online canadian pharmacy http://www.canadianpharmacy365.net/ pharmacy ratings phentermine no prescription

SIGNpost 00680

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00680 GBD 2010 + Abstracts + Extract + News 19 December 2012

CONTENTS
0. Moderators Note: SIGNpost resumes on 9 January 2013
1. New and Updated: Global Burden of Disease Study 2010
2. GBD 2010 Data Visualizations
3. Abstract: Effectiveness of incinerators in the management of medical
wastes in hospitals within Eldoret municipality
4. Abstract: Sharp injuries among hospital waste handlers
5. Abstract: Patients-to-healthcare workers HIV transmission risk from
sharp injuries, Southern Ethiopia
6. Abstract: Accidental injection with adrenaline autoinjectors
7. Abstract: Modeling of human immunodeficiency virus modes of transmission
in iran
8. Abstract: Drug trafficking, use, and HIV risk: The need for
comprehensive interventions
9. Abstract:Prevalences and associated risk factors of HCV/HIV co-infection
and HCV mono-infection among injecting drug users in a methadone
maintenance treatment program in Taipei, Taiwan
10. Abstract: Prevalence and knowledge of sexual transmitted infections,
drug abuse, and AIDS among male inmates in a Taiwan prison
11. Abstract: Transition to injection amongst opioid users in Iran:
implications for harm reduction
12. Abstract: Countries where HIV is concentrated among most-at-risk
populations get disproportionally lower funding from PEPFAR
13. Abstract: Intravitreal bevacizumab: safety of multiple doses from a
single vial for consecutive patients
14. Summary Points: Preventing Pandemics Via International Development: A
Systems Approach [Open Access Article]
15. Extract: Avoiding hand eczema in healthcare workers
16. Abstract: Occupational Exposures and the Prevalence of Blood-Borne
Pathogens in a Deployed Setting: Data from a US Military Trauma Center
in Afghanistan
17. Abstract: Inter-professional differences in compliance with standard
precautions in operating theatres: a multi-site, mixed methods study
18. Abstract: The rate of adverse events following BCG vaccination in
Poland
19. Abstract: Sweet-tasting solutions for needle-related procedural pain in
infants one month to one year of age
20. Abstract: Peptococcus infection after breast augmentation using
autologous fat injection
21. Abstract: Cold atmospheric air plasma sterilization against spores and
other microorganisms of clinical interest
22. No Abstract: Technology helps to reduce nurses’ risk to sharps injuries
23. No Abstract: Microbial stowaways in topical antiseptic products
24. No Abstract: Preventing unintentional adrenaline injection with
autoinjectors
25. Update: FUNGAL INFECTION, CONTAMINATED DRUG – USA (15)
26. News
– Global: Keep thimerosal in vaccines: pediatricians
– USA: Hepatitis C Victims’ Privacy Protected in Criminal Case
– USA: Single-Use Vials — The Debate Continues
– Mozambique: Vodafone partners with GSK and GAVI alliance to boost
vaccinations
– Africa & Global: How vaccines save lives, grow economies

The web edition of SIGNpost is online at:
http://signpostonline.info/archives/1377

More information follows at the end of this SIGNpost!

Please send your requests, notes on progress and activities, articles,
news, and other items for posting to: sign@lists.uq.edu.au

Normally, items received by Tuesday will be posted in the Wednesday
edition.

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

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

Visit the SIGNpostOnline archives at: http://signpostonline.info

Selected updates and breaking news items on the SIGN Moderator Facebook
page at: http://facebook.com/SIGN.Moderator

Selected updates at: http://twitter.com/#!/signmoderator
__________________________________________________________________
________________________________*_________________________________

0. Moderators Note: SIGNpost resumes on 9 January 2013
__________________________________________________________________
Injection safety for all!

Very best wishes to all SIGN Associates for 2013.

* SIGNpost resumes on 9 January 2013
__________________________________________________________________
________________________________*_________________________________

1. New and Updated: Global Burden of Disease Study 2010

The Lancet has published “The Global Burden of Disease Study 2010” (GBD
2010) and has mad the comments and articles available as a public service.
Please go to http://www.thelancet.com/themed/global-burden-of-disease for
the free text. Registration is required.
__________________________________________________________________
http://www.thelancet.com/themed/global-burden-of-disease

Global Burden of Disease Study 2010

Published Dec 13, 2012 in The Lancet

Executive summary

The Global Burden of Disease Study 2010 (GBD 2010) is the largest ever
systematic effort to describe the global distribution and causes of a wide
array of major diseases, injuries, and health risk factors.

The results show that infectious diseases, maternal and child illness, and
malnutrition now cause fewer deaths and less illness than they did twenty
years ago. As a result, fewer children are dying every year, but more young
and middle- aged adults are dying and suffering from disease and injury, as
non- communicable diseases, such as cancer and heart disease, become the
dominant causes of death and disability worldwide. Since 1970, men and
women worldwide have gained slightly more than ten years of life expectancy
overall, but they spend more years living with injury and illness.

GBD 2010 consists of seven Articles, each containing a wealth of data on
different aspects of the study (including data for different countries and
world regions, men and women, and different age groups), while accompanying
Comments include reactions to the study’s publication from WHO Director-
General Margaret Chan and World Bank President Jim Yong Kim.

The study is described by Lancet Editor-in-Chief Dr Richard Horton as “a
critical contribution to our understanding of present and future health
priorities for countries and the global community.”
__________________________________________________________________

The Lancet – Published Dec 13, 2012 – Vol 380

Contents
__________________________________________________________________

Comments

GBD 2010: understanding disease, injury, and risk – R Horton

From new estimates to better data – WHO Director-General Margaret Chan

Data for better health—and to help end poverty – World Bank President Jim
Yong Kim

GBD 2010: a multi-investigator collaboration for global comparative
descriptive epidemiology C J L Murray and others

AIDS is not over – M Sidibé and others

Should the GBD risk factor rankings be used to guide policy? C Watts, S
Cairncross

A promise to save 100 000 trauma patients – H Shakur and others

GBD 2010: design, definitions, and metrics – C J L Murray and others
__________________________________________________________________

Articles

Age-specific and sex-specific mortality in 187 countries, 1970–2010: a
systematic analysis for the Global Burden of Disease Study 2010 – H Wang
and others

Global and regional mortality from 235 causes of death for 20 age groups in
1990 and 2010: a systematic analysis for the Global Burden of Disease Study
2010 R Lozano and others

Common values in assessing health outcomes from disease and injury:
disability weights measurement study for the Global Burden of Disease Study
2010 – J A Salomon and others

Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis
for the Global Burden Disease Study 2010 J A Salomon and others

Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and
injuries 1990–2010: a systematic analysis for the Global Burden of Disease
Study 2010 – T Vos and others

Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21
regions, 1990–2010: a systematic analysis for the Global Burden of Disease
Study 2010 – C J L Murray and others

A comparative risk assessment of burden of disease and injury attributable
to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a
systematic analysis for the Global Burden of Disease Study 2010 S S Lim and
others
__________________________________________________________________

Special Report

The story of GBD 2010: a “super-human” effort P Das, U Samarasekera
__________________________________________________________________
________________________________*_________________________________

2. GBD 2010 Data Visualizations

A useful way to look at the data!

From the Institute for Health Metrics and Evaluation
__________________________________________________________________

GBD 2010 Data Visualizations

IHME strives to make its data freely and easily accessible and to provide
innovative ways to visualize complex topics.

Our data visualizations allow you to see patterns and follow trends that
are not readily apparent in the numbers themselves. Here you can watch how
trends in mortality change over time, choose countries to compare progress
in a variety of health areas, or see how countries compare against each
other on a global map.

http://www.healthmetricsandevaluation.org/tools/data-visualizations
http://www.healthmetricsandevaluation.org/gbd/visualizations/regional
__________________________________________________________________

IHME is an independent research center identifying the best strategies to
build a healthier world. By measuring health, tracking program performance,
finding ways to maximize health system impact, and developing innovative
measurement systems, IHME provides a foundation for informed decision-
making that ultimately will lead to better health for people worldwide.

http://www.healthmetricsandevaluation.org/
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Effectiveness of incinerators in the management of medical
wastes in hospitals within Eldoret municipality
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23120955

East Afr J Public Health. 2011 Sep;8(3):196-8.

