
multinomial logistic regression and prevalence rates of genotypes were
estimated with modified Poisson regression.

Results. The sample consisted of 441 individuals, 41.1 ± 12.0 years old,
56.5% men. Genotype 1 was observed in 41.5% (95% CI 37.9-48.1) of patients,
genotype 2 in 19.3% (95% CI 15.0-23.6), and genotype 3 in 39.2% (95% CI
35.6-43.0). HCV genotype was significantly associated with gender and age.
Dental procedures were associated with higher proportion of genotype 2
independently of age, education, and patient treatment center.

Conclusions. The hepatitis C virus genotype 1 was the most frequent.
Genotype 2 was associated with female gender, age, and dental procedure

Free PMC Article


7. Abstract: Effect of an Educational Course at an Iranian Dental School on
Students’ Knowledge of and Attitudes About HIV/AIDS

J Dent Educ. 2012 Jun;76(6):792-9.

Effect of an Educational Course at an Iranian Dental School on Students’
Knowledge of and Attitudes About HIV/AIDS.

Jafari A, Yazdani R, Khami MR, Mohammadi M, Hajiabdolbaghi M.

Department of Community Oral Health, Faculty of Dentistry, Tehran
University of Medical Sciences, End of North Karegar St., Tehran, Iran;.

This study investigated the effects of an educational program designed to
improve the knowledge and attitudes of senior dental students in an Iranian
dental school about caring for patients with HIV/AIDS.

As part of an extramural program in community dentistry, a new educational
program about HIV/AIDS was developed at Tehran University of Medical
Sciences in 2009. The program consisted of two days’ observation at the
Consultation Center for Behavioral Diseases and a one-day workshop on
infection control. A control group was selected from dental students at
Shahid Beheshti University of Medical Sciences. Before and after the
intervention, students in both the intervention and control groups
completed a questionnaire concerning their knowledge of and attitudes about
HIV/AIDS. Students in the intervention group also expressed their opinions
in a post-test questionnaire. An independent sample t-test was used for
statistical analysis.

In the control group, the means of students’ knowledge and attitude scores
did not differ significantly from pre-test to post-test. In the
intervention group, however, the means of both knowledge and attitude
scores on the post-test were significantly higher than on the pre-test (p=
0.001 and p=0.009, respectively). In the intervention group, more than 96
percent of the students reported that they would completely follow
infection control principles in future practice.

This study concludes that the educational program improved the students’
knowledge of and attitudes about HIV/AIDS and will have a positive effect
on their future practice.

8. Abstract: A Population-Based Study of the Epidemiology of Hepatitis C in
a North American Population

J Hepatol. 2012 Jun 2.

A Population-Based Study of the Epidemiology of Hepatitis C in a North
American Population.

Julia U, Bruce TR, Douglas T, Yossel MG.

Section of Hepatology, Department of Internal Medicine, and Faculty of
Medicine, University of Manitoba Winnipeg, Manitoba Canada.

Chronic hepatitis C virus (HCV) infection is a major public health problem
with approximately 3% of the world’s population thought to be chronically
infected. However, population-based data regarding HCV incidence rates,
prevalence, residence, age and gender distributions within North America
are limited.

OBJECTIVES: To provide a detailed descriptive epidemiology of HCV infection
in a North American population with a focus on time trends in the incidence
rates and prevalence of newly diagnosed HCV infection since 1991, the time
when laboratory testing for HCV infections became first available.

METHODS: A Research Database was developed linking records from multiple
administrative sources. HCV-positive residents of the Canadian province of
Manitoba were identified during a twelve year period (1991-2002). The
cumulative and annual incidence rates and prevalence of newly diagnosed HCV
infection in Manitoba were examined and compared between different
demographic groups and urban vs. rural residents.

RESULTS: A total of 5,018 HCV-positive cases were identified over a 12-year
period. The annual number of newly diagnosed HCV infections peaked in 1998
(59.2/100,000). On the other hand, the known prevalence of HCV continued to
increase (4.6-fold during the 12-year study period) among both men and
women reflecting the chronic nature of the disease. Males were 1.7 times
more often infected than females. HCV infections were more common in urban

CONCLUSIONS: Between 1995 and 2002 there was a fairly constant trend for
newly diagnosed HCV infection, ranging from approximately 500 to 600 new
cases annually. Hence, with a stable population size, and a low case
fatality rate, the prevalence of HCV infected persons in our population has
been steadily rising. There is no evidence to suggest that the incidence of
HCV infection will rise, however the burden of chronic HCV infection will
continue to increase, particularly amongst older males and those residing
in urban centers.

Copyright © 2012. Published by Elsevier B.V.

9. Abstract: Life after the ban: an assessment of US syringe exchange
programs’ attitudes about and early experiences with federal funding

Am J Public Health. 2012 May;102(5):e9-16.

Life after the ban: an assessment of US syringe exchange programs’
attitudes about and early experiences with federal funding.

Green TC, Martin EG, Bowman SE, Mann MR, Beletsky L.

Alpert School of Medicine, Brown University, USA.

OBJECTIVES: We aimed to determine whether syringe exchange programs (SEPs)
currently receive or anticipate pursuing federal funding and barriers to
funding applications following the recent removal of the long-standing ban
on using federal funds for SEPs.

METHODS: We conducted a telephone-administered cross-sectional survey of US
SEPs. Descriptive statistics summarized responses; bivariate analyses
examined differences in pursuing funding and experiencing barriers by
program characteristics.

RESULTS: Of the 187 SEPs (92.1%) that responded, 90.9% were legally
authorized. Three received federal funds and 116 intended to pursue federal
funding. Perceived federal funding barriers were common and included
availability and accessibility of funds, legal requirements such as written
police support, resource capacity to apply and comply with funding
regulations, local political and structural organization, and concern
around altering program culture. Programs without legal authorization,
health department affiliation, large distribution, or comprehensive
planning reported more federal funding barriers.

