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SIGNpost 00685


Post00685 Prevention + Finance + Tech + Abstracts + News 13 February 2013

1. Editorial: Hepatitis B and C: Prevention is better than cure
2. Policy Report: Financing Global Health 2012: The End of the Golden Age?
3. New Study: Promoting Access to Medical Technologies and Innovation
– Intersections between public health, intellectual property and trade
4. Abstract: Treatment of hepatitis B and C through National Programme — An
5. Abstract: Ditch the pinch: Bilateral exposure injuries during
subcutaneous injection
6. Abstract: WHO and the future of disease control programmes
7. Abstract: Acute hepatitis C virus infection in a nurse trainee following
a needlestick injury
8. Abstract: Prevalence and risk factors of Hepatitis C virus infection in
Brazil, 2005 through 2009: a cross-sectional study
9. Abstract: Prevalence and correlates of HIV discordance and concordance
among Chinese-Burmese mixed couples in the Dehong prefecture of Yunnan
province, China
10. Abstract: Sterile gloves: do they make a difference?
11. Abstract: Economic evaluation of universal newborn hepatitis B
vaccination in China
13. Abstract: A Decade of Experience with Injectable Poly-L-Lactic Acid: A
Focus on Safety
14. News
– Australia: Hepatitis infections blamed on incompetent medical board
– Researchers create needle-free vaccine out of sugar
– China: 99 Chinese get hepatitis C from contaminated needle
– China: Repeated Needle Use Leads to 95 Hepatitis C Infections
– Canada: Campaign Targets Rising Hepatitis Infections
– Steroid shots for tennis elbow may hurt, not help
– China: Chinese Clinic Suspected of Infecting 95 Patients With Hepatitis
C Contaminated Injections

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1. Editorial: Hepatitis B and C: Prevention is better than cure

Crossposted with thanks from the Journal of the Pakistan Medical
Association’s current issue.

See item 4. Abstract: Treatment of hepatitis B and C through National
Programme — An audit

It follows below in Abstracts and includes a link to the full text

J Pak Med Assoc February, 2013 p 154-5

Editorial: Hepatitis B and C: Prevention is better than cure

Ambreen Arif, Jinnah Postgraduate Medical Centre, Karachi.

The World Health Organization has estimated that the global burden of
hepatitis B and C is 4.3 million and 800, 000 persons respectively each
year in Eastern Mediterranean Region alone contributing to 2% deaths
secondary to cirrhosis and hepatocellular carcinoma.1

Prevention of hepatitis B has been achieved in many countries globally
following its incorporation in the childhood immunization programmes and as
individual vaccine in children and adults. For hepatitis C, no vaccine is
available therefore prevention following universal adherence to infection
control are the mainstay. As both these diseases spread through common
source i.e. blood and body secretions, therefore universal childhood
vaccination, infection control, blood screening and proper sterilization of
invasive medical devices is recommended.

Treatment of hepatitis B and C has evolved in the last 10 years leading to
viral clearance and disease control in over 60-70% cases following
meticulous selection2 Despite such a good treatment response rate, the cost
statistics for treatment suggest that treatment may not be an ideal option
for developing countries with limited resources where treatment options are
often misused.3 The prevention strategies include universal hepatitis B
vaccination to all neonates; catch up vaccination for those children who
have missed childhood immunization and vaccination of high risk groups
(health care professionals, families of hepatitis B positive cases,
population requiring multiple transfusions and people with risky

For hepatitis C, there is no preventive vaccine available.
Protection to the community is supported through adopting universal
infection control and safe injection practices in all public and private
sector hospitals/clinics and mandatory screening of blood for blood
transmissible viruses.

In Pakistan the prevalence for Hepatitis C is 4.9% and for Hepatitis B it
is 2.5% with districts having high (prevalence >8%), intermediate
(prevalence 2-7%) and low endemicity (prevalence <2).4 The overall 7.5%
exposure rate to either of the two viruses suggests that about 12 million
people have had exposure to them and about a quarter are likely to be
suffering from the chronic complications of these deadly diseases i.e.
cirrhosis and hepatocellular carcinoma. Hospital statistics show that about
30-40% medical ward admissions are due to cirrhosis5 and its complications
and over 50% of the hospital budget is spent on their management.

In Pakistan hepatitis B and C will take decades to contain because the
coverage of hepatitis B through expanded programme for immunization is
still about 54% after almost a decade of introduction of this vaccine in
the EPI, catch up vaccination for children is demand driven mostly through
NGOs and vaccination of high risk groups is not up to the mark (over 20%
health care workers in most public sector settings are still not
vaccinated).6 Screening of blood for these viruses is still not done in 25%
blood banks.1 Implementation of infection control practices and delivery of
safe injections are yet other major hurdles to cross before we contain
these deadly diseases.

