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SIGNpost 00676

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *SAFE INJECTION GLOBAL NETWORK*

Post00676      Note + Abstracts + News 21      November 2012

CONTENTS
0. Moderators Note
1. Abstract: Case control study to identify risk factors for acute
hepatitis C virus infection in Egypt
2. Abstract: Control of viral hepatitis infection in Africa: Are we
dreaming?
3. Abstract: Staffing Matters-Every Shift
4. Abstract: Prevalence of anti-HEV IgM among blood donors in Egypt
5. Abstract: Assessment of hepatitis B vaccination and compliance with
infection control among dentists in Saudi Arabia
6. Abstract: Hepatitis C Testing, Infection, and Linkage to Care Among
Racial and Ethnic Minorities in the United States, 2009-2010
7. Abstract: Individual and Network Factors Associated With Prevalent
Hepatitis C Infection Among Rural Appalachian Injection Drug Users
8. Abstract: Predictors of Active Injection Drug Use in a Cohort of
Patients Infected With Hepatitis C Virus
9. Abstract: Testing the WHO Hand Hygiene Self-Assessment Framework for
usability and reliability
9. No Abstract: Putting risk compensation to rest: reframing the
relationship between risk behavior and antiretroviral therapy among
injection drug users
10. News
– Global: AIDS Recedes as Home-Grown Funding Exceeds International Aid By
– VAX: WHO eases rules on meningitis vaccine: researchers
– VAX: New rule on vaccine to help fight meningitis in remotest Africa
– Global: Lead Funder on AIDS, Malaria, TB Gets a Reboot

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1. Abstract: Case control study to identify risk factors for acute
hepatitis C virus infection in Egypt
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23145873

BMC Infect Dis. 2012 Nov 12;12(1):294.

Case control study to identify risk factors for acute hepatitis C virus
infection in Egypt.

Kandeel AM, Talaat M, Afifi SA, El-Sayed NM, Fadeel MA, Hajjeh RA, Mahoney
FJ.

BACKGROUND: Identification of risk factors of acute hepatitis C virus (HCV)
infection in Egypt is crucial to develop appropriate prevention strategies.

METHODS: We conducted a case–control study, June 2007-September 2008, to
investigate risk factors for acute HCV infection in Egypt among 86 patients
and 287 age and gender matched controls identified in two infectious
disease hospitals in Cairo and Alexandria. Case-patients were defined as:
any patient with symptoms of acute hepatitis; lab tested positive for HCV
antibodies and negative for HBsAg, HBc IgM, HAV IgM; and 7-fold increase in
the upper limit of transaminase levels. Controls were selected from
patients’ visitors with negative viral hepatitis markers. Subjects were
interviewed about previous exposures within six months, including
community-acquired and health-care associated practices.

RESULTS: Case-patients were more likely than controls to have received
injection with a reused syringe (OR=23.1, CI 4.7-153), to have been in
prison (OR= 21.5, CI 2.5-479.6), to have received IV fluids in a hospital
(OR=13.8, CI 5.3-37.2), to have been an IV drug user (OR=12.1, CI
4.6-33.1), to have had minimal surgical procedures (OR=9.7, CI 4.2-22.4),
to have received IV fluid as an outpatient (OR=8, CI 4–16.2), or to have
been admitted to hospital (OR=7.9, CI 4.2-15) within the last 6 months.
Multivariate analysis indicated that unsafe health facility practices are
the main risk factors associated with transmission of HCV infection in
Egypt.

CONCLUSION: In Egypt, focusing acute HCV prevention measures on health-care
settings would have a beneficial impact.

Free full text http://www.biomedcentral.com/1471-2334/12/294/abstract
http://www.biomedcentral.com/content/pdf/1471-2334-12-294.pdf
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Control of viral hepatitis infection in Africa: Are we
dreaming?
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23149269

Vaccine. 2012 Nov 10. pii: S0264-410X(12)01591-5.

Control of viral hepatitis infection in Africa: Are we dreaming?

Mihigo R, Nshimirimana D, Hall A, Kew M, Wiersma S, Clements CJ.

Immunization and Vaccine Development Programme, World Health Organization
Regional Office for Africa, Brazzaville, Congo.