CONCLUSIONS: Policy implementation gaps appear to render federal support
primarily symbolic. In practice, funding opportunities may not be available
to all SEPs. Increased technical assistance and legal reform could improve
access to federal funds, especially for SEPs with smaller capacity and
tenuous local support.

10. Abstract: HIV development assistance and adult mortality in Africa

JAMA. 2012 May 16;307(19):2060-7.

HIV development assistance and adult mortality in Africa.

Bendavid E, Holmes CB, Bhattacharya J, Miller G.

Division of General Medical Disciplines, Center for Health Policy, Stanford
University, Stanford, California 94305, USA.

CONTEXT: The effect of global health initiatives on population health is
uncertain. Between 2003 and 2008, the US President’s Emergency Plan for
AIDS Relief (PEPFAR), the largest initiative ever devoted to a single
disease, operated intensively in 12 African focus countries. The
initiative’s effect on all- cause adult mortality is unknown.

OBJECTIVE: To determine whether PEPFAR was associated with relative changes
in adult mortality in the countries and districts where it operated most

DESIGN, SETTING, AND PARTICIPANTS: Using person-level data from the
Demographic and Health Surveys, we conducted cross-country and within-
country analyses of adult mortality (annual probability of death per 1000
adults between 15 and 59 years old) and PEPFAR’s activities. Across
countries, we compared adult mortality in 9 African focus countries
(Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, Tanzania, Uganda,
and Zambia) with 18 African nonfocus countries from 1998 to 2008. We
performed subnational analyses using information on PEPFAR’s programmatic
intensity in Tanzania and Rwanda. We employed difference-in-difference
analyses with fixed effects for countries and years as well as personal and
time-varying area characteristics.

MAIN OUTCOME MEASURE: Adult all-cause mortality.

RESULTS: We analyzed information on 1 538 612 adults, including 60 303
deaths, from 41 surveys in 27 countries, 9 of them focus countries. In
2003, age- adjusted adult mortality was 8.3 per 1000 adults in the focus
countries (95% CI, 8.0-8.6) and 8.5 per 1000 adults (95% CI, 8.3-8.7) in
the nonfocus countries. In 2008, mortality was 4.1 per 1000 (95% CI,
3.6-4.6) in the focus countries and 6.9 per 1000 (95% CI, 6.3-7.5) in the
nonfocus countries. The adjusted odds ratio of mortality among adults
living in focus countries compared with nonfocus countries between 2004 and
2008 was 0.84 (95% CI, 0.72-0.99; P = .03). Within Tanzania and Rwanda, the
adjusted odds ratio of mortality for adults living in districts where
PEPFAR operated more intensively was 0.83 (95% CI, 0.72-0.97; P = .02) and
0.75 (95% CI, 0.56-0.99; P = .04), respectively, compared with districts
where it operated less intensively.

CONCLUSIONS: Between 2004 and 2008, all-cause adult mortality declined more
in PEPFAR focus countries relative to nonfocus countries. It was not
possible to determine whether PEPFAR was associated with mortality effects
separate from reductions in HIV-specific deaths.

Comment in JAMA. 2012 May 16;307(19):2097-100.

11. Abstract: Analysis of Event Logs from Syringe Pumps: A Retrospective
Pilot Study to Assess Possible Effects of Syringe Pumps on Safety in a
University Hospital Critical Care Unit in Germany

Drug Saf. 2012 Jun 6.

Analysis of Event Logs from Syringe Pumps: A Retrospective Pilot Study to
Assess Possible Effects of Syringe Pumps on Safety in a University Hospital
Critical Care Unit in Germany.

Kastrup M, Balzer F, Volk T, Spies C.

Campus Virchow-Klinikum and Campus Charit Mitte, Department of
Anaesthesiology and Intensive Care, Charit-University Medicine Berlin,
Berlin, Germany.

Background: Medication errors occur in approximately one out of five doses
in a typical hospital setting. Patients in the intensive care unit (ICU)
are particularly susceptible to errors during the application of
intravenous drugs as they receive numerous potent drugs applied by syringe

Objective: The aim of this study was to analyse the effects on potential
harmful medication errors and to address factors that have potential for
improving medication safety after the introduction of a standardized drug
library into syringe pumps with integrated decision support systems.

Methods: A team of physicians and nurses developed a dataset that defined
standardized drug concentrations, application rates and alert limits to
prevent accidental overdosing of intravenous medications. This dataset was
implemented in 100 syringe pumps with the ability to log programming
errors, alerts, reprogramming events and overrides (‘smart pumps’). In this
retrospective pilot study, all pump- related transaction data were obtained
from the pump logs, by downloading the data from the pumps, covering 20
months of use between 1 April 2008 and 30 November 2009. Patient data were
gathered from the electronic patient charts. The study was performed in a
cardiothoracic ICU of the Charité University Hospital, Berlin, Germany.

Results: A total of 7884 patient treatment days and 133?601 infusion starts
were evaluated. The drug library with the features of the dose rate was
used in 92.8% of the syringe pump starts, in 1.5% of the starts a manual
dosing mode without the use of the drug library was used and in 5.7% of the
starts the mode ‘mL/h’, without any calculation features, was used. The
most frequently used drugs were vasoactive drugs, followed by sedation

The user was alerted for a potentially harmful overdosing in 717 cases and
in 66 cases the pumps were reprogrammed after the alert. During the early
morning hours a higher rate of alarms was generated by the pumps, compared
with the rest of the day.

Conclusions: Syringe pumps with integrated safety features have the
capacity to intercept medication errors. The structured evaluation of the
bedside programming history in log recordings is an important benefit of
smart pumps, as this enables the users to obtain an objective measurement
of infusion practice, which can be used to provide team feedback and to
optimize the programming of the pumps.

Further research will show if the combination of these data with
physiological data from ICU patients can improve the safety of pump-driven
intravenous medication.

12. Abstract: Sublingual allergen immunotherapy: mode of action and its
relationship with the safety profile

Allergy. 2012 Mar;67(3):302-11.

Sublingual allergen immunotherapy: mode of action and its relationship with
the safety profile.

