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SIGNpost 00683

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00683 Mercury Deadline + Job + Abstracts + News 23 January 2013

CONTENTS
1. World’s Governments Agree to Mercury-Free Healthcare in 2020
2. Opportunity for International Health Specialist to join leading not-for-
profit institute
3. Abstract: Chinks in the armor: activation patterns of hollow-bore
safety-engineered sharp devices
4. Abstract: Evaluation of healthcare waste treatment/disposal alternatives
by using multi criteria decision making techniques
5. Abstract: Medical safety in infectious disease–chairmen’s introductory
remarks
6. Abstract: Blood transfusion practice in a rural hospital in Northern
Ghana, Damongo, West Gonja District
7. Abstract: Case-control study of hepatitis B and hepatitis C in older
adults: Do healthcare exposures contribute to burden of new infections?
8. Abstract: Identifying and prioritising adverse episodes and failures
related to patient safety in Pain Treatment Units
9. Abstract: Geographical and temporal variation of injection drug users in
Pakistan
10. Abstract: Estimating the variability in the risk of infection for
hepatitis C in the Glasgow injecting drug user population
11. Abstract: Association of tattooing and hepatitis C virus infection: A
multicenter case-control study
12. Abstract: Vaccination Site and Risk of Local Reactions in Children 1
Through 6 Years of Age
13. Abstract: A randomized control trial comparing immunogenicity, safety,
and preference for self- versus nurse-administered intradermal
influenza vaccine
14. Abstract: Solar water disinfection (SODIS): a review from bench-top to
roof-top
15. Abstract: Health care workers’ mobile phones: a potential cause of
microbial cross-contamination between hospitals and community
16. No Abstract: Hierarchy and hand hygiene: would medical students speak
up to prevent hospital-acquired infection?
17. No Abstract: Review of evidence for alcohol-based skin preparation
agents
18. Article: To prevent the spread of blood-borne infections,
the US Centers for Disease Control and Prevention has launched a
campaign reminding clinicians not to reuse needles or syringes
19. MMWR Global Control and Regional Elimination of Measles, 2000–2011
20. News
– USA: Creditors probe meningitis-linked pharmacy owners’ pay
– Evidence Grows for Narcolepsy Link to Swine Flu Shot
– Canada: University Warns Students About Possible HIV, Hepatitis Exposure
After Exercise
– Australia: Needle exchanges ‘can curb Hep C’
– Online Tattoo and Piercing Kits Could Be Spreading Hepatitis C
– USA: Vaccine timetable for children is safe, experts say
– USA: Health Care Related Exposure Linked to HCV, HBV Infection in Older
Adults
– USA: Hospital Patients Potentially Exposed To Blood-borne Infectious
Diseases Through Reused Insulin Pens

The web edition of SIGNpost is online at:
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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
__________________________________________________________________
________________________________*_________________________________

1. World’s Governments Agree to Mercury-Free Healthcare in 2020
__________________________________________________________________
http://www.mercuryfreehealthcare.org/about.htm

World’s Governments Agree to Mercury-Free Healthcare in 2020
Mercury-Free Healthcare Press Release (19.01.13)

Phase-Out Date and Mandate for Mercury Thermometers and Blood Pressure
Devices

January 19, 2013

Geneva – The world’s governments have finalized text for a global legally
binding treaty on mercury, the bio-accumulative heavy metal that is
poisoning the world’s fish supply, threatening public health and the
environment. Among other measures, the treaty text mandates an end to the
manufacture, import and export of mercury thermometers and blood pressure
devices (sphygmomanometers) by 2020*.

Meeting around the clock in a marathon fifth and final round, negotiators
agreed on the phase-out of these mercury-based medical devices. While no
longer in use in Europe, most of the United States, and several developing
countries, they are still commonly found in hospitals and pharmacies in
much of the rest of the world, exposing workers, patients and the global
environment to mercury emissions when they break and/or are disposed of.

“WHO issued a policy in 2005 calling for the gradual phase-out of mercury-
based thermometers and blood pressure devices together with their
substitution with viable alternatives,” said Dr Maria Neira, Director,
WHO’s Department of Public Health and the Environment. “Today we are
extremely pleased that the world’s governments have agreed to such a phase-
out. This will have a major benefit for global health.”

Such a transition is already being supported and assisted in dozens of
countries by the joint initiative established in 2008 by WHO and the
international NGO Health Care Without Harm, to foster and support mercury
substitution in the health sector around the world.

“Together with WHO we have been working with nurses, doctors, hospitals,
health systems and ministries of health on every continent to demonstrate
that mercury-free health care is not only possible, but positively doable,”
said Josh Karliner, International Coordinator for Health Care Without Harm.
“We know that these alternatives are available, affordable and accurate. We
are thrilled that there is now a global intergovernmental mandate for this
phase-out by 2020* and are excited to get working on helping the health
sector meet this timeframe.”

The treaty is slated to be signed at diplomatic conference in Japan in
October. After that, governments will need to ratify it in order for it to
enter into force.

–––

*An exemption of up to 10 years will be available to governments that
cannot make the switch in time although there should be very few that find
themselves in these circumstances in 2020.

For more information see www.mercuryfreehealthcare.org

http://www.noharm.org/global/news_hcwh/2012/dec/hcwh2013-01-19.php
__________________________________________________________________

The Initiative to Substitute Mercury-Based Medical Devices around the World

Health Care Without Harm and the World Health Organization are co-leading a
global initiative to achieve virtual elimination of mercury-based
thermometers and sphygmomanometers over the next decade and their
substitution with accurate, economically viable alternatives.

The initiative is a component of the UN Environment Programme’s Mercury
Products Partnership.
http://mercuryfreehealthcare.org/about.htm
__________________________________________________________________
________________________________*_________________________________

2. Opportunity for International Health Specialist to join leading not-for-
profit institute
__________________________________________________________________

Date: 18 January 2013 10:30:01 AM AEDT

Subject: Opportunity for International Health Specialist to join leading
not-for-profit institute

International Health Systems Specialist Opportunity

12 month contract with options
Mix of experience needed: technical assistance on health aid programs,
operational research, evaluation methods, one area of strength in WCH or ID
Join an active team-based program of work in Burnet’s Centre for
International Health
Generous salary packaging, salary negotiable

Burnet Institute is one of Australia’s leading medical research and public
health organisations. We are a unique, not-for-profit, unaligned,
independent, Australian, non-government organisation that combines medical
research in the laboratory and at a population level with public health
action and advocacy to address major health issues of disadvantaged
populations in Australia and communities in the developing world.
The Centre for International Health (CIH) leads Burnet’s work to improve
health in low-income countries. The CIH is currently seeking the services
of an individual with broad experience in international public health with
particular interest and experience in health systems strengthening (HSS)
with demonstrated experience working within Developing Countries Health
Systems and in particular experience relevant to Papua New Guinea.

You will work closely with the Team leader for ID and Health Systems
Strengthening to develop and lead a growing portfolio of work in health
systems and/or other specific health themes. The position will take on
responsibility for existing contracted activities and also seek to secure
new work as part of CIH Business Development activities in the pursuit of
new long and short-term work opportunities.

You will have:

Post graduate qualifications in public health, health management,
international development or a related area.
· Significant experience working in the health sector in resource
poor settings including an understanding of broader “health systems”
policy, planning and reform issues
· Demonstrated experience and knowledge of health systems
strengthening, with knowledge of health systems in PNG desirable.
· Demonstrated expertise in relevant quantitative and/or
qualitative methods of operational research for health in resource-poor
settings.
· Demonstrated expertise in impact and process evaluations of
health system interventions or health development activities.
· Ability to provide expert technical advice with strengths in one
or more special areas, such as women’s and children’s health or an
infectious disease (TB or malaria or others) or another global health
priority
· Ability to provide effective, high quality policy and technical
input to program design/management, program quality and performance
assessment processes.
· Strong analytical skills, sound judgement and the capacity to
think strategically
· Strong communication and interpersonal skills
· The ability to work effectively as part of an organisation and as
a team.

Benefit from ongoing support, a monthly accrued day off and attractive
salary packaging working for this leading not for profit organisation.
Remuneration will be commensurate with skills and experience. For a copy
of the position description, please visit our website
http://www.burnet.edu.au/careers_and_employment. For further information
please contact the Team leader ID and Health Systems Strengthening, Dr
Chris Morgan via email on cmorgan@burnet.edu.au, or Anita Cranwell, HR
Officer acranwell@burnet.edu.au or 03 8506 2375.

Written applications addressing the selection criteria, as outlined in the
position description, and a detailed resume including the names and contact
details of three referees should be emailed to Anita Cranwell, HR Officer
acranwell@burnet.edu.au. Applications close Friday 15th February.

