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SIGNpost 00669



Post00669 No Meeting + MDG + Assessment + Abstracts + News 03 October 2012

0. Moderators Note: No SIGN 2012 Meeting
1. The Millennium Development Goals Report 2012
2. Health System Assessment Approach: A How-To Manual
3. Abstract: Management of healthcare waste: developments in Southeast Asia
in the twenty-first century
4. Abstract: Public Perceptions and Preferences for Patient Notification
After an Unsafe Injection
5. Abstract: Methods for insulin delivery and glucose monitoring in
diabetes: summary of a comparative effectiveness review
6. Abstract: Blood and body fluid exposure related knowledge, attitude and
practices of hospital based health care providers in United arab
7. Abstract: Injuries caused by sharp instruments among healthcare workers
– international and Polish perspectives
8. Abstract: Safe insulin use in the hospital setting
9. Abstract: Percutaneous injuries amongst Greek endodontists: a national
questionnaire survey
10. Abstract: Low dead-space syringes for preventing HIV among people who
inject drugs: promise and barriers
11. Abstract: Hepatitis C Virus Infection and Related Risk Factors among
Injection Drug Users in Montenegro
12. Abstract: HIV and Associated Risk Factors Among Male Clients of Female
Sex Workers in a Chinese Border Region
13. Abstract: Dual HIV risk and vulnerabilities among women who use or
inject drugs: no single prevention strategy is the answer
14. Abstract: Correlates of staying safe behaviors among long-term
injection drug users: psychometric evaluation of the staying safe
15. Abstract: Viral hepatitis: Global goals for vaccination
16. Abstract: The role of immunotherapy in the management of childhood
17. Abstract: A case of acute hepatitis B related to previous gynecological
surgery in Japan
18. No Abstract: Update on risk of endophthalmitis after intravitreal drug
19. News
– Philippines: 272 HIV/AIDS cases monitored in August
– USA: Ambulance patients may require screenings
– USA: Security has been tightened on Boston ambulances after suspected
drug tampering by paramedic
– Australia: AMA Pushes for Safe Injecting Trial
– USA: New products pitched to improve injection safety
– Canada: A call for pragmatism in clean-needle debate
– Bhutan: Hepatitis B cases on a rise in Bhutan
– Western Pacific: Countries in Western Pacific Region to Meet Hepatitis B
Control Target: WHOinjections and potential impact of elimination of
topical antibiotics

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0. Moderators Note: No SIGN 2012 Meeting

SIGN 2012 Meeting

We are reliably informed that there will not be a Safe Injection Global
Network meeting this year

Unfortunately, due to financial constraints at WHO, SIGN will not hold an
annual meeting in 2012.

Keep reading SIGNpost for the latest information.

1. The Millennium Development Goals Report 2012
The Millennium Development Goals Report 2012

This report is based on a master set of data that has been compiled by an
Inter-Agency and Expert Group on MDG Indicators led by the Department of
Economic and Social Affairs of the United Nations Secretariat, in response
to the wishes of the General Assembly for periodic assessment of progress
towards the MDGs.

2. Health System Assessment Approach: A How-To Manual

Crossposted from the WHO/PAHO EQUIDAD listserve with thanks.

Health System Assessment Approach: A How-To Manual

Partners for Health Reformplus (PHRplus) and Health Systems 20/20 projects,
with funding from the United States Agency for International Development

Version 2.0 in 2012. available online URL:

PDF [409p.] at:

The approach covers key health system functions and is organized around
WHO’s six health system building blocks:
leadership and governance; health financing; service delivery; human
resources for health; medical products, vaccines, and technologies; and
health information systems.

HSAA Manual Version 2.0 – Full Text – Version 2.0 of the HSAA Manual by

Section 1. Introduction to the Health System Assessment Approach and Manual

These modules describe the technical grounding and methodological approach
of the health system assessment. They also provide information on the
content and use of this manual.

Section 2. Conducting the Assessment
These five modules describe a five-step process of conducting a health
system assessment.

Section 3. Guidance on Assessing Health System Building Blocks
The modules in this section describe the indicators that can be used to
assess each of the health system building blocks. The section also includes
country stories and templates. The modules in Section 3 can be downloaded
separately, depending on areas of interest.

Complete Indicator Summary

Section 3 Module 1: Country and Health System Overview
Section 3 Module 2: Leadership and Governance
Section 3 Module 3: Health Financing
Section 3 Module 4: Service Delivery
Section 3 Module 5: Human Resources for Health
Section 3 Module 6: Medical Products, Vaccines, and Technologies
Section 3 Module 7: Health Information Systems


Annex 1: Section 1 Supplemental Materials
Annex 2: Section 2 Supplemental Materials
Annex 3: Section 3 Supplemental Materials
Additional Guidance:
Engaging Stakeholders in Health System Assessments: A Guide for HSA Teams

* * *
This message from the Pan American Health Organization, PAHO/WHO, is part
of an effort to disseminate information Related to: Equity; Health
inequality; Socioeconomic inequality in health; Socioeconomic health
differentials; Gender; Violence; Poverty; Health Economics; Health
Legislation; Ethnicity; Ethics; Information Technology – Virtual libraries;
Research & Science issues. [DD/ KMC Area] Washington DC USA

“Materials provided in this electronic list are provided “as is”. Unless
expressly stated otherwise, the findings and interpretations included in
the Materials are those of the authors and not necessarily of The Pan
American Health Organization PAHO/WHO or its country members”.

3. Abstract: Management of healthcare waste: developments in Southeast Asia
in the twenty-first century

Waste Manag Res. 2012 Sep;30(9 Suppl):100-4.

Management of healthcare waste: developments in Southeast Asia in the
twenty-first century.

Kühling JG, Pieper U.

ETLog Health EnviroTech & Logistics GmbH, Berlin, Germany.

In many Southeast Asian countries, significant challenges persist with
regard to the proper management and disposal of healthcare waste. The
amount of healthcare waste in these countries is continuously increasing as
a result of the expansion of healthcare systems and services. In the past,
healthcare waste, if it was treated at all, was mainly incinerated.

In the last decade more comprehensive waste management systems were
developed for Southeast Asian countries and implementation started. This
also included the establishment of alternative healthcare waste treatment
systems. The developments in the lower-middle-income countries are of
special interest, as major investments are planned. Based upon sample
projects, a short overview of the current development trends in the
healthcare waste sector in Laos, Indonesia and Vietnam is provided.