BACKGROUND: At least five different types of viral hepatitis cause problems
of significant public health importance in Africa, where together they
constitute a huge burden of disease. But until now, efforts to control the
infections have been largely piecemeal. Analysis of the strategies needed
to control each virus, however, reveals major overlaps.

PROPOSAL: We propose that the control of these infections in the WHO
African Region should start with the common strategies rather than with
each disease. But this approach presents potentially huge problems to
overcome, such as the difficulty of integrating multiple health service
elements – the track record for successful integration of such services is
not good. This is despite encouraging rhetoric from donors and national
leaders alike. And to succeed, disparate programmes must work closely
together. But we believe that the time is right to create new opportunities
for prevention and treatment of hepatitis, including increasing education,
and promoting screening and treatment for more than 500 million people
already infected with hepatitis B and C viruses.

IMPACT: The impact of these efforts on decreasing mortality and morbidity
will be significant because of the high burden of disease from these
infections, and also because the effect will spill over to benefit the
control of other communicable diseases and health systems strengthening.
Such a project will inevitably involve multiple strategies that will vary
somewhat according to the epidemiology of the diseases and the location.

Copyright © 2012. Published by Elsevier Ltd.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Staffing Matters-Every Shift
__________________________________________________________________
Am J Nurs. 2012 Nov 14.

Staffing Matters-Every Shift.

West G, Patrician PA, Loan L.

Gordon West is a doctoral student at the Uniformed Services University of
the Health Sciences (USUHS) Graduate School of Nursing, Bethesda, MD.
Patricia A. Patrician is an associate professor and the Banton Endowed
Professor in the Department of Community Health, Outcomes, and Systems at
the University of Alabama at Birmingham School of Nursing. Lori Loan is
chief of the Center for Nursing Science and Clinical Inquiry at the Madigan
Healthcare System in Tacoma, WA. Contact author: Gordon West,
gordon.west@us.army.mil.

The authors have disclosed no potential conflicts of interest, financial or
otherwise. The Military Nursing Outcomes Database project was funded by the
TriService Nursing Research Program at the USUHS (Grant N03-P07). The
information or conclusions in this article do not necessarily represent the
official position or policy of, nor should any official endorsement be
inferred by, the TriService Nursing Research Program, the USUHS, the
Department of Defense, or the U.S. government.

Data from the Military Nursing Outcomes Database can be used to demonstrate
that the right number and mix of nurses prevent errors.

OVERVIEW: Data from the Military Nursing Outcomes Database (MilNOD) project
demonstrate that inadequately staffed shifts can increase the likelihood of
adverse events, such as falls with injury, medication errors, and
needlestick injuries to nurses.

Such evidence can be used to show that it takes not only the right number
of nursing staff on every shift to ensure safe patient care, but also the
right mix of expertise and experience.

Based on findings from the MilNOD project, the authors present realistic
scenarios of common dilemmas hospitals face in nurse staffing, illustrating
the potential hazards for patients and nurses alike.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Prevalence of anti-HEV IgM among blood donors in Egypt
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23082470

Egypt J Immunol. 2011;18(2):47-58.

Prevalence of anti-HEV IgM among blood donors in Egypt.

Ibrahim EH, Abdelwahab SF, Nady S, Hashem M, Galal G, Sobhy M, Saleh AS,
Shata MT.

Blood Products Quality Control and Research Dept., National Organization
for Research and Control of Biologicals, Cairo, Egypt.

Hepatitis E virus (HEV) is a common cause of acute viral hepatitis (AVH) in
developing countries. In Egypt; where up to 80% of the inhabitants of rural
villages have anti-HEV antibodies denoting past infection, most of these
infections are asymptomatic with little evidence that the infection causes
AVH.

There are accumulating reports which suggest potential risk of HEV
transmission by blood transfusion. However, detection of serological
markers for HEV infection or HEV RNA in Egyptian blood banks is not
routinely performed. 760 blood samples from apparently healthy donors at
the National blood bank were tested for markers of acute HEV infection to
estimate the seroprevalence of acute HEV infection, and potential risk of
infection by blood transfusion.