Burnet is a child safe organisation. The successful applicant may be
required to apply for a criminal record check from the Australian Federal
Police.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Chinks in the armor: activation patterns of hollow-bore
safety-engineered sharp devices
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22759553

Infect Control Hosp Epidemiol. 2012 Aug;33(8):842-4.

Chinks in the armor: activation patterns of hollow-bore safety-engineered
sharp devices.

Black L, Parker G, Jagger J.

University of Nevada, Reno, Nevada, USA. lblack@unr.edu

A retrospective review of secondary injury data was used to evaluate the
characteristics of percutaneous injuries from safety-engineered sharp
devices. Injury rates and safety device activation rates differed by
healthcare provider type.

Approximately 22.8%-32% of injuries could have been prevented had an
available safety feature been activated after use.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Evaluation of healthcare waste treatment/disposal alternatives
by using multi criteria decision making techniques
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23315364
Waste Manag Res. 2013 Jan 11.

Evaluation of healthcare waste treatment/disposal alternatives by using
multi criteria decision making techniques.

Ozkan A.

Department of Environmental Engineering, Anadolu University, Faculty of
Engineering, Eskisehir, Turkey.

Healthcare waste should be managed carefully because of infected,
pathological, etc. content especially in developing countries. Applied
management systems must be the most appropriate solution from a technical,
environmental, economic and social point of view.

The main objective of this study was to analyse the current status of
healthcare waste management in Turkey, and to investigate the most
appropriate treatment/disposal option by using different decision-making
techniques.

For this purpose, five different healthcare waste treatment/disposal
alternatives including incineration, microwaving, on-site sterilization,
off-site sterilization and landfill were evaluated according to two multi-
criteria decision-making techniques: analytic network process (ANP) and
ELECTRE. In this context, benefits, costs and risks for the alternatives
were taken into consideration. Furthermore, the prioritization and ranking
of the alternatives were determined and compared for both methods.

According to the comparisons, the off-site sterilization technique was
found to be the most appropriate solution in both cases.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Medical safety in infectious disease–chairmen’s introductory
remarks
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23323465

Rinsho Byori. 2012 Oct;60(10):988-9.

[Medical safety in infectious disease–chairmen’s introductory remarks].

[Article in Japanese]

Shimetani N, Miida T.

Department of Laboratory Medicine, International University of Health and
Welfare Atami Hospital, Atami 413-0012, Japan. shime@iuhw.ac.jp

“The National Joint Action of Risk Management” was started in May 2008. The
Japanese Society of Laboratory Medicine took this opportunity to set up a
Medical Safety Committee as a participant in this Action.

The Society holds symposia concerning medical safety to educate the Society
members. Nosocomial infections are medical accidents.

Whereas community-acquired infections are likely to develop depending on a
balance between pathogens and hosts, nosocomial infections are implicated
with medical practices, so they develop depending on the interrelationship
among pathogens, hosts, and medical practices.

Medical practices are mostly indispensable for providing medical services;
therefore, activities against nosocomial infections are critical for
establishing medical safety, freedom from anxiety, and reliability.

Hence, this symposium deals with five themes: Countermeasures against and
the management of needle-stick and cut accidents, collaboration between the
infection control team (ICT) and the bacteriology laboratory, information
transmission from the clinical laboratory department to physicians engaged
in infectious disease treatment, utilization of laboratory data for
infection control, and medical safety against tuberculosis infection.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Blood transfusion practice in a rural hospital in Northern
Ghana, Damongo, West Gonja District
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22612858

Transfusion. 2012 Oct;52(10):2161-6. doi: 10.1111/j.1537-2995.2012.03709.x.
Epub 2012 May 21.

Blood transfusion practice in a rural hospital in Northern Ghana, Damongo,
West Gonja District.

Kubio C, Tierney G, Quaye T, Nabilisi JW, Ziemah C, Zagbeeb SM, Shaw S,
Murphy WG.

West Gonja Hospital, Damongo, Northern Region, Ghana.

BACKGROUND: Blood transfusion in rural sub-Saharan Africa presents special
challenges. Transfusions are primarily given for emergencies–life-
threatening blood loss or anemia; blood is usually collected from family or
replacement donors; and facilities to store an adequate reserve in a
hospital bank are constrained. We report the everyday and organizational
practices in a medium-sized district hospital in Northern Ghana.

STUDY DESIGN AND METHODS: Information and data on blood transfusion
practices at West Gonja Hospital, Damongo, were available from the
laboratory reports, from day books and workbooks, and from direct
observation in the following four areas: blood collection and blood donors;
blood donation testing; blood storage and logistics; and clinical
transfusion practice, adverse events, and follow- up.

RESULTS: The hospital serves a rural community of 86,000. In 2009, a total
of 719 units of whole blood were collected, a rate of 8.36 units per 1000
population. All donors were family or replacement donors. Positivity rates
for infectious disease markers were 7.5% (64/853) for hepatitis B surface
antigen, 6.1% (50/819) for hepatitis C virus, 3.9% (33/846) for human
immunodeficiency virus, and 4.7% (22/468) for syphilis. Supply of
laboratory materials was sometimes problematic, especially for temperature-
critical materials. Difficulties in sample labeling, storage of blood and
laboratory supplies, and disposal of waste were also incurred by
operational, material, and financial constraints. Follow-up for outcomes of
transfusion is not currently feasible.

CONCLUSIONS: The operational, demographic, and financial environment
pertaining in a rural hospital in Northern Ghana differs substantially from
that in which much of current blood transfusion practice and technology
evolved. Considerable effort and innovation will be needed to address
successfully the challenges posed.

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

7. Abstract: Case-control study of hepatitis B and hepatitis C in older
adults: Do healthcare exposures contribute to burden of new infections?
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22383058

Hepatology. 2012 Mar 2. doi: 10.1002/hep.25688.

Case-control study of hepatitis B and hepatitis C in older adults: Do
healthcare exposures contribute to burden of new infections?

Perz JF, Grytdal S, Beck S, Fireteanu AM, Poissant T, Rizzo E, Bornschlegel
K, Thomas A, Balter S, Miller J, Klevens RM, Finelli L.

Centers for Disease Control and Prevention, Atlanta, GA. JPERZ@CDC.GOV.

Reports of hepatitis B virus (HBV) and hepatitis C virus (HCV) transmission
associated with unsafe medical practices have been increasing in the United
States. However, the contribution of healthcare exposures to the burden of
new infections is poorly understood outside of recognized outbreaks.

We conducted a case-control study at three health departments that perform
enhanced viral hepatitis surveillance in New York and Oregon. Reported
cases of symptomatic acute hepatitis B and hepatitis C occurring in persons
=55 years of age from 2006 to 2008 were enrolled.

Controls were identified using telephone directories and matched to
individual cases by age group (55-59, 60-69, and =70 years) and residential
postal code.

Data collection covered exposures within 6 months before symptom onset
(cases) or date of interview (controls). Forty-eight (37 hepatitis B and 11
hepatitis C) case and 159 control patients were enrolled.

Case patients were more likely than controls to report one or more
behavioral risk exposures, including sexual or household contact with an
HBV or HCV patient, >1 sex partner, illicit drug use, or incarceration (21%
of cases versus 4% of controls exposed; matched odds ratio [mOR] = 7.1; 95%
confidence interval [CI]: 2.1, 24.1).

Case patients were more likely than controls to report hemodialysis (8% of
cases; mOR = 13.0; 95% CI: 1.5, 115), injections in a healthcare setting
(58%; mOR = 2.7; 95% CI: 1.3, 5.3), and surgery (33%; mOR = 2.3; 95% CI:
1.1, 4.7).

In a multivariate model, behavioral risks (adjusted OR [aOR] = 5.4; 95% CI:
1.5, 19.0; 17% attributable risk), injections (aOR = 2.7; 95% CI: 1.3, 5.8;
37% attributable risk), and hemodialysis (aOR = 11.5; 95% CI: 1.2, 107; 8%
attributable risk) were associated with case status.

Conclusion: Healthcare exposures may represent an important source of new
HBV and HCV infections among older adults. (HEPATOLOGY 2012).

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

8. Abstract: Identifying and prioritising adverse episodes and failures
related to patient safety in Pain Treatment Units
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22742871

Rev Esp Anestesiol Reanim. 2012 Oct;59(8):423-9.

[Identifying and prioritising adverse episodes and failures related to
patient safety in Pain Treatment Units].

[Article in Spanish]

Pérez Lázaro JJ, Fernández Ruiz I, Tejedor Fernández M, Guerra de Hoyos JA,
Jiménez Rodríguez M, de Pazzis Die de Ortega M, Insausti Valdivia J,
Rodríguez López M, Romero Cotelo J, Gálvez Mateos R.

