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SIGNpost 00678

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00678 Tools + 3 Quotes + Abstracts + News 5 December 2012

CONTENTS
1. USA: CDC releases digital press kit on the impact of unsafe injection
practices
2. USA: New Tools to Help Clinicians Ensure Every Injection is Safe
3. Abstract: Incidence of occupational exposures in a tertiary health care
center
4. Abstract: Screening for the hepatitis C virus in some dental clinics in
Alexandria, Egypt
5. Abstract: Prevalence and Risk Factors for Hepatitis C Virus, Hepatitis B
Virus, and Human Immunodeficiency Virus in Transfused Children in
Kinshasa
6. Abstract: Crossing the quality chasm in resource-limited settings
7. Abstract: Public health issues of hepatitis C virus infection
8. Abstract: Global epidemiology of hepatitis C virus infection: New
estimates of age-specific antibody to hepatitis C virus seroprevalence
9. Abstract: The cost of providing primary health-care services from a
needle and syringe program: A case study
10. Abstract: Developing effective health interventions for women who
inject drugs: key areas and recommendations for program development and
policy
11. Abstract: Compliance of healthcare professionals with safety measures
for control of hepatitis viruses in hemodialysis centers: an experience
from southeast iran
12. Abstract: Safe administration of the seasonal trivalent influenza
vaccine to children with severe egg allergy
13. Abstract: Fear of repeated injections in children younger than 4 years
receiving subcutaneous allergy immunotherapy
14. Abstract: Viremic profiles in asymptomatic and symptomatic chikungunya
fever: a blood transfusion threat?
15. Abstract: Environment cleaning without chemicals in clinical settings
16. Abstract: Water quality key to protecting patients
17. Abstract: The role of ‘no-touch’ automated room disinfection systems in
infection prevention and control
18. Abstract: Pocketed microneedles for rapid delivery of a liquid-state
botulinum toxin A formulation into human skin
19. News
– Pakistan: WHO report on Aids Day: Pakistan ill-prepared to check HIV
spread
– UN: UNDP Delivers On Full Transparency Pledge
– USA/Global: Secretary Clinton Unveils Blueprint For Achieving ‘AIDS-Free
Generation’
– Clean Syringe Exchange Program: keeping dirty needles off the streets
– Canada: Quebec man who put dirty needles in garments jailed 4 years
– Judge takes into account ‘state of terror’ caused in Sherbrooke
– Canada: Hema-Quebec issues blood alert
– Canada: Clean needle distribution stems health concerns
– Devices: Microneedle Patch Could Boost Immunization Programs

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at: http://www.who.int/injection_safety/en/

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__________________________________________________________________
________________________________*_________________________________

1. USA: CDC releases digital press kit on the impact of unsafe injection
practices
__________________________________________________________________
http://www.cdc.gov/media/releases/2012/dpk-unsafe-injections.html

CDC releases digital press kit on the impact of unsafe injection practices

On November 28, CDC posted The Impact of Unsafe Injection Practices in U.S.
Healthcare Settings, a digital press kit that includes a powerful statement
about the human cost of unsafe injections, as well as links to more than 20
related resources and professional articles. CDC’s summary of the digital
press kit is reprinted below.

Injection safety is part of the minimum expectation for safe care anywhere
healthcare is delivered; yet, CDC has had to investigate numerous outbreaks
of life-threatening infections caused by injection errors. Since 2001, at
least 150,000 U.S. patients have been negatively impacted by unsafe medical
injections. When healthcare providers fail to follow basic infection
control practices during injection preparation and administration, patients
can be exposed to life-threatening illnesses such as hepatitis and/or
bacterial infections. To assist you in covering this important topic, CDC
is releasing a digital press kit about the impact of unsafe injection
practices in U.S. healthcare settings. The digital press kit includes fact
sheets, an infographic, videos and podcasts, and quotes from CDC experts.

In addition, to further educate healthcare providers about safe injection
practices, CDC is releasing several new educational pieces today.
__________________________________________________________________

Selected Quotes:

“The three-point rule is simple: Use needles, syringes, and single-dose
medication vials only one time, for one patient. Patients and healthcare
providers must insist on these infection control basics to avoid serious
infections.”
– Dr. Joseph Perz, DrPH, MA, Centers for Disease Control and Prevention.

“Safe injection practices are basic but they are not optional – they are
every provider’s responsibility.”
– Dr. Michael Bell, MD, Centers for Disease Control and Prevention.

“Patients deserve safe care. Many patients who contract infections through
a reused needle, syringe, or single-dose vial are already ill and receiving
treatment for cancer, chronic pain, or a host of other conditions. We must
be able to count on healthcare providers to heal and protect us. When
healthcare workers follow CDC’s safe injection practices, problems are
prevented. I encourage patients to speak up and request One Needle, One
Syringe, Only One Time.”
– Evelyn McKnight, MD, HONOReform
__________________________________________________________________
________________________________*_________________________________

2. USA: New Tools to Help Clinicians Ensure Every Injection is Safe
__________________________________________________________________
http://www.oneandonlycampaign.org/news/new-tools-help-clinicians-ensure-
every-injection-safe

New Tools to Help Clinicians Ensure Every Injection is Safe

Injection safety is part of the minimum expectation for safe care anywhere
healthcare is delivered; yet, CDC has had to investigate outbreak after
outbreak of life-threatening infections caused by injection errors. How
can this completely preventable problem continue to go unchecked? Lack of
initial and continued infection control training, denial of the problem,
reimbursement pressures, drug shortages, and lack of appreciation for the
consequences have all been used as excuses; but in 2012 there is no
acceptable excuse for an unsafe injection in the United States.

Today, on CDC’s Safe Healthcare Blog, http://blogs.cdc.gov/safehealthcare/
the CDC and the Safe Injection Practices Coalition reveal a suite of new
materials to make it easier for doctors, nurses, and other healthcare
providers to learn about and follow safe injection practices.

Bloodborne Pathogen + Safe Patient Injections Training Presentation
http://www.oneandonlycampaign.org/content/bloodborne-pathogens-training

“How to do it Right” Animated Video http://youtu.be/6D0stMoz80k

Materials Demonstrating Proper Use of Injection Devices to Give Diabetes
Medication (poster and brochure)

Digital Press Kit (including an infographic, a podcast, fact sheets, and
backgrounder) http://www.oneandonlycampaign.org/digital-press-kit

Clinicians want to protect their patients and provide the best care
possible – requiring that everyone on the staff is educated about and is
following safe injection practices is an essential step toward this goal.
Please review these materials and share them widely with clinical and
training colleagues. Please leave feedback in the comments so we can
incorporate your thoughts into updated versions of these materials.

Join the conversation at http://blogs.cdc.gov/safehealthcare/
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Incidence of occupational exposures in a tertiary health care
center
__________________________________________________________________
Indian J Sex Transm Dis. 2012 Jul;33(2):91-7.

Incidence of occupational exposures in a tertiary health care center.

Shriyan A, Roche R, Annamma.

Department of Microbiology, A. J. Institute of Medical Sciences, Kuntikan,
Mangalore, Karnataka, India.

INTRODUCTION: Occupational exposure to Hepatitis B virus (HBV), human
immunodeficiency virus (HIV) and Hepatitis C virus (HCV) infection is a
cause of concern to all health care workers (HCWs), especially those, in
hospitals. Among the HCWs, nurses, interns, technicians, resident doctors
and housekeeping staff have the highest incidence of occupational exposure.