The projects presented include: (i) Lao Peoples Democratic Republic
(development of the national environmental health training system to
support the introduction of environmental health standards and improvement
of healthcare waste treatment in seven main hospitals by introducing steam-
based treatment technologies); (ii) Indonesia (development of a provincial-
level healthcare waste-management strategy for Province Nanggroe Aceh
Darussalam (NAD) and introduction of an advanced waste treatment system in
a tertiary level hospital in Makassar); and (iii) Vietnam (development of a
healthcare waste strategy for five provinces in Vietnam and a World Bank-
financed project on healthcare waste in Vietnam).

Free full text PDF: HTML:

4. Abstract: Public Perceptions and Preferences for Patient Notification
After an Unsafe Injection

J Patient Saf. 2012 Sep 20.

Public Perceptions and Preferences for Patient Notification After an Unsafe

Schneider AK, Brinsley-Rainisch KJ, Schaefer MK, Camilli T, Perz JF,
Cochran RL.

From the Centers for Disease Control and Prevention, Division of Healthcare
Quality Promotion, Atlanta, Georgia.

BACKGROUND: Unsafe injection practices in health-care settings often result
in notification of potentially affected patients, to disclose the error and
recommend blood-borne pathogens testing. Few studies have assessed public
perceptions and preferences for patient notification.

METHODS: Six focus groups were conducted during Fall 2009, with residents
of Atlanta, GA, and New York City, NY. Questions focused on preferences for
receiving health information, knowledge of safe injection practices, and
responses to and preferences for a patient notification letter. A mixed-
method analysis was performed for qualitative themes and descriptive

RESULTS: A total of 53 individuals participated; only 2 had ever heard of
the term safe injection practices. After identification of unsafe injection
practices, participants preferred to be notified via telephone,
letter/mailing, email, or face-to-face from the facility where the incident
occurred. More than 25 different types of information were mentioned as
elements to be placed in a patient notification letter including:
corrective actions by the facility, course of action for the patient,
assurance of medical coverage, and how it happened/reason for the incident.
Participants preferred that the tone of the letter be empathetic; nearly
all indicated it was “very likely” that they would seek testing if

CONCLUSIONS: Facilities and health departments should strive to assure the
notification process is conducted swiftly, clearly guiding affected
patients to the necessary course of action. Notification letters are not
“one size fits all,” and some preferences expressed by patients may not be
feasible in all situations. Prevention efforts should be complemented by
research on improving effective patient communications when unsafe
injection practices necessitate patient notification.

5. Abstract: Methods for insulin delivery and glucose monitoring in
diabetes: summary of a comparative effectiveness review
J Manag Care Pharm. 2012 Jul;18(6 Suppl B):1-17.

Methods for insulin delivery and glucose monitoring in diabetes: summary of
a comparative effectiveness review.

Golden SH, Sapir T.

Johns Hopkins University School of Medicine and Bloomberg, Johns Hopkins
Evidence-Based Practice Center, 615 N. Wolfe Street, Baltimore, MD 21205,

BACKGROUND: Diabetes mellitus is defined as a group of metabolic diseases
characterized by hyperglycemia, which when untreated can lead to long-term
complications, including micro- and macrovascular complications. Tight
glycemic control with intensive insulin therapy has been suggested to
reduce the risk of such complications in several diabetes populations;
however, such an approach can also be associated with risks and challenges.
There are currently several modalities available to deliver insulin and
monitor glucose levels to achieve glycemic goals in diabetic patients. In
July 2012, the Agency for Healthcare Research and Quality (AHRQ) published
a systematic review on the comparative effectiveness of insulin delivery
systems and glucose-monitoring modalities in diabetic patients receiving
intensive insulin therapy. Studies from 44 publications included in the
review compared the effects of continuous subcutaneous insulin infusion
(CSII) with multiple daily injections (MDI) and/or real time-continuous
glucose monitoring (rt-CGM) with self-monitoring of blood glucose (SMBG)
among children, adolescents, or adults with either type 1 (T1DM) or type 2
diabetes (T2DM), or pregnant women with pre-existing diabetes (either T1DM
or T2DM). This comparative effectiveness review evaluated which modality
results in improved glycemic control, less hypoglycemia, better quality of
life, and/or improved clinical outcomes. The numerous technologies and the
challenges that clinicians face when determining which patient population
may benefit from different insulin delivery systems and glucose-monitoring
approaches motivated AHRQ to synthesize the available information to assist
health professionals in making evidence-based practice decisions for their
patients. The review also delineates advances in insulin delivery and
glucose-monitoring systems, practical methods to achieve tight glycemic
control and strategies to minimize associated risks, as well as highlights
gaps in research and areas that need to be addressed in the future.

OBJECTIVES: To (a) educate health care professionals on the findings from
AHRQ’s 2012 comparative effectiveness review on insulin delivery and
glucose-monitoring modalities in patients with diabetes; (b) apply review
findings to make treatment decisions in clinical practice; and (c) identify
shortcomings in the current research and future directions relating to the
comparative effectiveness of insulin delivery and glucose-monitoring
modalities for patients with diabetes.

SUMMARY: The AHRQ systematic review of randomized clinical trials reveals
that both insulin delivery modalities (CSII and MDI) demonstrate similar
effectiveness on glycemic control and severe hypoglycemia in children and
adolescents with T1DM and in adults with T2DM. In adults with T1DM,
hemoglobin A1c decreased more with CSII than with MDI with low strength of
evidence, but one study heavily influenced these results. In children and
adults with T1DM, the use of CSII was associated with improved quality of
life compared with MDI, with low strength of evidence, while there was
insufficient strength of evidence to make conclusions regarding the quality
of life for adults with T2DM. The study investigators suggest that the
modality to deliver intensive insulin therapy can be individualized to
patient preference in order to maximize quality of life. On all measured
outcomes, there was insufficient or low strength of evidence regarding
pregnant women with pre-existing diabetes.The AHRQ investigators found
studies comparing the effectiveness of glucose-monitoring modalities in
individuals with T1DM only. The systematic review demonstrates that rt-CGM
is associated with greater lowering of A1c compared with SMBG (high
strength of evidence) without affecting the risk of severe hypoglycemia
(low strength of evidence) or quality of life (low strength of evidence) in
nonpregnant individuals with T1DM, particularly when compliance with device
use is high. Additional findings suggest that the use of sensor-augmented
insulin pumps (rt-CGM + CSII) is superior to the use of MDI/SMBG use in
lowering A1c in nonpregnant individuals with T1DM (moderate strength of
evidence). Comparison of other outcome measures did not yield firm
conclusions due to low or insufficient evidence.

Free full text

6. Abstract: Blood and body fluid exposure related knowledge, attitude and
practices of hospital based health care providers in United arab

Saf Health Work. 2012 Sep;3(3):209-15.