Área de Evaluación y Calidad, Escuela Andaluza de Salud Pública, Granada,
España. juanjose.perez.easp@juntadeandalucia.es

OBJECTIVES: An expert group coordinated by the Andalusian School of Public
Health identified the most serious and frequent adverse events in Pain
Treatment Units (PTU), as well the failures and underlying causes, as a
prior step to preparing preventive actions. The aims of the project were to
identify potential adverse events in Pain Treatment Units, identify
failures and their underlying causes, and prioritise these failures
according to a failure modes and effects analysis (FMEA) tool.

MATERIAL AND METHODS: The method employed consisted of a literature search,
the selection of an expert group with experience in PTU, creating a
catalogue of adverse events using the generation of ideas technique, and
putting the FMEA and Risk Priority Index tools into practice.

RESULTS: Up to 66 types of adverse events were identified associated with;
medication (30), invasive techniques (15), care process (10), patient
information and education (6), and clinical practice (5). It was found that
up to 101 failures could be triggered by these adverse events, and that 242
causes could lead to these failures.

CONCLUSIONS: The results indicated the need to work principally in two
directions, improving the care process in the PTU (the health care
organisation), and the professional work, this latter having two aspects,
improving the clinical practice, and increase professional skills by means
of specific training. Communication, whether inter-professional or inter-
department, or with the patient and their family, is identified as a key
aspect for improvement.

Copyright © 2011 Sociedad Española de Anestesiología, Reanimación y
Terapéutica del Dolor. Published by Elsevier España. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Geographical and temporal variation of injection drug users in
Pakistan
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23314301

Sex Transm Infect. 2013 Jan 11.

Geographical and temporal variation of injection drug users in Pakistan.

Archibald CP, Shaw SY, Emmanuel F, Otho S, Reza T, Altaf A, Musa N,
Thompson LH, Blanchard JF.

Centre for Communicable Diseases and Infection Control, Public Health
Agency of Canada, Ottawa, Ontario, Canada.

OBJECTIVES: We describe the characteristics of injecting drug users (IDU)
in Pakistan in 2006 and 2011, and assess the heterogeneity of IDU
characteristics across different cities and years as well as factors
associated with HIV infection.

METHODS: Cross-sectional, integrated behavioural-biological surveys of IDU
were conducted in 10 cities across Pakistan in 2006 and 2011. Univariate
and multivariable analyses were used to describe the differences in HIV
prevalence and risk behaviours between cities and over time.

RESULTS: Large increases in HIV prevalence among injection drug users in
Pakistan were observed, with overall HIV prevalence increasing from 16.2%
in 2006 to 31.0% in 2011; an increase in HIV prevalence was also seen in
all geographic areas except one. There was an increase in risk behaviours
between 2006 and 2011, anecdotally related to a reduction in the
availability of services for IDU. In 2011, larger proportions of IDU
reported injecting several times a day and using professional injectors,
and fewer reported always using clean syringes. An increase in the
proportion living on the street was also observed and this was associated
with HIV infection. Cities differ in terms of HIV prevalence, risk
profiles, and healthcare seeking behaviours.

CONCLUSIONS: There is a high prevalence of HIV among injection drug users
in Pakistan and considerable potential for further transmission through
risk behaviours. HIV prevention programs may be improved through geographic
targeting of services within a city and for involving groups that interact
with IDU (such as pharmacy staff and professional injectors) in harm
reduction initiatives.

Free full text
http://sti.bmj.com/content/early/2013/01/10/sextrans-2012-050775.long
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Estimating the variability in the risk of infection for
hepatitis C in the Glasgow injecting drug user population
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22459739

Epidemiol Infect. 2012 Dec;140(12):2190-8.

Estimating the variability in the risk of infection for hepatitis C in the
Glasgow injecting drug user population.

Sutton AJ, McDonald SA, Palmateer N, Taylor A, Hutchinson SJ.

Health Economics Unit, Public Health Building, University of Birmingham,
Edgbaston, Birmingham, UK. A.J.Sutton@bham.ac.uk

Glasgow (Scotland’s largest city) has a high prevalence of injecting drug
use and has one of the highest prevalences of hepatitis C virus (HCV)
infection in injecting drug users (IDUs) in Western Europe.

HCV prevalence data from surveys of Glasgow’s IDUs from 1990 to 2007 were
utilized and a model was applied that described the prevalence of HCV as a
function of the rate (force) of infection. Force-of-infection estimates for
HCV that may vary over time and injecting career length over a range of
variables were investigated.

New initiates to injecting were found to be at increased risk of HCV
infection, with being recruited from a street location and reporting
injecting in prison leading to a significant increase in the risk of
infection in new initiates.

These results indicate areas of importance for the planning of public
health measures that target the IDU population.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Association of tattooing and hepatitis C virus infection: A
multicenter case-control study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23315899
Hepatology. 2013 Jan 12. doi: 10.1002/hep.26245.

Association of tattooing and hepatitis C virus infection: A multicenter
case-control study.

Carney K, Dhalla S, Aytaman A, Tenner CT, Francois F.

NYU Langone Medical Center, New York, NY.

Although injection drug use (IDU) and blood transfusions prior to 1992 are
well-accepted risk factors for hepatitis C virus (HCV) infection, many
prior studies that have evaluated tattooing as a risk factor for HCV
infection did not control for a history of IDU or transfusion prior to
1992.

In this large, multicenter case-control study we analyzed demographic and
HCV risk factor exposure history data from 3,871 patients, including 1,930
with chronic HCV infection (HCV RNA positive) and 1,941 HCV negative (HCV
antibody negative) controls.

Crude and fully adjusted odds ratios of tattoo exposure by multivariate
logistic regression in HCV infected versus controls were determined. As
expected, injection drug use (65.9% vs. 17.8%, p < 0.001), blood
transfusions prior to 1992 (22.3% vs. 11.1%, p < 0.001), and history of
having one or more tattoos (OR = 3.81; 95% CI 3.23 – 4.49, p<0.001) were
more common in HCV-infected patients than in control subjects.

After excluding all patients with a history of ever injecting drugs and
those who had a blood transfusion prior to 1992, a total of 1,886 subjects
remained for analysis (465 HCV positive and 1,421 controls).

Among these individuals without traditional risk factors, HCV positive
patients remained significantly more likely to have a history of one or
more tattoos after adjustment for age, sex, and race/ethnicity (OR = 5.17;
95% CI 3.75 – 7.11, p<0.001).

Conclusion: Tattooing is associated with HCV infection, even among those
without traditional HCV risk factors such as injection drug use and blood
transfusion prior to 1992. (HEPATOLOGY 2013.).

Copyright © 2013 American Association for the Study of Liver Diseases.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Vaccination Site and Risk of Local Reactions in Children 1
Through 6 Years of Age
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23319538

Pediatrics. 2013 Jan 14. [

Vaccination Site and Risk of Local Reactions in Children 1 Through 6 Years
of Age.

Jackson LA, Peterson D, Nelson JC, Marcy SM, Naleway AL, Nordin JD, Donahue
JG, Hambidge SJ, Balsbaugh C, Baxter R, Marsh T, Madziwa L, Weintraub E.

Group Health Research Institute, Seattle, Washington;

OBJECTIVE: Our objective was to assess whether the occurrence of medically
attended local reactions to intramuscularly administered vaccines varies by
injection site (arm versus thigh) in children 1 to 6 years of age.

METHODS: This is a retrospective cohort study of children in the Vaccine
Safety Datalink population from 2002 to 2009. Site of injection and the
outcome of medically attended local reactions were identified from
administrative data.

RESULTS: The study cohort of 1.4 million children received 6.0 million
intramuscular (IM) vaccines during the study period. The primary analyses
evaluated the IM vaccines most commonly administered alone, which included
inactivated influenza, hepatitis A, and diphtheria- tetanus-acellular
pertussis (DTaP) vaccines. For inactivated influenza and hepatitis A
vaccines, local reactions were relatively uncommon, and there was no
difference in risk of these events with arm versus thigh injections.

The rate of local reactions after DTaP vaccines was higher, and vaccination
in the arm was associated with a significantly greater risk of this outcome
compared with vaccination in the thigh, both for children 12 to 35 months
(relative risk: 1.88 [95% confidence interval: 1.34-2.65]) and 3 to 6 years
of age (relative risk: 1.41 [95% confidence interval: 0.84-2.34]), although
this difference was not statistically significant in the older age group.