The Prime Minister\’s programme for hepatitis prevention and control was
launched in 2006 with the objectives to contain hepatitis B and C through
preventive strategies and to treat a small number of marginalized/non
affording cases and see their treatment response. Pakistan is probably the
only country in the world to start such a huge programme on a disease of
national interest without any donor support. It was an opportunity where
not only childhood vaccination could have been escalated but also the
disease could have been started to be contained following prevention
guidelines apart from monitoring the treatment response in a selected group
of cases.

Sheer demand for free treatment from the public and the politicians, lead
to providing treatment to a huge population without catering for obvious
difficulties in the drug supply chain and tests at the planning and
management side. Concerns were also shown on the quality of drugs as these
were procured in mass scale on a quarter of the market price.

The paper by Qureshi et al, in the current issue aims to evaluate the
efficacy of National Hepatitis Programme for Control and Prevention of
hepatitis (NPCPH) in terms of success of treatment for hepatitis B and C.
The authors have tried to audit the patient\’s data that were treated
through the programme by using the guidelines set by the programme. The
authors have demonstrated that though 85 to 99% hepatitis C cases met the
eligibility criteria and were suitable candidates for treatment through the
programme but this figure was dismally low for hepatitis B selection where
only 7 to 10% were eligible, clearly indicating gaps on the training and
management side.

Authors reported improper documentation of serological and biochemical
tests in the patient\’s file and high default rate during and post
treatment being major drawbacks in correctly evaluating the patient\’s
response and have raised questions on monitoring/evaluation by those
concerned with the programme. A response rate of 67% with conventional
interferon in hepatitis C is very similar to that reported by others within
Pakistan and negates the issues of quality of drugs. The study clearly
shows that huge amount of money was spent on treatment and tests with
minimal gains. The technical paper by WHO also documents that cost of
treating hepatitis B and C far outweighs the cost of implementing
preventive strategies hence it is recommended that perhaps a better
solution to the problem should be addressing the preventive component and
introducing harm reduction measures in clinical practice along with scale
up and advocacy of the existing infrastructure.

The lessons learnt from this programme should be used by the policy makers
especially in the scenario when Provincial health ministries have been
given the task to handle all health issues at their own level and where
quality standards, documentation, monitoring and evaluation are not so
strong in the Provinces. It is time that Provinces should revisit their
hepatitis programme in consultation with experts and using evidence from
international guidelines and use their already low health care budget
amicably with regular monitoring and evaluation of each component of the

1. Technical paper. The growing threats of hepatitis B and C in the Eastern
Mediterranean Region: a call for action 2009 EM/RC56/3.
2. Ahmed WA, Arif A, Qureshi H, Alam SE, Ather R, Fariha S, et al. Factors
influencing the response of interferon therapy in chronic hepatitis C
patients. J Coll Physicians Surg Pak 2011; 21: 69-73.
3. Franco E, Bagnato B, Marino MG, Meleleo C, Serino L, Zaratti L.
Hepatitis B: Epidemiology and prevention in developing countries. World J
Hepatol 2012; 4: 74-80.
4. Qureshi H, Bile KM, Jooma R, Alam SE, Afridi HUR. Prevalence of
hepatitis B and C viral infections in Pakistan: findings of a national
survey appealing for effective prevention and control measures. EMHJ 2010;
16: S15-S23.
5. Clinical Signs of Chronic Liver Disease. (Niaz … – Medical Channel.
(Online) (Cited 2012 April 14). Available from URL:…/10-.
6. Memon SM, Ansari S, Nizamani R, Khatri NK, Mirza MA, Jafri W. Hepatitis
B vaccination status in Health care workers of two University hospitals.
JLUMHS 2007. (Online) (Cited 2012 April 14). Available from URL:

2. Policy Report: Financing Global Health 2012: The End of the Golden Age?

Policy Report: Financing Global Health 2012: The End of the Golden Age?
The Institute for Health Metrics and Evaluation (IHME)

Financing Global Health 2012: The End of the Golden Age? is IHME’s fourth
annual report on global health expenditure and includes preliminary
estimates for health financing in the most recent years. In this year’s
report, IHME built on its past data collection and analysis efforts to
monitor the resources made available through development assistance for
health (DAH) and government health expenditure (GHE). It confirms what many
in the global health community expected: After reaching a historic high in
2010, overall DAH declined slightly in 2011, with some organizations and
governments spending more and others spending less.

The research suggests that, despite global macroeconomic stress, the
international community continues to respond to the need for health and
health system support across the developing world. Over the past two years
in particular, DAH has been sustained at levels of spending that would have
been inconceivable a decade ago. The recent plateau in DAH, however, raises
a number of considerations for decision-makers and other global health

Among other improvements in this year’s edition of Financing Global Health,
the information produced by the Global Burden of Diseases, Injuries, and
Risk Factors Study 2010 (GBD 2010) added another significant facet to the
analysis. The comprehensive and comparable estimates of disability and
premature mortality produced by GBD 2010 allowed us, for the first time, to
relate DAH to burden of disease.