Blood and body fluid exposure related knowledge, attitude and practices of
hospital based health care providers in United arab emirates.

Zaidi MA, Griffiths R, Beshyah SA, Myers J, Zaidi MA.

Occupational and Aviation Medicine, University of Otago, Wellington, New

OBJECTIVES: Knowledge, attitudes, and practices of healthcare providers
related to occupational exposure to bloodborne pathogens were assessed in a
tertiary- care hospital in Middle East.

METHODS: A cross-sectional study was undertaken using a self-administered
questionnaire based on 3 paired (infectivity known vs. not known-suspected)
case studies. Only 17 out of 230 respondents had an exposure in the 12
months prior to the survey and of these, only 2 had complied fully with the
hospital’s exposure reporting policy.

RESULTS: In the paired case studies, the theoretical responses of
participating health professionals showed a greater preference for
initiating self- directed treatment with antivirals or immunisation rather
than complying with the hospital protocol, when the patient was known to be
infected. The differences in practice when exposed to a patient with
suspected blood pathogens compared to patient known to be infected was
statistically significant (p < 0.001) in all 3 paired cases.

Failure to test an infected patient’s blood meant that an adequate risk
assessment and appropriate secondary prevention could not be performed, and
reflected the unwillingness to report the occupational exposure.

CONCLUSION: Therefore, the study demonstrated that healthcare providers
opted to treat themselves when exposed to patient with infectious disease,
rather than comply with the hospital reporting and assessment protocol.

Free full text Open Access

7. Abstract: Injuries caused by sharp instruments among healthcare workers
– international and Polish perspectives

Ann Agric Environ Med. 2012 Sep 20;19(3):523-7.

Injuries caused by sharp instruments among healthcare workers –
international and Polish perspectives.

Goniewicz M, Wloszczak-Szubzda A, Niemcewicz M, Witt M, Marciniak-
Niemcewicz A, Jarosz MJ.

Emergency Medicine Unit, Medical University of Lublin, Poland.

Health care workers (HCW) worldwide are especially exposed to injury by
sharp instruments in the course of their duty. The most often executed
procedures with injury risk are: intramuscular or subcutaneous injection
(22%), taking blood samples, or during intravenous cannulation (20%), and
repeatedly replacing the cap on an already used needle (30%). Even a minor
sharp injury with only a small loss of blood carries the risk of transfer
of over 20 pathogens: Hepatitis B Virus (HBV), Hepatitis C Virus (HCV),
HIV/AIDS virus, malaria, syphilis, tuberculosis, brucellosis, herpes virus
and diphtheria.

The World Health Organization (WHO) estimates that more than two million
health care workers experience the stressful event of a percutaneous injury
with a contaminated sharp object each year (25-90% of them, however, remain
unreported). These exposures result in about 16,000 infections with HCV,
66,000 with HBV and about 1,000 (200-5000) with HIV, which lead to about
1,100 deaths or significant disability. Exposures to sharp injuries and
their consequences are highly preventable through simple interventions,
such as HBV vaccination, education and providing containers for sharp

Specific guidelines, similar to the American Occupational Safety and Health
Administration (OSHA) regulations that have lowered by up to 88% of needle
stabbing incidents, should be introduced by the European Union (EU) and
other countries. The results of a review of reports leads to the following
conclusions: 1) elaboration and implementation of new State regulations,
especially in EU countries and in countries where such regulations do not
exist; 2) the training of health care personnel should always be undertaken
for new employees, and periodically for those already employed; 3)
periodical control by appointed inspectors of knowledge of procedures for
the prevention of injuries by sharp instruments among health care workers;
4) introducing and training in the use of equipment, which can prevent the
sharp injuries; 5) an advanced monitoring system of sharp injuries
sustained by worker should also be introduced.

Successful implementation of these prevention measures will result in
progress for public health and HCW’s health and safety.

8. Abstract: Safe insulin use in the hospital setting

Hosp Pract (Minneap). 2009 Dec;37(1):51-9.

Safe insulin use in the hospital setting.

Schmeltz LR.

Oakland University William Beaumont School of Medicine, USA.

Inpatients have a high rate of diabetes (12%-26%) and hyperglycemia (~38%).
All patients should have their glycosylated hemoglobin (A1C) checked on
admission to help differentiate between long-term and new-onset
hyperglycemia. Good glycemic control throughout the hospital stay is
associated with decreases in short- and long-term risk of mortality,
inpatient complications, length of hospital stay, and health care costs.

Insulin is first-line therapy for hyperglycemia; patients with
hyperglycemia should be managed using either intravenous (IV) or
subcutaneous (SC) insulin algorithms.

A hypoglycemia management protocol should be in place at the hospital for
safety purposes. For successful glycemic control, insulin algorithms should
have dynamic scales, require frequent glucose monitoring, and be simple and
easy to use. The algorithm should address transitioning patients from IV to
SC insulin and a discharge plan. Insulin analogues are preferred for basal,
mealtime, and correction doses instead of human insulins (regular and NPH)
because analogues have a more predictable absorption and action profile and
less pharmacokinetic fluctuation.

Institutions can increase safe insulin use by utilizing insulin algorithms,
preprinted order sets, and hypoglycemia protocols; by supporting patient
and health care provider education; and by implementing needle-stick
prevention techniques.

9. Abstract: Percutaneous injuries amongst Greek endodontists: a national
questionnaire survey

Int Endod J. 2012 Aug 20.

Percutaneous injuries amongst Greek endodontists: a national questionnaire

Zarra T, Lambrianidis T.

Department of Endodontology, Dental School, Aristotle University of
Thessaloniki, Thessaloniki, Greece.

AIM: To investigate amongst Greek endodontists the incidence of
percutaneous injuries, the circumstances associated with them, the
therapeutic measures taken after the injuries and their compliance with
infection control measures.

METHODOLOGY: One hundred and forty-seven endodontists met the inclusion
criteria and were invited to participate in the survey. Personal and
professional data, information on percutaneous injuries in the past 5 years
and on infection control practices were gathered through interviews based
on a questionnaire. Data were analysed using chi-square test, independent
samples t-test, one-way anova and Pearson’s correlation coefficient. The
level of significance was set at P = 0.05.