CONCLUSIONS: Injection in the thigh is associated with a significantly
lower risk of a medically attended local reaction to a DTaP vaccination
among children 12 to 35 months of age, supporting current recommendations
to administer IM vaccinations in the thigh for children younger than 3
years of age.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: A randomized control trial comparing immunogenicity, safety,
and preference for self- versus nurse-administered intradermal
influenza vaccine
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22902784

Vaccine. 2012 Sep 28;30(44):6287-93.

A randomized control trial comparing immunogenicity, safety, and preference
for self- versus nurse-administered intradermal influenza vaccine.

Coleman BL, McGeer AJ, Halperin SA, Langley JM, Shamout Y, Taddio A, Shah
V, McNeil SA.

Mount Sinai Hospital, Department of Microbiology, Toronto, Canada.
bcoleman@mtsinai.on.ca

BACKGROUND: Intradermally administered influenza vaccine is as immunogenic
as intramuscular vaccine at a lower unit dose. New microinjection systems
could allow self-administration of vaccine, potentially reducing the cost
and inconvenience.

OBJECTIVE: To compare the immunogenicity, reactogenicity, success rate, and
acceptability of self- versus nurse-administered intradermal trivalent
seasonal influenza vaccine.

METHODS: Adults (18-59 years old) were randomized to either self- or nurse-
administered intradermal vaccine. Prior to vaccination, participants
completed a questionnaire and had blood drawn for hemagglutination
inhibition titres. Participants in the nurse-administered group were
vaccinated by study personnel. The self-administered group were given an
instruction sheet and administered their own vaccine. All participants
completed a questionnaire and adverse event diaries for 21 days post
vaccination, at which time blood was again collected.

RESULTS: Of the 228 participants, 115 were randomized to self-
administration and 113 to nurse administration. Groups did not differ by
sex, age, or levels of seroprotection at baseline. Of the 114 who completed
self-administration, 106 (93%) were successful on the first attempt. There
were no group differences in measures of immunogenicity for any of the
strains. Self- administering participants reported a lower mean pain rating
at vaccination but had larger areas of redness post-vaccination. Seventy
percent of all participants said they would prefer intradermal over
intramuscular vaccinations in the future, if given the choice.

CONCLUSION: Compared to nurse-administered intradermal influenza vaccine,
self- administered vaccine was immunologically non-inferior and reached all
EMA immunogenicity criteria for the A strains, was highly successful and
well- accepted by study participants. Together, these data provide
preliminary evidence of feasibility for this method of influenza vaccine
administration, which may improve vaccine uptake in adults and increase
efficiency of vaccine delivery during outbreaks.

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

14. Abstract: Solar water disinfection (SODIS): a review from bench-top to
roof-top
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22906844

J Hazard Mater. 2012 Oct 15;235-236:29-46.

Solar water disinfection (SODIS): a review from bench-top to roof-top.

McGuigan KG, Conroy RM, Mosler HJ, du Preez M, Ubomba-Jaswa E, Fernandez-
Ibañez P.

Royal College of Surgeons in Ireland, Dublin 2, Ireland. kmcguigan@rcsi.ie

Solar water disinfection (SODIS) has been known for more than 30 years. The
technique consists of placing water into transparent plastic or glass
containers (normally 2L PET beverage bottles) which are then exposed to the
sun. Exposure times vary from 6 to depending on the intensity of sunlight
and sensitivity of the pathogens. Its germicidal effect is based on the
combined effect of thermal heating of solar light and UV radiation. It has
been repeatedly shown to be effective for eliminating microbial pathogens
and reduce diarrhoeal morbidity including cholera.

Since 1980 much research has been carried out to investigate the mechanisms
of solar radiation induced cell death in water and possible enhancement
technologies to make it faster and safer.

Since SODIS is simple to use and inexpensive, the method has spread
throughout the developing world and is in daily use in more than 50
countries in Asia, Latin America, and Africa. More than 5 million people
disinfect their drinking water with the solar disinfection (SODIS)
technique.

This review attempts to revise all relevant knowledge about solar
disinfection from microbiological issues, laboratory research, solar
testing, up to and including real application studies, limitations, factors
influencing adoption of the technique and health impact.

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

15. Abstract: Health care workers’ mobile phones: a potential cause of
microbial cross-contamination between hospitals and community
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22793671

J Occup Environ Hyg. 2012;9(9):538-42.

Health care workers’ mobile phones: a potential cause of microbial cross-
contamination between hospitals and community.

Ustun C, Cihangiroglu M.

Ministry of Health, Elazig, Harput General Hospital, Department of
Infectious Diseases and Clinical Microbiology, Elazig, Turkey.
drcustun@gmail.com

This study evaluated the microbial contamination of health care workers’
(HCWs) mobile phones. The study was conducted at a secondary referral
hospital in July 2010. Samples were taken from all surfaces of the mobile
phones using a sterile swab, and incubated on Brain Heart Infusion agar at
37.5°C for 24 hr.

Any isolated microorganisms were grown aerobically on 5% sheep blood agar
and eosin methylene-blue agar medium at 37.5°C for 24-48 hr. The Sceptor
microdilution system was used to identify the microorganisms, together with
conventional methods. The oxacillin disc diffusion test and double-disc
synergy test were used to identify methicillin-resistant Staphylococcus
aureus (MRSA) and expanded-spectrum beta-lactamase (ESBL)-producing Gram-
negative bacilli, respectively. The mobile phones were also categorized
according to whether the HCWs used them in the intensive care unit (ICU).

Overall, 183 mobile phones were screened: 94 (51.4%) from nurses, 32
(17.5%) from laboratory workers, and 57 (31.1%) from health care staff. In
total, 179 (97.8%) culture-positive specimens were isolated from the 183
mobile phones, including 17 (9.5%) MRSA and 20 (11.2%) ESBL-producing
Escherichia coli, which can cause nosocomial infections.

No statistical difference was observed in the recovery of MRSA (p = 0.3)
and ESBL-producing E. coli (p = 0.6) between the HCW groups. Forty-four
(24.6%) of the 179 specimens were isolated from mobile phones of ICU
workers, including two MRSA and nine ESBL-producing E. coli. A significant
(p = 0.02) difference was detected in the isolation of ESBL- producing E.
coli between ICU workers and non-ICU workers.

HCWs’ mobile phones are potential vectors for transferring nosocomial
pathogens between HCWs, patients, and the community.
__________________________________________________________________
________________________________*_________________________________

16. No Abstract: Hierarchy and hand hygiene: would medical students speak
up to prevent hospital-acquired infection?
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22759561

Infect Control Hosp Epidemiol. 2012 Aug;33(8):861-3.

Hierarchy and hand hygiene: would medical students speak up to prevent
hospital-acquired infection?

Samuel R, Shuen A, Dendle C, Kotsanas D, Scott C, Stuart RL.
__________________________________________________________________
________________________________*_________________________________

17. No Abstract: Review of evidence for alcohol-based skin preparation
agents
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22961031

Infect Control Hosp Epidemiol. 2012 Oct;33(10):1059-60.

Review of evidence for alcohol-based skin preparation agents.

Talsma A, Chenoweth CE.
__________________________________________________________________
________________________________*_________________________________

18. Article: To prevent the spread of blood-borne infections,
the US Centers for Disease Control and Prevention has launched a
campaign reminding clinicians not to reuse needles or syringes

This open access article is kindly provided by the JAMA and the US CDC
__________________________________________________________________
JAMA, December 26, 2012—Vol 308, No. 24 2551

To prevent the spread of blood-borne infections, the US Centers for Disease
Control and Prevention has launched a campaign reminding clinicians not to
reuse needles or syringes.

©2012 American Medical Association. All rights reserved.

Full Free text http://jama.jamanetwork.com/article.aspx?articleid=1487494

Unsafe Injection Practices Plague US Outpatient Facilities, Harm Patients

By Bridget M. Kuehn, MSJ

When an astute staff member at a county public health department in New
York noticed that 2 patients who had been newly diagnosed with
hepatitisCvirus (HCV) had recently received epidural injections from the
same pain management clinic, it sparked a visit by state public health
officials to the clinic. During the visit, they observed the physician who
treated both patients withdrawing medication from a multiple-dose vial with
a previously used syringe topped with a new needle, a breach of safe
injection practices that may have contaminated the vial and exposed
subsequent patients to potential blood-borne infections.

The physician was not aware of the risk posed by this practice, explained
Guthrie Birkhead,MD,MPH,deputy commissioner of the New York State
Department of Health’s Office of Public Health, during the US Centers for
Disease Control and Prevention (CDC) Public Health Grand Rounds in November
(http://www.cdc.gov/about/grand-rounds/archives/2012/November2012.htm). But
further investigation and testing of some of the more than 8000 patients
who were notified of potential exposure identified 8 more patients with HCV
infection, and molecular testing found an identical strain of the virus in
2 patients treated on the same day, Birkhead noted. The case garnered media
attention and lawsuits and prompted the state medical board to place
conditions on the physician’s practice.