Report Contents

Report overview (2,887KB pdf)
Chapter 1: Overview of development assistance for health trends (2,653KB
Chapter 2: Recipients of development assistance for health (8,047KB pdf)
Chapter 3: Development assistance for health to specific health focus areas
(16.7MB pdf)
Chapter 4: Sources of development assistance for health (2,610KB pdf)
Chapter 5: Government health expenditure (5,332KB pdf)
Conclusions and references (2,564KB pdf)
Methods annex (2,308KB pdf)
Statistical annex (2,512KB pdf)
Full report high resolution (31MB pdf)
Full report medium resolution (28MB pdf)

About IHME

The Institute for Health Metrics and Evaluation (IHME) is an independent
global health research center at the University of Washington that provides
rigorous and comparable measurement of the world’s most important health
problems and evaluates the strategies used to address them. IHME makes this
information freely available so that policymakers have the evidence they
need to make informed decisions about how to allocate resources to best
improve population health.


IHME aspires to make available to the world high-quality information on
population health, its determinants, and the performance of health systems.
We seek to achieve this directly, by catalyzing the work of others, and by
training researchers as well as policymakers.


Our mission is to improve the health of the world’s populations by
providing the best information on population health.

3. New Study: Promoting Access to Medical Technologies and Innovation
– Intersections between public health, intellectual property and trade

Promoting Access to Medical Technologies and Innovation
Intersections between public health, intellectual property and trade

“Promoting Access to Medical Technologies and Innovation” examines the
interplay between public health, trade and intellectual property, and how
these policy domains affect medical innovation and access to medical

Co-published by the World Health Organization, the World Intellectual
Property Organization and the World Trade Organization, the study draws
together the three Secretariats’ respective areas of expertise.

Medical technologies — medicines, vaccines and medical devices – are
essential for public health. Access to essential medicines and the lack of
research to address neglected diseases have been a major concern for many
years. More recently, the focus of health policy debate has broadened to
consider how to promote innovation and how to ensure equitable access to
all vital medical technologies.

Today’s health policy-makers need a clear understanding both of the
innovation processes that lead to new technologies and of the ways in which
these technologies are disseminated in health systems. This study captures
a broad range of experience and data in dealing with the interplay between
intellectual property, trade rules and the dynamics of access to, and
innovation in, medical technologies.

The study is intended to inform ongoing technical cooperation activities
undertaken by the three organizations and to support policy discussions.
Based on many years of field experience in technical cooperation, the study
has been prepared to serve the needs of policy-makers who seek a
comprehensive presentation of the full range of issues, as well as
lawmakers, government officials, delegates to international organizations,
non-governmental organizations and researchers.

Published in 2013

Download full publication [Free]

4. Abstract: Treatment of hepatitis B and C through National Programme — An

J Pak Med Assoc Vol. 63, No.2, February 2013, 220-224

Treatment of hepatitis B and C through National Programme — An audit

Huma Qureshi,1 Bile Khalif Mohamud,2 Syed Ejaz Alam,3 Ambreen
Arif,4Waquaruddin Ahmed5

Objectives: To evaluate the response to treatment given on a large scale
for hepatitis B and C through a nationwide programme.

Methods: Records of patients who received treatment of hepatitis B and C
during past 2 years through the Prime Minister’s programme for the
Prevention and Control of Hepatitis Viral Infection was retrieved randomly
from 12 sites after taking consent from the management and the site
managers. Data confidentiality was ensured. All data was photocopied and
brought to the Pakistan Medical Research Centre at the Jinnah Postgraduate
Medical Centre, Karachi, where it was entered and analysed. The
inclusion/exclusion criteria and the followup tests that were to be done
before, during and after treatment were taken from the National programme
manager so that actual data could be matched with the guidelines. Data was
analysed through a specially developed programme.

Results: A total of 7752 patients received treatment at the 12 sites for
hepatitis C. Adherence to inclusion/exclusion criteria or protocol was
followed in 7572 (97.6%) patients. Out of 7572 patients, 3440 (45.4%)
completed 6 months of interferon therapy, but the polymerase chain reaction
test at the end of 6 months was available in 1686 (49%) cases. It was not
detected at 6 months in 1133/1686 (67%) cases, while in 553 (33%) cases
there was no response.

Data for hepatitis B was collected from 8 sites. A total of 454 cases
received treatment and 85 (18.72%) fulfilled the inclusion criteria.
Treatment was completed by 9 (10.58%) cases, with 3 (3.52%) cases showing
Hepatitis B ‘e’ antigen clearance and anti-HBe (antibody to hepatitis B ‘e’
antigen) production.

Conclusion: Poor followup and inadequate documentation of
serological/biochemical tests were the major drawbacks in both hepatitis B
and C patients, resulting in wastage of huge human and financial resources
without proper planning and accountability.

Keywords: Hepatitis B and C, Viral Infection, Pakistan Medical Research
Centre, JPMC. (JPMA 63: 220; 2013)

5. Abstract: Ditch the pinch: Bilateral exposure injuries during
subcutaneous injection

Am J Infect Control. 2013 Feb 7. pii: S0196-6553(12)01372-7.