AIMS: To analyze the cases of needle stick injuries and other exposures to
patient’s blood or body fluids among health care workers.

MATERIALS AND METHODS: A detailed account of the exposure is documented
which includes incidence of needle stick injuries (NSI) and implementation
of post-exposure prophylaxis (PEP) as per the hospital guidelines. We
report a two-year continuing surveillance study where 255 health care
workers (HCWs) were included. PEP was given to HCWs sustaining NSI or
exposures to blood and body fluids when the source is known sero-positive
or even unknown where the risk of transmission is high. Follow-up of these
HCW’s was done after three and six months of exposure.

RESULTS: Of the 255 HCWs, 59 sustained needle stick injuries and two were
exposed to splashes. 31 of the NSI were from known sources and 28 from
unknown sources. From known sources, thirteen were seropositive; seven for
HIV, three for HCV and three for HBV. Nineteen of them sustained needle
stick during needle re-capping, six of them during clean up, six of them
while discarding into the container, 17 during administration of injection,
eight of them during suturing, two occurred in restless patient, 17 during
needle disposal.

CONCLUSION: So far, no case of sero-conversion as a result of needle stick
injuries was reported at our center.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505302/
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Screening for the hepatitis C virus in some dental clinics in
Alexandria, Egypt
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23196884

J Egypt Public Health Assoc. 2012 Dec;87(5-6):109-15.

Screening for the hepatitis C virus in some dental clinics in Alexandria,
Egypt.

Hashish MH, Selim HS, Elshazly SA, Diab HH, Elsayed NM.

aDepartment of Microbiology, High Institute of Public Health bDepartment of
Oral Medicine, Faculty of Dentistry, Alexandria University, Alexandria,
Egypt.

BACKGROUND/OBJECTIVES: Individuals can be exposed to the hepatitis C virus
(HCV) infection through inadequately or improperly sterilized medical or
dental equipment. The aim of this study was to detect HCV RNA in the dental
setting in Alexandria, Egypt.

MATERIALS AND METHODS: The study included 100 samples collected from five
dental clinics (A-E) in Alexandria. The samples were collected from
critical, semicritical, and noncritical instruments during different
periods of the day (morning, mid- day, end of the day). Samples were
subjected to a reverse transcriptase-PCR for the detection of HCV RNA.

RESULTS: HCV RNA was detected in 18% (18 out of 100) of the instrument
samples tested. Two positive HCV RNA samples were collected from
semicritical instruments in clinic B, whereas 16 positive HCV RNA samples
were collected from clinic D (eight samples from critical, six samples from
semicritical, and two samples from noncritical instruments). There was a
statistically significant difference between clinics B and D in terms of
the samples collected in the morning and those collected at the end of the
day. CONCLUSION AND RECOMMENDATIONS:

HCV RNA as detected by PCR was found in a considerable percent of
instruments’ samples (18%). Most of the positive HCV RNA samples (16 out of
18 samples) obtained from instruments were among those collected from
clinic D. This clinic used only glutaraldehyde as a method of
sterilization. Therefore, proper infection control measures, including
sterilization and disinfection should be strictly adopted.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Prevalence and Risk Factors for Hepatitis C Virus, Hepatitis B
Virus, and Human Immunodeficiency Virus in Transfused Children in
Kinshasa
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23180402

Indian J Pediatr. 2012 Nov 24.

Prevalence and Risk Factors for Hepatitis C Virus, Hepatitis B Virus, and
Human Immunodeficiency Virus in Transfused Children in Kinshasa.

Katabuka M, Mafuta ME, Ngoma AM, Beya PM, Yuma S, Aketi L, Kayembe KP, Gini
JR.

Department of Pediatrics, University of Kinshasa School of Medicine,
Kinshasa, Japan.

OBJECTIVE: To determine seroprevalence of hepatitis C virus (HCV), human
immunodeficiency virus (HIV), and hepatitis B virus (HBV) and associated
factors among transfused children.

METHODS: A multicenter cross-sectional study of transfused children aged
between 18 mo and 13 y old was conducted in 4 hospitals in Kinshasa. Blood
samples were collected for the detection of Hepatitis B surface antigen
(HBsAg) and antibodies to HCV, HIV 1and 2.

RESULTS: A total of 177 (47.7 %) boys and 194 (52.3 %) girls participated
in the study. The median age was 59.5 mo (Interquartile range IQR?=?60.6).
The prevalence rates of HCV, HBV, and HIV infection were 13.5 %, 1.6 %, and
1.3 %, respectively. Frequency of transfusion events were significantly
associated with HCV (p?<?0.001) and HIV (p?<?0.05) infections.

CONCLUSIONS: HCV infection was by far more frequently identified than HBV
and HIV infections among Congolese transfused children. Frequency of
transfusion events was the only significant risk factor associated with HCV
and HIV infections but not for HBV.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Crossing the quality chasm in resource-limited settings

Crossposted with thanks from the PAHO/WHO Equity
http://listserv.paho.org/Archives/equidad.html
__________________________________________________________________

Globalization and Health 2012, 8:41 Published: 30 November 2012

Crossing the quality chasm in resource-limited settings

Duncan Smith-Rohrberg Maru, Jason Andrews, Dan Schwarz, Ryan Schwarz,
Bibhav Acharya, Astha Ramaiya, Gregory Karelas, Ruma Rajbhandari, Kedar
Mate and Sona Shilpakar

Over the last decade, extensive scientific and policy innovations have
begun to reduce the “quality chasm” – the gulf between best practices and
actual implementation that exists in resource-rich medical settings.
While limited data exist, this chasm is likely to be equally acute and
deadly in resource-limited areas. While health systems have begun to be
scaled up in impoverished areas, scale-up is just the foundation necessary
to deliver effective healthcare to the poor.

This perspective piece describes a vision for a global quality improvement
movement in resource-limited areas.

The following action items are a first step toward achieving this vision:

1) revise global health investment mechanisms to value quality;
2) enhance human resources for improving health systems quality;
3) scale up data capacity;
4) deepen community accountability and engagement initiatives;
5) implement evidence-based quality improvement programs;
6) develop an implementation science research agenda.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Public health issues of hepatitis C virus infection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23199497

Best Pract Res Clin Gastroenterol. 2012 Aug;26(4):371-80.

Public health issues of hepatitis C virus infection.

Papatheodoridis G, Hatzakis A.

2nd Department of Internal Medicine, Athens University Medical School,
Hippokration General Hospital, Athens, Greece; Hepatitis B & C Public
Policy Association, Greece.

Hepatitis C virus (HCV) is a leading cause of liver disease worldwide, as
130-170 million individuals are chronically infected and 350,000 patients
die every year from HCV infection. The HCV prevalence varies widely among
countries being highest in several African and Eastern Mediterranean
countries. The incidence of new HCV infections may be declining in
developed countries, but there is still a large reservoir of chronic
infections.

The most important mode of HCV transmission has been injecting drug use in
developed countries with low prevalence and unsafe therapeutic injections
in developing countries with moderate-high prevalence. Since there are no
systematic screening policies, most patients remain undiagnosed. Even among
diagnosed patients, a minority receives treatment due to several barriers
to therapy.

Given the high efficacy of treatment, public health authorities should
recognise the importance of HCV and make resources available for the
implementation of effective primary prevention, screening and management
policies.