Calderón MA, Simons FE, Malling HJ, Lockey RF, Moingeon P, Demoly P.

Section of Allergy and Clinical Immunology, Imperial College-NHLI, Royal
Brompton Hospital, London, UK.

Allergen immunotherapy reorients inappropriate immune responses in allergic
patients. Sublingual allergen immunotherapy (SLIT) has been approved,
notably in the European Union, as an effective alternative to subcutaneous
allergen immunotherapy (SCIT) for allergic rhinitis patients.

Compared with SCIT, SLIT has a better safety profile. This is possibly
because oral antigen-presenting cells (mostly Langerhans and myeloid
dendritic cells) exhibit a tolerogenic phenotype, despite constant exposure
to danger signals from food and microbes. This reduces the induction of
pro- inflammatory immune responses leading to systemic allergic reactions.
Oral tissues contain relatively few mast cells and eosinophils (mostly
located in submucosal areas) and, in comparison with subcutaneous tissue,
are less likely to give rise to anaphylactic reactions.

SLIT-associated immune responses include the induction of circulating,
allergen-specific Th1 and regulatory CD4+ T cells, leading to clinical
tolerance. Although 40-75% of patients receiving SLIT experience mild,
transient local reactions in the oral mucosa, these primary reactions
rarely necessitate dose reduction or treatment interruption.

We discuss 11 published case reports of anaphylaxis (all nonfatal)
diagnosed according to the World Allergy Organization criteria and relate
this figure to the approximately 1 billion SLIT doses administered
worldwide since 2000. Anaphylaxis risk factors associated with SCIT and/or
SLIT should be characterized further.

© 2011 John Wiley & Sons A/S.

13. Abstract: Acellular vaccines for preventing whooping cough in children

Cochrane Database Syst Rev. 2012 Mar 14;3:CD001478.

Acellular vaccines for preventing whooping cough in children.

Zhang L, Prietsch SO, Axelsson I, Halperin SA.

Faculty of Medicine, Federal University of Rio Grande, Rua Visconde
Paranaguá 102, Centro, RioGrande, RS, Brazil.

BACKGROUND: Routine use of whole-cell pertussis (wP) vaccines was suspended
in some countries in the 1970s and 1980s because of concerns about adverse
effects. Following such action, there was a resurgence of whooping cough.
Acellular pertussis (aP) vaccines, containing purified or recombinant
Bordetella pertussis (B. pertussis) antigens, were developed in the hope
that they would be as effective, but less reactogenic than the whole-cell

OBJECTIVES: To assess the efficacy and safety of acellular pertussis
vaccines in children.

SEARCH METHODS: We searched the Cochrane Register of Controlled Trials
(CENTRAL) (The Cochrane Library 2011, Issue 4) which contains the Cochrane
Acute Respiratory Infections Group’s Specialised Register, MEDLINE (1950 to
December week 4, 2011), EMBASE (1974 to January 2012), Biosis Previews
(2009 to January 2012), and CINAHL (2009 to January 2012).

SELECTION CRITERIA: We selected double-blind randomised efficacy and safety
trials of aP vaccines in children up to six years old, with active follow-
up of participants and laboratory verification of pertussis cases.

DATA COLLECTION AND ANALYSIS: Two review authors independently extracted
data and assessed the risk of bias in the studies. Differences in trial
design precluded a meta-analysis of the efficacy data. We pooled the safety
data from individual trials using a random-effects meta-analysis model.

MAIN RESULTS: We included six efficacy trials with a total of 46,283
participants and 52 safety trials with a total of 136,541 participants.
Most of the safety trials did not report the methods for random sequence
generation, allocation concealment and blinding, which made it difficult to
assess the risk of bias in the studies.

The efficacy of multi-component (= three) vaccines varied from 84% to 85%
in preventing typical whooping cough (characterised by 21 or more
consecutive days of paroxysmal cough with confirmation of B. pertussis
infection by culture, appropriate serology or contact with a household
member who has culture-confirmed pertussis), and from 71% to 78% in
preventing mild pertussis disease (characterised by seven or more
consecutive days of cough with confirmation of B. pertussis infection by
culture or appropriate serology). In contrast, the efficacy of one- and
two-component vaccines varied from 59% to 75% against typical whooping
cough and from 13% to 54% against mild pertussis disease. Multi- component
acellular vaccines are more effective than low-efficacy whole- cell
vaccines, but may be less effective than the highest-efficacy whole- cell

Most systemic and local adverse events were significantly less common with
aP vaccines than with wP vaccines for the primary series as well as for the
booster dose.

AUTHORS’ CONCLUSIONS: Multi-component (= three) aP vaccines are effective
and show less adverse effects than wP vaccines for the primary series as
well as for booster doses.

Update of Cochrane Database Syst Rev. 2011;(1):CD001478.

Full Article at:

14. Abstract: Priority medicines for maternal and child health: a global
survey of national essential medicines lists

PLoS One. 2012;7(5):e38055.

Priority medicines for maternal and child health: a global survey of
national essential medicines lists.

Hill S, Yang A, Bero L.

Department of Essential Medicines and Pharmaceutical Policies, World Health
Organization, Geneva, Switzerland.

BACKGROUND: In April 2011, the World Health Organization (WHO) published a
list of “priority medicines” for maternal and child health based on 1) the
global burden of disease and 2) evidence of efficacy and safety. The
objective of this study was to examine the occurrence of these priority
medicines on national essential medicines lists.

METHODS AND FINDINGS: All essential medicines lists published since 1999
were selected from the WHO website collection. The most-up-to date list for
each country was then selected, resulting in 89 unique country lists. Each
list was evaluated for inclusion of medicines (chemical entity,
concentration, and dosage form) on the Priority Medicines List.

There was global variation in the listing of the Priority Medicines. The
most frequently listed medicine was paracetamol, on 94% (84/89) of lists.
Sodium chloride, gentamicin and oral rehydration solution were on 93%
(83/89) of lists. The least frequently listed medicine was the children’s
antimalarial rectal artesunate, on 8% of lists (7/89); artesunate injection
was on 16% (14/89) of lists. Pediatric artemisinin combination therapy, as
dispersible tablets or flexible oral solid dosage form, appeared on 36%
(32/89) of lists.