Effectiveness of incinerators in the management of medical wastes in
hospitals within Eldoret municipality.

Njoroge SM, Koskei P, Chepngeno E, Lutukai L, Okwiri R, Maluki A.

School of Public Health, Moi University, Eldoret Kenya. mburu_s@yahoo.com

INTRODUCTION AND OBJECTIVES: Medical waste incinerators release into the
air a host of pollutants that have serious adverse consequences on public
health and the environment. This study aimed at determining the
effectiveness of incinerators in Eldoret municipality in the management of
medical wastes in relation to its maintenance and operation with an aim of
giving recommendations towards reducing environmental pollution caused by
emission of toxic pollutants and safeguarding the health of the incinerator
operators as well as the surrounding communities.

METHODOLOGY: A cross sectional study was carried out at three health
facilities in Eldoret Municipality namely Moi Teaching and Referral
Hospital blood Bank Transfusion Centre, Elgon View and Eldoret hospitals.
Questionnaires, researcher observation and laboratory investigations of ash
samples were used in data collection. The questionnaires were administered
to all the personnel operating the incinerators. The ash samples collected
were analyzed using Atomic Absorption Spectroscopy.

RESULTS: The results showed that the incinerators were operated in
substandard conditions due to breakdown of the ignition starter, lack of
pollution control equipment, and a low combustion temperature. Laboratory
investigation of the ash showed that the levels of the heavy metals tested
were high compared to the national and international standards. Forty
percent (40%) of the interviewees were aware of the health risks they were
exposed to and used protective clothing and equipment.

CONCLUSIONS: This study showed that the incinerators investigated are
maintained and operated in substandard conditions. The ashes produced
contain a wide range of toxic pollutants, including concentrated levels of
a number of heavy metals. This poses serious environmental health and
occupational safety hazard.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Sharp injuries among hospital waste handlers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23175914

Nig Q J Hosp Med. 2012 Apr-Jun;22(2):134-7.

Sharp injuries among hospital waste handlers.

Olaitan PB, Odu OO, Olaitan JO, Oseni OG.

Department of Surgery, University of Technology Teaching Hospital, Osogbo.
[Nigeria] emiolaitan@yahoo.com

BACKGROUND: Health care workers are generally predisposed to injuries from
sharps as a health hazard. This is more pronounced among waste handlers.

OBJECTIVE: It is therefore important to assess these injuries among this
group of people with a view to identifying the risk factors and suggesting
preventive methods.

METHODS: Questionnaires were administered to People handling wastes in our
hospital to assess their level of education on injury prevention,
immunization status and preventive methods used by them to prevent these
injuries and subsequent infections.

RESULTS: Forty three waste handlers were interviewed. Twenty eight (65.8%)
of them received training before commencing on the job while 14 (32.5%)
never received any training. Only thirty nine (90.7%) of them always use
hand gloves before carrying wastes. Only three (7.0%) of the respondents
have been screened for Hepatitis B, 19 (44.2%) for HIV, while 10 (23.3%)
were screened for Hepatitis B, C, and HIV. Eleven (25.6%) of them have been
injured with sharps. The finger was the most injured in 7 (93%) of them.

CONCLUSION: Training and re-training of health workers is important and
should be encouraged. All health workers should have pre-employment
immunization against Hepatitis B, C as well as other before commencing on
their jobs. Workers should be screened for infective diseases that can be
of legal problem while at the job and the workers should be effectively
immunized.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Patients-to-healthcare workers HIV transmission risk from
sharp injuries, Southern Ethiopia
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23237015

SAHARA J. 2012 Mar;9(1):1-5.

Patients-to-healthcare workers HIV transmission risk from sharp injuries,
Southern Ethiopia.

Desalegn B, Beyene H, Yamada R.

Background: Accidental needlestick injury rate among healthcare workers in
Hawassa is extremely high. Epidemiological findings proved the infectious
potential of this injury contaminated with a Human Immunodeficiency Virus
(HIV)-infected patient’s blood.

Objective: This study aimed at estimating the risk of HIV transmission from
patients to healthcare workers in Hawassa City, Ethiopia.

Method: A probabilistic risk model was employed. Scenario- based
assumptions were made for the values of parameters following a review of
published reports between 2007 and 2010. Parameters: HIV prevalence,
needlestick injury rate, exposure rate, sero-conversion rate, risk of HIV
transmission and cumulative risk of HIV transmission.

Finding: Generally, healthcare workers in Hawassa are considered to be at a
relatively low (0.0035%) occupational risk of contracting HIV – less than 4
in 100,000 of healthcare workers in the town (1 in 28,751 workers a year).

The 30 years’ maximum cumulative risk estimate is approximately five
healthcare workers per 1000 workers in the study area. Still, this small
number should be considered a serious matter requiring post-exposure
prophylaxis following exposure to unsafe medical practice leading to HIV
infection.

http://www.ncbi.nlm.nih.gov/pubmed/23237015
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Accidental injection with adrenaline autoinjectors
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23185846

Prescrire Int. 2012 Oct;21(131):236-7, 239.

Accidental injection with adrenaline autoinjectors.

[No authors listed]

Adrenaline (epinephrine) is the treatment of choice for severe anaphylactic
reactions. Some manufacturers sell autoinjectors that patients can use for
intramuscular self-injection.

Case reports describing unintentional injection with these devices have
been published, as well as a North American study that identified 15 190
calls to 61 US poison control centres between 1994 and 2007 and a series of
105 cases of unintentional injection reported to the US Food and Drug
Administration (FDA).

Errors in handling these autoinjectors, particularly by children and
healthcare professionals, can result in severe consequences, including
death and finger amputation, mainly due to the vasoconstriction caused by
adrenaline.

Most of these unintentional injections are due to poor knowledge of the
proper use of autoinjectors among patients, families and caregivers,
although malfunctions and design flaws are also sometimes implicated.

In practice, the best way to prevent such handling errors is to provide
precise and repeated training in the use of adrenaline autoinjectors to
healthcare professionals, patients and their carers.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Modeling of human immunodeficiency virus modes of transmission
in iran
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23241516

J Res Health Sci. 2012 Dec 13;12(2):81-7.

Modeling of human immunodeficiency virus modes of transmission in iran.

Nasirian M, Doroudi F, Gooya MM, Sedaghat A, Haghdoost AA.

Regional Knowledge Hub for HIV/AIDS Surveillance, Kerman University of
Medical Sciences, Iran. maryamnasirian27@gmail.com.

BACKGROUND: Main technique to control acquired immunodeficiency syndrome
(HIV) infection is the effective preventive programs among high-risk
groups. Modeling is one of the effective methods where there is inadequate
data. We used the modes of transmission (MOT) model to predict the
transmission of HIV infection in Iran.

METHODS: We systematically searched published and grey literature to find
values for the input parameters of MOT in 2010. The data were discussed by
experts before being fed into the model. Using the Monte Carlo simulation,
we computed the 95% confidence interval (CI) for the outputs of the MOT.

RESULTS: The MOT estimates that 9136 new HIV infections would have occurred
in Iran in 2010 (95% CI: 6831, 11757). About 56% (95% CI: 47.7%, 61.6%) of
new infections were among intravenous drug users (IDUs) and 12% (95% CI:
9.5%, 15%) among their sexual partners. The major routes of direct and
indirect HIV transmission in Iran are unsafe injection (68%) and
unprotected sexual contact (34% unprotected heterosexual and 10%
homosexual) respectively. If current coverage for safe injection among IDUs
increases from 80% to 95%, new HIV infections in this group would decrease
around 75%.