RESULTS: The response rate was 84%. The injury rate was estimated at 1.35
per endodontist per year. Endodontic files were associated with 37% of the
injuries and fingers were injured in 75% of the most recent cases. Medical
assistance was sought in 36% of the most recent injuries. Endodontists who
always or usually practiced 4-handed endodontics (P = 0.007) as well as
those not performing surgical endodontics (P = 0.007) reported
significantly fewer injuries. In 91% of the participants, a complete
hepatitis B virus vaccination was reported. Gloves, masks, rubber dam
isolation and puncture-resistant containers for disposal of sharp
instruments were always used by 98%, 94%, 100% and 81% of the respondents,

CONCLUSIONS: The injury rate was low. The practice of four-handed
endodontics was associated with a reduced number of percutaneous injuries;
the performance of surgical endodontics increased their incidence. Greek
endodontists showed a high level of compliance with infection control

© 2012 International Endodontic Journal.

10. Abstract: Low dead-space syringes for preventing HIV among people who
inject drugs: promise and barriers

Curr Opin HIV AIDS. 2012 Jul;7(4):369-75.

Low dead-space syringes for preventing HIV among people who inject drugs:
promise and barriers.

Zule WA.

Substance Abuse Treatment Evaluations and Interventions Program, RTI
International, Research Triangle Park, NC 27709-2194, USA.

PURPOSE OF REVIEW: This review examines evidence regarding the differential
effects of high dead-space syringes (HDSS) and low dead-space syringes
(LDSS) on HIV transmission among people who inject drugs (PWID). It also
identifies areas for additional research and examines potential barriers to
interventions that promote LDSS.

RECENT FINDINGS: Results of laboratory experiments and cross-sectional bio-
behavioral surveys provide circumstantial evidence that the probability of
HIV transmission associated with sharing LDSS is less than the probability
of HIV transmission associated with sharing HDSS. Mathematical models
suggest that LDSS may prevent injection-related HIV epidemics among PWID.

SUMMARY: Circumstantial evidence suggests that LDSS may substantially
reduce HIV transmission among PWID, who share syringes. Additional research
that links LDSS to reductions in HIV incidence is needed.

Most currently available LDSS are 1 ml or smaller and have fixed needles.
These cannot be used by PWID ‘injecting’ larger volumes of fluid and they
may be rejected by PWID, who prefer syringes with detachable needles.
Nonetheless, LDSS represent a potentially promising intervention that
deserves serious consideration.

11. Abstract: Hepatitis C Virus Infection and Related Risk Factors among
Injection Drug Users in Montenegro
Eur Addict Res. 2012 Sep 19;19(2):68-73.

Hepatitis C Virus Infection and Related Risk Factors among Injection Drug
Users in Montenegro.

Bacak V, Lauševic D, Mugoša B, Vratnica Z, Terzic N.

Department of Sociology, Faculty of Humanities and Social Sciences,
University of Zagreb, Zagreb, Croatia.

Background: In Southeastern Europe, similar to other postsocialist regions
on the continent, injection drug users (IDU) are exposed to a high risk of
blood-borne infections. In this paper, we report the prevalence of HIV,
hepatitis C (HCV) and hepatitis B (HBV) among IDUs in Montenegro. We also
examine the risk factors associated with HCV diagnosis.

Methods: In 2008, 322 IDUs in Montenegro participated in a respondent-
driven sampling survey. Blood specimens were collected and tested for HIV,
HCV and HBV. Behavioral data were collected with self-administered

Results: In comparison to 2005, HCV prevalence had increased from an
estimated 22 to 53.7%. Only one HIV and no HBV cases were detected. Anti-
HCV positivity was associated with the region of origin, income, sharing
injection equipment and frequency of injecting drugs.

Conclusion: The increasing HCV prevalence among IDUs in Montenegro calls
for increased and better designed programs to prevent its further spread
and a potential HIV outbreak.

Copyright © 2012 S. Karger AG, Basel.

12. Abstract: HIV and Associated Risk Factors Among Male Clients of Female
Sex Workers in a Chinese Border Region

Sex Transm Dis. 2012 Oct;39(10):750-755.

HIV and Associated Risk Factors Among Male Clients of Female Sex Workers in
a Chinese Border Region.

Reilly KH, Wang J, Zhu Z, Li S, Yang T, Ding G, Qian HZ, Kissinger P, Wang

From the *National Center for AIDS/STD Control and Prevention, Chinese
Center for Disease Control and Prevention, Beijing, People’s Republic of
China; †Tulane University Health Sciences Center, School of Public Health
and Tropical Medicine, New Orleans, LA; ‡Hekou Center for Disease Control
and Prevention, Hekou County, Yunnan Province, China; §Vanderbilt Institute
for Global Health, Vanderbilt University School of Medicine, Nashville, TN;
and ¶Division of Epidemiology, Department of Medicine, Vanderbilt
University School of Medicine, Nashville, TN.

BACKGROUND: Male clients of female sex workers (FSWs) serve as a potential
bridge of human immunodeficiency virus (HIV) to the general population.
Little is known about the characteristics and risk factors for HIV
infection among male clients patronizing FSWs in Hekou County, Yunnan
Province in southern China bordering with Vietnam.

METHODS: Male clients were recruited through outreach of study staff,
referrals by Vietnamese FSWs and their bosses, and snowball sampling. Each
participant completed a questionnaire survey and donated a blood specimen
to test for HIV, herpes simplex virus type 2 (HSV-2), and syphilis.
Logistic regression models were fitted to identify factors associated with
HIV infection.

RESULTS: Among 306 participants, 28 (9.2%) were HIV positive, 81 (26.5%)
were HSV-2 positive, and none was infected with syphilis. Approximately
half (n = 149, 49.2%) reported always using condoms with sex workers in the
past year; 36 (11.8%) reported a history of injection drug use (IDU).
Compared with HIV- negative men, HIV-positive men were more likely to have
a history of IDU (64.3% vs. 6.5%) and be coinfected with HSV-2 (50.0% vs.

CONCLUSIONS: IDU was the most salient risk factor for HIV infection in this
study, which suggests that male clients may acquire HIV from routes other
than commercial sex, but the significance of HSV-2 infection indicates that
sexual transmission is also of concern. HIV prevention intervention
programs for this often ignored and hard-to-reach risk group should be two-
pronged, addressing both drug use and commercial sex.

13. Abstract: Dual HIV risk and vulnerabilities among women who use or
inject drugs: no single prevention strategy is the answer

Curr Opin HIV AIDS. 2012 Jul;7(4):326-31.

Dual HIV risk and vulnerabilities among women who use or inject drugs: no
single prevention strategy is the answer.

El-Bassel N, Wechsberg WM, Shaw SA.

Columbia University School of Social Work, New York, New York, USA.

PURPOSE OF REVIEW: This article examines the dual HIV and sexually
transmitted infection (STI) risk behaviors engaged in by women who use or
inject drugs; the individual, social, and structural drivers of HIV and STI
risk; prevention strategies; and the implications for multilevel, combined,
sex-specific HIV prevention strategies.