Copyright © 2012 Elsevier Ltd. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Global epidemiology of hepatitis C virus infection: New
estimates of age-specific antibody to hepatitis C virus seroprevalence
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23172780

Hepatology. 2012 Nov 21.

Global epidemiology of hepatitis C virus infection: New estimates of age-
specific antibody to hepatitis C virus seroprevalence.

Hanafiah KM, Groeger J, Flaxman AD, Wiersma ST.

Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe Street,
Baltimore, MD 21205.

In efforts to inform public health decision makers, the Global Burden of
Diseases, Injuries and Risk Factors 2010 (GBD2010) Study aims to estimate
the burden of disease using available parameters. This study was conducted
to collect and analyze available prevalence data to be used for estimating
hepatitis C burden of disease.

In this systematic review, antibody to hepatitis C virus (anti-HCV)
seroprevalence data from 232 articles were pooled to estimate age-specific
seroprevalence curves in 1990 and 2005, and to produce age-standardized
prevalence estimates for each of 21 GBD regions using a model based meta-
analysis.

This review finds that globally, the prevalence and number of people with
anti-HCV has increased from 2.3% (95% UI: 2.1-2.5%) to 2.8% (95% UI:
2.6-3.1%) and >122 million to >185 million between 1990 and 2005.

Central and East Asia and North Africa/Middle East are estimated to have
high prevalence (>3.5%);

South and Southeast Asia, sub-Saharan Africa, Andean, Central, and Southern
Latin America, Caribbean, Oceania, Australasia and Central, Eastern and
Western Europe have moderate prevalence (1.5-3.5%);

while Asia Pacific, Tropical Latin America, and North America have low
prevalence (<1.5%).

Conclusion: The high prevalence of global HCV infection necessitates
renewed efforts in primary prevention, including vaccine development, as
well as new approaches to secondary and tertiary prevention to reduce the
burden of chronic liver disease and to improve survival of those who
already have evidence of liver disease.

Copyright © 2012 American Association for the Study of Liver Diseases.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: The cost of providing primary health-care services from a
needle and syringe program: A case study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23194468

Drug Alcohol Rev. 2012 Nov 29.

The cost of providing primary health-care services from a needle and
syringe program: A case study.

Islam MM, Shanahan M, Topp L, Conigrave KM, White A, Day CA.

School of Public Health and Community Medicine, University of New South
Wales, Sydney, Australia; Drug Health Service, Royal Prince Alfred
Hospital, Sydney, Australia.

INTRODUCTION AND AIMS: Targeted primary health-care services for injecting
drug users have been established in several countries to reduce barriers to
health care, subsequent poor health outcomes and the considerable costs of
emergency treatment. The long-term sustainability of such services depends
on the resources required and the coverage provided. This study assesses
the additional cost required to operate a nurse-led primary health care in
an existing needle syringe program setting, estimates the costs per
occasion of service and identifies key factors influencing improved service
utilisation.

DESIGN AND METHODS: Using standard costing methods and the funder
perspective, this study estimates costs using the ‘ingredients’ approach
where the costs of inputs are based on quantities and unit prices (the
ingredients).

RESULTS: During the 2009-2010 fiscal year, the primary health-care clinic
provided 1252 occasions of service to 220 individuals, who each made an
average of 3.9 presentations. A total cost of AU$250?626 was incurred, 69%
of which was for personnel and 22% for pathology. During the study period
the average cost per occasion of service was AU$199.96, which could be as
low as AU$93.32 if the clinic reached its full utilisation level.

DISCUSSION AND CONCLUSIONS: Although the average number of presentations
per client was satisfactory, the clinic was underutilised during the study
period. Proactive engagement of clients at the needle syringe program
shopfront and an increased range of services offered by the clinic may help
to attract more clients.

© 2012 Australasian Professional Society on Alcohol and other Drugs.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Developing effective health interventions for women who
inject drugs: key areas and recommendations for program development and
policy
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23198158

Adv Prev Med. 2012;2012:269123.

Developing effective health interventions for women who inject drugs: key
areas and recommendations for program development and policy.

Pinkham S, Stoicescu C, Myers B.

Department of Slavic Languages, Columbia University, 1130 Amsterdam Avenue,
Mail Code 2839, New York, NY 10027, USA.

Women who inject drugs face multiple gender-specific health risks and
barriers to healthcare access. These gendered factors may contribute to
elevated rates of HIV for this population.

Though few countries systematically collect gender-disaggregated data
related to injecting drug use, evidence indicates that there are large
populations of women who inject drugs and who are in need of improved
health services, including HIV prevention. Research on the effectiveness of
interventions specifically tailored for women who inject drugs, along with
the experience of programs working with this subpopulation, suggests that
HIV risk practices need to be addressed within the larger context of
women’s lives.

Multifaceted interventions that address relationship dynamics, housing,
employment, and the needs of children may have more success in reducing
risky practices than interventions that focus exclusively on injecting
practices and condom use.

Improved sexual and reproductive healthcare for women who use drugs is an
area in need of development and should be better integrated into basic harm
reduction programs.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3501794/
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Compliance of healthcare professionals with safety measures
for control of hepatitis viruses in hemodialysis centers: an experience
from southeast iran
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23198145

Hepat Res Treat. 2012;2012:415841.

Compliance of healthcare professionals with safety measures for control of
hepatitis viruses in hemodialysis centers: an experience from southeast
iran.

Darvish Moghaddam S, Zahedi MJ, Dalili M, Shokoohi M.

Physiology Research Center, Department of Internal Medicine, Kerman
University of Medical Sciences, Kerman 7616913911, Iran.

Introduction. Noncompliance with the recommended infection control measures
by the healthcare professionals (HCPs) plays a major role in transmission
of hepatitis B (HBV) and hepatitis C (HCV) viruses in hemodialysis (HD)
wards. This study aimed to determine the compliance rate of the HCP with
safety measures in the HD wards in southeast Iran. Patients and Methods. A
total of 208 patients were enrolled. Adherence of HCPs with standard
infection control measures was assessed.

Results. Sixty-one HCPs with a
mean age of 32.4 ± 11.2 years old were responsible for healthcare services.
Compliance with the following items was weak: not sharing medications
trolley (29.8%), disinfecting the shared instruments (46.2%), using single
use materials for many patients (52.4%), carrying used materials in
disposable containers (51.9%), not returning of unused materials to the
clean room (55.3%), and adherence to hand washing (58.7%). Periodic
monitoring for HBV and HCV was performed on 100% and 69.7% of the patients,
respectively. Less than 2/3 of HCPs participated in the retraining courses.

Conclusion. Compliance of HCPs with safety measures for viral hepatitis
prevention was partly inadequate in HD wards. Emphasis on retraining of
HCPs and official supervision would be effective steps in the reduction of
viral dissemination.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3503279/
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Safe administration of the seasonal trivalent influenza
vaccine to children with severe egg allergy
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23176882

Ann Allergy Asthma Immunol. 2012 Dec;109(6):426-30.

Safe administration of the seasonal trivalent influenza vaccine to children
with severe egg allergy.

Greenhawt MJ, Spergel JM, Rank MA, Green TD, Masnoor D, Sharma H, Bird JA,
Chang JE, Sinh D, Teich E, Kelso JM, Sanders GM.

Division of Allergy and Clinical Immunology, University of Michigan Medical
School, University of Michigan Health System, Ann Arbor, Michigan.
Electronic address: mgreenha@med.umich.edu.