CONCLUSION: IDUs remain at highest risk of HIV infection in Iran, so the
preventive program coverage for IDUs and their spouses needs to be
increased. As the sexual transmission of HIV contributes increasingly to
the pool of new infections, serious measures such as harm reduction program
are required to reduce sexual transmission of HIV among the relevant key
populations.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Drug trafficking, use, and HIV risk: The need for
comprehensive interventions
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23237070

SAHARA J. 2012 Sep;9(3):154-9.

Drug trafficking, use, and HIV risk: The need for comprehensive
interventions.

Mbwambo J, McCurdy SA, Myers B, Lambdin B, Kilonzo GP, Kaduri P.

The rapid increase in communication and transportation between Africa and
other continents as well as the erosion of social fabric attended by
poverty, ethnic conflicts, and civil wars has led to increased trafficking
and consumption of illicit drugs. Cannabis dominates illicit trade and
accounts for as much as 40% of global interdiction. Due to escalating
seizures in recent years, the illicit trade in heroin and cocaine has
become a concern that has quickly spread from West Africa to include
Eastern and Southern Africa in the past 10 years. All regions of Africa are
characterized by the use of cannabis, reflecting its entrenched status all
over Africa.

Most alarming though is the use of heroin, which is now being injected
frequently and threatens to reverse the gain made in the prevention of
HIV/AIDS.

The prevalence of HIV infection and other blood-borne diseases among
injection drug users is five to six times that among the general
population, calling for urgent intervention among this group.

Programs that aim to reduce the drug trafficking in Africa and needle
syringe programs as well as medication-assisted treatment (MAT) of heroin
dependence while still in their infancy in Africa show promise and need to
be scaled up.
__________________________________________________________________
________________________________*_________________________________

9. Abstract:Prevalences and associated risk factors of HCV/HIV co-infection
and HCV mono-infection among injecting drug users in a methadone
maintenance treatment program in Taipei, Taiwan
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23227904

BMC Public Health. 2012 Dec 11;12(1):1066.

Prevalences and associated risk factors of HCV/HIV co-infection and HCV
mono-infection among injecting drug users in a methadone maintenance
treatment program in Taipei, Taiwan.

Yen YF, Yen MY, Su LW, Li LH, Chuang P, Jiang XR, Deng CY.

BACKGROUND: Injecting drug users (IDUs) in Taiwan contributed significantly
to an HIV/AIDS epidemic in 2005. In addition, studies that identified risk
factors of HCV/HIV co-infection among IDUs were sparse. This study aimed to
identify risk factors of HCV/HIV co-infection and HCV mono-infection, as
compared with seronegativity, among injecting drug users (IDUs) at a large
methadone maintenance treatment program (MMTP) in Taipei, Taiwan.

METHODS: Data from enrollment interviews and HCV and HIV testing completed
by IDUs upon admission to the Taipei City Hospital MMTP from 2006–2010
were included in this cross-sectional analysis. HCV and HIV testing was
repeated among re-enrollees whose HCV or HIV test results were negative at
the preceding enrollment. Backward stepwise multinomial logistic regression
was used to identify risk factors associated with HCV/HIV co-infection and
HCV mono-infection.

RESULTS: Of the 1,447 IDUs enrolled, the prevalences of HCV/HIV co-
infection, HCV mono-infection, and HIV mono-infection were 13.1%, 78.0%,
and 0.4%, respectively. In backward stepwise multinomial regression
analysis, after controlling for potential confounders, syringe sharing in
the 6 months before MMTP enrollment was significantly positively associated
with HCV/HIV co-infection (adjusted odds ratio [AOR]=27.72, 95% confidence
interval [CI] 13.30–57.76). Incarceration was also significantly
positively associated with HCV/HIV co-infection (AOR=2.01, 95% CI
1.71–2.37) and HCV mono- infection (AOR=1.77, 95% CI 1.52–2.06), whereas
smoking amphetamine in the 6 months before MMTP enrollment was
significantly inversely associated with HCV/HIV co-infection (AOR=0.44, 95%
CI 0.25–0.76) and HCV mono-infection (AOR=0.49, 95% CI 0.32–0.75). HCV
seroincidence was 45.25/100 person-years at risk (PYAR; 95% CI
24.74–75.92/100 PYAR) and HIV seroincidence was 0.53/100 PYAR (95% CI
0.06–1.91/100 PYAR) among re-enrolled IDUs who were HCV- or HIV-negative
at the preceding enrollment.

CONCLUSIONS: IDUs enrolled in Taipei MMTPs had very high prevalences of
HCV/HIV co- infection and HCV mono-infection. Interventions such as
expansion of syringe exchange programs and education regarding HCV/HIV
prevention should be implemented for this high-risk group of drug users.

Open Access Free full text
http://www.biomedcentral.com/1471-2458/12/1066/abstract
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Prevalence and knowledge of sexual transmitted infections,
drug abuse, and AIDS among male inmates in a Taiwan prison
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23217358

Kaohsiung J Med Sci. 2012 Dec;28(12):660-6.

Prevalence and knowledge of sexual transmitted infections, drug abuse, and
AIDS among male inmates in a Taiwan prison.

Feng MC, Feng JY, Chen YH, Chang PY, Lu PL.

Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung,
Taiwan.

This cross-sectional, descriptive, correlational study performed a
structured questionnaire survey of a Taiwan population of male prison
inmates to determine the prevalence of sexually transmitted infections
(STIs), intravenous drug users (IDUs), and drug abuse and to assess their
knowledge of HIV/AIDS.

The objective was to obtain data needed to control the spread of HIV. Out
of 1000 questionnaires distributed, 908 valid questionnaires were returned.
Inmates were classified into three groups: IDUs with HIV (13.5%), IDUs
without HIV (49.3%), and non-IDUs without HIV (37.2%).

A total of 115 (12.7%) inmates had contracted STIs other than HIV. Compared
with inmates without HIV, those with HIV were more likely to have a junior
high school education level or lower and a history of the following:
employment as a blue-collar laborer, STI, unprotected sexual activity, and
needle sharing during intravenous drug use.

The longer they have used intravenous drugs, the higher the probability
that they shared needles, and the more likely they contracted with HIV.
Taiwanese male inmates had a low level of knowledge about safe sex and HIV
transmission routes, except for sharing needles. The three groups did not
significantly differ in HIV-related knowledge.

Given the high percentage of IDU and HIV infection in male prison inmates
in Taiwan, interventions are needed to educate this population in the
increased risk of contracting HIV/AIDS associated with unsafe sex and
needle sharing during illicit drug use.

Such interventions are crucial for limiting the spread of HIV as this
population reintegrates with the community.

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

11. Abstract: Transition to injection amongst opioid users in Iran:
implications for harm reduction
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/21996166

Int J Drug Policy. 2012 Jul;23(4):333-7.

Transition to injection amongst opioid users in Iran: implications for harm
reduction.

Malekinejad M, Vazirian M.

Institute for Health Policy Studies, University of California, San
Francisco, San Francisco, CA 94118, USA. mmalekinejad@psg.ucsf.edu

Driven by opioid use, HIV prevalence is high (15-27%) amongst injection
drug users (IDU) in Iran. Harm reduction programmes are associated with a
reduction in high risk injecting behaviours; however, Iran has a large
number of non-injecting opioid users not immediately targeted by harm
reduction programmes.

The vast majority of heroin injectors tend to have a history of several
years of smoking opium or heroin before transitioning to injection, and a
small fraction may even start their drug career by injection of opioids,
behaviours that can undermine the effectiveness of the harm reduction
programmes.

In this study, we have reviewed evidence on the HIV epidemic, extent and
pattern of opioid use, and correlates of the transition to injection in
Iran.

We have concluded that harm reduction policies should also emphasize
prevention of the transition to injection amongst high-risk non-injecting
opioid users as an additional strategy against the spread of HIV infection
in Iran.

Copyright © 2011 Elsevier B.V. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Countries where HIV is concentrated among most-at-risk
populations get disproportionally lower funding from PEPFAR
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22778341

Health Aff (Millwood). 2012 Jul;31(7):1519-28.