RECENT FINDINGS: Women who use or inject drugs, especially female sex
workers, are at dual risk for HIV, the hepatitic C virus (HCV), and other
STIs. In countries with HIV prevalence higher than 20% among injecting drug
users (IDUs), female IDUs have slightly higher HIV prevalence than male
IDUs. Women who use or inject drugs face multilevel drivers that increase
their vulnerabilities to HIV, HCV, and STIs. Despite advances in behavioral
HIV prevention strategies for this population, most prevention studies have
not sufficiently targeted dyadic, social, and structural levels. Few recent
advances in biomedical HIV prevention have focused on women who use drugs
and their unique needs.

SUMMARY: HIV prevention strategies and services need to address the unique
and multilevel drivers that increase the vulnerabilities to HIV, HCV, and
STIs among women who use drugs including those who engage in sex work.
Scaling- up and improving access to multilevel and combined HIV prevention
strategies for these women is central to combating the HIV epidemic.

14. Abstract: Correlates of staying safe behaviors among long-term
injection drug users: psychometric evaluation of the staying safe

AIDS Behav. 2012 Aug;16(6):1472-81.

Correlates of staying safe behaviors among long-term injection drug users:
psychometric evaluation of the staying safe questionnaire.

Vazan P, Mateu-Gelabert P, Cleland CM, Sandoval M, Friedman SR.

National Development and Research Institutes, Inc., New York, NY 10010,

We report on psychometric properties of a new questionnaire to study long-
term strategies, practices and tactics that may help injection drug users
(IDUs) avoid infection with HIV and hepatitis C.

Sixty-two long-term IDUs were interviewed in New York City in 2009. Five
scales based on a total of 47 items were formed covering the following
domains: stigma avoidance, withdrawal prevention, homeless safety,
embedding safety within a network of users, and access to resources/social

All scales (a = .79) except one (a = .61) were highly internally
consistent. Seven single-item measures related to drug use reduction and
injection practices were also analyzed. All variables were classified as
either belonging to a group of symbiotic processes that are not directly
focused upon disease prevention but nonetheless lead to risk reduction
indirectly or as variables describing prevention tactics in risky
situations. Symbiotic processes can be conceived of as unintentional
facilitators of safe behaviors.

Associations among variables offer suggestions for potential interventions.
These Staying Safe variables can be used as predictors of risk behaviors
and/or biological outcomes.

15. Abstract: Viral hepatitis: Global goals for vaccination

J Clin Virol. 2012 Sep 20. pii: S1386-6532(12)00326-5.

Viral hepatitis: Global goals for vaccination.

Lavanchy D.

Consultant, Ruelle des Chataigniers 1, CH-1026 Denges VD, Switzerland.
Electronic address:

In countries where hepatitis A is highly endemic, exposure to hepatitis A
virus (HAV) is almost universal before the age of 10years, and large-scale
immunization efforts are not required. In contrast, in areas of
intermediate endemicity or in transition from high to intermediate
endemicity, where transmission occurs primarily from person to person in
the general community (often with periodic outbreaks), control of hepatitis
A may be achieved through widespread vaccination programmes.

Hepatitis B virus (HBV) is one of the world’s most widespread infectious
agents and the cause of millions of infections each year. Between 500,000
and 700,000 people die each year from chronic infection-related cirrhosis,
hepatocellular carcinoma (HCC) or from acute hepatitis B. Hepatitis B
vaccine provides protection against infection and its complications
including liver cirrhosis and HCC. It is therefore, the first vaccine
against a cancer, the first vaccine protecting from a sexually transmitted
infection, and the first vaccine against a chronic disease ever licensed.

Control and significant reduction in incidence of new HBV infections as
well as hepatocellular carcinoma has repeatedly been reported in countries
in East Asia (i.e. Taiwan) and Africa (i.e. The Gambia).

Two experimental vaccines against hepatitis E have been developed; one of
them has been recently licensed but is not yet widely available.

Attempts to develop a hepatitis C vaccine were so far unsuccessful.

Copyright © 2012 Elsevier B.V. All rights reserved.

16. Abstract: The role of immunotherapy in the management of childhood

Ther Adv Respir Dis. 2012 Jun;6(3):137-46.

The role of immunotherapy in the management of childhood asthma.

Hedlin G, van Hage M.

Centre for Allergy Research, Karolinska Institutet, PO Box 287, SE-17177
Stockholm, Sweden.

Subcutaneous immunotherapy (SCIT) is still questioned as a safe and
efficacious way of treating allergic asthma in children. In a Cochrane
review published in 2010 it was, however, concluded that SCIT has
significant and beneficial effects on symptoms and medication use in both
children and adults with mostly mild asthma.

Only a few studies have been performed to specifically study if SCIT in
children with moderate asthma reduces the need for inhaled corticosteroids.
There are conflicting results that illustrate the problem of the
heterogeneity of the asthma disease and the fact that allergies may play
different roles on the severity and symptoms of the disease. Furthermore,
children with severe allergic asthma are often sensitized to multiple
allergens, which makes SCIT both complicated and less safe to administer.
On the other hand, if the child suffers from asthmatic symptoms despite
adherence to pharmacotherapy, omalizumab or a combination of omalizumab and
allergen immunotherapy might be useful. There is a need for more studies on
this combination before it can be considered as an additional therapy in
children with asthma and severe allergies.

Sublingual immunotherapy (SLIT) has also been shown to improve asthma
symptoms and medication use. SLIT is safe although its efficacy compared
with SCIT has been studied very little. Another approach is to try to
prevent asthma by treating children with SCIT for allergic
rhinoconjunctivitis before asthma has developed.

The most attractive prospect, however, is to find ways of preventing asthma
by vaccination against the most common viruses, particularly rhinovirus.
There is evidence that there are children at high risk of developing asthma
in whom a viral infection can also enhance the risk of allergen
sensitization. So far this vaccination has not been achievable although
research is in progress.

17. Abstract: A case of acute hepatitis B related to previous gynecological
surgery in Japan

J Infect Chemother. 2012 Sep 26.

A case of acute hepatitis B related to previous gynecological surgery in

Sugimoto S, Nagakubo S, Ito T, Tsunoda Y, Imamura S, Tamura T, Morohoshi Y,
Koike Y, Fujita Y, Ito S, Fujita S, Tachikawa N, Komatsu H.

Department of Gastroenterology, Yokohama Municipal Citizen’s Hospital, 56
Okazawa-cho, Hodogaya-ku, Yokohama, Kanagawa, 240-8555, Japan.