BACKGROUND: Anaphylaxis to egg or severe egg allergy has been considered a
contraindication to receiving trivalent seasonal influenza vaccine (TIV).

OBJECTIVE: To evaluate the safety of TIV among severely egg allergic
children.

METHODS: A 2-phase, multicenter study at 7 sites was conducted between
October 2010 and March 2012. Inclusion criteria included a history of a
severe reaction, including anaphylaxis, to the ingestion of egg and a
positive skin test result or evidence of serum specific IgE antibody to
egg. Phase 1 consisted of a randomized, prospective, double-blind, placebo
controlled trial of TIV administration to egg allergic children, using a 2-
step approach; group A received 0.1 mL of influenza vaccine, followed in 30
minutes if no reaction with the remainder of an age-appropriate dose,
whereas group B received an injection of normal saline followed in 30
minutes if no reaction with the full 100% of the age-appropriate dose.
Phase 2 was a retrospective analysis of single dose vs split-dose
administration of TIV in eligible study participants who declined
participation in the randomized controlled trial.

RESULTS: Thirty-one study participants were prospectively evaluated in the
randomized controlled trial (group A, 14; group B, 17); 45.1% had a history
of anaphylaxis after egg ingestion. A total of 112 participants were
retrospectively evaluated (87 with the single dose and 25 with the split
dose); 77.6% of participants had a history of anaphylaxis after egg
ingestion. All participants in both phases received TIV without developing
an allergic reaction.

CONCLUSION: TIV administration is safe even in children with histories of
severe egg allergy. Use of 2-step split dosing appears unnecessary because
a single dose was well tolerated.

Copyright © 2012 American College of Allergy, Asthma & Immunology.
Published by Elsevier Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Fear of repeated injections in children younger than 4 years
receiving subcutaneous allergy immunotherapy
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23176889

Ann Allergy Asthma Immunol. 2012 Dec;109(6):465-9.

Fear of repeated injections in children younger than 4 years receiving
subcutaneous allergy immunotherapy.

de Vos G, Shankar V, Nazari R, Kooragayalu S, Smith M, Wiznia A,
Rosenstreich D.

Albert Einstein College of Medicine, New York, New York. Electronic
address: gabriele.de-vos@einstein.yu.edu.

BACKGROUND: Allergy immunotherapy during early childhood may have potential
benefits for the prevention of asthma and allergy morbidity. However,
subcutaneous immunotherapy has not yet been prospectively researched in
children younger than 4 years, primarily because of safety concerns,
including the fear and psychological distress young children may experience
with repeated needle injections.

OBJECTIVE: To quantify fear in atopic children younger than 4 years with a
history of wheezing who are receiving subcutaneous immunotherapy.

METHODS: Fear of injection was graded during a total of 788 immunotherapy
injection visits in 18 children (age, 37 months; SD, 9 months) receiving
subcutaneous allergy immunotherapy. The parent and the injection nurse
assigned fear scores on a scale of 0 to 10 after each injection visit.

RESULTS: At the time of analysis, children had a median of 49 injection
visits (range, 12-88) during a median study period of 81.5 weeks (range,
15-165 weeks). Fifteen children (83%) lost their fear of injections during
the study. A fear score of 0 was achieved after a mean of 8.4 visits (SD,
7.4). The more injection visits were missed, the more likely children were
to retain fear of injections (hazard ratio, 0.13; 95% confidence interval,
0.02-1.02; P=.05). Age, adverse events, number of injections at each visit,
and change of injection personnel were not associated with increased fear.

CONCLUSION: Our analysis suggests that most children receiving weekly
subcutaneous immunotherapy lose their fear of injections during the
treatment course. Children with increased intervals between visits may be
at higher risk of experiencing fear of injections.

CLINICAL TRIAL REGISTRATION: clinicaltrial.gov identifier NCT01028560.

Copyright © 2012 American College of Allergy, Asthma & Immunology.
Published by Elsevier Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Viremic profiles in asymptomatic and symptomatic chikungunya
fever: a blood transfusion threat?
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23176378

Transfusion. 2012 Nov 26.

Viremic profiles in asymptomatic and symptomatic chikungunya fever: a blood
transfusion threat?

Appassakij H, Khuntikij P, Kemapunmanus M, Wutthanarungsan R, Silpapojakul
K.

Department of Pathology and the Department of Medicine, Faculty of
Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand; Bureau
of Epidemiology, Department of Disease Control, Ministry of Public Health,
Nonthaburi, Thailand.

BACKGROUND: The presence of a chikungunya virus (CHIKV) outbreak could have
an impact on transfusion safety when there are a large number of infected
persons during an epidemic. Serosurveys have found that 3% to 28% of
infected persons remain asymptomatic and are potential disseminators of
transfusion-associated chikungunya. However, the viremic profiles of
asymptomatic chikungunya patients, the major determinant of the transfusion
risk, are unknown.

STUDY DESIGN AND METHODS: Data on CHIKV viremic profiles were obtained from
a case-control study carried out in a chikungunya-affected area during the
2009 epidemic in Songkhla, Thailand. CHIKV-infected individuals were
classified based on a combination of the patient’s history and clinical and
laboratory findings.

RESULTS: There were 134 laboratory-proven CHIKV-infected cases, of whom 122
(91.0%) were symptomatic and 12 (9.0%) were asymptomatic. The viremic
levels in the symptomatic infected individuals peaked on the first 3 days
and lasted up to 8 days as defined by viral isolates. CHIKV genomic
products were detected as late as Day 17 of illness. The viral loads
observed in the symptomatic individuals (median, 5.6?×?10(5) plaque-forming
units per milliliter [pfu/mL]; range, 1.3?×?10(1) -2.9?×?10(8) ?pfu/mL)
were higher than but not significantly different from those observed in the
viremic asymptomatic individuals (median, 3.4?×?10(3) ?pfu/mL; range,
8.4?×?10(1) -2.9?×?10(5) ?pfu/mL [p?=?0.22, Wilcoxon test]).

CONCLUSION: CHIKV infection is highly symptomatic and is associated with
high-titred viremia. The viremic levels in asymptomatic CHIKV-infected
individuals were in the range known to be capable of transmitting the
disease to experimental animals. Asymptomatic CHIKV viremia individuals
could be potential disseminators of transfusion-associated chikungunya.

© 2012 American Association of Blood Banks.
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Environment cleaning without chemicals in clinical settings
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23177456

Am J Infect Control. 2012 Nov 21. pii: S0196-6553(12)00931-5.

Environment cleaning without chemicals in clinical settings.

Gillespie E, Wilson J, Lovegrove A, Scott C, Abernethy M, Kotsanas D,
Stuart RL.

Southern Health, Infection Control and Epidemiology Unit, Victoria,
Australia. Electronic address: elizabeth.gillespie@southernhealth.org.

Effective cleaning of elements in the health care environment has a crucial
role in reducing the risk of health care-acquired infection. We assessed
ultramicrofiber cloth and steam technology in 2 clinical settings.

This new technology performed extremely well.

Our pilot study supports using ultramicrofiber cloth and steam technology
as an alternative to cleaning with chemicals.

Copyright © 2012 Association for Professionals in Infection Control and
Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Water quality key to protecting patients
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23193926

Health Estate. 2012 Nov;66(10):54-60.

Water quality key to protecting patients.

Pearson S.

According to David Graham of the Scottish National Blood Transfusion
Service (SNBTS), “the importance of the safe diagnosis and treatment of
patients cannot be overstated – yet the role played by water quality in
patient safety has sometimes been under-stated”.