Countries where HIV is concentrated among most-at-risk populations get
disproportionally lower funding from PEPFAR.

Grosso AL, Tram KH, Ryan O, Baral S.

Center for Public Health and Human Rights, Department of Epidemiology,
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
grossoas@gmail.com

The legislation reauthorizing the President’s Emergency Plan for AIDS
Relief (PEPFAR) in 2008 recognized the need for HIV/AIDS programs directed
to most-at-risk populations, including men who have sex with men and people
who inject drugs.

To examine whether that goal is being met, we analyzed data from PEPFAR’s
Operational Plans for fiscal years 2009 and 2010.

The eighteen countries in our study accounted for nearly two-thirds of
overall PEPFAR financing for those fiscal years and approximately 60
percent of the total number of people living with HIV in the world in 2010.
After controlling in each country for the number of people living with HIV,
total population, and per capita income, we found that countries where HIV
transmission occurs primarily among men who have sex with men and people
who inject drugs received on average $235 million less in 2009 and 2010
than countries with widespread HIV epidemics among the general population.

These findings raise questions about whether the country allocations of
PEPFAR fully address needs based on the epidemiology of HIV infection in
individual countries. Administrators should ensure that funding allocations
directed to various countries reflect the best epidemiological data and
latest science and best practices, and are devoid of bias against most-at-
risk populations; they should also be more transparent about where PEPFAR’s
dollars go. Otherwise, it is unlikely that PEPFAR will realize its
established goal of achieving an AIDS-free generation.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Intravitreal bevacizumab: safety of multiple doses from a
single vial for consecutive patients
__________________________________________________________________
http://www.hkmj.org/abstracts/v18n6/488.htm

Hong Kong Med J. 2012 Dec;18(6):488-95.

Intravitreal bevacizumab: safety of multiple doses from a single vial for
consecutive patients.

Ng DS, Kwok AKh, Chan CW, Li WW.

Department of Ophthalmology, Tung Wah Eastern Hospital, Sheung Wan, Hong
Kong.

OBJECTIVES. To report the incidence of endophthalmitis after intravitreal
injection of anti-vascular endothelial growth factor and the safety profile
of multiple doses of bevacizumab from the same vial reused for multiple
patients.

DESIGN. Case series.

SETTING. A private hospital in Hong Kong.

PATIENTS. A systematic retrospective review of consecutive intravitreal
anti-vascular endothelial growth factor injections between 5 June 2006 and
17 December 2010 at a single institute was conducted. Patients were
identified from prospectively designed audit forms, and each patient’s
medical record was reviewed for any documented complications. Bevacizumab
1.25 mg/0.05 mL to 2.50 mg/0.1 mL was aspirated from the designated vial,
with a maximum of 10 consecutive injections being aspirated from the same
vial. The opened vial was then discarded without overnight storage.
Ranibizumab was aspirated from the commercially available 1 mg/0.1 mL
single-use vial.

RESULTS. A total of 1655 intravitreal anti-vascular endothelial growth
factor injections into 392 eyes of 383 patients were evaluated during the
study period. There were 1184 bevacizumab injections and 471 ranibizumab
injections. There was one case of suspected endophthalmitis after
ranibizumab injection, though culture of the vitreous tap was negative. The
point prevalence of endophthalmitis was 0.06% (1/1655) for the total number
of injections: 0.21% (1/471) after ranibizumab, and 0% after bevacizumab.

CONCLUSION. Although many centres aliquot multiple syringes from a single
vial to be kept in a refrigerator for use, the current study shows that so
long as proper sterile techniques are implemented, there were no cases of
endophthalmitis from using the same vial, which was reused for a maximum of
10 consecutive injections. For intravitreal injection, bevacizumab costs
approximately US$50 to US$100 per dose, as opposed to US$2000 per dose for
ranibizumab. Sharing multiple doses of bevacizumab from a single vial can
substantially reduce the cost of treatment.

Free full text

http://www.hkmj.org/abstracts/v18n6/488.htm
__________________________________________________________________
________________________________*_________________________________

14. Summary Points: Preventing Pandemics Via International Development: A
Systems Approach [Open Access Article]
__________________________________________________________________
http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001354

PLoS Med 9(12): e1001354.

Preventing Pandemics Via International Development: A Systems Approach

Tiffany L. Bogich Rumi Chunara, David Scales, Emily Chan, Laura C.
Pinheiro, Aleksei A. Chmura, Dennis Carroll, Peter Daszak, John S.
Brownstein

Published: December 11, 2012
Provenance: Not commissioned; externally peer reviewed.

Summary Points

> The way in which public health programs are designed and funded has
changed significantly; however, the trend toward establishing vertical,
disease-specific global health programs may be at the cost of strengthening
basic public health infrastructure and development in the long term.

> In a review of nearly 400 public health events of international concern,
we found that a breakdown or absence of public health infrastructure was
the driving factor in the largest fraction of outbreaks (39.5%). No single
other driving factor accounted for more than 10% of outbreaks.

> The relative roles of emergency response versus long-term development
strategies to mitigate infectious disease threats are being debated within
bilateral and intergovernmental aid agencies.

> We propose a systems approach within development agencies to address
pandemic prevention at the intersection of people and their environment
where the risk of disease emergence is highest. To achieve this goal,
mainstream development funding, rather than emergency funding, is required.

Open Access free full text at:
http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001354

This is an open-access article, free of all copyright, and may be freely
reproduced, distributed, transmitted, modified, built upon, or otherwise
used by anyone for any lawful purpose. The work is made available under the
Creative Commons CC0 public domain dedication.

Funding: We acknowledge Google.org and a National Science Foundation Human
and Social Dynamics ‘Agents of Change’ award (BCS – 0826779 & BCS-0826840),
two NIH National Library of Medicine grants (5G08LM009776 and
5R01LM010812), the Research and Policy for Infectious Disease Dynamics
(RAPIDD) program of the Science and Technology Directorate, U.S. Department
of Homeland Security, and the Fogarty International Center, NIH and the
generous support of the American people through the United States Agency
for International Development (USAID) Emerging Pandemic Threats PREDICT.
The contents are the responsibility of the authors and do not necessarily
reflect the views of USAID or the United States Government. The funders had
no role in study design, data collection and analysis, decision to publish,
or preparation of the manuscript.

Competing interests: DC is the director of USAID’s Avian Influenza and
Other Emerging Threats Unit. All other authors have declared that no
competing interests exist.

Abbreviations: IHR, International Health Regulations; WHO, World Health
Organization; IOM, Institute of Medicine
__________________________________________________________________
________________________________*_________________________________

15. Extract: Avoiding hand eczema in healthcare workers
__________________________________________________________________

BMJ 2012;345:e8370

Avoiding hand eczema in healthcare workers

Kim Thomas, associate professor 1, John English, consultant dermatologist2
kim.thomas@nottingham.ac.uk

Good evidence that individualised education can lead to secondary
prevention

Occupational hand eczema in healthcare workers is common worldwide and an
important public health concern.1 In our institution, and probably across
the whole of the healthcare sector, the rise in incidence and prevalence
has mirrored the campaigns to reduce hospital acquired infections.2 It is
perhaps not surprising that irritant contact dermatitis occurs in people
who wash their hands as often as 50-60 times a shift, and because damaged
skin often carries a higher bacterial load,3 this also has implications for
infection control. Fortunately, this problem is potentially amenable to
prevention strategies.

In a linked research paper (doi:10.1136/bmj.e7822), Ibler and colleagues
evaluate the usefulness of a structured skin care intervention to prevent
hand eczema among healthcare workers in Denmark.4 Primary prevention
generally involves the introduction of a skin protection programme,5 which
includes reducing exposure to irritants, regularly using fragrance-free and
lipid-rich moisturisers, and wearing occlusive gloves for …

Access to the full text of this article requires a subscription or payment
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Occupational Exposures and the Prevalence of Blood-Borne
Pathogens in a Deployed Setting: Data from a US Military Trauma Center
in Afghanistan
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23221196

Infect Control Hosp Epidemiol. 2013 Jan;34(1):74-9.