Ditch the pinch: Bilateral exposure injuries during subcutaneous injection.

Black L.

Orvis School of Nursing University of Nevada, Reno, Reno, NV. Electronic

BACKGROUND: Subcutaneous injection into an elevated skin fold poses a risk
of “bilateral exposure” injury whereby the needle pierces the opposite side
of a skin fold and subsequently enters the tissue of the health care worker

METHODS: Retrospective review was conducted examining the Exposure
Prevention Information Network (EPINet) needlestick surveillance data. Data
from 2,402 injuries occurring during subcutaneous injection were included
for analysis. Descriptive data, statistical comparisons, and a logistic
regression model reporting relative risk are provided.

RESULTS: Eighty-five bilateral exposure injuries were identified between
2000 and 2009, representing 3.5% (n/N=85/2,402) of all injection-related
percutaneous injuries. 65.4% Of the variance in bilateral exposure injury
occurrence is explained through examination of the following: (1) manual
elevation (“pinching”) subcutaneous tissue prior to injection; (2)
thin/emaciated patient; (3) injection of insulin; (4) injection of heparin;
(5) injection of enoxaparin (Lovenox); (6) if a safety device was used; and
(7) whether the health care worker was wearing gloves at the time of the
injury (?(2)(7) = 424.2; P<.01).

CONCLUSION: Manual tissue elevation should be avoided to minimize the risk
of bilateral exposure injuries.

Copyright © 2013 Association for Professionals in Infection Control and
Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

6. Abstract: WHO and the future of disease control programmes

Lancet. 2013 Feb 2;381(9864):413-8.

WHO and the future of disease control programmes.

Dye C, Mertens T, Hirnschall G, Mpanju-Shumbusho W, Newman RD, Raviglione
MC, Savioli L, Nakatani H.

HIV/AIDS, Tuberculosis, Malaria & Neglected Tropical Diseases Cluster,
World Health Organization, CH-1211 Geneva 27, Switzerland.

Huge increases in funding for international health over the past two
decades have led to a proliferation of donors, partnerships, and health
organisations. Over the same period, the global burden of non-communicable
diseases has increased absolutely and relative to communicable diseases.

In this changing landscape, national programmes for the control of
HIV/AIDS, tuberculosis, malaria, and neglected tropical diseases must be
reinforced and adapted for three reasons: the global burden of these
communicable diseases remains enormous, disease control programmes have an
integral and supporting role in developing health systems, and the health
benefits of these control programmes go beyond the containment of specific

WHO’s traditional role in promoting communicable disease control programmes
must also adapt to new circumstances. Among a multiplicity of actors, WHO’s
task is to enhance its normative role as convenor, coordinator, monitor,
and standard-setter, fostering greater coherence in global health.

Copyright © 2013 Elsevier Ltd. All rights reserved.

7. Abstract: Acute hepatitis C virus infection in a nurse trainee following
a needlestick injury

World J Gastroenterol. 2013 Jan 28;19(4):581-5.

Acute hepatitis C virus infection in a nurse trainee following a
needlestick injury.

Scaggiante R, Chemello L, Rinaldi R, Bartolucci GB, Trevisan A.

Renzo Scaggiante, Roberto Rinaldi, Department of Infectious and Tropical
Diseases, Padua Hospital, I-35128 Padua, Italy.

Hepatitis C virus (HCV) infection after biological accident (needlestick
injury) is a rare event. This report describes the first case of acute HCV
infection after a needlestick injury in a female nursing student at Padua
University Hospital.

The student nurse was injured on the second finger of the right hand when
recapping a 23-gauge needle after taking a blood sample. The patient who
was the source was a 72-year-old female with weakly positive anti-HCV test
results. Three months after the injury, at the second step of follow-up, a
relevant increase in transaminases with a low viral replication activity
(350 IU/mL) was observed in the student, indicating HCV infection. The
patient tested positive for the same genotype (1b) of HCV as the injured
student. A rapid decline in transaminases, which was not accompanied by
viral clearance, and persistently positive HCV-RNA was described 1 mo

Six months after testing positive for HCV, the student was treated with
pegylated interferon plus ribavirin for 24 wk. A rapid virological response
was observed after 4 wk of treatment, and a sustained virological
response(SVR) was evident 6 mo after therapy withdrawal, confirming that
the patient was definitively cured. Despite the favourable IL28B gene
(rs12979860) CC- polymorphism observed in the patient, which is usually
predictive of a spontaneous clearance and SVR, spontaneous viral clearance
did not take place; however, infection with this genotype was promising for
a sustained virological response after therapy.

Free full text

8. Abstract: Prevalence and risk factors of Hepatitis C virus infection in
Brazil, 2005 through 2009: a cross-sectional study

BMC Infect Dis. 2013 Feb 1;13(1):60.

Prevalence and risk factors of Hepatitis C virus infection in Brazil, 2005
through 2009: a cross-sectional study.