David Graham was speaking
at a one day Pall Medical-sponsored meeting on the prevention and control
of healthcare-associated waterborne infections in healthcare facilities
held in Edinburgh earlier this year. David Graham, other speakers, and the
chair, Consultant Microbiologist and Infection Prevention and Control
Doctor for NHS Grampian,

Dr Anne Marie Karcher, stressed that good quality
water is essential in healthcare premises to prevent the potentially
catastrophic consequences of contaminated water for some patients. Susan
Pearson BSc reports.
__________________________________________________________________
________________________________*_________________________________

17. Abstract: The role of ‘no-touch’ automated room disinfection systems in
infection prevention and control
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23195691

J Hosp Infect. 2012 Nov 26. pii: S0195-6701(12)00336-2.

The role of ‘no-touch’ automated room disinfection systems in infection
prevention and control.

Otter JA, Yezli S, Perl TM, Barbut F, French GL.

Centre for Clinical Infection and Diagnostics Research (CIDR), Department
of Infectious Diseases, King’s College London, School of Medicine and Guy’s
and St Thomas’ NHS Foundation Trust, UK; Bioquell UK Ltd, Andover,
Hampshire, UK. Electronic address: jon.otter@bioquell.com.

BACKGROUND: Surface contamination in hospitals is involved in the
transmission of pathogens in a proportion of healthcare-associated
infections. Admission to a room previously occupied by a patient colonized
or infected with certain nosocomial pathogens increases the risk of
acquisition by subsequent occupants; thus, there is a need to improve
terminal disinfection of these patient rooms. Conventional disinfection
methods may be limited by reliance on the operator to ensure appropriate
selection, formulation, distribution and contact time of the agent. These
problems can be reduced by the use of ‘no-touch’ automated room
disinfection (NTD) systems.

AIM: To summarize published data related to NTD systems.

METHODS: Pubmed searches for relevant articles.

FINDINGS: A number of NTD systems have emerged, which remove or reduce
reliance on the operator to ensure distribution, contact time and process
repeatability, and aim to improve the level of disinfection and thus
mitigate the increased risk from the prior room occupant. Available NTD
systems include hydrogen peroxide (H(2)O(2)) vapour systems, aerosolized
hydrogen peroxide (aHP) and ultraviolet radiation. These systems have
important differences in their active agent, delivery mechanism, efficacy,
process time and ease of use. Typically, there is a trade-off between time
and effectiveness among NTD systems. The choice of NTD system should be
influenced by the intended application, the evidence base for
effectiveness, practicalities of implementation and cost constraints.

CONCLUSION: NTD systems are gaining acceptance as a useful tool for
infection prevention and control.

Copyright © 2012 The Healthcare Infection Society. Published by Elsevier
Ltd. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

18. Abstract: Pocketed microneedles for rapid delivery of a liquid-state
botulinum toxin A formulation into human skin
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23178949

J Control Release. 2012 Nov 23. pii: S0168-3659(12)00806-1.

Pocketed microneedles for rapid delivery of a liquid-state botulinum toxin
A formulation into human skin.

Torrisi BM, Zarnitsyn V, Prausnitz MR, Anstey A, Gateley C, Birchall JC,
Coulman SA.

School of Pharmacy and Pharmaceutical Sciences, Cardiff University,
Cardiff, CF10 3NB, UK.

Botulinum toxin A (BT) is used therapeutically for the treatment of primary
focal hyperhidrosis, a chronic debilitating condition characterised by
over-activity of the eccrine sweat glands. Systemic toxicity concerns
require BT to be administered by local injection, which in the case of
hyperhidrosis means multiple painful intradermal injections by a skilled
clinician at 6-monthly intervals.

This study investigates the potential of a liquid-loaded pocketed
microneedle device to deliver botulinum toxin A into the human dermis with
the aim of reducing patient pain, improving therapeutic targeting and
simplifying the administration procedure.

Initially, ß-galactosidase was employed as a detectable model for BT to (i)
visualise liquid loading of the microneedles, (ii) determine residence time
of a liquid formulation on the device and (iii) quantify loaded doses. An
array of five stainless steel pocketed microneedles was shown to possess
sufficient capacity to deliver therapeutic doses of the potent BT protein.
Microneedle-mediated intradermal delivery of ß-galactosidase and
formaldehyde-inactivated botulinum toxoid revealed effective deposition and
subsequent diffusion within the dermis.

This study is the first to characterise pocketed microneedle delivery of a
liquid formulation into human skin and illustrates the potential of such
systems for the cutaneous administration of potent proteins such as BT.

A clinically appropriate microneedle delivery system for BT could have a
significant impact in both the medical and cosmetic industries.

Copyright © 2012. Published by Elsevier B.V.
__________________________________________________________________
________________________________*_________________________________

19. News

– Pakistan: WHO report on Aids Day: Pakistan ill-prepared to check HIV
spread
– UN: UNDP Delivers On Full Transparency Pledge
– USA/Global: Secretary Clinton Unveils Blueprint For Achieving ‘AIDS-Free
Generation’
– Clean Syringe Exchange Program: keeping dirty needles off the streets
– Canada: Quebec man who put dirty needles in garments jailed 4 years
– Judge takes into account ‘state of terror’ caused in Sherbrooke
– Canada: Hema-Quebec issues blood alert
– Canada: Clean needle distribution stems health concerns
– Devices: Microneedle Patch Could Boost Immunization Programs

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
http://tinyurl.com/aty7ugw

Pakistan: WHO report on Aids Day: Pakistan ill-prepared to check HIV spread
Dawn.com Newspaper, Pakistan (01.12.12)

ISLAMABAD, Nov 30: As World Aids Day is being observed on Saturday, World
Health Organisation (WHO) has expressed concern that Pakistan has high
rates of unscreened blood transfusions and a very high demand for
therapeutic injections and poor infection control practices in hospitals
and clinics nationwide.

“This has led to transmission of infection through unscreened blood
transfusions, or re-use of syringes or use of un-sterilised medical
equipment,” the World Health Organisation said in a statement on World Aids
Day.

This year’s theme is: “Getting to Zero: Zero new HIV infections, Zero
deaths from Aids-related illness, Zero discrimination.”

This sounds difficult but is achievable keeping in view the fact that
antiretroviral medicines used for the treatment of HIV and Aids reduce the
amount of virus in the blood which increases the chance they will stay
healthy and decreases the risk they can pass the virus to someone else.

In Pakistan, HIV epidemic is in its second stage (concentrated epidemic)
meaning that the prevalence in traditional risk groups has exceeded five
per cent. Within the country two groups have surpassed this threshold:
injecting drug users (27 per cent) and transgender (6 per cent) sex
workers.

Of the estimated 150,000 injecting drug users nationwide, according to
national surveillance data, rates of infection range from 15 per cent to 50
per cent in most major cities of Pakistan including Sarghoda, Faisalabad,
Peshawar, Quetta, Karachi, Larkana, Hyderabad, Mandi Bahauddin and
Lahore.In addition, there has been “mini-outbreaks of HIV epidemics” in
rural communities like Jalal Pur Jattan, district Gujrat as a results of
alarming overlap between injecting drug use, unsafe hospital infection
control practices/therapeutic injections and commercial sex.

According to latest figures, the number of HIV positives in 2009 is around
98,000 cases in Pakistan with an overall general population prevalence of
0.05 per cent while 5,800 died due to Aids.