Occupational Exposures and the Prevalence of Blood-Borne Pathogens in a
Deployed Setting: Data from a US Military Trauma Center in Afghanistan.

Okulicz JF, Yun HC, Murray CK.

Infectious Disease Service, San Antonio Military Medical Center, San
Antonio, Texas.

Objective. Occupational exposures to blood and other bodily fluids occur in
approximately 5 per 100 persons every year in US hospitals. Since the
provision of health care in the deployed environment poses unique
challenges to hospital personnel, it is important to characterize the rates
of occupational exposures and understand the prevalence of blood-borne
pathogens (BBPs) in host nations.

Methods. A retrospective review of public health and laboratory records at
a US military trauma center in Afghanistan from October 1, 2010, to March
31, 2012.

Results. A total of 65 occupational exposures were reported, including 47
(72%) percutaneous and 18 (28%) mucocutaneous, with a yearly rate of 8.6
exposures per 100 persons. During 6-month deployment cycles, the majority
of exposures (46.2%) occurred in the first 2 months after arrival in
Afghanistan. Physicians reported the most exposures (26%), and the
operating room (48%) was the most common hospital location. The prevalence
of hepatitis B and hepatitis C among local national source patients
([Formula: see text]) was 8.9% and 2.3%, respectively, with no cases of HIV
or syphilis detected. In contrast, there were no BBPs detected in coalition
source ([Formula: see text]) or exposed ([Formula: see text]) patients.

Conclusions. The characteristics of occupational exposures in this deployed
environment were comparable to those of US-based hospitals. Standard
practices used to reduce occupational exposures, such as use of personal
protective equipment and safety devices, should continue to be prioritized
in the deployed setting. Although BBP rates are not well defined in
Afghanistan, our results were consistent with those of prior epidemiologic
studies.
__________________________________________________________________
________________________________*_________________________________

17. Abstract: Inter-professional differences in compliance with standard
precautions in operating theatres: a multi-site, mixed methods study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22459981

Int J Nurs Stud. 2012 Aug;49(8):953-68.

Inter-professional differences in compliance with standard precautions in
operating theatres: a multi-site, mixed methods study.

Cutter J, Jordan S.

College of Human and Health Science, Swansea University, United Kingdom.
j.cutter@swan.ac.uk

BACKGROUND: Occupational acquisition of blood-borne infections has been
reported following exposure to blood or body fluids. Consistent adherence
to standard precautions will reduce the risk of infection.

OBJECTIVES: To identify: the frequency of self-reported adverse exposure to
blood and body fluids among surgeons and scrub nurses during surgical
procedures; contributory factors to such injuries; the extent of compliance
with standard precautions; and factors influencing compliance with
precautions.

DESIGN: A multi-site mixed methods study incorporating a cross-sectional
survey and interviews.

SETTINGS: Six NHS trusts in Wales between January 2006 and August 2008.

PARTICIPANTS: Surgeons and scrub nurses and Senior Infection Control
Nurses.

METHODS: A postal survey to all surgeons and scrub nurses, who engaged in
exposure prone procedures, followed by face to face interviews with
surgeons and scrub nurses, and telephone interviews with Infection Control
Nurses.

RESULTS: Response rate was 51.47% (315/612). Most 219/315 (69.5%)
respondents reported sustaining an inoculation injury in the last five
years: 183/315 (58.1%) reported sharps’ injuries and 40/315 (12.7%)
splashes. Being a surgeon and believing injuries to be an occupational
hazard were significantly associated with increased risk of sharps’
injuries (adjusted odds ratio 1.73, 95% confidence interval 1.04-2.88 and
adjusted odds ratio 2.0, 1.11-3.5, respectively). Compliance was
incomplete: 31/315 (10%) respondents always complied with all available
precautions, 1/315 (0.003%) claimed never to comply with any precautions;
64/293 (21.8%) always used safety devices, 141/310 (45.5%) eye protection,
72 (23.2%) double gloves, and 259/307 (84.4%) avoided passing sharps from
hand to hand. Others selected precautions according to their own assessment
of risk. Surgeons were less likely to adopt eye protection (adjusted odds
ratio 0.28, 0.11-0.71) and to attend training sessions (odds ratio 0.111,
0.061-0.19). The professions viewed the risks associated with their roles
differently, with nurses being more willing to follow protocols.

CONCLUSION: Inter-professional differences in experiencing adverse
exposures must be addressed to improve safety and reduce infection risks.
This requires new training initiatives to alter risk perception and promote
compliance with policies and procedures.

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

18. Abstract: The rate of adverse events following BCG vaccination in
Poland
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23230718

Przegl Epidemiol. 2012;66(3):465-9.

The rate of adverse events following BCG vaccination in Poland.

Krysztopa-Grzybowska K, Paradowska-Stankiewicz I, Lutynska A.

Zaklad Badania Surowic i Szczepionek, Narodowego Instytutu Zdrowia
Publicznego–Panstwowego Zakladu Higieny w Warszawie.

PURPOSE OF THE STUDY: The purpose of the study was to evaluate the capacity
of the surveillance system to respond to the schedule changes in the view
of TB vaccination uptake. Complications of Bacillus Calmette-Guerin (BCG)
vaccination in Poland are as elsewhere uncommon. In Poland, BCG vaccination
with a vaccine produced with Mycobacterium bovis BCG Moreau has been a part
of the National Immunization Program since 1955. In the beginning the
immunization schedule involved several BCG revaccinations in children and
youths, with the first dose given to neonates up to 1 month old followed by
revaccinations at 2, 4, 7, 12, 15, and 18 years of life. In 90s, the number
of BCG doses was reduced and since 2006, according to recommendations made
by the WHO, a single BCG dose is given to neonates only.

METHODS: In the study we have analyzed data on adverse events following BCG
vaccination registered within a period of 1994-2010, with attention to the
periods before and after 2006, when different BCG vaccination schedules
were used for immunization.

RESULTS: The frequency of adverse events following BCG vaccination in
Poland oscillated within 1994-2000 and 2001-2010 periods around 0.2 per
thousand and 0.6 per thousand respectively, and in half consisted of local
lesions at the injection sites and in half–appeared in the form of the
regional lymphadenopathy. The analysis of surveillance data revealed
similar rates of adverse events following BCG vaccination in the periods of
different BCG vaccination schedules, eg. before and after 2006.

CONCLUSIONS: Improvements in the data collecting manner from passive to
active one and the introduction of the routine laboratory confirmation of
the infection might evaluate the real prevalence of Mycobacterium bovis BCG
infections and improve the treatment of adverse events following BCG
vaccination cases.
__________________________________________________________________
________________________________*_________________________________

19. Abstract: Sweet-tasting solutions for needle-related procedural pain in
infants one month to one year of age
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/23235662

Cochrane Database Syst Rev. 2012 Dec 12;12:CD008411.

Sweet-tasting solutions for needle-related procedural pain in infants one
month to one year of age.

Kassab M, Foster JP, Foureur M, Fowler C.

Department of Maternal and Child Health / Faculty of Nursing, Jordan
University of Science and Technology (JUST), PO Box 3030, Irbid, Jordan,
22110.

BACKGROUND: Administration of oral sucrose or glucose with and without non-
nutritive sucking is frequently used as a non-pharmacological intervention
for needle-related procedural pain relief in infants.

OBJECTIVES: To determine the effectiveness of sweet-tasting solutions for
needle- related procedural pain in infants one month to one year of age
compared with no treatment, placebo, other sweet-tasting solutions, or
pharmacological or other non-pharmacological pain-relieving methods.