They included 124 females (16.82%) and 636 males (83.68%), with a mean age
of 23.8 +/- 5.3 years and mean ALT value of 23.3 +/- 13.2 IU/ml. Samples
were tested as pools of 10 subjects. Pools with highest reactivity were
retested individually to determine the frequency of positive subjects. Out
of the 760 samples, three (0.45%) samples were positive for anti-HEV IgM
and two of them had HEV RNA as determined by RT-PCR.

In conclusion, this study suggests that the tested blood donors have low
prevalence of ongoing subclinical infection with HEV and that the potential
risk of transfusion may be low.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Assessment of hepatitis B vaccination and compliance with
infection control among dentists in Saudi Arabia
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23147878

Saudi Med J. 2012 Nov;33(11):1205-10.

Assessment of hepatitis B vaccination and compliance with infection control
among dentists in Saudi Arabia.

Al-Dharrab AA, Al-Samadani KH.

Oral & Maxillofacial Rehabilitation Department, Faculty of Dentistry, King
Abdulaziz University, PO Box 80209, Jeddah 21589, Kingdom of Saudi Arabia.
Tel/Fax. +966 (2) 6403316. E-mail: aaldharab@kau.edu.sa.

OBJECTIVE: To evaluate hepatitis B virus (HBV) vaccine coverage and the use
of infection control among dentists in Saudi Arabia.

METHODS: This cross-sectional study was carried out during the Third
International Conference at the King Abdulaziz University Faculty of
Dentistry, held on March 2012 in Jeddah, Saudi Arabia. Saudi or expatriate
dentists working in Saudi Arabia were included in the study. The
questionnaires were designed to meet the objective of the study.

RESULTS: A total of 402 dentists of whom 176 (44%) were male and 226 (56%)
female took part in this study. Their mean age was 37.4 years. In all, 246
(61%) were general dentists and 156 (39%) specialists. Four-fifths (80.5%)
of them had been vaccinated. Almost half (48.5%) had experience of needle
stick injury, but none reported having been infected with HBV. Among the
vaccinated dentists, 186 (57.5%) had not been screened for HBV antibodies.

Younger dentists were more particular about vaccination and more careful in
using protective wear. There was an association between protective barriers
and HBV vaccination, but there was no association between history of needle
stick injury and vaccination.

CONCLUSION: Dental healthcare workers have a high risk of infection with
HBV due to the nature of their work; so there should be a mandatory program
to vaccinate dentists against HBV and to ensure application of protective
measures during their practice.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Hepatitis C Testing, Infection, and Linkage to Care Among
Racial and Ethnic Minorities in the United States, 2009-2010
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23153151

Am J Public Health. 2012 Nov 15. e1-e8

Hepatitis C Testing, Infection, and Linkage to Care Among Racial and Ethnic
Minorities in the United States, 2009-2010.

Tohme RA, Xing J, Liao Y, Holmberg SD.

Rania A. Tohme, Jian Xing, and Scott D. Holmberg are with the Division of
Viral Hepatitis, Centers for Disease Control and Prevention (CDC), Atlanta,
GA. Youlian Liao is with the Division of Adult and Community Health, CDC.

Objectives. We estimated rates and determinants of hepatitis C virus (HCV)
testing, infection, and linkage to care among US racial/ethnic minorities.

Methods. We analyzed the Racial and Ethnic Approaches to Community Health
Across the US Risk Factor Survey conducted in 2009-2010 (n?=?53?896
minority adults).

Results. Overall, 19% of respondents were tested for HCV. Only 60% of those
reporting a risk factor were tested, with much lower rates among Asians
reporting injection drug use (40%). Odds of HCV testing decreased with age
and increased with higher education. Of those tested, 8.3% reported HCV
infection. Respondents with income of $75?000 or more were less likely to
report HCV infection than those with income less than $25?000. College-
educated non-Hispanic Blacks and Asians had lower odds of HCV infection
than those who did not finish high school. Of those infected, 44.4% were
currently being followed by a physician, and 41.9% had taken HCV
medications.