A 41-year-old woman became ill with acute hepatitis B after gynecological
surgery performed by a surgeon who was hepatitis B surface antigen
positive. The surgeon was positive for hepatitis B e antigen, and HBV DNA
concentrations in the serum, saliva, and sweat of the surgeon were very
high. HBV genotype and partial HBV DNA sequences from the HBV-infected
surgeon were identical to those in the HBV-infected patient.

Extensive research by the committee including infection control and
prevention specialists judged the source of infection to be a surgeon
infected with HBV. Transmission of HBV from a healthcare worker to patients
who are not immune to HBV can actually happen.

This case report illustrates the importance of a stringent policy of a
nationwide HBV universal vaccination program.

18. No Abstract: Update on risk of endophthalmitis after intravitreal drug
injections and potential impact of elimination of topical antibiotics

Arch Ophthalmol. 2012 Jun;130(6):809-10.

Update on risk of endophthalmitis after intravitreal drug injections and
potential impact of elimination of topical antibiotics.

Bhavsar AR, Stockdale CR, Ferris FL 3rd, Brucker AJ, Bressler NM, Glassman
AR; Diabetic Retinopathy Clinical Research Network.

19. News

– Philippines: 272 HIV/AIDS cases monitored in August
– USA: Ambulance patients may require screenings
– USA: Security has been tightened on Boston ambulances after suspected
drug tampering by paramedic
– Australia: AMA Pushes for Safe Injecting Trial
– USA: New products pitched to improve injection safety
– Canada: A call for pragmatism in clean-needle debate
– Bhutan: Hepatitis B cases on a rise in Bhutan
– Western Pacific: Countries in Western Pacific Region to Meet Hepatitis B
Control Target: WHO

Selected news items reprinted under the fair use doctrine of international
copyright law:
Philippines: 272 HIV/AIDS cases monitored in August
By Sheila Crisostomo,The Philippine Star, Manila, Philippines (03.10.12)

MANILA, Philippines – A total of 272 new HIV/AIDS cases were monitored by
the Department of Health (DOH) last August, bringing to 2,150 the number of
cases in the country this year alone.

The DOH’s HIV/AIDS Registry showed that of the 2,150 cases, 118 have
progressed into AIDS.

The 272 new infections are 39 percent higher than the 196 cases recorded in
August 2011. Sexual contact accounted for 253 cases, followed by needle
sharing among injecting drug users at 19 cases.

“Males having sex with other males (86 percent) was the predominant type of
sexual transmission. Most (93 percent) of the cases were still asymptomatic
at the time of reporting,” the registry showed.

Asymptomatic means the patients did not show symptoms of the disease.
USA: Ambulance patients may require screenings
By Christine McConville, Boston Herald, Boston MA USA (02.10.12)

Boston health officials are offering free screenings for blood-borne
infections, including Hepatitis C and HIV, to the 57 people who may have
been treated with compromised painkillers or sedatives while in a city-run
ambulance last summer.

“We’re doing this out an abundance of caution,” Boston Public Health
spokesman Nick Martin told the Herald. “There’s no reason to suspect that
the paramedic had a blood-born disease.”

The terrifying offer comes days after city officials notified the 57 still-
unidentified people that they may have been exposed to an infection when
they were given compromised medicines in the summer of 2011.

Martin declined to be specific, saying the former city of Boston paramedic
at the center of the scandal is being investigated by Boston police, and
because of the criminal probe, he said he wouldn’t say exactly what

The city discovered the alleged misconduct last fall, Martin said, and
“immediately strengthened the policies and procedures around controlled
substances” in city ambulances.

Then, this past weekend, the city reached out to 64 people believed to have
received tampered medications. City officials found seven of them had died,
mostly from the injuries that required them to use an ambulance, Martin
USA: Security has been tightened on Boston ambulances after suspected drug
tampering by paramedic
By Kay Lazar, Boston Globe, Boston MA USA (01.10.12)

Boston health officials Monday said security measures have been tightened
aboard the city’s ambulances following the discovery of suspected drug
tampering by a Boston EMS paramedic.

The alleged tampering, discovered Sept. 6, 2011, may have exposed as many
as 64 patients to blood-borne infections during the summer of 2011, when
they were treated with the compromised painkillers and sedatives, officials

Boston EMS Chief James Hooley said since the alleged incident, they have
started a “very strict” inspection schedule and have improved packaging of
the drugs.

“We feel pretty confident we have put additional safeguards in place to
prevent something like this from happening again,” Hooley said.

He said the system already had a “robust” security, which required double
signatures on the medications used, and periodic inspections by
supervisors, as well as an annul inspection by state officials.

The Boston Public Health Commission, which runs the city’s ambulance
service, began notifying patients over the weekend and offering free
medical tests to determine whether they were exposed to infectious

“We have had, for the most part, a very positive response,” Barbara Ferrer,
executive director of the commission, said in news conference Monday
afternoon at the agency’s Boston headquarters. “People have been glad that
we did in fact notify them, and I think it’s mixed in terms of what people
are worried about or whether or not people want to get tested.”

Officials do not believe the paramedic carried any infectious diseases, but
acknowledged that health officials do not know for sure. Nor do they know
how the individual may have tampered with the medications, which are in
liquid form and are injected.

“The paramedic in question did not treat all 57 patients personally, and we
also have no reason to believe that this individual had or was transmitting
an infectious disease to any patients,” Ferrer said.

Letters and phone calls are going out to 57 of the 64 who may have been
affected. Seven died shortly after they were transported to the hospital by
Boston Emergency Medical Services, and officials believe their deaths were
not related to the suspected medication tampering and instead were due to
their “initial catastrophic injury or medical event.”

Dr. Anita Barry, director of the commission’s Infectious Disease Bureau,
said the chances of any of the 57 being infected are quite small. She said
that if the patients want to be tested for potential infections, they would
suggest they be screened for blood-borne illnesses such as HIV and
hepatitis C.

Someone who is directly stuck with a needle from someone who has HIV has a
0.3 percentchance of getting infected, Barry said. “We are miles away from
that here. This has got to be much much, much lower risk,” she added.

Similarly, Barry said, someone who is directly stuck with a needle from a
person who has hepatitis C, has a 1 to 2 percent risk of getting infected.