SEARCH METHODS: We searched the Cochrane Central Register of Controlled
Trials (CENTRAL) (The Cochrane Library 2012); MEDLINE via Ovid (1966 to
2012); CINAHL via OVID (1982 to 2012). The World Health Organization
International Clinical Trials Registry Platform was also searched for any
ongoing trials. Clinical trial registries, conference proceedings and
references for randomised controlled trials (RCTs) were also searched. An
updated search was run to capture any new publications before finalising
the review in April 2012 and no new included studies were identified. Two
review authors (MK & JF) independently abstracted data and assessed quality
using a standard form. Authors have been contacted for missing data.

SELECTION CRITERIA: Randomised-controlled trials using a sweet-tasting
solution to treat pain in healthy term infants (gestational age 37 weeks
and over), between one month and 12 months of age who required needle-
related procedures. These procedures included but were not limited to:
subcutaneous or intramuscular injections, venepuncture, and heel lance.
Studies in which the painful procedure was circumcision, lumbar puncture or
supra-pubic bladder aspiration were not included as they are more severe
and painful than needle-related procedures. Control conditions included no
treatment or placebo (water) or any other identical intervention (same
appearance and consistency) without active ingredient, another sweet-
tasting solution, a pharmacological pain-relieving method (e.g.
paracetamol, topical anaesthetic cream), non-pharmacological pain-relieving
method (e.g. distraction method, non-nutritive sucking). DATA COLLECTION
AND ANALYSIS: Assessment of trial quality, data extraction and synthesis of
data were performed using standard methods of the Cochrane Pain, Palliative
and Supportive Care Group. We report mean differences (MD) with 95%
confidence intervals (CI) using fixed-effect models as appropriate for
continuous outcome measures. We planned to report risk ratio (RR) and risk
difference (RD) for dichotomous outcomes. The Chi(2) test and I(2)
statistic were used to assess between-study heterogeneity.

MAIN RESULTS: Sixty-five (65) studies were identified for possible
inclusion in this review. Fourteen published RCTs with a total of 1551
participants met the inclusion criteria. Duration of cry was significantly
reduced in infants who were administered a sweet-tasting solution [MD
-13.47 (95% CI -16.80 to -10.15)], P < 0.00001 compared with water.
However, there was considerable heterogeneity between the studies (I(2) =
94%) that we were unable to explain. Meta-analysis was not able to be
undertaken for any of the other outcome measures, except for cry duration,
because of differences in study design. However, most of the individual
studies that measured pain found sucrose to significantly reduce pain
compared with the control group. One study compared sucrose and Lidocaine-
prilocaine cream and no significant difference was found between the two
treatments for the outcomes pain and cry duration. Due to the differences
between the studies, we were unable to identify the optimal concentration,
volume or method of administration of sweet-tasting solutions in infants
aged one to 12 months. Further large RCTs are needed.

AUTHORS’ CONCLUSIONS: There is insufficient evidence to confidently judge
the effectiveness of sweet-tasting solutions in reducing needle-related
pain in infants (one month to 12 months of age). The treatments do,
however, appear promising. Data from a series of individual trials are
promising, as are the results from a subset meta-analysis of studies
measuring duration of crying. Further well controlled RCTs are warranted in
this population to determine the optimal concentration, volume, method of
administration, and possible adverse effects.
__________________________________________________________________
________________________________*_________________________________

20. Abstract: Peptococcus infection after breast augmentation using
autologous fat injection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23233897

Arch Plast Surg. 2012 Nov;39(6):669-71.

Peptococcus infection after breast augmentation using autologous fat
injection.

Gang SG, Kim JK, Wee SY, Kim CH, Tark MS.

Department of Plastic and Reconstructive Surgery, Soonchunhyang University
College of Medicine, Seoul, Korea.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3518015/
__________________________________________________________________
________________________________*_________________________________

21. Abstract: Cold atmospheric air plasma sterilization against spores and
other microorganisms of clinical interest
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22582068

Appl Environ Microbiol. 2012 Aug;78(15):5077-82.

Cold atmospheric air plasma sterilization against spores and other
microorganisms of clinical interest.

Klämpfl TG, Isbary G, Shimizu T, Li YF, Zimmermann JL, Stolz W, Schlegel J,
Morfill GE, Schmidt HU.

Max Planck Institute for Extraterrestrial Physics, Garching, Germany.
klaempfl@mpe.mpg.de

Physical cold atmospheric surface microdischarge (SMD) plasma operating in
ambient air has promising properties for the sterilization of sensitive
medical devices where conventional methods are not applicable. Furthermore,
SMD plasma could revolutionize the field of disinfection at health care
facilities. The antimicrobial effects on Gram-negative and Gram-positive
bacteria of clinical relevance, as well as the fungus Candida albicans,
were tested.

Thirty seconds of plasma treatment led to a 4 to 6 log(10) CFU reduction on
agar plates. C. albicans was the hardest to inactivate.

The sterilizing effect on standard bioindicators (bacterial endospores) was
evaluated on dry test specimens that were wrapped in Tyvek coupons. The
experimental D(23)(°)(C) values for Bacillus subtilis, Bacillus pumilus,
Bacillus atrophaeus, and Geobacillus stearothermophilus were determined as
0.3 min, 0.5 min, 0.6 min, and 0.9 min, respectively. These decimal
reduction times (D values) are distinctly lower than D values obtained with
other reference methods.

Importantly, the high inactivation rate was independent of the material of
the test specimen. Possible inactivation mechanisms for relevant
microorganisms are briefly discussed, emphasizing the important role of
neutral reactive plasma species and pointing to recent diagnostic methods
that will contribute to a better understanding of the strong biocidal
effect of SMD air plasma.
__________________________________________________________________
________________________________*_________________________________

22. No Abstract: Technology helps to reduce nurses’ risk to sharps injuries
__________________________________________________________________

Am Nurse. 2012 Sep-Oct;44(5):4.

Technology helps to reduce nurses’ risk to sharps injuries.

Trossman S.
__________________________________________________________________
________________________________*_________________________________

23. No Abstract: Microbial stowaways in topical antiseptic products
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23215554

N Engl J Med. 2012 Dec 6;367(23):2170-3.

Microbial stowaways in topical antiseptic products.

Chang CY, Furlong LA.

Center for Drug Evaluation and Research, Food and Drug Administration,
Silver Spring, MD, USA.

Free full text: http://www.nejm.org/doi/full/10.1056/NEJMp1212680
__________________________________________________________________
________________________________*_________________________________

24. No Abstract: Preventing unintentional adrenaline injection with
autoinjectors
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/23185847

Prescrire Int. 2012 Oct;21(131):238.

Preventing unintentional adrenaline injection with autoinjectors.

[No authors listed]
__________________________________________________________________
________________________________*_________________________________

25. Update: FUNGAL INFECTION, CONTAMINATED DRUG – USA (15)

Crossposted from A ProMED-mail post <http://www.promedmail.org> with thanks
__________________________________________________________________
FUNGAL INFECTION, CONTAMINATED DRUG – USA (15)

A ProMED-mail post <http://www.promedmail.org>
ProMED-mail is a program of the International Society for Infectious
Diseases <http://www.isid.org>

Date: Mon 10 Dec 2012
Source: Centers for Disease Control and Prevention (CDC) [edited]
<http://www.cdc.gov/HAI/outbreaks/meningitis.html>

At-a-glance
– ———–
Status: ongoing Investigation
Infection: fungal
Facility type: outpatient setting
Case count: 590
States: 19
Deaths: 37

Cases and Deaths with Fungal Infections Linked to Steroid Injections

State / Total Cases / CNS / Only Joint Infection / Deaths
– ———————————————————
Florida / 25 / 22 / 0 / 3
Georgia / 1 / 1 / 0 / 0
Idaho / 1 / 1 / 0 / 0
Illinois / 2 / 2 / 0 / 0
Indiana / 63 / 57 / 0 / 6
Maryland / 25 / 25 / 0 / 2
Michigan / 214 / 199 / 15 / 10
Minnesota / 12 / 12 / 0 / 0
North Carolina / 4 / 4 / 0 / 1
New Hampshire / 13 / 13 / 0 / 0
New Jersey / 40 / 40 / 0 / 0
New York / 1 / 1 / 0 / 0
Ohio / 19 / 19 / 0 / 0
Pennsylvania / 1 / 1 / 0 / 0
Rhode Island / 3 / 3 / 0 / 0
South Carolina / 1 / 1 / 0 / 0
Tennessee / 112 / 110 / 0 / 13
Texas / 2 / 2 / 0 / 0
Virginia / 51 / 51/ 0 / 2
– ——————————
TOTALS = 590 / 368 / 21 / 37

Some patients with meningitis had other infections diagnosed in
addition; to date, all of these other infections have been
paraspinal/spinal infections. The patient reported to have a
peripheral joint infection and a spinal/paraspinal infection had both
a joint injection and a spinal/paraspinal injection.