Conclusions. HCV testing and linkage to care among racial/ethnic minorities
are suboptimal, particularly among those reporting HCV risk factors.
Socioeconomic factors were significant determinants of HCV testing,
infection, and access to care. Future HCV testing and prevention activities
should be directed toward racial/ethnic minorities, particularly those of
low socioeconomic status.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Individual and Network Factors Associated With Prevalent
Hepatitis C Infection Among Rural Appalachian Injection Drug Users
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23153148

Am J Public Health. 2012 Nov 15.e1-e9.

Individual and Network Factors Associated With Prevalent Hepatitis C
Infection Among Rural Appalachian Injection Drug Users.

Havens JR, Lofwall MR, Frost SD, Oser CB, Leukefeld CG, Crosby RA.

Jennifer R. Havens, Michelle R. Lofwall, and Carl G. Leukefeld are with the
Center on Drug and Alcohol Research, Department of Behavioral Science,
University of Kentucky College of Medicine, Lexington. Simon D.?W. Frost is
with the Department of Veterinary Medicine, University of Cambridge,
Cambridge, UK. Carrie B. Oser is with the Department of Sociology,
University of Kentucky College of Arts and Sciences, Lexington. Richard A.
Crosby is with the Department of Health Behavior, University of Kentucky
College of Public Health, Lexington.

Objectives. We determined the factors associated with hepatitis C (HCV)
infection among rural Appalachian drug users.

Methods. This study included 394 injection drug users (IDUs) participating
in a study of social networks and infectious disease risk in Appalachian
Kentucky. Trained staff conducted HCV, HIV, and herpes simplex-2 virus
(HSV-2) testing, and an interviewer-administered questionnaire measured
self-reported risk behaviors and sociometric network characteristics.

Results. The prevalence of HCV infection was 54.6% among rural IDUs.
Lifetime factors independently associated with HCV infection included
HSV-2, injecting for 5 or more years, posttraumatic stress disorder,
injection of cocaine, and injection of prescription opioids. Recent
(past-6-month) correlates of HCV infection included sharing of syringes
(adjusted odds ratio?=?2.24; 95% confidence interval?=?1.32, 3.82) and
greater levels of eigenvector centrality in the drug network.

Conclusions. One factor emerged that was potentially unique to rural IDUs:
the association between injection of prescription opioids and HCV
infection. Therefore, preventing transition to injection, especially among
prescription opioid users, may curb transmission, as will increased access
to opioid maintenance treatment, novel treatments for cocaine dependence,
and syringe exchange.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Predictors of Active Injection Drug Use in a Cohort of
Patients Infected With Hepatitis C Virus
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23153145

Am J Public Health. 2012 Nov 15. e1-e7.

Predictors of Active Injection Drug Use in a Cohort of Patients Infected
With Hepatitis C Virus.

Reed C, Bliss C, Stuver SO, Heeren T, Tumilty S, Horsburgh CR Jr, Samet JH,
Cotton DJ.

Carrie Reed, Sherri O. Stuver, and C. Robert Horsburgh Jr are with the
Department of Epidemiology, Boston University School of Public Health,
Boston, MA. Caleb Bliss and Timothy Heeren are with the Department of
Biostatistics, Boston University School of Public Health. Sheila Tumilty
and Deborah J. Cotton are with the Department of Medicine, Section of
Infectious Diseases, Boston University School of Medicine. Jeffrey H. Samet
is with the Department of Medicine, Section of General Internal Medicine,
Boston University School of Medicine.

Objectives. We investigated potential risk factors for active injection
drug use (IDU) in an inner-city cohort of patients infected with hepatitis
C virus (HCV).

Methods. We used log-binomial regression to identify factors independently
associated with active IDU during the first 3 years of follow-up for the
289 participants who reported ever having injected drugs at baseline.

Results. Overall, 142 (49.1%) of the 289 participants reported active IDU
at some point during the follow-up period. In a multivariate model, being
unemployed (prevalence ratio [PR]?=?1.93; 95% confidence interval
[CI]?=?1.24, 3.03) and hazardous alcohol drinking (PR?=?1.67; 95%
CI?=?1.34, 2.08) were associated with active IDU. Smoking was associated
with IDU but this association was not statistically significant. Patients
with all 3 of those factors were 3 times as likely to report IDU during
follow-up as those with 0 or 1 factor (PR?=?3.3; 95% CI?=?2.2, 4.9).
Neither HIV coinfection nor history of psychiatric disease was
independently associated with active IDU.