The paramedic, who officials declined to identify, is believed to have
tampered with the powerful drugs during a six-week period in the summer of
2011, but officials said they could not be more specific about the exact
dates because of an ongoing criminal investigation. No charges have been
filed against the paramedic, who was relieved of duties when the problem
was discovered in September 2011.
Australia: AMA Pushes for Safe Injecting Trial
Kate Hagan and Julia Medew, The Age, Melbourne Australia (01.10.12)

The Australian Medical Association (AMA) has called for the trial of a
supervised injecting facility in Victoria that would help prevent overdoses
and control the spread of blood-borne diseases such as hepatitis C. With a
successful facility operating in Sydney for more than 10 years, AMA
Victorian president Stephen Parnis said it was time the Victorian
government considered a trial. The Baillieu government has repeatedly ruled
out such a trial since coming to power two years ago and did so again last
night. However, the opposition and the Greens [a political party] urged the
government to consider the proposal.

Dr. Parnis suggested that the facilities could work in “Melbourne’s drug
hotspots.” Heroin-related ambulance attendances were particularly high in
the City of Yarra, where councillors voted last year to introduce a trial,
but were thwarted by the government when it refused to change legislation
that would have allowed the city to move forward. In Victoria, during the
years 2009 through 2010, there were 2,033 heroin-related ambulance
attendances, and more than one in five were in the City of Yarra. The mayor
of Yarra, Geoff Barbour, said the council maintained its support for a safe
injecting facility within the municipality because the current criminal
approach had failed. Yarra Drug and Health Forum executive officer Greg
Denham welcomed AMA’s statement and called on other community leaders and
organizations to express support. He added that approximately 100
Victorians continued to die each year from drug overdoses.

USA: New products pitched to improve injection safety
By Kevin B. O’Reilly, American Medical News, USA (01.10.12)

– Injection-related outbreaks have proved difficult to eliminate. Syringes
that prevent reuse and systems that simplify injections involving multiple
medications are being pushed as potential fixes. –

Despite repeated warnings from the Centers for Disease Control and
Prevention and others, unsafe injection practices continue to lead to
disease outbreaks. Though rare in the U.S., safety experts say these
mishaps should never happen.

Health industry companies say they have a solution: injection systems they
say are designed to make it easier for physicians, nurses and other health
professionals to deliver shots safely.

From 2001 to 2006, nine outbreaks infected nearly 300 patients with
bloodborne diseases such as hepatitis C at ambulatory care clinics, the
U.S. Government Accountability Office said in a July report. The CDC issued
guidelines on injection safety in 2007. In 2008, the CDC and many physician
and health-professional organizations formed the Safe Injection Practices
Coalition and launched the One and Only Campaign to spread the word on
preventing injection-related disease transmission.

Yet problems continue. From 2007 to 2011, another nine outbreaks infected
66 patients with bloodborne diseases. The culprits are unsafe injection
practices, such as the reuse of syringes and single-dose vials, and
improper aseptic technique when using multidose vials. Nearly 100,000
patients had to be notified for follow-up testing related to these

In spring 2012, the CDC traced injection-related outbreaks of
Staphylococcus aureus infections that hospitalized 10 patients to clinics
in Arizona and Delaware. Studies have found that safety lapses in injection
practices happen at 30% of ambulatory surgery centers and among 6% of
nurses. CDC officials remain flummoxed on how to eliminate the problem.

“If I had an answer for why it keeps happening, we would have fixed it by
now,” said Melissa Schaefer, MD, a medical officer in the CDC’s Division of
Healthcare Quality Promotion. “It’s rare, but it’s not rare enough. I don’t
know why they continue to occur. It’s completely unacceptable. Health care
should not be a mechanism for these kinds of infections.”

Drug shortages have exacerbated the problem, experts say, with smaller
sizes for some single-dose packages becoming costlier or harder to find.

Whatever is contributing to unsafe injection practices, some product
manufacturers see a market opportunity in safety. One innovation is the
syringe that is automatically disabled after one use. If a health
professional attempts to draw back the locked plunger after use, it breaks
off and is rendered unusable. Franklin Lakes, N.J.-based Becton, Dickinson
and Co., is the world’s largest manufacturer of syringes and launched a
line of safety syringes in 2011.

But the company, known as BD, only sells its auto-disabled syringes in
developing countries, where unsafe injections kill an estimated 1.3 million
people a year, according to the World Health Organization. The United
Nation’s Children’s Fund says auto-disable syringes cost developing nations
about six cents each, while traditional syringes cost four cents each.

In the U.S., BD markets several other products aimed at making injections
safer. Its prefilled heparin and saline syringes remove the additional
infection risk of drawing the fluid into the syringe. Another injection
device is called Integra and features a needle that, after use, retracts
into the barrel of the syringe to prevent needlesticks and syringe reuse.
Little Elm, Texas-based Retractable Technologies markets a similar line of
retractable-needle syringes. The products are “designed to be
nonresusable,” according to the company’s website.

Simplifying injection technique

Although much of the safety focus has been on preventing the reuse of
single-dose vials with multiple patients, multidose vials also can pose a
danger to patients.

CDC guidelines call for using only sterile needles to access the multidose
vial, keeping the vials away from patient treatment areas and storing them
according to manufacturer’s recommendations. Drawing the medications for an
injection involving multiple drugs can increase the risk for slipups. An
injection to treat joint pain that involves anesthetics and a steroid can
take as long as 15 minutes to prepare, said John S. Reach Jr., MD,
assistant professor of orthopedics and rehabilitation at Yale University
School of Medicine in Connecticut.

“You’re taking three different vials, and you have to swab the vials on the
top,” said Dr. Reach, director of Yale’s Foot and Ankle Section. “Then you
take a bigger needle and stick it through the rubber gasket on the top of
it, suck up each of those fluids, and you have to maintain sterility
through all that. There are a lot of different places to make a mistake.”

Dr. Reach is a paid consultant for Carticept Medical Inc. of Alpharetta,
Ga., which in 2011 launched a product designed to automate the process of
delivering intra-articular pain-relief injections. Its product, the
Navigator Delivery System, allows health professionals to draw the drugs
without needles, using disposable cassettes. The physician preparing the
injection determines how much medication to draw from each vial using a
computer interface that is part of the device.

The system, which costs $12,000, is being marketed to orthopedic and sports
medicine practices that do 10 or more ultrasound-guided injections daily.
The product was cleared for marketing by the Food and Drug Administration
in 2011, but its efficacy in reducing injection-related disease
transmission has not yet been tested. Fewer than 20 clinics are using the
product, but company officials say they expect a revised version to gain
more traction in the marketplace.

The CDC’s Dr. Schaefer declined to comment on the potential for these
products to help improve injection safety. A May 2010 meeting of
pharmacists, nurses, industry companies and others hosted by the CDC and
the FDA said new equipment designs such as auto-disable syringes and vials
and tamper-evident packaging could help improve injection safety.