Case counts by state are based on the state where the procedure was
performed, not the state of residence.
__________________________________________________________________
________________________________*_________________________________

26. News

– Global: Keep thimerosal in vaccines: pediatricians
– USA: Hepatitis C Victims’ Privacy Protected in Criminal Case
– USA: Single-Use Vials — The Debate Continues
– Mozambique: Vodafone partners with GSK and GAVI alliance to boost
vaccinations
– Africa & Global: How vaccines save lives, grow economies

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
Global: Keep thimerosal in vaccines: pediatricians
By Genevra Pittman, Reuters Health (17.12.12)

NEW YORK | (Reuters Health) – A mercury-containing preservative should not
be banned as an ingredient in vaccines, U.S. pediatricians said Monday, in
a move that may be controversial.

In its statement, the American Academy of Pediatrics (AAP) endorsed calls
from a World Health Organization (WHO) committee that the preservative,
thimerosal, not be considered a hazardous source of mercury that could be
banned by the United Nations.

Back in 1999, a concern that kids receiving multiple shots containing
thimerosal might get too much mercury – and develop autism or other
neurodevelopmental problems as a result – led the AAP to call for its
removal, despite the lack of hard evidence at the time.

“It was absolutely a matter of precaution because of the absence of more
information,” said Dr. Louis Cooper, from Columbia University in New York,
who was on the organization’s board of directors at the time.

“Subsequently an awful lot of effort has been put into trying to sort out
whether thimerosal causes any harm to kids, and the bottom line is
basically, it doesn’t look as if it does,” Cooper, who wrote a commentary
published with the AAP’s statement, told Reuters Health.

In a 2004 safety review, for example, the independent U.S. Institute of
Medicine concluded there was no evidence thimerosal-containing vaccines
could cause autism. A study from the Centers for Disease Control and
Prevention came to the same conclusion in 2010.

With the exception of some types of flu shots, the compound is not used in
vaccines in the United States, which are distributed in single-dose vials.

And nobody is arguing that should change, according to Dr. Walter
Orenstein, a member of the AAP Committee on Infectious Diseases and a
researcher at the Emory Vaccine Center in Atlanta.

But in countries with fewer resources – where many children still die of
vaccine-preventable diseases – it’s cheaper and easier to use multi-dose
vials of vaccines against diphtheria and tetanus, for example.

Thimerosal prevents the rest of a multi-dose vial from getting contaminated
with bacteria or fungi each time a dose is used.

Researchers estimated it could cost anywhere from two to five times as much
to manufacture vaccines for developing countries without thimerosal, and
both transporting vaccines and keeping them refrigerated would be much
harder as well.

“If we had to take the thimerosal out of those multi-dose vials, we’re
having a hard time completing the task of getting every kid immunized now,
that would add a tremendous burden,” Cooper said – and more children would
probably die as a result.

“Children who can now be protected from these life-threatening diseases
could become vulnerable,” Orenstein told Reuters Health.

The new statement is published in the AAP’s journal Pediatrics.

Thimerosal contains a type of mercury called ethyl mercury. Toxic effects
have been tied to its cousin, methyl mercury, which stays in the body for
much longer.

Earlier this year, the WHO said replacing thimerosal with an alternative
preservative could affect vaccine safety and might cause some vaccines to
become unavailable.

Mercury, however, is still on the list of global health hazards to be
banned in a draft treaty from the United Nations Environment Program –
which would mean a ban on thimerosal.

Reducing mercury exposure “is a wonderful thing,” Orenstein said.

However, “We need this exception because thimerosal is so vital for
protecting children.”

He said keeping thimerosal in vaccines is essential mostly for humanitarian
reasons – although preventing childhood diseases in the developing world
could also help the U.S. because other countries can serve as reservoirs
for illness.

“For American parents, this is more looking at the world and our role and
responsibility in protecting the children of the world than it is a direct
impact,” Orenstein said.

SOURCE: bit.ly/cxXOG Pediatrics, online December 17, 2012.
__________________________________________________________________
__________________________________________________________________
USA: Hepatitis C Victims’ Privacy Protected in Criminal Case
Aaron Sanborn, Seacoastonline New Hampshire USA (14.12.12)

In response to a request from Assistant U.S. Attorney John Farley, Judge
Joseph Laplante ordered defense attorneys in the trial of David Kwiatkowski
to protect the identity of patients infected with hepatitis C by
Kwiatkowski.

Kwiatkowski, a traveling medical technician, is infected with hepatitis C.
He is accused of acting as a “serial infector” by stealing syringes filled
with the drug fentanyl and using the drug himself. Kwiatkowski then
refilled the syringes with saline and used the syringes to inject patients.
From 2003 to 2011, Kwiatkowski worked in over 17 hospitals in New
Hampshire, Michigan, New York, Pennsylvania, Maryland, Arizona, Kansas, and
Georgia. By May 2012, the investigation had discovered 32 patients from
these hospitals who are infected with the strain of hepatitis C carried by
Kwiatkowski.

Kwiatkowski will stand trial in February 2013 on seven counts of “tampering
with a consumer product and seven counts of illegally obtaining drugs.”
Judge Laplante’s ruling protects the privacy of the hepatitis C-infected
patients’ health information by requiring that defense counsel and
prosecutors redact all personal information in pre-trial preparation
activities and get the approval of the court before presenting the health
care information of any individuals in court.
__________________________________________________________________
__________________________________________________________________
http://www.medscape.com/viewarticle/775682

USA: Single-Use Vials — The Debate Continues
Laura A. Stokowski, RN, MS, Medscape.com (11.12.12)

Clinicians Are Still Talking About Single-Use Vials

Waste, cost, and “common sense” continue to rationalize healthcare
providers’ use of single-use vials of injectable medications for more than
1 patient. Following publication of Single-Use Vials: Cost, Safety, and
Availability on Medscape, http://www.medscape.com/viewarticle/768187 many
readers responded with comments either supportive of or in opposition to
the Centers for Disease Control and Prevention (CDC) position statement
about appropriate use of single-use vials.

This position statement restated the CDC’s long-standing position that
vials labeled by manufacturers as “single-dose” or “single-use” (or even
“single-unit” — all mean the same thing) should be used only once, for a
single patient, to protect against life-threatening infections. These
single-dose/single use medication vials typically lack antimicrobial
preservatives and can become contaminated during entry, serving as a source
of infection if the vial contents are used on subsequent patients.

So, what did healthcare providers have to say?

Single-Use Means Single Use, Period

Is the practice of re-entering a single-use vial acceptable, “if proper
basic injection practices are employed,” or is it simply “an appalling
breach in safe healthcare delivery that puts patients at risk”? Both of
these views were expressed by readers. In aggregate, however, most of those
who joined the discussion supported using single-use vials as intended — 1
patient, 1 dose, and 1 time.

An internal medicine physician wrote, “Patients deserve better than
multiple uses from a single-dose container. Infections caused by a
healthcare provider using poor technique [are] malpractice, and worse, a
betrayal of trust placed in a provider by the patient.” A medical student
adds, “I absolutely agree. We are here to save lives and maintain the
highest quality of life possible. There is no reason good enough to risk
infection.”