Far from being an isolated case, Birkhead and officials from the CDC and
the Center for Medicare & Medicaid Services (CMS) presented evidence
suggesting that such lapses are a common occurrence in US health care,
particularly at outpatient facilities. Thomas Hamilton, MD, director of the
survey and certification group in CMS’s Center for Clinical Standards and
Quality, noted that a 3-state pilot survey published in 2010 found 46 of 68
facilities (67.6%) had at least 1 lapse of infection control (Schaefer M K
et al. JAMA. 2010; 303[22]:2273-2279). The survey, part of the CMS’s effort
to audit whether ambulatory surgery centers were following the CDC’s
recommended infection control practices, found that reuse of single-dose
vials for multiple patients was a common lapse, occurring at one-third of
facilities surveyed. Results of a follow-up survey involving all states
found similarly high rates of infection control violations, reported
Hamilton, with 51.3% of facilities having such a failure in 2010. Small
declines in infection control slipups have been documented at ambulatory
surgical centers in the most recent national surveys, with such lapses
found at 43.5% of centers in 2011 and 42.1% in 2012.

Michael Bell, MD, associate director for infection control in the CDC’s
division of health care quality promotion, was frank in his assessment of
the data, saying US patients deserve better than a “coin toss” chance of
being exposed to infection at a surgical center.

“It is not cutting-edge science,” Bell said. “It is, in fact, appalling.”

COMMON MISTAKES

In the last decade, there have been at least 48 US outbreaks of infectious
diseases traced back to unsafe injection practices, not including cases
involving medications contaminated at the site of production, such as those
implicated in the ongoing outbreak of fungal meningitis, said Joseph Perz,
DrPH, of the CDC. Of these outbreaks, 21 involved patients infected with
hepatitis B or C and 27 resulted in patients developing bacterial
infections, often invasive blood infections, said Perz, team leader of the
ambulatory and long-term care prevention and response branch in the CDC’s
division of health care quality promotion. Most of the affected patients
were infected during treatment at an outpatient facility, particularly pain
clinics and outpatient oncology centers, he noted.

During these outbreaks, more than 150 000 patients were notified of
potential exposure to infection. In addition to causing potential distress
to patients and imposing costs related to testing and follow-up care, such
notifications may erode public trust in the health care system, Perz said.
For example, Birkhead noted that high profile episodes involving patients
placed at risk during colonoscopy procedures in Nevada or during influenza
vaccinations in New York may lead patients to forgo such preventive
interventions.

Perz said that certain unsafe practices have been implicated in multiple
outbreaks. For example, in the Nevada case, clinicians at a busy endoscopy
clinic employed syringes that had been previously used on a patient, using
the syringe, capped with a new needle, to withdraw from a vial medication
that was subsequently injected in a different patient. Because a used
syringe can contain fluid drawn from the patient receiving an injection,
this can contaminate medication vials later reused on patients. The clinic
was also routinely using vials of medication intended for single-dose use
for multiple patients, a practice that can expose patients to bacteria in
contaminated vials or to blood-borne pathogens in cases of needle or
syringe reuse.

Unfortunately, data indicate that risky injection practices are not
uncommon. A survey of 550 health care professionals found 1% of clinicians
reported sometimes reusing syringes and 6% reported reusing single-dose
vials (Pugliese G et al.AmJ Infect Control. 2010;38[10]:789-798). Similar
behaviors, such as reusing insulin pens (which may also retain patient
fluids) on multiple patients and reusing syringes after injections through
tubing, have been linked to outbreaks of infection, Perz noted.

ONE & ONLY CAMPAIGN

Public health officials and agencies have tried to curb such misuse by
launching initiatives to educate clinicians at outpatient facilities and
elsewhere about safe injection practices.

In 2009, the CDC and the Safe Injection Practices Coalition launched a
campaign to educate clinicians about the need to follow the CDC’s standard
precautions to ensure safe injections
www.cdc.gov/injectionsafety/1anonly.html#Background The One & Only campaign
emphasizes using each needle and each syringe only once. The CDC is
providing funding for 3 states — North Carolina, New Jersey, and New York —
to disseminate campaign materials.

In addition to participating in the campaign, New York has made changes to
its laws to facilitate investigations of outbreaks, increased regulation of
ambulatory surgical centers, and mandated clinician training in safe
injection practices, Birkhead said. The state has also created an
iatrogenic disease transmission working group that includes
epidemiologists, public affairs staff, physician disciplinary board
representatives, and other stakeholders who meet regularly to review
ongoing investigations.

But Birkhead noted a major challenge to these efforts has been refusal by
clinicians to acknowledge that unsafe injection practices are a problem.
“Providers need to be educated and denial addressed,” he said. Perz also
highlighted the problem of physician denial, explaining that the agency has
received push-back from pain management specialists about the safety of
using single-dose vials for multiple patients. Perz said defense of the
practice is based on a lot of “ifs”—for example, if only a new syringe is
used.

Since the Nevada out break, which occurred in a CMS-certified facility, CMS
has partnered with the CDC to give teeth to the public health agency’s
evidence based guidanceon injection practices. As the largest purchaser of
health care in the world, CMS has considerable enforcement authority, noted
Hamilton. It conducts unannounced surveys of a range of organizations
providing outpatient care, including ambulatory surgical centers, clinical
laboratories, dialysis centers,hospitals, nursing homes, rural health
centers, and home health agencies. To be certified and receive payment for
care of beneficiaries of Medicare and Medicaid, facilities must promptly
remedy problems identified by surveyors.

But CMS has also faced growing challenges in its oversight of outpatient
facilities. The number of such facilities has grown substantially, with
thenumberof ambulatorysurgical centers participating in Medicare increasing
from 3094 in 2000 to about 5368 in 2011, Hamilton said. Similarly, the
number of dialysis centers has increased from 3957 in 2000 to almost 5706
in 2011. Healso noted that most of these facilities operate on a for-profit
model, which may lead to efforts to cut costs by using single-dose vials
for multiple patients or by reusing syringes.

Alignment of CMS and CDC’s capabilities to tackle the problem is a good
strategy, said Hamilton, and CMS has also been requiring credentialing
organizations to address these issues.

Perz noted the need to engineer foolproof injection products or systems, to
build “a safer system from the ground up.” For example, he noted that
autosafe syringes have been promoted for use overseas. Such products may
automatically retract the needle after use and become disabled to prevent
reuse.

The CDC has encouraged outpatient facilities to move toward prepared
singledose injections, said Bell, but he acknowledged that many of these
facilities lack the resources hospitals may have, such as dedicated space
and personnel for such preparation. In such circumstances, the agency has
recommended that facilities consider compounding pharmacies as a source for
single-dose products. Now, however, he noted that the recent fungal
meningitis outbreak traced to contaminated medication from a large
compounding pharmacy calls such a strategy into question. It has led the
agency to recommend pharmaceutical manufacturers, who are held to tighter
standards, as a source for single-dose products, he said.

Hamilton noted there are several more steps CMS is taking as well, starting
with declining to pay for medical errors, as well as championing those
individuals within facilities who are working to promote patient safety and
calling on top management to support those efforts. Addressing the need for
improved injection safety will not be easy, given the number of outpatient
facilities springing up and the competing demands for clinicians’ and
facilities’ attention, Bell acknowledged.“

This is a huge mountain of work that needs to be done,” he said.

2552 JAMA, December 26, 2012—Vol 308, No. 24 ©2012 American Medical
Association. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

19. MMWR Global Control and Regional Elimination of Measles, 2000–2011
__________________________________________________________________
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6202a3.htm?s_cid=mm6202a3_e

Global Control and Regional Elimination of Measles, 2000–2011

Morbidity and Mortality Weekly Report (MMWR)
January 18, 2013 / 62(02);27-31

Introduction:
Widespread use of measles vaccine since 1980 has led to a substantial
decline in global measles morbidity and mortality; measles elimination* has
been achieved and sustained in the World Health Organization (WHO) Region
of the Americas (AMR) since 2002.