The American Academy of Orthopaedic Surgeons also did not comment directly
on how new products might prevent injection-related disease outbreaks. The
organization’s Patient Safety Committee is examining injection safety and
“will continue to monitor developments on this issue as more information
becomes available to help ensure best practices of orthopedic care are
maintained,” the academy said in a statement.


“HHS Has Taken Steps to Address Unsafe Injection Practices, but More Action
is Needed,” U.S. Government Accountability Office, July 13

Centers for Disease Control and Prevention on preventing unsafe injection

“Infection Control Assessment of Ambulatory Surgical Centers,” The Journal
of the American Medical Association, June 9, 2010

“Injection practices among clinicians in United States health care
settings,” American Journal of Infection Control, December 2010

“Invasive Staphylococcus aureus Infections Associated with Pain Injections
and Reuse of Single-Dose Vials — Arizona and Delaware, 2012,” Morbidity and
Mortality Weekly Report, July 13

Auto-disabled syringe, Star Syringe Ltd.

BD Emerald PRO Reuse Prevention Syringe

Navigator Delivery System, Carticept Medical Inc.

Canada: A call for pragmatism in clean-needle debate
André Picard, The Globe and Mail, (01.10.12)

Four AIDS groups and a former inmate have filed a lawsuit in Federal Court
seeking a supervisory injunction – a court order that would force Ottawa to
establish needle exchange programs in Canadian prisons.

The claimants argue, essentially, that prisoners should have the same
access to health care as non-prisoners, and denying them clean needles
violates their rights under the Charter of Rights and Freedoms.

It’s an imaginative use of the courts but has little chance of success.
Criminal conviction and incarceration have some consequences, including
temporary loss of some privileges of citizenship, if not fundamental
rights. The courts have been clear that access to all health and social
services is not an absolute right; the provision of services has to be
balanced against other societal interests, in prison as elsewhere.

That being said, the Correctional Service of Canada would be well-advised
to establish needle-exchange programs – and quickly – not because it’s a
legal obligation but because it’s a sensible public-health measure, and
makes good economic sense.

The common reaction to the suggestion of prison needle exchanges is
sputtering outrage. The two principal arguments go something like this:
“Drugs are illegal and prisons are drug-free so why would we give junkies
needles?” And: “You’re going to give dangerous criminals a weapon – are you

Public Security Minister Vic Toews articulated that position in responding
to the lawsuit, saying: “Our government has a zero-tolerance policy for
drugs in our institutions.”

The law-and-order argument is, on the surface, compelling.

But here’s the reality: There is no such thing as a drug-free prison; never
has been, never will be. According to CSC’s own figures, one in every nine
prisoners injects drugs regularly – this despite all rules, the searches
and the guards.

Drugs are easy to smuggle, but hiding a six-pack of needles in an orifice
is a little more tricky. So injection drug users do two things: They
fashion needles out of any material they can find, and they share. To
access those needles they use the common prison currency: sex.

All these practices entail serious health risks. Dull needles cause wounds
and infections. Sharing homemade, unsterilized needles spreads infections
with incredible efficiency, and transactional sex is almost as efficient.

Lack of access to clean needles is one of the principal reasons that
infection rates for HIV and hepatitis C are 10 to 30 times higher in the
prison population than in the general population.

Prisoners are not prisoners forever – 90 per cent return to the community,
too often with deadly baggage like HIV/AIDS and hepatitis C.

Prisoners already have access to condoms – even though having sex with
other inmates is against the rules – and, in some prisons, inmates are
provided with bleach to disinfect needles.

These harm-reduction measures are entirely appropriate, but they are
insufficient. We should provide needles too.

A dozen countries worldwide, as diverse as Iran and Switzerland, already do
so. Where these programs exist, needles aren’t used as weapons, not any
more than forks and bed sheets.

The greatest risk posed by needles in prison is when they are hidden and
staff and other prisoners suffer accidental needle sticks.

Drugs are a public-health issue much more than a justice issue. Good public
health practice demands needle exchanges in communities, and this is doubly
true in communities where injection drug users are commonplace – prisons.

We can blithely pursue our macho, tough-on-crime approach and prisoners
will continue to inject with makeshift, disease-ridden kits, at great cost,
both human and financial.

Or we can take a pragmatic, health-first approach and provide needles to
reduce, as much as possible, the harm done to prison staff, to prisoners
and to members of the general public.

The right choice seems obvious. And we should not ignore it just because
the idea of distributing needles in prison leaves us a little squeamish.

Bhutan: Hepatitis B cases on a rise in Bhutan
Health, India (01.10.12)

Bhutan is facing a major health concern with the rising cases of Hepatitis
B infection. Tucked in the eastern Himalayas, Bhutan, with a population of
just over 650,000, is bordered to the west, south and east by India and in
the north by China. Bhutan launched Hepatitis B vaccine in 1997 after high
prevalence of the disease came to light.

Last year alone, 744 Hepatitis B cases were reported, Jigme Dorji Wangchuk,
a doctor at the National Referral Hospital here, said. The higher rate of
detection was due to the increasing number of testing centres. But Bhutan
also has Hepatitis A and C, The Bhutanese daily quoted Wangchuk as saying.
Hepatitis B infection could lead to liver cirrhosis and cancer. The virus
is spread through blood transfusion, unsafe sex or sharing of needles
contaminated by the virus.

There is currently no government awareness campaign, but patients are
provided free medical treatment, the health ministry’s chief programme
officer Tandin said last week. There is however less emphasis on testing
Hepatitis C, which is more serious. About 95 percent of patients lead a
normal life with treatment but the virus remains in the body.
Diseases like malaria, dengue and cholera are also widespread in the
Western Pacific: Countries in Western Pacific Region to Meet Hepatitis B
Control Target: WHO
The Philippine Star (27.09.12)

Shin Young-soo stated on September 26 that at least 30 countries and areas
in the region will likely reach the target of reducing the prevalence of
hepatitis B infection to less than 2 percent among children of at least 5
years old by 2012. Shin, the World Health Organization (WHO) Regional
Director for the Western Pacific, made the statement in Hanoi at the 63rd
Meeting of the WHO Regional Committee for the Western Pacific.

The Committee is reviewing WHO’s efforts to control or eliminate vaccine-
preventable, life-threatening diseases, including measles, polio, and
hepatitis B. Shin stated that because of this progress, the Region’s
Expanded Programme on Immunization Technical Advisory Group and Hepatitis B
Expert Resource Panel have recommended setting 2017 as the target year for
the goal to reduce hepatitis B infection rates to less than 1 percent.
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