Conclusions. Optimal treatment of persons with HCV infection will require
attention to unemployment, alcohol use, and smoking in conjunction with IDU
treatment and prevention.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Testing the WHO Hand Hygiene Self-Assessment Framework for
usability and reliability
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23149056

J Hosp Infect. 2012 Nov 10. pii: S0195-6701(12)00190-9.

Testing the WHO Hand Hygiene Self-Assessment Framework for usability and
reliability.

Stewardson AJ, Allegranzi B, Perneger TV, Attar H, Pittet D.

Infection Control Programme, University of Geneva Hospitals and Faculty of
Medicine, Geneva, Switzerland; World Health Organization Collaborating
Centre on Patient Safety, Geneva, Switzerland.

BACKGROUND: The World Health Organization (WHO) Hand Hygiene Self-
Assessment Framework (HHSAF) was conceived as a structured self-assessment
tool to provide a situation analysis of hand hygiene resources, promotion
and practices within healthcare facilities.

AIM: To perform usability pretesting and reliability testing of the HHSAF.

METHODS: The HHSAF draft was developed in consultation with experts to
reflect key elements of the WHO Multimodal Hand Hygiene Improvement
Strategy. Forty-two facilities were invited to pretest the draft HHSAF and
complete a feedback survey. For reliability testing, two users in each
facility completed the HHSAF independently. The reliability of each
indicator, component subtotal and the overall score were estimated using
the variance components model. After each phase, the tool was re-examined
and modified as appropriate.

FINDINGS: Twenty-seven indicators were selected during drafting. Twenty-six
facilities in 19 countries completed pretesting (62% response rate), with
total scores ranging from 35 to 480 (mean 262). The HHSAF took less than 2
h to complete for 21 facilities. Most agreed that the HHSAF was ‘easy to
use’ (23/26) and ‘useful for establishing facility status with regard to
hand hygiene promotion’ (24/26). Complete reliability responses were
received from 41 facilities in 16 countries. Reliability for the total
score for the HHSAF and the subtotal of each of the five components ranged
from 0.54 to 0.86. Seven indicators had poor reliability; these were
examined for potential flaws and modified accordingly.

CONCLUSION: This process confirmed the usability and reliability of this
tool for the promotion of hand hygiene in health care.

Copyright © 2012 World Health Organization. Published by Elsevier Ltd.. All
rights reserved.
__________________________________________________________________
________________________________*_________________________________

9. No Abstract: Putting risk compensation to rest: reframing the
relationship between risk behavior and antiretroviral therapy among
injection drug users
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23151496

AIDS. 2012 Nov 28;26(18):2405-7.

Putting risk compensation to rest: reframing the relationship between risk
behavior and antiretroviral therapy among injection drug users.

Marshall BD, Wood E.

aDepartment of Epidemiology, Columbia University Mailman School of Public
Health, New York, New York, USA bUrban Health Research Initiative, British
Columbia Centre for Excellence in HIV/AIDS cFaculty of Medicine, University
of British Columbia, St. Paul’s Hospital, Vancouver, British Columbia,
Canada.
__________________________________________________________________
________________________________*_________________________________

10. News

– Global: AIDS Recedes as Home-Grown Funding Exceeds International Aid By
– VAX: WHO eases rules on meningitis vaccine: researchers
– VAX: New rule on vaccine to help fight meningitis in remotest Africa
– Global: Lead Funder on AIDS, Malaria, TB Gets a Reboot

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
Global: AIDS Recedes as Home-Grown Funding Exceeds International Aid By
Simeon Bennett, Bloomberg USA (21.11.12)

Spending on AIDS by the countries hit hardest by the disease exceeded
foreign aid for the first time last year, as developing nations lessened
their dependence on rich countries that curbed donations to battle
deficits.