In 2010, the World Health Assembly established three milestones for measles
eradication to be reached by 2015: 1) increase routine coverage with the
first dose of measles-containing vaccine (MCV1) for children aged 1 year to
=90% nationally and =80% in every district or equivalent administrative
unit; 2) reduce and maintain annual measles incidence to <5 cases per
million; and 3) reduce measles mortality by 95% from the 2000 estimate (1).
The Global Vaccine Action Plan (GVAP) includes monitoring progress toward
achievement of goals to reduce or eliminate measles in four WHO regions by
2015 and five WHO regions by 2020 (2).†

This report updates the previous report (3) and describes progress in
global control and regional elimination of measles during 2000–2011.
Estimated global MCV1 coverage increased from 72% in 2000 to 84% in 2011,
and the number of countries providing a second dose of measles- containing
vaccine (MCV2) through routine services increased from 97 (50%) in 2000 to
141 (73%) in 2011. During 2000–2011, annual reported measles incidence
decreased 65%, from 146 to 52 cases per 1 million population, and estimated
measles deaths decreased 71%, from 542,000 to 158,000. However, during
2010–2011, measles incidence increased, and large outbreaks of measles were
reported in multiple countries.

To resume progress toward achieving regional measles elimination targets,
national governments and partners are urged to ensure that measles
elimination efforts receive high priority and adequate resources.

Centers for Disease Control and Prevention 1600 Clifton Rd. Atlanta, GA
30333, USA

Free full text
www.cdc.gov/mmwr/preview/mmwrhtml/mm6202a3.htm?s_cid=mm6202a3_e
__________________________________________________________________
________________________________*_________________________________

20. News

– USA: Creditors probe meningitis-linked pharmacy owners’ pay
– Evidence Grows for Narcolepsy Link to Swine Flu Shot
– Canada: University Warns Students About Possible HIV, Hepatitis Exposure
After Exercise
– Australia: Needle exchanges ‘can curb Hep C’
– Online Tattoo and Piercing Kits Could Be Spreading Hepatitis C
– USA: Vaccine timetable for children is safe, experts say
– USA: Health Care Related Exposure Linked to HCV, HBV Infection in Older
Adults
– USA: Hospital Patients Potentially Exposed To Blood-borne Infectious
Diseases Through Reused Insulin Pens

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
USA: Creditors probe meningitis-linked pharmacy owners’ pay
By Tim McLaughlin, Reuters (22.01.13)

BOSTON (Reuters) – Creditors of the bankrupt pharmacy linked to a deadly
U.S. meningitis outbreak are investigating $16 million in salary and
shareholder distributions made to company owners in 2012, a lawyer for the
group said on Tuesday.

Some of the transfers from the New England Compounding Center, which had
2012 sales of $32.4 million, followed the discovery last fall of the
meningitis outbreak that has killed 44 people, according to documents filed
late on Friday.

“The bottom line is that instead of using the money to remedy the
pharmacy’s problems, which now look like a ticking time bomb, they took the
money out,” said David Molton, a lawyer at Brown Rudnick LLP, which is
representing the official committee of unsecured creditors in NECC’s
bankruptcy.

The unsecured creditors committee, which includes victims of the meningitis
outbreak, plans to meet on Tuesday to discuss whether the payments to
insiders were proper.

Bankruptcy law allows creditors to go back two years before the Chapter 11
filing and claw back transfers and payouts deemed improper, or
“fraudulently conveyed,” Molton said in a telephone interview.

NECC owner Carla Conigliaro, the largest shareholder in the privately held
company, received nearly $9 million in 2012, according to court papers.

NECC also paid about $18,000 on her American Express card for purchases
from gas stations, restaurants, the Apple Store and other places.

Barry Cadden, NECC’s chief pharmacist, received about $3.2 million in 2012,
filings show. His wife, Lisa Cadden, received about $2.8 million. Greg
Conigliaro, a recycling entrepreneur who is Lisa Cadden’s brother and Carla
Conigliaro’s brother-in-law, received about $1.6 million.

The filings also showed that Framingham, Massachusetts-based NECC had made
lease payments for a 2012 BMW X5 and 2011 Mercedes Benz GL-550. NECC paid,
for example, $1,251 a month for Carla Conigliaro’s Mercedes Benz lease
payment, court papers show.

Brown Rudnick LLP, in a statement, said NECC had paid a total of more than
$21 million to the pharmacy’s four primary owners and other insiders.

Medical Sales Management, which shares some common ownership with NECC,
received more than $4 million from NECC in 2012, court papers show.

A spokesman for NECC did not return a telephone call seeking comment.

NECC filed for bankruptcy protection last month after U.S. authorities shut
down its pharmacy operations amid a meningitis outbreak that has killed 44
people and sickened 678 others, according to the U.S. Centers for Disease
Control.

NECC shipped thousands of vials of a fungus-tainted steroid to medical
facilities throughout the United States, according to authorities.

(Reporting by Tim McLaughlin; Editing by Lisa Von Ahn)
__________________________________________________________________
__________________________________________________________________
Evidence Grows for Narcolepsy Link to Swine Flu Shot
By Kate Kelland, Reuters Health Information (22.01.13)

STOCKHOLM (Reuters) Jan 22 – Emelie Olsson is plagued by hallucinations and
nightmares. When she wakes up, she’s often paralyzed, unable to breathe
properly or call for help. During the day she can barely stay awake, and
often misses school or having fun with friends. She is only 14, but at
times she has wondered if her life is worth living.

Emelie is one of around 800 children in Sweden and elsewhere in Europe who
developed narcolepsy after being immunized with the Pandemrix H1N1 swine
flu vaccine made by British drugmaker GlaxoSmithKline in 2009.

Finland, Norway, Ireland and France have seen spikes in narcolepsy cases,
too, and people familiar with the results of a soon-to-be-published study
in Britain have told Reuters it will show a similar pattern in children
there.

Europe’s drugs regulator has ruled Pandemrix should no longer be used in
people younger than age 20. The chief medical officer at GSK’s vaccines
division, Norman Begg, says his firm views the issue extremely seriously
and is “absolutely committed to getting to the bottom of this”, but adds
there is not yet enough data or evidence to suggest a causal link.

Others – including Emmanuel Mignot, a leading expert on narcolepsy, who is
being funded by GSK to investigate further – agree more research is needed
but say the evidence is already clearly pointing in one direction.

“There’s no doubt in my mind whatsoever that Pandemrix increased the
occurrence of narcolepsy onset in children in some countries – and probably
in most countries,” says Mignot, from Stanford University in Palo Alto,
California.

30 MILLION RECEIVED PANDEMRIX

In total, the GSK shot was given to more than 30 million people in 47
countries during the 2009-2010 H1N1 swine flu pandemic. Because it contains
an adjuvant it was not used in the United States because drug regulators
there are wary of adjuvanted vaccines.

GSK says 795 people across Europe have reported developing narcolepsy since
the vaccine’s use began in 2009.

Questions about how the narcolepsy cases are linked to Pandemrix, what the
triggers and biological mechanisms might have been, and whether there might
be a genetic susceptibility are currently the subject of deep scientific
investigation.

But experts on all sides are wary. Rare adverse reactions can swiftly
develop into “vaccine scares” that spiral out of proportion and cast what
one of Europe’s top flu experts calls a “long shadow” over public
confidence in vaccines that control potential killers like measles and
polio.

“No-one wants to be the next Wakefield,” said Mignot, referring to the now
discredited British doctor Andrew Wakefield who sparked a decades-long
backlash against the measles, mumps and rubella (MMR) shot with false
claims of links to autism.

With the narcolepsy studies, there is no suggestion that the findings are
the work of one rogue doctor.

Independent teams of scientists have published peer-reviewed studies from
Sweden, Finland and Ireland showing the risk of developing narcolepsy after
the 2009-2010 immunization campaign was between seven and 13 times higher
for children who had Pandemrix than for their unvaccinated peers.

“We really do want to get to the bottom of this. It’s not in anyone’s
interests if there is a safety issue that needs to be addressed,” said
GSK’s Begg.

LIFE CHANGED

Emelie’s parents, Charles and Marie Olsson, say she was a top student who
loved playing the piano, taking tennis lessons, creating art and having fun
with friends. But her life started to change in early 2010, a few months
after she had Pandemrix. In the spring of 2010, they noticed she was often
tired, needing to sleep when she came home from school.

But it wasn’t until May, when she began collapsing at school, that it
became clear something serious was happening.

As well as the life-limiting bouts of daytime sleepiness, narcolepsy brings
nightmares, hallucinations, sleep paralysis and episodes of cataplexy, when
strong emotions trigger a sudden and dramatic loss of muscle strength.

Narcolepsy is estimated to affect between 200 and 500 people per million
and is a lifelong condition. It has no known cure and scientists don’t
really know what causes it. But they do know patients have a deficit of the
brain neurotransmitter orexin, also known as hypocretin, which regulates
wakefulness.

Research has found that some people are born with an HLA gene variant that
leads to low hypocretin, making them more susceptible to narcolepsy. Around
25% of Europeans are thought to have this genetic vulnerability.