Pereira LM, Martelli CM, Moreira RC, Merchan-Hamman E, Stein AT, Cardoso
MR, Figueiredo GM, Montarroyos UR, Braga C, Turchi MD, Coral G, Crespo D,
Lima ML, Alencar LC, Costa M, Dos Santos AA, Ximenes RA.

BACKGROUND: Hepatitis C chronic liver disease is a major cause of liver
transplant in developed countries. This article reports the first
nationwide population-based survey conducted to estimate the seroprevalence
of HCV antibodies and associated risk factors in the urban population of

METHODS: The cross sectional study was conducted in all Brazilian macro-
regions from 2005 to 2009, as a stratified multistage cluster sample of
19,503 inhabitants aged between 10 and 69 years, representing individuals
living in all 26 State capitals and the Federal District. Hepatitis C
antibodies were detected by a third-generation enzyme immunoassay.
Seropositive individuals were retested by Polymerase Chain Reaction and
genotyped. Adjusted prevalence was estimated by macro-regions. Potential
risk factors associated with HCV infection were assessed by calculating the
crude and adjusted odds ratios, 95% confidence intervals (95% CI) and p
values. Population attributable risk was estimated for multiple factors
using a case–control approach.

RESULTS: The overall weighted prevalence of hepatitis C antibodies was
1.38% (95% CI: 1.12%–1.64%). Prevalence of infection increased in older
groups but was similar for both sexes. The multivariate model showed the
following to be predictors of HCV infection: age, injected drug use (OR =
6.65), sniffed drug use (OR = 2.59), hospitalization (OR = 1.90), groups
socially deprived by the lack of sewage disposal (OR = 2.53), and injection
with glass syringe (OR = 1.52, with a borderline p value). The genotypes 1
(subtypes 1a, 1b), 2b and 3a were identified. The estimated population
attributable risk for the ensemble of risk factors was 40%. Approximately
1.3 million individuals would be expected to be anti-HCV-positive in the

CONCLUSIONS: The large estimated absolute numbers of infected individuals
reveals the burden of the disease in the near future, giving rise to costs
for the health care system and society at large. The known risk factors
explain less than 50% of the infected cases, limiting the prevention
strategies. Our findings regarding risk behaviors associated with HCV
infection showed that there is still room for improving strategies for
reducing transmission among drug users and nosocomial infection, as well as
a need for specific prevention and control strategies targeting individuals
living in poverty.

Free full text

9. Abstract: Prevalence and correlates of HIV discordance and concordance
among Chinese-Burmese mixed couples in the Dehong prefecture of Yunnan
province, China

Sex Health. 2012 Nov;9(5):481-7.

Prevalence and correlates of HIV discordance and concordance among Chinese-
Burmese mixed couples in the Dehong prefecture of Yunnan province, China.

Duan S, Ding Y, Yang Y, Lu L, Sun J, Wang N, Wang L, Xiang L, Jia M, Wu Z,
He N.

Dehong Prefecture Centre for Disease Control and Prevention, Mangshi
678400, Yunnan Province, China.

Background: Many people from Burma have migrated to Dehong prefecture and
married local residents during the past decades; however, little is known
about HIV risk-taking behaviours and HIV prevalence among these mixed
couples. We investigated factors correlated with HIV discordance and
concordance within Chinese?Burmese mixed couples in Dehong prefecture,
Yunnan province, China.

Methods: A cross-sectional study with face-to-face questionnaire interviews
and HIV blood testing was conducted.

Results: Of 5742 couples, 1.6% couples were HIV-infected concordant, 2.2%
were HIV serodiscordant with an HIV-infected male spouse and 0.9% were HIV
serodiscordant with an HIV-infected female spouse. HIV discordance with an
HIV-infected male spouse was significantly associated with characteristics
of the male spouse, including being aged =30 years, non-Han ethnic
minority, a marital relationship of <3 years, commercial sex and injection
drug use by the male spouse. HIV discordance with an HIV-infected female
spouse was significantly associated with an education level of primary
school (v. illiterate); a marital status of being in their second marriage,
widowed or divorced; a history of sexually transmissible infection
diagnosis of the female spouse; noncommercial extramarital sex by the
female spouse or by both spouses; and injection drug use by the male

A marital relationship of =3 years was the only significant independent
correlate of HIV-infected seroconcordance.

Conclusions: The study findings underscore the importance of premarital HIV
counselling and testing for this population, and the need for targeted
interventions among HIV serodiscordant mixed couples to reduce secondary
transmission as early as possible when the relationship begins.

10. Abstract: Sterile gloves: do they make a difference?

Am J Surg. 2012 Dec;204(6):976-9; discussion 979-80.

Sterile gloves: do they make a difference?

Creamer J, Davis K, Rice W.

Department of Surgery, William Beaumont Army Medical Center, El Paso, TX,

BACKGROUND: Multiple studies have demonstrated that >10(5) organisms/mL are
needed to cause a wound infection. The aim of this study was to determine
if there was a difference in bacterial colony-forming units (CFUs) on
sterile gloves versus clean gloves in an outpatient clinical setting.