Since 1987, when first case was reported in Lahore, the spread has been
progressive from low prevalence to a more concentrated epidemic in the high
risk groups.

According to WHO, there are 17 HIV surveillance centres functioning all
over the country providing free antiretroviral medicines and diagnostics
free of cost and in some centres the analysis of the data shows more than
95 per cent success rate. This is a significant achievement which is now
mainly supported by Global Fund.

Meanwhile, Pakistans Global Aids Response Progress Report 2012 confirms
that HIV prevalence among continues to rise in 19 cities of the country.

Official sources told Dawn that a new Aids strategy was being evolved by
the government. Due to devolution, each province was developing its own
provincial aids strategy tailored to their specific context.

The main goal of 2012-16 strategy will have three main goals: to increase
the quality of coverage of HIV prevention services; diagnostic, treatment,
care and support service; and to improve response management at national,
provincial and local levels.

According to the national report, the decentralisation of the health
ministry from the national to the provincial levels necessitates advocacy
for sustained domestic resources at provincial and district levels.
__________________________________________________________________
__________________________________________________________________
www.devex.com/en/news/blogs/undp-delivers-on-full-transparency-pledge

UN: UNDP Delivers On Full Transparency Pledge
Eliza Villarino, DEVEX (30.11.12)

The United Nations Development Program has made details on thousands of its
projects — and their outcomes — available to the public, through its new
portal, open.undp.org.

Launched Nov. 29, the portal embodies the fulfillment of UNDP’s commitment
to full transparency by 2013 “above and beyond international standards,”
according to the agency.

The site features comprehensive information, including income, expenses,
activities and results, on more than 6,000 active projects in 177 countries
and territories, along with those financially closed in 2011. And beginning
2013, UNDP will publish updates on its ongoing development projects
quarterly.

With the move, UNDP lives to its reputation as a transparency champion. It
is a founding member of the International Aid Transparency Initiative and
part of the IATI Secretariat.

UNDP’s efforts have not gone unnoticed. In an index released early last
month, the agency ranked 10th among 72 funding organizations assessed by
Publish What You Fund, moving from a grade of “fair” in 2011 to “good” in
2012.

“We are committed to working in the open, and we will continue improving
the quality, quantity, and timeliness of our reporting so that our partners
can monitor their investments in fighting poverty, supporting human
development, and securing a sustainable future for all,” said UNDP
Administrator Helen Clark.

The UNDP is also considered a trailblazer on the issue among U.N. agencies,
some of whom have long drawn criticism for their lack of openness.

But the transparency movement appears to have caught on within the U.N.
system. In June, UNICEF announced it will publish all its audit reports on
the Internet starting later this year.

Read more development aid news online, and subscribe to The Development
Newswire to receive top international development headlines from the
world’s leading donors, news sources and opinion leaders — emailed to you
FREE every business day. https://www.devex.com/en
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/d4nbz9f

USA/Global: Secretary Clinton Unveils Blueprint For Achieving ‘AIDS-Free
Generation’
The Kaiser Daily Global Health Policy Repor (30.11.12)

“Secretary of State Hillary Clinton on Thursday unveiled a game plan for
achieving a global ‘AIDS-free generation,’ committing the United States to
rapidly scaling up medical interventions that are beating back what once
was seen as an unconquerable disease,” Reuters reports (Quinn, 11/29).
“Clinton announced the plan, officially titled the ‘President’s Emergency
Plan for AIDS Relief (PEPFAR) Blueprint: Creating an AIDS-free Generation,’
[.pdf] at the State Department, two days ahead of World AIDS Day,” CNN
notes (Ariosto, 11/29).
http://www.pepfar.gov/documents/organization/201386.pdf

The 54-page blueprint — “immediately welcomed by AIDS researchers and
advocates” — aims “to treat as many people as possible, both to keep them
well and to help keep them from infecting others” and will target high-risk
populations, such as drug users, gay men, and sex workers, NBC News’
“Vitals” blog writes. The blog notes Clinton released new PEPFAR data
(.pdf) showing the program has provided antiretroviral treatment to more
than five million people worldwide (Fox, 11/29).

“The report from [PEPFAR] states that the world is at a ‘tipping point’ on
AIDS, and promises to usher in a generation free of the disease,” The
Hill’s “Healthwatch” blog states (Viebeck, 11/29). Once the number of
people on treatment surpasses the number of new infections every year, “[w]
e will then get ahead of the pandemic and an AIDS-free generation will be
in our sight,” Clinton said, Politico Pro reports (Smith, 11/29). The
Washington Post adds, “But she warned: ‘Now we have to deliver. … The
history of global health is littered with grand plans that never panned
out'” (Brown, 11/29).

“The blueprint has been masterminded by the [U.S. Global AIDS Coordinator
Ambassador Eric Goosby], and the executive director of [UNAIDS], Michel
Sidibe,” the Guardian notes, adding, “It focuses on four themes: taking
immediate action to save lives; improving the efficiency of health
investments; sharing responsibilities with other countries; and exploiting
scientific progress” (Boseley, 11/29).

“The document consists of a series of ‘roadmaps’ enumerating more specific
goals and implementation steps,” CQ HealthBeat reports (Reichard, 11/29).
According to Agence France-Presse, under the roadmap, the U.S. will “work
towards the elimination of new HIV infections in children by 2015”;
“increase its coverage of HIV treatment to cut the number of deaths from
AIDS and boost HIV prevention”; “increase the numbers of men that get
circumcisions”; and “step up access to testing and counseling, as well as
to condoms and other prevention methods” (11/29). The “document and an
additional fact sheet use existing country data to show what the plan can
accomplish,” the Center for Global Health Policy’s “Science Speaks” blog
states (Barton, 11/29).

The plan “outlines how progress could continue at current spending levels
— something far from certain as Congress and Obama struggle to avert
looming budget cuts at year’s end — or how faster progress is possible
with stepped-up commitments from hard-hit countries themselves,” the
Associated Press writes (Neergaard, 11/29). However, the Washington Post
notes, the document “contains no specific targets or a schedule for
achieving” its goals (11/29).

For more information on the blueprint for achieving an “AIDS-free
generation,” visit the Kaiser Family Foundation’s “Policy Tracker.”
http://tinyurl.com/akld6cb
__________________________________________________________________
__________________________________________________________________
Clean Syringe Exchange Program: keeping dirty needles off the streets
By Neal Putnam, LGBT Weekly Around the City, (29.11.12)

“Can you imagine what a pile of 1.8 million dirty syringes would look
like?”

That was the question posed by the City’s emergency medical director, James
Dunford, regarding the City’s Clean Syringe Exchange Program that he
chairs, and he told the recent Public Safety and Neighborhood Services
Committee his own answer.

“That’s what we have been able to keep off the streets in San Diego,” said
Dunford, referring to the total number of dirty needles the program has
received since its start in 2001.

A non-descript mobile van accepts dirty syringes from drug addicts in
downtown and North Park once a week and also gives out clean needles in
exchange. Addicts are given referrals for drug treatment, detoxification
services, mental health and other medical problems.

“Our conclusion is this is successful as a public health and safety
strategy that has been shown to be helpful,” said Dunford.

“Even if you don’t like the part of trading needles, you have to realize
what we’re really doing is a come on,” said Dunford. “It’s a come on, a
gateway to refer people to drug treatment, HIV counseling, referring people
to health care and other services.”