Procaine benzylpenicillin, for treatment of pediatric pneumonia and
neonatal sepsis, was on 50% (45/89) of the lists. Zinc, for treatment of
diarrhoea in children, was included on only 15% (13/89) of lists.

For prevention and treatment of postpartum hemorrhage in women, oxytocin
was more prevalent on the lists than misoprostol; they were included on 55
(62%) and 31 (35%) of lists, respectively. Cefixime, for treatment of
uncomplicated anogenital gonococcal infection in woman was on 26% (23/89)
of lists. Magnesium sulfate injection for treatment of severe pre-eclampsia
and eclampsia was on 50% (45/89) of the lists.

CONCLUSIONS: The findings suggest that countries need to urgently amend
their lists to provide all priority medicines as part of the efforts to
improve maternal and child health.

Free full text

15. No Abstract: Minimum impact. Reducing the detrimental effects of
hospital waste

Health Facil Manage. 2012 Mar;25(3):43-4, 47.

Minimum impact. Reducing the detrimental effects of hospital waste.

Zimmer C.

PSC Healthcare Services, Houston, USA.

16. LIVE from Rio Plus 20: on 13 June – In English with simultaneous
translation to Spanish

Sustainable Development and Environmental Health – SDE – PAHO/WHO

Crossposted from the paho/who Equity List with thanks
XIX SDE Seminar Series towards Rio+20

Sustainable Development and Environmental Health – SDE – PAHO/WHO

Wednesday June 13 2012 – In English with simultaneous translation to

Time: 12:00 am – 1:30 pm – EDT (Washington, DC USA) To check your time
zone, see the World Clock

Website PAHO/WHO Rio+20 at:

“….The past webinars we have addressed many of the critical issues to be
prepared to address the negotiations and discussions during the Río+20
World Conference. This is now the time for the final drive. A shared focus
on economic, environmental and social goals is a hallmark of sustainable
development and represents a broad consensus on which the world can build
(Sachs, 2012).

Health has regained its position in the draft document of “The Future We
Want”, and there are initiatives from several sectors to move forward the
agenda on health.

We will address in this seminar the call to all those supporting or
attending the Río Conference. We will review the advances to date, the
WHO/PAHO actions during the World Conference, and the key issues that have
to be addressed.

We expect during this seminar to set the stage for the immediate action
during the next 9 critical days of the Conference, for those attending,
supporting or following it from their countries.…..”


12:00 Welcome and Introduction
Carlos Santos Burgoa, Senior Advisor and Coordinator of Occupational and
Environmental Risks

12:05 Advancing the integration of Health and Sustainable Development
during the World Summit,
Maria Neira, Head of Environmental Health at the World Health Organization

12:15 Health equity is a development outcome:
PAHO perspectives in the sustainable development agenda

Mirta Roses Periago, Pan American Health Organization PAHO/WHO Director

12:30 The health agenda of Rio+20 – a country perspective
Guilherme Franco Netto, Environmental Health Surveillance General

12:40 Questions and Remarks

12: 50 Comments: Luiz A. Galvão, Manager, Sustainable Development and
Environmental Health, PAHO / WHO
Closing remarks Agnes Soares, Advisor Environmental Epidemiology, SDE,

How to participate

In person:
525 23rd ST NW
Washington DC, 20037 Room 1017 – 12h to 13:30h Eastern Time (WDC)

Online: via Elluminate link:
– Spanish room:
– English room

Related material:

From Millennium Development Goals to Sustainable Development Goals

From the Earth Summit to Rio+20: integration of health and sustainable
The Lancet

Our Planet Our Health Our Future
Human health Rio Conventions:biological diversity climate change and

SDE Seminar Series towards Rio+20

For those who cannot follow the live seminar, we will have the recordings
and presentations available at

PAHO Rio+20 Toolkit at:

Social Determinants of Health
No.18 Moving the Agenda of the Social Determinants of Health towards Rio+20

The Brazilian perspective on Rio+20 and its link to the World Conference on
Paulo Buss

Health, social justice and sustainability Prof Marmot Presentation

Health Promotion
No.17 Health Promotion, Social Determinants of Health – SDOH

Air Pollution
No.16 Air Pollution

Food Security
No 15 Food Security

Global Sustainable Development
No.14 Global Sustainable Development and Environmental Health- Joint
Discussion with the US Institute of Medicine

Sustainable Development Indicators
No.13 Health at the heart of Sustainable Development Indicators

Economic – social aspects Non Communicable Diseases
No.12 Economic and social aspects of Non Communicable Diseases NCDs

Non Communicable Diseases
No.11 Non Communicable Diseases and Sustainable Development

Workers health
No.10 Green Economy /Green Jobs: Health Risks & Benefits

Regional Experiences
No. 9 The Voice and Experience of the Caribbean Islands towards SD

Road Safety
No. 8 Road Safety and Public Transportation towards Sustainable
an agenda for health for Rio+20

No. 7 Globalization and Health Equity towards Sustainable Development

Civil Society
No. 6 The Voices of Civil Society – Creating the Healthy Future

Working Environments
No. 5 Employment and working conditions for Sustainable Development

The Environment
No. 4 Amazon Region: Environment and Health in the Context of Sustainable

Climate Change
No. 3 Climate Change and health in the context of Rio+20

No. 2 Water and Sanitation

Sustainable Development
No. 1 Public Health Challenges

17. News

– Canada: Students screened after blood-test incident; followup due
– USA: 14 diagnosed with hepatitis C in outbreak at New Hampshire hospital
– Injections ineffective for knee arthritis: study
– Philippines: HIV spreading via needles
– Ireland: Tests for hospital patients where worker has HIV: HSE says 63
to get ‘precautionary’ screenings
– Russia: Injection Drug Use, Sexual Risk, Violence and STI/HIV Among
Moscow Female Sex Workers
– USA: Official Says Shared Syringe Eyed as Possibility in Hepatitis
– Kenya: Mung’aro vows to block needles for drug addicts
– Kenya: Needles to be distributed to injecting drug users
– USA: Vaccines for U.S. children may not be properly stored: study

Selected news items reprinted under the fair use doctrine of international
copyright law:
Canada: Students screened after blood-test incident; followup due
By: Jenny Ford, Winnipeg Free Press, Canada (12.06.12)

STUDENTS at risk of infection for HIV and hepatitis from a botched diabetes
test might not be out of the woods, even if initial screening results came
back negative Monday.