METHODS: Volunteers self-gloved with pairs of clean gloves, and culture
swabs were obtained from the palmar surface. Cultures were also obtained
after volunteers self-donned sterile gloves and donned sterile gloves with
the assistance of a surgical technician.

RESULTS: Twenty-five volunteers participated. Mean growths were as follows:
clean gloves, 14.08 ± 15.45 CFUs/mL (range, 0-44 CFUs/mL); self-donned
sterile gloves, 1.28 ± 4.28 CFUs/mL (range, 0-20 CFUs/mL); and technician-
assisted sterile gloves, 1 positive with 8 CFUs/mL.

CONCLUSIONS: There was a statistically significant difference in bacterial
load on clean gloves versus sterile gloves (P < .001). However, when
comparing the bacterial contamination on clean gloves with that required to
cause an infection, it appeared that this statistically significant
difference was clinically irrelevant.

Published by Elsevier Inc.

11. Abstract: Economic evaluation of universal newborn hepatitis B
vaccination in China

Vaccine. 2013 Feb 2. pii: S0264-410X(13)00077-7.

Economic evaluation of universal newborn hepatitis B vaccination in China.

Lu SQ, McGhee SM, Xie X, Cheng J, Fielding R.

Department of Community Medicine, School of Public Health, the University
of Hong Kong, Hong Kong Special Administrative Region, China; Shenzhen
Center for Disease Control and Prevention, Shenzhen, Guangdong, China.

OBJECTIVE: To estimate the long-term cost-effectiveness of universal
newborn hepatitis B vaccination in China, an area of high endemicity.

METHOD: A decision tree was used to describe perinatal hepatitis B virus
(HBV) transmission, early infection and impact of vaccination. A Markov
model based on 1-year cycles was used to simulate these impacts for the
lifetime of a cohort of 10,000,000 infants born in 2002 in China. We
compared both cost and health outcomes for two strategies: universal
newborn vaccination comprising a timely birth dose (HepB1) with a three-
dose vaccination (HepB3) compared with no vaccination. Univariate and
probabilistic sensitivity analyses using Monte Carlo simulations were
performed to test parameter uncertainty.

RESULTS: Over the cohort’s lifetime, 79,966 chronic infections, 37,553
cases of hepatocellular carcinoma (HCC) and 130,796 HBV related deaths
would be prevented by universal infant vaccination. The prevalence of HBV
infection is reduced by 76%. Over 743,000 life-years and 620,000 quality
adjusted life years (QALYs) would be gained and there would be monetary
benefits of more than 1 billion US dollars in medical care costs and lost
productivity avoided.

CONCLUSION: The newborn vaccination programme for Hepatitis B in China both
gains QALYs and saves medical care costs. It is important to ensure that
timely and comprehensive vaccination programmes continue.

Copyright © 2013 Elsevier Ltd. All rights reserved.

13. Abstract: A Decade of Experience with Injectable Poly-L-Lactic Acid: A
Focus on Safety

Dermatol Surg. 2013 Feb 4.

A Decade of Experience with Injectable Poly-L-Lactic Acid: A Focus on

Bartus C, William Hanke C, Daro-Kaftan E.

Advanced Dermatology Associates, Allentown, Pennsylvania.

BACKGROUND: Injectable poly-L-lactic acid (PLLA) is a biodegradable
synthetic polymer device that stimulates collagen production, leading to
gradual volume restoration. It has been used worldwide for more than a
decade to treat the lines and wrinkles of the aging face and in individuals
with the human immunodeficiency virus for treatment of facial lipoatrophy.

OBJECTIVE: To provide an overview of the experience with injectable PLLA in
Europe and the United States and the practices that have improved product

MATERIALS AND METHODS: A review of the literature was conducted, and the
authors’ clinical experience was included detailing the evolution of the
use of injectable PLLA for facial restoration.

RESULTS: Although relatively high rates of nodule and papule formation were
reported during early use of injectable PLLA, updated methods have led to
better safety and efficacy, including patient selection, preparation, and
instruction; product preparation; timing of injections and avoidance of
overcorrection; an updated understanding of the anatomy of the aging face;
and site-specific injection techniques.

CONCLUSION: Important lessons have been learned that have enhanced the
safety and efficacy of injectable PLLA and have made it a desirable product
for restoring facial volume.

© 2013 by the American Society for Dermatologic Surgery, Inc. Published by
Wiley Periodicals, Inc.