Low- and middle-income countries have doubled spending on AIDS to $8.6
billion since 2005, compared with international funding for the disease
that stalled at $8.2 billion last year, the Joint United Nations Programme
on HIV/AIDS, or UNAIDS, said in its annual report on the epidemic today.

Those investments helped curb deaths, which have dropped by about a quarter
globally since peaking in 2005, according to the report. Still, the virus
is spreading in the Middle East, North Africa, eastern Europe and Central
Asia as epidemics driven by sex between men and injecting drug users go
unchecked by poorly targeted or inadequately funded government programs.

“In many cases the investments are not sufficiently targeted at where the
epidemic is really happening,” Peter Ghys, UNAIDS’s chief of data for
action, said in a telephone interview. Some countries spend on preventing
mother-to-child transmission instead of making investments that would have
a bigger impact such as needle-exchange programs or condoms, Ghys said. Sex
Work or Drugs

New infections rose by 37 percent in the Middle East and North Africa
between 2001 and 2011, and by 7.7 percent in eastern Europe and Central
Asia, the report said.

“In the general population levels of HIV are quite low, but in several key
populations in many of the countries in North Africa and Middle East there
is substantial prevalence being measured,” Ghys said. “In Iran, most of the
transmission is linked to injecting drug users. If you go to Morocco the
current assessment is that most of the transmission is linked to sex work.”
New infections also climbed in Bangladesh, Indonesia, the Philippines and
Sri Lanka. New cases fell by 42 percent in the Caribbean, the region with
the steepest decline.

Globally, the number of people newly infected with HIV last year fell to
2.5 million from 2.7 million in 2010, and AIDS- related deaths declined to
1.7 million from 1.9 million. The number of people with access to
antiretroviral drugs has risen 63 percent over the past two years,
according to the report.

While sub-Saharan Africa remains the region hit hardest by the disease,
accounting for more than 70 percent of new HIV infections and AIDS-related
deaths last year, the research shows that new cases have dropped by a
quarter since 2001 and deaths have fallen by a third since 2005. South
Africa, the nation with the most HIV infections, increased spending five-
fold between 2006 and 2009.

About $24 billion a year will be needed by 2015 to meet targets of reducing
new infections through sex and needle sharing by half, eliminating new
infections among children, and expanding treatment to 15 million people,
the report says.
__________________________________________________________________
__________________________________________________________________
VAX: WHO eases rules on meningitis vaccine: researchers
(AFP) – (16.11.12)

WASHINGTON — In a breakthrough for the fight against meningitis in poor
countries, researchers say the WHO has ruled that a key vaccine can be
transported or stored for up to four days without refrigeration.
The previously-approved vaccine is aimed at helping in the so-called
“Meningitis Belt,” which stretches across the African Sahel from Senegal to
Ethiopia, where epidemics of the deadly infection regularly break out.
In these countries, where reliable electricity is rare, especially in rural
areas, assuring that the low-cost vaccine can be stored safely without
refrigeration will vastly improve vaccination campaigns, researchers say.
Called MenAfriVac and made by the Indian company Serum Institute, the
vaccine costs less than 50 cents a dose and, according to the latest
research, can be conserved without any refrigeration, even an icepack, at
temperatures up to 104 degrees Fahrenheit (40 degrees Celsius) for four
days.

“Reaching the millions of children in last mile communities like those in
rural Africa continues to challenge us,” said Dr. Orin Levine, director of
vaccine delivery at the Bill & Melinda Gates Foundation.

“The potential for some vaccines to remain safely outside the cold chain
for short periods of time has been widely known for over 20 years,” said
Michel Zaffran, director of a nonprofit collaboration with the WHO aimed at
improving immunization systems and technologies.

“We expect this announcement to build momentum” for testing other vaccines
for storage without refrigeration, he said.

The findings, from a study of the vaccine carried out by Health Canada and
confirmed by the World Health Organization Vaccines Pre-Qualification
Program and the Drugs Controller General of India — were unveiled
Wednesday at a conference in Atlanta.

Other research presented there showed that the vaccine has been effective
in reducing meningitis A in Burkina Faso, the first country to introduce
the vaccine, in 2010.

Just two years later, the bacteria that causes meningitis A had been
eliminated, not only in those who received the vaccine, but in others
around them, said Marie-Pierre Preziosi, director of the Meningitis Vaccine
Project.