Dozens of students and some staff members from Southeast Collegiate, a
First Nations high school, were poked with a glucometer to test blood-sugar
levels on May 4 by a University of Manitoba professor.

The professor changed the needle after each use, but didn’t know the part
that holds the needle is not supposed to be used on more than one person.
The affected students and staff were tested for HIV and hepatitis B and C,
and many were to receive their results Monday. School officials, however,
would not divulge any results.

The Winnipeg Regional Health Authority said the results are private and
will not be released.

All students and staff who were poked by the glucometer will have to be re-
tested in six months, WRHA spokeswoman Heidi Graham said Monday, which
means their results may change.

“The chance of them having something is extremely low,” said Graham. “But
we are arranging for followup testing in six months.”

Southeast Collegiate principal Sheryl McCorrister also took part in the
diabetes test as part of the school’s Health and Wellness Day.

“Obviously, for school administrators, this hits home directly for them, as
well, and their own health,” said Brian Bowman, spokesman and lawyer for
the high school.

“We’re being told by health officials and the university that the risk is
very low, but there is still a risk, and they’re not minor ailments that
can be transmitted, so it’s really important that students and relevant
staff get tested if they haven’t already.”

Many parents made their way to Southeast Collegiate — a boarding school
for aboriginal students — on Monday to be with their children for the test
results, said Brennan Manoakeesick, official assistant to Grand Chief David
Harper of the Manitoba Keewatinowi Okimakanak, which represents 30 First
Nations in the province.

Manoakeesick said there has been a lot of confusion among parents about the
incident. Many learned about what was happening through social media rather
than the school.

“A lot of them are quite shocked,” he said. “They didn’t know anything
about it. They just trusted that their kids were OK.”
USA: 14 diagnosed with hepatitis C in outbreak at New Hampshire hospital, USA (10.06.12(

EXETER, N.H. — Four more people have been diagnosed with the strain of
hepatitis C recently found in 10 people associated with a lab at a New
Hampshire hospital.

The state’s Department of Health and Human Services (DHHS) announced the
additional results on Saturday.

Fourteen patients treated at Exeter Hospital’s Cardiac Catheterization Lab
since April 1, 2011 have been diagnosed. Of the 14, one is also an Exeter
Hospital employee.

“We realize this may be very concerning to people, but we are working as
quickly and as thoroughly as we can in close collaboration with Exeter
Hospital to determine how these individuals were infected,” said Jose
Montero, director of public health at DHHS.

“At this time, we do not need to expand the testing, but as we have said
since the beginning, if we need to we will let people know as soon as

Hepatitis C is a viral infection transmitted through contact with an
infected person’s blood. The infection causes inflammation of the liver,
and possible chronic health issues.

Injections ineffective for knee arthritis: study
By Amy Norton, Reuters (11.06.12)

NEW YORK | (Reuters Health) – Injections of the lubricating substance
hyaluronic acid may be little help to people with knee arthritis,
researchers reported Monday.

Hyaluronic acid exists naturally in the fluids that bathe the joints, where
it acts like a shock absorber and lubricant. People with osteoarthritis —
the common, “wear-and-tear” type of arthritis — seem to have lower-than-
normal levels.

So one treatment for arthritis patients is to get injections of hyaluronic
acid directly into the affected joint, a therapy also known as
viscosupplementation. In the United States, it’s been approved since 1997
for knee arthritis only; in Europe, it’s been used longer and for more
types of arthritis.

But a new research review, published in the Annals of Internal Medicine,
finds the benefits may be minimal for aching knees.

Looking at 89 past clinical trials, researchers found that overall,
viscosupplementation did seem to bring pain relief to some knee arthritis
sufferers — as compared to “sham” injections or no treatment.

But when they focused on 18 larger trials (with at least a couple hundred
patients), there were only “clinically irrelevant” effects, according to
the researchers.

On top of that, they report, the injections can carry side effects like
swelling and inflammation in the joint soon after treatment.

“We don’t have evidence that viscosupplementation works, but it is
associated with an increased risk of adverse events,” said Dr. Peter Juni
from the University of Bern in Switzerland, who worked on the study.

“That is not very reassuring,” Juni told Reuters Health. He and his
colleagues recommend that the injections “be discouraged” for people with
knee arthritis.

But an orthopedic surgeon not involved in the study said hyaluronic acid
injections should still be an option for at least some patients.

“I think patient selection is key,” said Dr. Joseph Bosco, from the NYU
Langone Medical Center in New York.

The injections are more likely to help someone with mild to moderate knee
arthritis and “no big pieces of cartilage floating around in the joint,”
according to Bosco. (Osteoarthritis occurs when the cartilage cushioning
the ends of the bones begins to break down.)

Bosco also pointed to the limitations of the new study.

It’s what researchers call a “meta-analysis,” which means the results of
different studies are pooled together. The issue, Bosco said, is that the
individual studies differ from each other — in how they are done, the
specific hyaluronic acid formulations and characteristics of the patients.

“I think it’s difficult to make an overarching comment on the use of
hyaluronic acid, based on this,” Bosco said.

In general, the evidence on hyaluronic acid is not high-quality, according
to Dr. John Richmond, who chaired the committee that devised the current
treatment guidelines on knee arthritis from the American Academy of
Orthopedic Surgeons.