14. News

– Australia: Hepatitis infections blamed on incompetent medical board
– Researchers create needle-free vaccine out of sugar
– China: 99 Chinese get hepatitis C from contaminated needle
– China: Repeated Needle Use Leads to 95 Hepatitis C Infections
– Canada: Campaign Targets Rising Hepatitis Infections
– Steroid shots for tennis elbow may hurt, not help
– China: Chinese Clinic Suspected of Infecting 95 Patients With Hepatitis
C Contaminated Injections

Selected news items reprinted under the fair use doctrine of international
copyright law:
Australia: Hepatitis infections blamed on incompetent medical board
Andrea Petrie, The Age, Australia (11.02.13)

The “complete incompetence” of Victoria’s former medical practitioners
board allowed drug addicted anaesthetist James Latham Peters to infect 55
women with hepatitis C, a court has heard.

Peters, 63, has pleaded guilty to 55 counts of negligently causing serious
injury to the female patients by infecting them with the virus between June
2008 and November 2009.

Peters, who had a history of drug abuse and drug convictions, injected
himself with pre-filled syringes of fentanyl — an opioid used in general
anaesthesia — in theatre at Croydon Day Surgery, before administering the
remaining drug to the patients as they underwent pregnancy terminations.

His pre-sentence plea hearing in Victoria’s Supreme Court on Monday heard
that while the now-deregistered anaesthetist had told the board as early as
1996 about his addiction to fentanyl and pethidine in a letter requesting
he be suspended from practising as a medical professional, he did not
inform them that he had contracted hepatitis c after he was diagnosed in

This was despite the health department being notified in accordance with
infectious diseases laws that a man with the same name and age had
contracted hepatitis c.

Chief Crown prosecutor Gavin Silbert, SC, told the court that the medical
board showed “complete incompetence” in its monitoring of Peters after he
was allowed to return to work under what was ultimately “useless”

Mr Silbert said the board had “ultimately placed the Victorian public at

He told the hearing the incidence of drug addictions in medical
practitioners was above the average of the rest of the population and was
even higher among anaesthetists.

“Box Hill Hospital was, at the time the prisoner worked there, staffed
almost entirely by anaesthetists who were recovering from major drug
addiction,” he told the court.

Mr Silbert said the prosecution had only been able to find three other
similar “clusters” of hepatitis C outbreaks around the world. In Spain, 275
patients had been infected between 1988 and 1997. In another cluster, 30
patients in the United States had been infected at the same place last
year, followed by another 18 in a separate cluster in Denver, Colorado.

Mr Silbert said being infected by Peters had had “tragic” consequences for
the victims.

As many as 10 women had refused to speak to police about contracting the
disease at the clinic for fear that their partners would find out about
pregnancy terminations, he said.

Several others have not disclosed to their partners that they had hepatitis
c or how they got it.

Mr Silbert said that while there had been advances in treatment of the
disease, the women would have to live with a “ticking time bomb” over the
next 40 years to see whether they developed potentially fatal, related
medical conditions such as cirrhosis or cancer.

The plea hearing, before Justice Terry Forrest, continues.
Researchers create needle-free vaccine out of sugar
ITV News, UK (09.02.13)

Researchers have developed a new way to administer vaccines without an
injection which they hope could combat diseases like HIV and Malaria more
cheaply and safely.

They have developed a patch that is made up of rows of tiny spikes moulded
in sugar. When the patch is pressed to skin, the spikes dissolve carrying
the dried vaccine into the body.

The researchers at King’s College in London say the technique may one day
be used in poor countries where the costs of refrigerating vaccines in

The patches also eliminate the risks of infecting people with contaminated
needles and are pain-free.

Dr Linda Klavinskis of King’s College London, said: “This new technique
represents a huge leap forward in overcoming the challenges of delivering a
vaccination programme for diseases such as HIV and malaria.”
China: 99 Chinese get hepatitis C from contaminated needle
IANS (08.02.13)

Beijing: Ninety-nine people in China contracted hepatitis C after they
received injections with a single contaminated syringe at a private clinic,
officials said Friday.

The injection were taken in the northeast province of Liaoning, Xinhua

The Donggang city government said all patients were hospitalised and are in
stable condition.

In January, health authorities traced and screened 120 people who had
received varicose vein treatment at the clinic.

Xue Feng, a doctor believed to be responsible for the infections, has been
arrested and may face criminal charges.

Another doctor at the clinic, two municipal officials and another at the
local TV station have been sacked or suspended for their roles in the

A health official said the private clinic posted fake TV ads and flouted
medical rules by using one syringe needle in all the cases.

Hepatitis C virus causes a liver disease, which the World Health
Organization says can lead to cirrhosis of the liver and liver cancer.
China: Repeated Needle Use Leads to 95 Hepatitis C Infections
Yangyang, (06.02.13)

Repeated use of needles is the suspected cause of a hepatitis C infection
of 95 people in Donggang, northeast China’s Liaoning province, reports the
Beijing Morning Post.

Li Jingyou, a 57-year-old patient said he was getting intravenous drip
treatment for his varicose veins at a clinic attached to the municipal
social security department and shared one bottle of the medicine with other
patients. One needle was suspected of being repeatedly used in the process.

One hundred twenty patients who received injections at the clinic were
traced and screened for hepatitis C infection. Among them, 95 are suspected
of having been infected with the disease, which the World Health
Organization says can lead to cirrhosis of the liver and liver cancer.