When results of Emelie’s hypocretin test came back in November last year,
it showed she had 15% of the normal amount, typical of heavy narcolepsy
with cataplexy.

TRIGGERS?

Scientists investigating these cases are looking in detail at Pandemrix’s
adjuvant, called AS03, for clues.

Some suggest AS03, or maybe its boosting effect, or even the H1N1 flu
itself, may have triggered the onset of narcolepsy in those who have the
susceptible HLA gene variant.

Angus Nicoll, a flu expert at the European Centre for Disease Prevention
and Control (ECDC), says genes may well play a part, but don’t tell the
whole story.

“Yes, there’s a genetic predisposition to this condition, but that alone
cannot explain these cases,” he said. “There was also something to do with
receiving this specific vaccination. Whether it was the vaccine plus the
genetic disposition alone or a third factor as well – like another
infection – we simply do not know yet.”

GSK is funding a study in Canada, where its adjuvanted vaccine Arepanrix,
similar to Pandemrix, was used during the 2009-2010 pandemic. The study
won’t be completed until 2014, and some experts fear it may not shed much
light since the vaccines were similar but not precisely the same.

It all leaves this investigation with far more questions than answers, and
a lot more research ahead.

WAS IT WORTH IT?

In his glass-topped office building overlooking the Maria Magdalena church
in Stockholm, Goran Stiernstedt, a doctor turned public health official,
has spent many difficult hours going over what happened in his country
during the swine flu pandemic, wondering if things should have been
different.

“The big question is was it worth it? And retrospectively I have to say it
was not,” he told Reuters in an interview.

Being a wealthy country, Sweden was at the front of the queue for pandemic
vaccines. It got Pandemrix from GSK almost as soon as it was available, and
a nationwide campaign got uptake of the vaccine to 59%, meaning around 5
million people got the shot.

Stiernstedt, director for health and social care at the Swedish Association
of Local Authorities and Regions, helped coordinate the vaccination
campaign across Sweden’s 21 regions.

The World Health Organisation (WHO) says the 2009-2010 pandemic killed
18,500 people, although a study last year said that total might be up to 15
times higher.

While estimates vary, Stiernstedt says Sweden’s mass vaccination saved
between 30 and 60 people from swine flu death. Yet since the pandemic
ended, more than 200 cases of narcolepsy have been reported in Sweden.

With hindsight, this risk-benefit balance is unacceptable. “This is a
medical tragedy,” he said. “Hundreds of young people have had their lives
almost destroyed.”

PANDEMICS ARE EMERGENCIES

Yet the problem with risk-benefit analyses is that they often look
radically different when the world is facing a pandemic with the potential
to wipe out millions than they do when it has emerged relatively unscathed
from one, like H1N1, which turned out to be much milder than first feared.

David Salisbury, the British government’s director of immunization, says
“therein lies the risk, and the difficulty, of working in public health”
when a viral emergency hits.

“In the event of a severe pandemic, the risk of death is far higher than
the risk of narcolepsy,” he told Reuters. “If we spent longer developing
and testing the vaccine on very large numbers of people and waited to see
whether any of them developed narcolepsy, much of the population might be
dead.”

Pandemrix was authorized by European drug regulators using a so-called
“mock-up procedure” that allows a vaccine to be authorized ahead of a
possible pandemic using another flu strain. In Pandemrix’s case, the
substitute was H5N1 bird flu.

When the WHO declared a pandemic, GSK replaced the mock-up’s strain with
the pandemic-causing H1N1 strain to form Pandemrix.

GSK says the final H1N1 version was tested in trials involving around 3,600
patients, including children, adolescents, adults and the elderly, before
it was rolled out.

The ECDC’s Nicoll says early warning systems that give a more accurate
analysis of a flu strain’s threat are the best way to minimize risks of
this kind of tragedy happening in future.

Salisbury agrees, and says progress towards a universal flu vaccine – one
that wouldn’t need last-minute changes made when a new strain emerged –
would cuts risks further.

“Ideally, we would have a better vaccine that would work against all
strains of influenza and we wouldn’t need to worry about this ever again,”
he said. “But that’s a long way off.”
__________________________________________________________________
__________________________________________________________________
Canada: University Warns Students About Possible HIV, Hepatitis Exposure
After Exercise
Victoria Times Colonist, Canada (18.01.13)

First Nations University of Canada in Regina, Saskatchewan, is currently
trying to locate students who participated in the Northern Health Science
Access Program’s blood-typing exercise between 2002 and 2011, to alert them
that they may have been exposed to diseases such as hepatitis and HIV.

According to the university, the lancet used to draw blood during the
process may have caused the possible exposure. The part that pierces the
skin was discarded after each test, but the lancet holder, which should
have been discarded as well, was cleaned with alcohol and reused.

The school states that the risk to students is low, as any viruses would
have had to survive the cleaning with alcohol.
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__________________________________________________________________
Australia: Needle exchanges ‘can curb Hep C’
Peter Jean, The Canberra Times, Canberra Australia (17.01.13)

Needle exchange services should be provided in late-night convenience
stores, petrol stations and in all Australian prisons to help stop the
spread of hepatitis C, says a public health group.

A report by the Economist Intelligence Unit warns hepatitis C has become a
“silent pandemic” that kills 350,000 people each year.

The impact of the disease was likely to increase as many people who were
infected with the blood-borne virus before it was discovered in 1989 reach
the end stages of associated medical conditions.

Commenting on the report, the president of Hepatitis Australia Stuart
Loveday said health authorities were doing well to combat the disease but
more action was needed, such as in the area of prevention.

Mr Loveday said better access to clean injecting equipment for intravenous
drug users should be considered.

“We would dearly love to see injecting equipment in service stations, in
late-night convenience stores because the primary needle and syringe
programs are open only from nine to five and that’s limiting access and
service,” he said.

“So we need expansion of outlets, we need more distribution machines –
vending machines and the like. Overall, we need a proper official look at
what the impact of the drug laws in Australia is on blood-borne virus
transmission.”

Mr Loveday praised the ACT government’s proposal for a needle exchange
program in Canberra’s jail.

“It is something that we believe is absolutely essential to reduce the
transmission of blood-borne viruses, particularly hepatitis C. Prisons are
a hotbed of hepatitis C transmission,” he said.

Hepatitis C can spread between prisoners and then into the general
community when detainees are released, Mr Loveday said.

“The need for a prison-based needle exchange is not just necessary in the
Alexander Maconochie Centre, it is necessary in every single prison in
Australia. That’s not going to happen yet, however the ACT is showing great
leadership.” Chief Minister Katy Gallagher’s plan for a needle exchange
program in the Alexander Maconochie Centre has been opposed by the prison
officers’ union and the Liberal Party.

Hepatitis C can damage the liver for decades before symptoms appear. It can
also lead to cirrhosis and liver cancer.

The Economist Intelligence Unit report said that in developed countries the
stigma associated with drug use could deter many people at risk of
hepatitis C from being tested.

In developing countries, many people became infected through the health
system when injections were given with unsterilised equipment or when
infected blood was transfused.

The report was funded with an educational grant from the pharmaceutical
company Janssen.

In 2006, it was estimated that there were about 9700 hepatitis C
transmissions in Australia each year. It is believed the transmission rate
has since fallen.

Mr Loveday said that in 2011 there were about 225,000 people living in
Australia with chronic hepatitis C.
__________________________________________________________________
__________________________________________________________________
Online Tattoo and Piercing Kits Could Be Spreading Hepatitis C
Tory Shepherd, News.com.au (17.01.13)

Hepatitis Australia warned that people using tattooing and piercing kits
purchased online could be unknowingly spreading the hepatitis C virus
(HCV).

Stuart Loveday, president of Hepatitis Australia, explained that the
disease is transmitted when people share equipment to inject illicit drugs,
but that the association does not have data on those who were infected in
other ways. Loveday noted that tattooing and body piercing are very
popular, and that people are participating in tattooing and body piercing
parties with kits purchased online for $100 or less. Many of these kits are
advertised as being suitable for beginners. The problem is that the persons
using these kits do not have the knowledge or equipment to properly
sterilize the instruments.

Loveday warned that HCV is 10 times more infectious than HIV, and that
early detection is difficult because there may be no obvious signs or
symptoms. He explained that the disease causes liver damage and can cause
liver cancer, liver failure, and death. Loveday said that new treatments
provided a good chance of a cure and that the association hoped that these
treatments would be added to the Pharmaceutical Benefits Scheme (a
government program that provides subsidized prescription drugs) to make the
treatments more accessible. Jack Wallace of La Trobe University added that
because of stigma, people did not want to admit that they had HCV infection
or get tested or treated. He said that more than 225,000 Australians are
estimated to be infected with HCV.
__________________________________________________________________
__________________________________________________________________
USA: Vaccine timetable for children is safe, experts say
By Susan Heavey, Reuters (16.01.13)

WASHINGTON (Reuters) – The current guideline for immunizing children
against polio, whooping cough, measles and other infectious diseases is
safe, but should still be monitored, federal health advisers said on
Wednesday.