But he agreed the therapy should remain an option. “It’s a reasonable way
to manage pain” for at least some people, Richmond, also the head of
orthopedics at New England Baptist Hospital in Boston, said in an


In the early stages of knee arthritis, people may be able to go with non-
drug options alone, like exercise or, if needed, weight loss. And pain
relievers such as acetaminophen might help.

But when that no longer works, people often arrive at a place where they
are “stuck,” Richmond said.

Most commonly, they turn to non-steroidal anti-inflammatory drugs (NSAIDs)
— painkillers like ibuprofen, naproxen and the prescription drug celecoxib

But both Richmond and Bosco pointed out that regularly using those drugs
has significant downsides, such as stomach irritation in some people.

Injections of cortisone, which fight inflammation, can bring a temporary
reprieve. But those should not be done repeatedly, Richmond said.

The final resort is surgery to replace part or all of the damaged knee
joint. But, Richmond and Bosco said, that may not be appropriate for
younger, more active people.

“Hyaluronic acid is no panacea,” Bosco said. But, he added, “I think it
should be kept in physicians’ armamentarium” against knee arthritis.”

In the U.S., the injections are approved for knee arthritis that cannot be
managed with non-drug tactics and simple analgesics like acetaminophen or
topical rubs.

When they work, the injections — which involve anywhere from one to five
separate shots, depending on the formulation — offer only temporary pain
relief. You might feel better for a few months, then need a repeat round of

Based on what’s known so far, repeated rounds of treatment appear safe,
Richmond said.

But that gets pricey. With all costs and fees considered, one round of
treatment approaches $1,000, according to Richmond. (In the U.S., Medicare
and many private insurers will at least partly pay.)

As for safety, some studies in the current review looked at “serious
adverse events” — including life-threatening conditions or problems severe
enough to land someone in the hospital.

Only eight studies actually described those events, which were more common
in viscosupplementation patients — 26 suffered serious problems, versus 14
patients in the untreated groups.

But those “events” included cases of cancer, cardiovascular disease and
musculoskeletal disorders. And Bosco and Richmond both doubted those
problems could be pinned on hyaluronic acid injections.

The trials typically lasted four months. Attributing something like cancer
to the injections “doesn’t make a whole lot of sense,” Richmond said.

Juni said there is an “unfortunate” lack of both safe and effective options
for people with knee arthritis. But he also urged people with the condition
to “not be too pessimistic.”

He said the basic approaches to knee arthritis, like exercise therapy and
losing excess weight, can help ease symptoms in many people, if they stick
with them.

The study was funded by the Arco Foundation, a private research

SOURCE: Annals of Internal Medicine, online June 11, 2012.

Philippines: HIV spreading via needles
By Cynthia D. Balana, Philippine Daily Inquirer, Philippines (10.06.12)

A growing number of Filipinos have been infected with the human
immunodeficiency virus (HIV) as a result of using injecting drugs with
contaminated needles, according to Rep. Arnel Ty of the LPG Marketers’
Association (LPG-MA).

Ty said that contaminated needle-sharing among drug users was rapidly
emerging as the second leading mode of spread of HIV in the country, next
to sexual contact.

He said the number of fresh infections attributable to needle-sharing had
doubled as a percentage of new HIV cases reported.

Of the 1,032 new HIV infections from January to April, at least 96 cases,
or 9.3 percent, were due to injectable drug use (IDU).

“Should the trend persist, we might have around 300 new HIV cases this year
due to tainted needle-sharing alone—nearly three times the 110 detected in
2011,” Ty said.

The 110 infections caused by IDU in 2011 comprised only 4.6 percent of the
cumulative 2,349 new HIV cases discovered that year.

Ty is one of the authors of House Bill No. 5312, which would earmark P400
million for the launch of a new HIV/AIDS Prevention and Control Plan with
stronger strategies and definite operating guidelines as well as targets.
“We should avoid what is happening in China, Indonesia, Malaysia and
Vietnam, where needle-sharing has become a major driving factor in the
spread of HIV. In China, almost half of all people hit by HIV are believed
to have become infected via IDU,” Ty said.

HIV causes the dreaded Acquired Immune Deficiency Syndrome (AIDS) which
destroys the human body’s immune system. Until now, there is still no known
cure for AIDS although expensive antiretroviral treatments can slow down
the disease.

The Philippines has the highest abuse rate for methamphetamine
hydrochloride, or “shabu,” in East Asia, according to the 2011 United
Nations World Drug Report.

Since the hydrochloride salt of methamphetamine is water-soluble, Ty said
an increasing number of shabu users could be injecting the drug to get a
faster and more powerful high, rather than inhaling or smoking the highly
addictive substance.

The Philippine HIV & AIDS Registry now lists an aggregate of 9,396 cases
since 1984, including 361 infections caused by the use of common needles.
Almost all of the 361 infections due to needle-sharing, or 353 cases to be
exact, were spotted from 2010 onward, Ty pointed out.

Ty noted that groups of injectable drug users and commercial sex workers in
the country often overlap.

“Many sex workers resort to IDU to cope with their stressful trade. Some of
them may be using protection against HIV and other sexually transmitted
diseases. Yet, they may be infected on account of reckless needle-sharing,”
Ty said.
Ireland: Tests for hospital patients where worker has HIV: HSE says 63 to
get ‘precautionary’ screenings
By Philip Ryan, Irish Independent, Ireland (10.06.12)

THE Health Service Executive (HSE) will tomorrow ask 63 patients to attend
a screening in Mayo General Hospital after it emerged a health worker was
diagnosed with HIV.

However, the HSE stressed that the risk of infection to patients was very
low and said the tests were precautionary.

According to a 2005 HSE report on preventing blood-borne diseases, there
have only been two incidents worldwide of health workers transmitting HIV
to a patient.

Patients affected will be contacted through their GPs and the HSE will also
send a letter to those they want to attend the screening in the hospital.

A spokeswoman said: “HSE West can confirm that 63 patients will be asked to
attend a screening this week as a result of a diagnosis of HIV in a
healthcare worker who worked at Mayo General Hospital.

“The risk to patients is extremely low, however screening is good practice
and is being undertaken as a precautionary measure.