Dunford and other officials from the Family Health Centers, which
administers the program, presented their findings to the committee as part
of its annual report.

The report says nine out of every 10 clients are given referrals to drug
treatment or other types of programs which also include referrals for
shelter, food, clothing, Medi-Cal, HIV, hepatitis and STD screening. San
Diego has the third highest rate of HIV infection in the state, and last
year more than 2,000 people were diagnosed with Hepatitis C, which is
mostly contracted from using dirty needles.

Hepatitis C is the number one cause of liver cancer and the leading
condition requiring a liver transplant.

The report says 7,222 have died of AIDS in San Diego since 1981.
Approximately 23 percent of women with AIDS and 11-18 percent of men with
AIDS were infected through dirty needles, the report says.

One goal is to prevent accidental needle sticks by police and fire-rescue
personnel who interact with addicts who may have dirty syringes in their
pockets. Dirty needles have been found in sandboxes, trash bins, beaches
and off freeways.

The Clean Syringe Exchange Program is operated by the Family Health Centers
of San Diego, which is a non-profit community clinic organization.

Current funding comes from community development block grants, which are
approved by the City Council and private donors, such as the Human Dignity
Foundation and AIDS United.

Alliance Healthcare Foundation provided most of the funding in the first
decade of the program’s operations. The report says without their support,
the City “would likely not have” the program.

In the past, the City Council had to vote for a state of health emergency
due to the infections of HIV/AIDS and Hepatitis C in order to legally give
out clean needles in exchange for dirty ones. State legislation changed in
2006 allowing cities to operate such programs with only an initial
resolution.

No one spoke in opposition to the program and many praised it, such as
Third District Councilmember Todd Gloria who said he had visited the sites
where the needles were exchanged and clean ones given out.

“It’s very professionally run. It’s extremely discreet,” said Gloria.
“People are there, they get the (drug) referrals. You see people getting
referrals to hopefully break the cycle.”

“Since 2002, this program has accepted 180,000 more syringes than it
disbursed and has prevented more than 1.8 million syringes from improper
disposal,” said Gloria. “That’s public safety, ladies and gentlemen.” “If
we could just add the County to this growing list of supporters, it would
be even better,” said committee chairperson Marti Emerald. “That’s my soap
box comment for today.”

“The County remains opposed to this program, so we won’t see any funding
there,” said Ben Avey, the media relations manager for Family Health
Centers.

Councilmember Lorie Zapf asked why the County was opposed, and several
people said it was philosophical, but no one said the word political. All
five County supervisors are Republican since 1995, but Dave Roberts, a
Democrat, won the seat of retiring supervisor Pam Slater-Price Nov. 6.

“I understand the benefit of taking all these syringes out, especially when
so many are found, for example along the river … we don’t want these to
make their way down to the beaches and bays,” said Zapf, a Republican.

Though no one at the meeting expressed opposition, former Mayor Dick Murphy
was opposed to it because he said it encouraged illegal drug use. He
remained opposed to the program during his tenure from 2000 until he
resigned in 2005.

During the meeting, Gloria said other branches of government which oppose
the program are “ignoring science.”

“I know few things that save more money than keeping someone from
infectious disease. This is one way of doing that,” said Gloria.

The program operates with a facilitation committee whose members include
two public health experts, San Diego Association of Governments program
operator, people from the community and a San Diego Police officer in the
narcotic division.

The mayor appoints people to sit on the facilitation committee. The needle
exchanges take place in vans that meet downtown Thursday evenings and in
North Park Friday mornings. Some diabetics also dispose of their insulin
needles in the program.
__________________________________________________________________
__________________________________________________________________
Canada: Quebec man who put dirty needles in garments jailed 4 years
Judge takes into account ‘state of terror’ caused in Sherbrooke
CBC News Canada (29.11.12

The Sherbrooke, Que., man convicted of leaving bloody needles in garment
pockets in several clothing stores was sentenced to four years in prison on
Thursday.

In May, Claude Létourneau, 50, was charged with several counts of
aggravated assault, after DNA evidence taken from the syringes linked him
to the needles.

He pleaded not guilty to the charges in June.

He returned to court in July to face additional charges of aggravated
assault, theft and weapons possession. He faced a total of 32 charges.

Crown prosecutor Émilie Baril-Côté said Judge Conrad Chapdelaine took the
man’s criminal past into account in determining his sentence.

Chapdelaine said the needle incidents caused a “state of terror” in
Sherbrooke before Létourneau’s arrest.

A total of eight people have come forward saying they were pricked by
needles and have undergone testing.

A few of those individuals had to undergo therapy, but results showed they
were not infected with any disease.

Twenty-five needles have been found since January. The last needle was
found on May 24 at The Bay in Carrefour de l’Estrie, a shopping centre in
Quebec’s Eastern Townships.

Létourneau was arrested on May 31. He will remain in prison for another 42
months.

In June, police said bloody needles found in Lévis in 2002 were also linked
to Létourneau.
__________________________________________________________________
__________________________________________________________________
Canada: Hema-Quebec issues blood alert
By Trudie Mason, CJAD Canada (29.11.12)

Hema-Quebec has issued an alert to hospitals and blood banks across the
province about possibly contaminated blood products.

The agency has discovered that the bags containing the blood products may
have been punctured during the production process, creating a contamination
risk.

No contamination has been confirmed and the order to quarantine certain
stocks of blood while tests are conducted is being called precautionary by
Hema-Quebec. The order covers about 70-percent of the agency’s supply,
leaving only enough cleared supplies for emerency surgeries.

It is not yet clear how the recall may affect the surgical units of
hospitals in the Montreal area.
__________________________________________________________________
__________________________________________________________________
Canada: Clean needle distribution stems health concerns
Tyler Clarke, Prince Albert Daily Herald, Canada (27.11.12)

Even with a confirmed link between sharing needles and the spread HIV and
hepatitis C, giving away free needles results in mixed feelings from the
public.

Even with a confirmed link between sharing needles and the spread HIV and
hepatitis C, giving away free needles results in mixed feelings from the
public.

“They’re going to do it anyway, and before we started handing out needles,
they found needles,” case manager Megan Belanger said of drug users.
“Anyone can walk into a pharmacy and buy a standard insulin syringe.”

Belanger works alongside program co-ordinator Angie Sheppard at the
Straight to the Point Harm Reduction Program in Prince Albert — the city’s
needle exchange centre.

They see an average of about 60 people walk in the door per day to accept a
maximum of 20 clean needles and other necessary paraphernalia.

“You share a spoon, there’s just as much risk to get blood on the spoon as
there is sharing a syringe, which increases your risk of hepatitis C,”
Belanger said, explaining the inclusion of paraphernalia.

They give away as many as 20 needles per person, because they’re only used
once — not only to prevent being shared between more that one person, but
to prevent repeated with the individual, since needles dull and barb quite
easily, tearing up veins.

Although some people criticize the needle exchange as a means of enabling
drug use, it’s more about harm or risk reduction, Sheppard said.

“We always try to guide toward the harm reduction side,” she said. “If you
don’t want to be doing this, what else can you be doing?

“At least 20 times a day we ask, ‘have you thought of getting off this
stuff yet?’ They usually always say yes, they’ve thought about it.” Easier
said that done, she said.

Sincerely doubting anyone aspires to become a drug addict, it’s usually a
culmination of things that result in drug addiction.

“It’s social, so (it’s) how were they raised — learned behaviours,”
Sheppard said.