“Our findings show that the bacteria causing meningitis A have disappeared
from the noses and throats of those too old or too young to have received
the vaccine, resulting from a phenomenon known as ‘herd immunity,'” she
said.

“And we can also show that after introduction in Burkina Faso, we saw the
lowest level of epidemic meningitis in 15 years,” added Preziosi, the lead
author of the study, which will appear in Clinical Infection Diseases.
Meningitis A is a bacterial infection that affects the membrane of the
brain.

It can cause brain lesions and has a 50 percent fatality rate when left
untreated, according to the WHO.

Viral meningitis is generally less severe, with most patients fully
recovering on their own within a week or two.

Copyright © 2012 AFP. All rights reserved
__________________________________________________________________
__________________________________________________________________
VAX: New rule on vaccine to help fight meningitis in remotest Africa
By Kate Kelland, Reuters, UK (14.11.12)

LONDON | Wed Nov 14, 2012 (Reuters) – A cheap meningitis vaccine designed
to treat a type of the disease common in Africa was ruled safe to use after
several days without refrigeration on Wednesday, allowing health workers to
get it to people in more remote parts.

Epidemics of meningitis A occur every seven to 14 years in Africa’s
“meningitis belt”, a band of 26 countries stretching from Senegal to
Ethiopia, and are particularly devastating to children and young adults.

The World Health Organisation (WHO) ruling, that vaccine MenAfriVac is safe
to use for up to four days at up to 40 degrees Celsius, will save money
spent on expensive “cold chain” systems in the final miles of delivery,
said Orin Levine, director of vaccine delivery at the Bill & Melinda Gates
Foundation, which helped fund the vaccine’s development.

Meningitis Vaccine Project (MVP) and WHO experts said in 2011 that
introducing MenAfriVac in seven highly endemic African countries could save
up to $300 million over a decade and prevent a million cases of disease.

The ruling comes after a review by the Drugs Controller General of India
(DCGI) supported by analysis from Health Canada and confirmed by the WHO
Vaccines Pre-qualification Programme.

Bacterial meningitis, called meningococcal meningitis, is a serious
infection of the thin lining surrounding the brain and spinal cord. It can
cause severe brain damage and is fatal in 50 percent of cases if untreated.

Studies presented along with the WHO ruling at an American Society of
Tropical Medicine and Hygiene conference in Atlanta showed that the
vaccine, which costs just 50 cents a dose and is made by the Indian generic
drugmaker Serum Institute, is already having a big impact, eliminating
meningitis A in the first countries where it was introduced.

Researchers writing in the journal Clinical Infectious Diseases said that
in Burkina Faso, where the vaccine was introduced in 2010, swabs taken from
the throats of thousands of residents before and after its introduction
showed infections with the bacteria causing meningitis A had been
eliminated in both vaccinated and unvaccinated people.

Marie-Pierre Prezioso, an MVP director who led the study, said the findings
showed that a phenomenon known as ‘herd immunity’ was being achieved.

“From early evidence … we can say the signs are very promising,” she said
in a statement. “We have herd immunity … and we can also show that after
introduction in Burkina Faso, we saw the lowest level of epidemic
meningitis in 15 years.”

(Editing by Louise Ireland)
__________________________________________________________________
__________________________________________________________________
www.ipsnews.net/2012/11/lead-funder-on-aids-malaria-tb-gets-a-reboot/

Global: Lead Funder on AIDS, Malaria, TB Gets a Reboot
By Sarah McHaney,Copyright IPS-Inter Press Service. (14.11.12)

WASHINGTON, Nov 14 2012 (IPS) – After weathering the departure of its
executive director amidst a misallocation scandal earlier this year, the
world’s largest funder of programmes to address HIV/AIDS, tuberculosis and
malaria is poised to announce a new leader Thursday.

The performance-based Global Fund is a giant in the field of multilateral
health financing, channeling 82 percent of the funds for TB, 50 percent for
malaria, and 21 percent of the international financing against HIV/AIDS. To
date, it has approved 30 billion dollars’ worth of spending.