“The GPs of those affected are being telephoned on Monday morning to make
arrangements for their patients to be tested and letters to those patients
will also be sent on Monday.”

She added: “International research identifies the risk of transmission as
extremely unlikely.”

Similar investigations in the UK over the past 20 years, which tested
10,000 patients, have never identified a case of HIV infection from a
healthcare worker.

The UK’s health department recommends all new healthcare workers who will
carry out exposure-prone procedures should be tested and shown to be free
from infection with HIV and hepatitis B and C.

However, guidance for the prevention of transmission of blood-borne
diseases issued by the Department of Health here does not recommend
screening for healthcare workers for HIV.

This is highlighted in the HSE report, The Prevention of Transmission of
Blood-borne Diseases in the Health-Care Setting (2005).

It states: “As there is still as yet no vaccine available to protect
against HIV infection, the policy for protecting healthcare workers and
patients from HIV continues to rely on good general infection control

“Mandatory screening for HIV is not recommended on the basis of the low
levels of risk involved.”

The Health Service Executive said that this guidance was currently under
review by the Department.

They also stated that all healthcare employees have an obligation to inform
their employer if they may have contracted a blood-borne virus.
Russia: Injection Drug Use, Sexual Risk, Violence and STI/HIV Among Moscow
Female Sex Workers
Michele R. Decker; and others, Sexually Transmitted Infections Vol. 88; No.
4: P. 278-283 (06.12)

In Eastern Europe and Central Asia, the prevalence of HIV continues to
rise. And although injection drug use (IDU) remains a leading risk factor,
transmission via heterosexual sex is increasing. While commercial sex work
plays a central role globally in the heterosexual transmission of HIV and
STI, little is known about female sex workers (FSWs) in this region.

The authors of the current study evaluated STI and HIV prevalence among
FSWs in Moscow and potential risk factors, including IDU, sexual risks, and
violence victimization. During an eight-month period in 2005, 147 Moscow
FSWs completed a clinic-based survey and were tested for STI and HIV.

The results indicated that HIV prevalence was 4.8 percent, and 31.3 percent
of the women were infected with at least one STI including HIV. Sexual
behaviors found to be significantly associated with STI/HIV included anal
sex (adjusted odds ratio 3.48), high volume of clients (AOR 2.71 for three
or more clients daily), recent “subbotnik” (sex demanded by police, AOR
2.50), and regularly being presented with more clients than was originally
agreed to (AOR 2.45).

Also associated with STI/HIV were past-year experiences of physical
violence from clients (AOR 3.14) and threats of violence by pimps (AOR
3.65). “IDU was not significantly associated with STI/HIV,” the researchers
reported. “Anal sex and high client volume partially mediated the
associations of abuse with STI/HIV.”

“Findings illustrate substantial potential for heterosexual STI/HIV
transmission in a setting better known for IDU-related risk,” the authors
concluded. “Many of the STI/HIV risks observed are not modifiable by FSWs
alone. STI/HIV prevention efforts for this vulnerable population will
benefit from reducing coercion and abuse perpetrated by pimps and clients.”
USA: Official Says Shared Syringe Eyed as Possibility in Hepatitis Probe
Shawne K. Wickham, Manchester New HampshireUnion Leader (09.06.12)

The possibility of drug diversion by an employee is among potential causes
being explored for a recent hepatitis C outbreak at Exeter Hospital’s
cardiac catheterization lab, Dr. José Montero, New Hampshire’s public
health director, said Saturday. “That’s one of the possibilities” being
investigated, though the source of the outbreak is still not known, he

Fourteen people linked to the lab have been diagnosed with the same strain
of hepatitis C; one is a hospital employee. All have been notified of their
test results.

“It has happened before in other states,” Montero said of drug diversion
cases, where an infected employee uses syringes to inject narcotics and
then re-uses these same syringes on patients. State investigators are
reviewing Exeter’s “policies and procedures and the use of supplies and
disposables,” he said.

Exeter has notified 879 patients treated at the lab and its recovery unit
of their need to be tested for infection. All had been treated between
April 1, 2011, and May 25 of this year. Of the other blood samples the
state has tested: 473 showed no sign of infection; 55 results are still
pending; and another 350 samples are expected to be sent to the state lab,
Montero said. Two cases of hepatitis C that were of a different strain are
considered unrelated to the outbreak, he added.

If officials continue to diagnose infections among the lab’s patients, the
state could need to test those treated earlier than April 1, 2011, Montero
said. The state health department has determined the lab is safe now, and
normal operations have resumed.
Kenya: Mung’aro vows to block needles for drug addicts
BY Kerubo Lornah, The Star, Kenya (08.06.12)

COAST Parliamentary Group vice chair Gideon Mung’aro has threatened to go
to court to block the planned distribution of free needles and syringes to
drug addicts in Mombasa. Mung’aro said the move threatens the lives of
people and he said that he was not going to allow that to happen. He
pointed said Coast is where majority of injecting drug users are found
adding that the move will worsen the situation.

Speaking during the opening of a dispensary in Sabaki within his
constituency, he said that the plan was ill-advised. “Giving out needles
and syringes to people who are using drugs is like legalising drug abuse. I
wonder who came up with such a plan,” he said.

Mung’aro, who is the Malindi MP, said the government needs to come up
with measures to avert HIV/AIDs instead of giving people needles. He said
it is illegal to give people who are not medics to use needles and
syringes. “We all know that syringes and needles are used in hospitals by
doctors and nurses but not just with anybody who feel like it. What will
happen when people will start using them as weapons?” Mungaro posed. “This
is like giving every citizen a gun to fight insecurity. Let the government
set aside these funds to hospitals so that patients can be get proper
services.”The MP challenged the government to deal with drug barons if it
wanted the problem of drug abuse to end.

“The government well knows that needles and syringes are not a lasting
solution. The government has not dealt with drug barons who bring drugs
into the country.” He told the government to beef up security at the Kenyan
borders to ensure that drugs are not smuggled to the country. “Saying that
the government will put up a rehabilitation centre is not a solution.
Rehabilitations mean that we want our people to use drugs then we start
treating them,” he said.