In what they called the most comprehensive review to date, scientists at
the Institute of Medicine (IOM) said there is no evidence that giving
children vaccines according to the recommended timetable causes other
problems such as autism or asthma.

IOM, part of the National Academies, a federally-charted group of
scientific advisers to the government, said it hopes the findings would
reassure parents, doctors and others even as it recommends that the
research continue.

“The message is that the schedule is safe by all existing data,” said Dr.
Pauline Thomas, an IOM adviser and a professor at New Jersey Medical School
in Newark.

Requested by U.S. health officials, the year-long review of existing
studies underscores the lingering concerns some people have about the
vaccines, especially the many shots babies and toddlers receive.

The findings come as the nation wrestles with various outbreaks, including
an influenza epidemic. Several U.S. states are also grappling with record
spikes of whooping cough.

Federal vaccine guidelines recommend 24 immunizations by age 2, and
sometimes children can get up to five shots in one doctor’s visit.

While most people follow the recommended timetable, IOM said about 1
percent of Americans refuse all vaccines.

The reasons vary. Some object for religious reasons but others are
concerned that underlying medical conditions could raise the risk of
possible complications from the injections. Others worry potential harms
outweigh the benefits or simply mistrust the government, which reviews and
approves vaccines before they can be marketed.

Still, most parents comply.

Pamela Maslen, a registered nurse and lactation consultant in Silver
Spring, Maryland, said her work overseas influenced her decision to follow
the recommendations when her first daughter was born nearly five years ago.

“I pretty much decided I wanted to keep on the schedule because I knew we
would be moving, and I didn’t want her to be susceptible to anything,” said
Maslen, 35, who has two daughters and is expecting her third child soon.

SOME PARENTS STILL WORRY

IOM’s panel of independent scientists looked at the schedule of
immunizations and all available scientific literature to determine safety.
They also reviewed CDC and the Food and Drug Administration databases that
track side effects.

Yet suspicions over vaccines have continued for years. Nearly 40 percent of
U.S. parents have some mistrust of childhood vaccines, the CDC has said.

Some suspicions arose over autism and thimerosal, a mercury-based
preservative once used in many U.S. vaccines but no longer. No studies have
shown a clear link, and IOM said in 2004 that researchers should look
elsewhere for the disorder’s cause.

“The concerns are certainly still out there,” said Cassandra Jessee, 39,
who opted to “delay” the vaccines for her 16-month-old son by spreading
them over several months rather than one doctor’s visit.

“It means more co-pays and doctors appointments, but to me it is worth it,”
she said.

While some pediatricians allow their patients to stretch the timetable,
others refuse to do so saying it poses risks.

The IOM panel said there is no evidence that an alternative schedule that
would be safer or less safe.

But studying the health impact of children who get vaccines on time versus
those who do not would be too risky and expensive, it said. Instead, while
current databases could be enhanced, they are still the best way to monitor
safety, it added.

Panelists also said doctors need to find better ways to communicate with
the public about vaccine safety and concerns.

(Additional reporting by Elvina Nawaguna; Editing by Jilian Mincer and Tim
Dobbyn)
__________________________________________________________________
__________________________________________________________________
USA: Health Care Related Exposure Linked to HCV, HBV Infection in Older
Adults
Healio (15.01.13)

Researcher Joseph Perz reported that older patients who received healthcare
had increased risk of becoming infected with hepatitis C or hepatitis B.
Patients’ behavioral risks—being in jail, using “non-injected illicit
drugs,” or having sex with hepatitis-infected partners or with multiple
partners—had no relation to this increased risk. The study included 48
hepatitis-infected patients ages 55 and older who showed hepatitis symptoms
within six months of exposure to healthcare settings.

Most of the hepatitis-infected patients (94 percent) reported exposure to
healthcare within six months of showing symptoms of hepatitis C or B. The
hepatitis-infected patients in the study had experienced surgery, blood
transfusion, hemodialysis, healthcare-related injections, emergency
department visits, or overnight hospitalization. Hemodialysis and
injections, in particular, were associated with increased risk of hepatitis
infection. Study results were compared to a matched control group of 159
people; 89 percent of the control group had contact with healthcare during
the same time period.

Perz recommended better public health surveillance and “stronger oversight”
of infection control in healthcare settings to reduce the risk to patients.

The full report, “Case-control Study of Hepatitis B and Hepatitis C in
Older Adults: Do Healthcare Exposures Contribute to Burden of New
Infections?” was published online in the journal Hepatology (2012; DOI:
10.1002/hep.25688). http://www.ncbi.nlm.nih.gov/pubmed/22383058
__________________________________________________________________
__________________________________________________________________
USA: Hospital Patients Potentially Exposed To Blood-borne Infectious
Diseases Through Reused Insulin Pens
The Inquisitr, USA (15.01.13)

Buffalo, NY – Authorities report that more than 700 patients admitted to
The Veterans Affairs Western New York Healthcare System over a two-year
period, may have been exposed to blood-borne infectious diseases. Blood-
borne diseases included Human immunodeficiency virus (HIV) and hepatitis B
and C.

In this situation, multi-dose injectable insulin pens indented for single
person use, were instead used to treat multiple patients. The hospital’s
storage of insulin could have also been contaminated through needle flow
back. The reuse of insulin pens is akin to the reuse of other syringes,
potentially spreading pernicious diseases from one unsuspecting patient to
another.

The Buffalo hospital began using insulin pens in October 2010. An
inspection in November 2012 led to the discovery that the pens had likely
been used on more than one patient.

CBS News reports, federal health agencies have been warning against sharing
insulin pens for several years. The Food and Drug Administration (FDA)
issued an alert in March 2009 after learning that more than 2,000 patients
may have been exposed at a Texas hospital between 2007 and 2009. A clinical
alert from the Centers for Disease Control and Prevention (CDC) last year
came amid continued reports of the practice.

Dr. Melissa Schaefer of the CDC said Monday:

“This just shouldn’t happen, but it does. And I think the incidents we hear
about are likely under-reported.”

More than 150,000 patients have been impacted by unsafe injection practices
since 2001. The CDC sponsors a One and Only Campaign, used as an
educational tool. The One and Only Campaign aims to eradicate avoidable
outbreaks from unsafe medical injections by raising awareness among
patients and healthcare providers about proper practices. The CDC urges
that each medical establishment undergo proper Blood-borne Pathogens
Training, which not only protects the patient but the administrators from
possible exposure from mishandling samples and needles.

There have been cases where clinicians and technicians have intentionally
contaminated needles thorough drug addiction. Last year, David Kwiatkowski,
a lab technician absconded with syringes containing the powerful painkiller
fentanyl. He acquired them from the cardiac catheterization lab at New
Hampshire’s Exeter Hospital. In hopes of covering his tracks, David
replaced the used fentanyl syringes with saline. However, they were tainted
with his blood. Over 40 people have since been diagnosed with the same
strain of hepatitis C that Kwiatkowski carries.

During the summer of 2012, Colorado oral surgeon, Dr. Stephen Stein, was
accused of repeatedly reusing needles in his practice over a 12 year
period. Stein was accused of saving unused drugs in syringes and then
combining those drugs into another syringe, used later on another patient.
The Colorado Department of Public Health looked into the matter and
initially found five patients who tested positive for a blood disease. It
is possible up to 8,000 people could have been exposed while under his
care.

Representatives of the Department of Veterans Affairs indicate they’ll be
contacted previous patients in the reused pen case. The VA will establish a
nurse-staffed call center to field notifications and respond to questions.
Blood tests and follow up care will be arranged. Employees will be given
educational material on the proper use of insulin pens, in order to
eliminate the threat of spreading disease.

The VA’s National Center for Patient Safety has also been asked to prepare
a safety alert for all VA facilities. The notices are designed to reinforce
best practices for patient care.
__________________________________________________________________
________________________________*_________________________________
* SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org

A fact sheet on injection safety is available at:
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* 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

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Facsimile: +41 22 791 4836 E- mail: sign@who.int
__________________________________________________________________
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SIGN meets annually to aid collaboration and synergy among SIGN network
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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:
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The report is navigable using bookmarks and is searchable. Viewing
requires the free Adobe Acrobat Reader at: http://get.adobe.com/reader/

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or http://www.freetranslation.com
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