“They need to do reform 2.0 which focuses on better measurement and
accountability on actual disease results,”
Amanda Glassman, director of global health policy at the Centre for Global
Development, told IPS.

“We focus too much on paperwork being consistent instead of on what we want
the paperwork to achieve,” she said.

The former executive director, Michel Kazatchkine, resigned at the
beginning of this year after the AIDS Health Foundation wrote a report in
September 2011 urging him to step down amidst a funding misallocation
scandal.

More than a year later, the Global Fund is still attempting to recover from
that experience, which saw millions of dollars go unaccounted for in four
African countries.

“The Global Fund has a terrific record of saving lives,” Deb Derrick, the
president of Friends of the Global Fight Against AIDS, Tuberculosis, and
Malaria, told IPS. “They have cut their staff by 20 percent and are
operating under a tightened budget. I think a good manager is very well-
positioned to do even more with the resources at hand.”

The vast majority of that money, 95 percent, has come from the public
sector. The United States leads donations, followed by France, Japan,
Germany and the United Kingdom.

For this reason, however, the global financial crisis has hit the Global
Fund hard, resulting in a large decrease of public sector donations. In May
2011, the Fund stated that it was 1.3 billion dollars short of its proposed
budget for 2011-13.

The Global Fund gives grants based not only on need and vulnerability, but
also on the results that recipient countries are able to show. Countries
apply for each new round of funding and measure their results against the
goals set by previous grants.

In November 2011, the Global Fund was forced to cancel its 11th round of
funding due to inadequate resources from donors.

The Fund also suffered, both politically and financially, following the
misallocation scandal that came to light in early 2011. Months prior, the
Global Fund’s independent Office of the Inspector General had published
reports finding that 34 million dollars had gone unaccounted for in four
African countries receiving grants.

Germany and Sweden both suspended their donations following this discovery,
although they resumed funding in 2011.

In direct response, in September 2011 the Global Fund announced a new five-
year strategy for 2012-16 that supports more “aggressive management and
oversight of grants, encourages more flexibility in tailoring activities to
specific country’s needs, and embraces more country ownership of programs
through increased involvement of country governments.”

Still, the Global Fund remains one of the most transparent aid
organisations in the world – a fact that led to the discovery of
misallocation in the first place. According to the Aid Transparency Index,
a ranking of 77 aid-giving organisations and countries, the Global Fund is
the fourth in the world.

“I think the inspector-general has done a fabulous job in looking at how to
make the Fund more transparent and has undertaken a lot of the reforms and
activities to achieve this,” Derrick told IPS.

In September, the Board approved a new funding model for the Global Fund
based on the decrease in donations. The new model changes the way in which
countries apply for grants, with the aim of putting more money into the
most vulnerable populations.

However, there is concern that this will stray slightly from the
performance-based funding for which the Global Fund is renowned.

“In order for the Global Fund to remain distinguishable from other
organisations that can handle the money such as the World Bank, it needs to
build out their performance base model and their accountability for
results,” Glassman told IPS.

“If the Global Fund does this it will thrive in the next 10 years of its
existence.”

Others are concerned that the new funding model would virtually leave Latin
America and the Caribbean out of the Global Fund’s granting, due to how the
Fund categorises income levels.

Commenting on this criticism, Derrick says, “Part of this whole reform
effort is adjusting to this fiscally constrained environment, getting the
money to where it is most needed, and trying to make sure that all
vulnerable populations have money allocated to them.”

In October, the U.S. government passed a budget that included a 27-percent
increase in funding for the Global Fund. However, the budget also included
significant cuts to programmes that addressed only one of the diseases
focused on by the Global Fund.

This will likely result in an increase of applications for grants from the
Global Fund as money dries up from the U.S. malaria and TB programmes.

“In my view, this budget assignment shows a moving towards multilateral
efforts and away from U.S. bilateral efforts. In terms of multilateral aid,
the Global Fund performs well,” Glassman told IPS.

The new executive director will have to manage the new funding plan as well
as the likely increase of applications while still maintaining the Global
Fund’s defining principles.

Copyright © 2012 IPS-Inter Press Service. All rights reserved.
__________________________________________________________________
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