“A lot of times when you’re living in a low-income (situation), then if you
don’t have that helping hand to help you out you fall back to what you
know.”

For many people, it’s an endless cycle of prostitution to buy drugs and
taking drugs to live with prostitution, Belanger said.

“When you’re a 12, 13-year-old girl and your parents say ‘you have to go
work the streets because mama needs drugs,’ that’s what you’re going do,”
she said.

“The needles bring people into the door. After that, it’s up to us to build
a rapport and put them out toward people who can help them. They need
someone to connect the dots for them, give them the links to services.”

One service offered on-site is speedy HIV testing, with people given test
results within a half hour of walking through the front door.

A counsellor specializing in HIV is available to greet people after they
receive their test results.

“HIV is definitely the hugest concern that we have with these programs, and
we do see a lot of the reason behind the needle exchange program is trying
to cut down the HIV epidemic in Saskatchewan,” Belanger said.

Between 2005 and 2007 — the latest statistics made available – the Prince
Albert Parkland Health Region (PAPHR) reported between eight and nine new
cases of HIV attributed to injection drug use, per year.

There are an estimated 600 injection drug users in the PAPHR, which
operates the city’s needle exchange.

This number is lower in the winter and higher in the summer, following the
tide of transient community members, Belanger said.

About 627,000 needles were handed out in 2008, about 617,000 of which
returned to the exchange or deposited into drop boxes.

These are the latest numbers available, and are comparable to more recent
years, Belanger said.

During Canadian HIV/AIDS Awareness Week, which culminates with World Aids
Day on Saturday, the tidbit of awareness Belanger wants to make clear is
that the needle exchange program is a health issue, not a crime issue.

“Addictions is not a crime,” she said. “Addiction is a disease and it does
not discriminate.”

Technically, someone returning used syringes to the needle exchange could
find themselves in trouble with the law.

“That’s why you see needles on the street. People will see police and just
drop their needles so they don’t get charged,” Belanger said. “That’s
turning a health issue into a crime issue, right?”

Overhearing Belanger’s comments, a drug user picking up fresh needles
chimed in; “They help people from spreading disease. It saves people’s
lives.”
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/b4vuua9

Devices: Microneedle Patch Could Boost Immunization Programs
ScienceBlog.com (11/27/12)

Measles vaccine given with painless and easy-to-administer microneedle
patches can immunize against measles at least as well as vaccine given with
conventional hypodermic needles, according to research done by the Georgia
Institute of Technology and the Centers for Disease Control and Prevention
(CDC).

In the study, the researchers developed a technique to dry and stabilize
the measles vaccine – which depends on a live attenuated virus – and showed
that it remained effective for at least 30 days after being placed onto the
microneedles. They also demonstrated that the dried vaccine was quickly
released in the skin and able to prompt a potent immune response in an
animal model. The microneedle technique could provide a new tool for
international immunization programs against measles, which killed nearly
140,000 children in 2010. The research was reported online October 5 in the
journal Vaccine, and will appear in a special issue of the journal. The
research was supported by the Georgia Research Alliance – and indirectly by
the Division of Viral Diseases and Animal Resources Branch of the CDC, and
by the National Institutes of Health through its support of efforts to
develop a microneedle-based influenza vaccine.

“We showed in this study that measles vaccine delivered using a microneedle
patch produced an immune response that is indistinguishable from the
response produced when the vaccine is delivered subcutaneously,” said Chris
Edens, the study’s first author and a graduate student in the Wallace H.
Coulter Department of Biomedical Engineering at Georgia Tech and Emory
University.

Measles immunization programs now use conventional hypodermic needles to
deliver the vaccine. Large global immunization programs therefore require
significant logistical support because the vaccine must be kept
refrigerated, large numbers of needles and syringes must be shipped, and
the ten-dose vaccine vials must be reconstituted with sterile water before
use.

Because it requires a hypodermic needle injection, measles immunization
programs must be carried out by trained medical personnel. Finally, used
needles and syringes must be properly disposed of to prevent potential
disease

Use of microneedle patches could eliminate the need to transport needles,
syringes and sterile water, reducing logistical demands. Vaccination could
be done by personnel with less medical training, who would simply apply the
patches to the skin and remove them after several minutes, making possible
door-to-door campaigns similar to those used in polio vaccination. Single-
use patches could also reduce the waste of vaccine that occurs when all ten
doses in a vial cannot be used.

“A major advantage would be the ease of delivery,” said Mark Prausnitz, a
professor in the Georgia Tech School of Chemical and Biomolecular
Engineering, and one of the inventors of the microneedle patch.

“Microneedles would allow us to move away from central locations staffed by
health care personnel to the use of minimally-trained personnel who would
go out to homes to administer the vaccine.”

Read more at http://tinyurl.com/b4vuua9
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* SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org

A fact sheet on injection safety is available at:
http://www.who.int/mediacentre/factsheets/fs231/en/index.html

* Visit the WHO injection safety website and the SIGN Alliance Secretariat
at: http://www.who.int/injection_safety/en/

* Download the WHO Best Practices for Injections and Related Procedures
Toolkit March 2010 [pdf 2.47Mb]:
http://whqlibdoc.who.int/publications/2010/9789241599252_eng.pdf

Use the Toolbox at: http://www.who.int/injection_safety/toolbox/en/

Get SIGN files on the web at: http://signpostonline.info/signfiles-2
get SIGNpost archives at: http://signpostonline.info/archives-by-year

Like on Facebook: http://facebook.com/SIGN.Moderator

The SIGN Secretariat, the Department of Health Systems Policies and
Workforce, WHO, Avenue Appia 20, CH-1211 Geneva 27, Switzerland.
Facsimile: +41 22 791 4836 E- mail: sign@who.int
__________________________________________________________________
________________________________*_________________________________

SIGN meets annually to aid collaboration and synergy among SIGN network
participants worldwide.

The 2010 annual Safe Injection Global Network meeting was held from 9
to 11 November 2010 in Dubai, The United Arab Emirates.

The SIGN 2010 meeting report pdf, 1.36Mb is available on line at:
http://www.who.int/entity/injection_safety/toolbox/sign2010_meeting.pdf

The report is navigable using bookmarks and is searchable. Viewing
requires the free Adobe Acrobat Reader at: http://get.adobe.com/reader/

Translation tools are available at: http://www.google.com/language_tools
or http://www.freetranslation.com
__________________________________________________________________
________________________________*_________________________________
All members of the SIGN Forum are invited to submit messages, comment on
any posting, or to use the forum to request technical information in
relation to injection safety.

The comments made in this forum are the sole responsibility of the writers
and does not in any way mean that they are endorsed by any of the
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Use of trade names and commercial sources is for identification only and
does not imply endorsement.

The SIGN Forum welcomes new subscribers who are involved in injection
safety.

* Subscribe or un-subscribe by email to: sign.moderator@gmail.com, or to
sign@who.int

The SIGNpost Website is http://SIGNpostOnline.info

The new website is a work in progress and will grow to provide an archive
of all SIGNposts, meeting reports, field reports, documents, images such as
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We would like your help in building this archive. Please send your old
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Email mailto:sign.moderator@gmail.com
__________________________________________________________________
________________________________*_________________________________

The SIGN Internet Forum was established at the initiative of the World
Health Organization’s Department of Essential Health Technologies. The
SIGN Forum is moderated by Allan Bass and is hosted on the University of
Queensland computer network. http://www.uq.edu.au
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