“Single-use vials don’t contain preservatives,” commented an oncologist.
“Puncturing a vial, drawing out half the contents, and placing it back on
the shelf for the next day is a recipe for bacterial growth.”

Many agree that the potential consequences just aren’t worth the risk,
regardless of cost or availability. A pediatric nurse writes, “Some people
maintain that limiting single-dose vials to one-time use is costly and
unnecessary. What is the cost of a new vial of medication compared with the
cost of hospitalization, blood cultures, and multiple antibiotics to treat
the infection? It’s a no-brainer. If it says ‘single-use,’ it’s exactly
that.”

It is easy to see why clinicians are frustrated. A critical care nurse
complained, “My hospital is supplied with 10-mL vials of folic acid with a
concentration of 5 mg/mL. The dose that we use is only 1 mg; therefore, if
we follow policy we would use only 0.2 mL of that 10 mL and throw the rest
away. That kind of waste on a daily basis really bothers me.”

A gastroenterologist described the impact on clinical practice. “During
shortages of propofol and midazolam, we have to do cases with less than
adequate sedation or even put off any elective cases for weeks.”

For many, it seems that the frustration is magnified by the conviction that
reusing single-use vials does not, in fact, endanger patients.

Continues at http://www.medscape.com/viewarticle/775682_2
Registration required
__________________________________________________________________
__________________________________________________________________
Mozambique: Vodafone partners with GSK and GAVI alliance to boost
vaccinations
By Katherine Rushton, The Telegraph, London UK (11.12.12)

Vodafone is to allow aid agencies to piggyback on its networks in
developing countries, to help boost their vaccination programmes and to
cement its own position as a crucial part of the infrastructure of those
markets.

The mobile giant has inked deals with the GAVI Alliance, a UK government-
backed scheme to help the 73 poorest countries in the world gain access to
new vaccines, and with pharmaceuticals giant GSK, whose chairman Sir
Christopher Gent is a former Vodafone chief executive.

The three-year partnership with GAVI will be used to collect information
about how many children have been vaccinated, and to give parents
reminders, for example to take their offspring for booster injections.

Meanwhile Vodafone will run a one-year pilot in Mozambique with GSK and
Save the Children to provide health workers with mobiles so that they can
track drug stocks and ensure clinics have what they need to vaccinate the
communities they serve.

Vittorio Colao, group chief executive of Vodafone, told The Daily Telegraph
that the initiative would improve health services in developing countries,
but also offer Vodafone “a selfish positive note”.

“If you improve the society you operate in, you also improve the business
you operate in it,” he said.

“By doing this we become one of the pillars of society working. Like
Gutenberg – printing is an infrastructure, and mobile is another
infrastructure. Sometimes we think of mobiles just as smartphones and
YouTube and having fun, but it’s really about improving living conditions,
reducing costs and saving time and energy. We need to be a market and we
need to be a perceived utility.”

Seth Berkley, chief executive of Gavi, added: “Vaccination becomes the
basis for the healthcare system, but the challenge is in antiquated
systems.” At the moment it can take up to 18 months for clinics in Africa
to get information about a vaccinated child to the organisation, he added.
“That’s not a supply chain.”

Vodafone has already established localised health scheme, often referred to
as m-health, in some parts of sub-Saharan Africa, boosting its brand in
those countries and helping it to secure a key position in those societies.
However, the deals that have been signed this week are the largest scheme
of this kind.

The mobile giant has also forged a place in these markets through its
mobile payments scheme, MPesa, which allows people without bank accounts to
send money electronically.
__________________________________________________________________
__________________________________________________________________
http://edition.cnn.com/2012/12/07/opinion/vaccine-gavi-seth-berkley/

Africa & Global: How vaccines save lives, grow economies
By Seth Berkley, CNN/Inside Africa (07.12.12)

A child receives an oral polio vaccine in June 2011, in Abidjan, Ivory
Coast.

Editor’s note: Dr. Seth Berkley is the CEO of the GAVI Alliance. He has
been featured on the cover of Newsweek, recognized by TIME magazine as one
of the “100 Most Influential People in the World” and by Wired Magazine as
among “The Wired 25 — a salute to dreamers, inventors, mavericks and
leaders.”

Dar es Salaam, Tanzania (CNN) — We all know that vaccines save lives by
protecting people against disease. What is less well-known is that vaccines
also are an engine for economic growth — far beyond their health benefits.
I am reminded of this in Tanzania this week, where my organization, the
GAVI Alliance, is hosting a conference for its partners. GAVI’s mission is
to save children’s lives and protect people’s health by increasing access
to immunization in developing countries.

We don’t do this alone. We have many partners, including prominent
companies that work closely with GAVI. They recognize that in addition to
the humanitarian need, countries such as Tanzania are emerging markets that
can fulfill their economic ambitions only if they also can ensure good
health for their citizens.

The private sector is a critical part of the equation. Our corporate
partners know they can do well by doing good.

Consider Tanzania. It has an ambitious five-year development plan that aims
to transform the country into a middle-income economy by 2025. The plan
includes critical funding to ensure a healthy population by strengthening
the health system, which will significantly improve child and maternal
mortality rates.

Tanzania already has begun this process by working closely with GAVI and
its partners to significantly increase its routine vaccine coverage rates
to above 90% today from 79% in 2001, the year before GAVI began its work
there, according to data from the World Health Organization and UNICEF. At
the same time, Tanzania’s GDP growth has been astounding, rising to $23.7
billion last year from $10.2 billion in 2001, according to the World Bank.

Is there a connection? Further study is needed in the case of Tanzania. But
we know for a fact that vaccines — in addition to saving lives and
improving health — are the cornerstone of a vibrant economy, fuel growth
and serve as a magnet for foreign investment. Indeed, research has shown
vaccines to be among the most cost-effective investments in global
development.

This has been borne out of several independent studies that look beyond the
health impacts toward areas such as cognitive development, educational
attainment, labor productivity and financial attainment.

In other words, healthier children — spurred by immunization — attend
school more often, learn more while they are there and remain in school
longer. As adults, they therefore are more productive, earn more money,
save and invest more, and live longer. Healthier children also spread less
disease through the adult population, further increasing productivity.

These academic papers, including one recently published that focuses on how
to measure the economic benefits of the HPV vaccine, are getting noticed in
African countries — not only by health ministers, but also by finance
ministers and other officials.

For instance, I attended a landmark meeting in Tunis in July organized by
the African Development Bank, where its President Donald Kaberuka brought
together a variety of ministers and experts to discuss how to allocate
budgets and make healthcare a national priority.

I was in Tunis because of the wide recognition that immunization can be the
high-octane fuel that leads to increased trade, capital infrastructure
projects and technological improvement.

This brings me back to the private sector and the benefits many companies
now see in playing a role in supporting global health, including
immunization services. One benefit, of course, is humanitarian. The GAVI
Alliance — with help from partners such as UNICEF, WHO, the Bill & Melinda
Gates Foundation, the World Bank and donors — has helped countries
immunize 370 million people, saving more than 5.5 million lives since 2000.
GAVI now is in the midst of helping immunize another quarter billion
people, which could save an additional 4 million lives by 2015. The private
sector is involved, providing core business skills to tackle key obstacles
to immunization in the developing world.

For example, GAVI is working with a leading telecommunications company to
explore the use of its mobile technology with hopes of improving vaccine
stock management in implementing countries and alerting parents when
children are due for vaccines.

GAVI is constantly looking for partners to lend their business savvy to
help us accomplish our mission. An increasing number of them are
responding, compassionate in their outlook while aware of the underlying
economic value of vaccines.

They understand that this is the highest return on investment they could
ever make.
__________________________________________________________________
________________________________*_________________________________
* 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
organizations and agencies to which the authors may belong.

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
photographs, posters, signs and symbols, and video.

We would like your help in building this archive. Please send your old
reports, studies, articles, photographs, tools, and resources for posting.

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
__________________________________________________________________

Comments are closed.