Kenya: Needles to be distributed to injecting drug users
IRIN PlusNews, UN (07.06.12)

MOMBASA, 7 June 2012 (PlusNews) – The Kenyan government will begin
distributing free syringes and needles to more than 50,000 injecting drug
users (IDUs) across the country in the next month. Policy-makers and
experts said the decision was reached following concerns over the spread of
HIV and other blood-borne illnesses through injection drug use.

The plan was announced on 5 June at a workshop in the coastal city of
Mombasa, where the programme will be piloted. The area has been reported as
a transit route for international drug trafficking and has the country’s
highest number of injecting heroin users.

“We are trying our best to address the entire problem of drug abuse amongst
the youths. We had to identify an alternative of stopping the youths from
sharing needles, our attention having been drawn by the rate at which these
young… [people] were contracting HIV and other diseases, such as
hepatitis,” said Dr Anisa Omar, the Coast Provincial Director of Public
Health and Sanitation.

“In Mombasa alone, we have over 26,000 youths who use injection drugs, with
at least one out of every four being found to be HIV-positive. In Nairobi
[the capital] we have 20,000 youths who are IDUs.” Injecting drug use is
responsible for close to 4 percent of national HIV infections, and 17
percent of new infections in Coast Province annually, according to
government statistics.

Needle distribution follows a decision by the government in 2010 to address
injection drug use as a public health issue rather than a criminal matter.

Research shows that encouraging IDUs to test for HIV, treating the
addiction and the infection, and keeping the individuals in care, is a more
successful strategy for preventing the spread of HIV than incarcerating
addicts, as risk behaviours like needle-sharing often increase in prison.

The government aims to distribute some eight million needles and syringes
to drug users countrywide once the programme is rolled out, and will also
encourage HIV testing, provide antiretroviral drugs, condoms, and
medication for tuberculosis, the most commonly found co-infection with HIV.


The move has drawn criticism from groups who say the programme is at odds
with their efforts to end injecting drug use, and some have threatened
legal action. “We will file a petition in court… these children of ours
don’t even have any veins remaining in their bodies,” said Amina Abdalla,
secretary of the Coast Community Anti-Drugs Coalition.

“Where do they expect them to inject themselves? Their bodies are ruptured
and rotten as a result of constant use of the needles. Besides, [drug]
peddlers and barons will have a field day, for they’ll know their products
will be on demand, and that’s not acceptable.”

Religious leaders on the coast expressed similar views, urging the
government to spend the money and manpower allocated for the project on
drug rehabilitation instead.

But Coast Province health director Omar said the new programme was
justified by the unsafe techniques used by drug users, including needle-
sharing and “flash blood” – in which a syringe with blood containing drugs
is shared – significantly heightening infection risk.

A 2009 assessment of more than 100 narcotics users – mostly IDUs – in
Mombasa, by Darat-HIV/AIDS International Agency, a local NGO, identified
flash blood as the likely cause of high levels of HIV (50 percent) and
hepatitis C (70 percent) infection among participants.

Omar said, “The programme, which will see every addict given three needles
and syringes per day, will be supplied to specified private rehabilitation
centres and hospitals by NGOs and qualified medical practitioners, in
collaboration with anti-drug campaigners, whom we soon plan to train on how
they’ll best handle the addicts.”

[This report does not necessarily reflect the views of the United Nations]

IRIN, the humanitarian news and analysis service of the UN Office for the
Coordination of Humanitarian Affairs

USA: Vaccines for U.S. children may not be properly stored: study
By Anna Yukhananov, Reuters (06.06.12)

WASHINGTON (Reuters) – Free vaccines meant for children as part of a U.S.
government program may have been stored at the wrong temperature, which
could make them less effective, according to a report released on

The report also found that both expired and unexpired vaccines had been
stored together in some doctors’ offices and clinics, which could
potentially lead to mistakes in giving the wrong version, the Office of the
Inspector General (OIG) in the Department of Health and Human Services

The findings could apply to a much wider lot of vaccines, since many of the
same clinics that provide free immunizations for low-income children also
give shots to insured children.

“We do know that vaccines exposed to temperatures that are too warm, too
cold, or past the expiration date, may not provide maximum protection
against disease,” Holly Williams, a program analyst in the OIG’s office,
said in a podcast interview posted online. She added that the vaccines are
still safe.

The OIG visited 45 medical practices from the five areas that ordered the
most vaccines in 2010: California, Florida, Georgia, New York City and
Texas. Together, they accounted for 36 percent of all vaccine orders that

The inspectors found 76 percent of the offices or clinics had stored
vaccines at the wrong temperature for at least five hours in a row during a
two-week period. These improperly stored vaccines were worth nearly

The study also found 13 of the 45 providers mixed expired and unexpired
vaccines, and 16 of them kept expired vaccines.

Since 1994, the Centers for Disease Control and Prevention (CDC) has been
providing free vaccines to children when parents cannot afford them or do
not have insurance. The Vaccines for Children program spent $3.6 billion in
2010 to give 82 million vaccines to some 40 million children.

The federal government gives grants to state or local health departments,
who then distribute the vaccine funds to 44,000 doctors’ offices and

None of the providers managed vaccines according to all the program’s
rules, or had the proper documentation. And none of the five state or city
agencies that gave the grants met all the oversight rules.

The CDC agreed to work with clinics and states to make sure the vaccines
are better managed, and said the United States still has one of the best
vaccination rates in the world, with 90 percent or greater reduction in
preventable diseases.

The CDC said its efforts could help vaccine management in general, since 90
percent of U.S. children are vaccinated by medical practices that
participate in the Vaccines for Children program.

Vaccines from companies including Sanofi SA, Merck & Co Inc and
GlaxoSmithKline PLC provide protection against communicable diseases such
as diphtheria, tetanus, measles and meningococcal disease.

(Reporting by Anna Yukhananov, Editing by Maureen Bavdek)
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