A doctor, surnamed Xue, was detained by local police on February 2 and is
being investigated, according to sources with the city’s health bureau.
Canada: Campaign Targets Rising Hepatitis Infections
CBC News, Canada (05.02.13)

According to the Sioux Lookout First Nations Health Authority, hepatitis C
virus infection has increased in the region throughout the last two years.
The health authority attributed the increase to the spread of drug abuse
and needle sharing for the purpose of injecting drugs.

Dr. Kathy Pouteau, a physician at Kasibonika Lake First Nation, Sioux
Lookout announced the launch of a new awareness campaign, called “Get
Informed. Get Tested,” on February 4. The region’s First Nation chiefs
endorsed the campaign, which focuses on respecting oneself and respecting
others, getting more specific about ensuring that drug users have clean
equipment, and using protection to prevent sexually transmitted diseases.
Dr. Pouteau explained that the region-wide ad campaign will also encourage
testing for HIV and hepatitis B and C, and will provide information on
reducing the risk of acquiring or transmitting infections for persons who
choose to use drugs.

The program seeks to educate and empower individuals to make choices that
will help them protect themselves and others. It will feature culturally
relevant print and radio advertisements for the next two months on regional
media, and will include postcards and audio and video public service
announcements for distribution to First Nations communities. Staff will
also provide as much personal outreach as possible at events such as hockey
games and at schools. Dr. Pouteau commented that people are beginning to
get the message that they should not share needles, but needles are not the
only potential source of infection. She noted that any drug-related
equipment could possibly be a contaminant and stressed the importance of
ensuring that such items are for single-person single-use only.
Steroid shots for tennis elbow may hurt, not help
By Genevra Pittmanm Reuters (05.02.13)

NEW YORK | (Reuters Health) – Getting a cortisone injection won’t cure
tennis elbow any better than a drug-free saline shot, according to a new
study – and it might actually slow recovery.

Researchers found that a few weeks after receiving the steroid shots,
people reported less pain and disability than those who’d been given
placebo injections. But a year later, the same patients lagged behind the
placebo group in their likelihood of complete recovery.

“This absolutely confirms that steroid injections are not a good idea,”
said Dr. Allan Mishra, an orthopedic surgeon at Stanford University in
Menlo Park, California.

“This is important, because people think that it’s okay to get a cortisone
injection (for tennis elbow), and it’s not okay. It puts you at a
disadvantage long term in terms of getting better,” Mishra, who has studied
tennis elbow treatment but wasn’t involved in the new study, told Reuters

The condition is caused by overuse of tendons in the elbow and typically
treated with non-steroidal anti-inflammatory drugs, physical therapy and
steroid shots.

Last month, a study from Denmark found neither steroid nor platelet
injections improved pain and functioning among people with tennis elbow any
better than saline shots, over a period of three months (see Reuters Health
story of January 22, 2013 here:

Researchers at the time cautioned that the study’s follow-up period was
short and the results might look different at six months or a year post-

By following patients longer, the new report shines a light on the possible
long-term tendon damage that can be caused by cortisone shots, Mishra said.


Bill Vicenzino from the University of Queensland in Australia and his
colleagues randomly assigned 165 adults with tennis elbow to one of four
treatment groups: cortisone shots with physical therapy, placebo shots with
physical therapy, cortisone shots without physical therapy and placebo
shots without physical therapy.

After one year, there was no difference in people’s improvement in pain or
functioning based on whether they’d had the eight sessions of prescribed

Among those who’d received a cortisone shot, 83 percent reported they had
completely recovered from tennis elbow by one year. That compared to 96
percent of those who’d received a placebo injection, according to findings
published Tuesday in the Journal of the American Medical Association.

Symptoms were also more likely to come back after a cortisone injection.
The research team calculated that one more person would have a recurrence
for every two or three treated with steroids instead of a saline shot.

“This evidence does not support the clinical practice of using
corticosteroid injection to facilitate active rehabilitation,” the study
team wrote.

Cortisone injections typically start at about $100.

Mishra said researchers are looking for better treatments to address what
is causing tendon pain in the first place, such as weakening of collagen in
the tendon. One possible option being studied by himself and others is so-
called platelet-rich plasma injections, but “we’re not quite there yet,” he

Many cases of tennis elbow also go away on their own with time and basic
stretching, Mishra added.

“I think home-based exercises are probably sufficient for treating this,”
he said. “You’d be better off with that than with a cortisone injection.
That’s what you should start with, because you might not even need physical

SOURCE: Journal of the American Medical Association,
online February 5, 2013.
China: Chinese Clinic Suspected of Infecting 95 Patients With Hepatitis
C Contaminated Injections
Associated Press (04.02.13)

The official Xinhua News Agency in Beijing, China, reported that on
February 5, local authorities in the Liaoning Province were alerted that
120 patients receiving varicose vein treatment at a private clinic could
have been given injections infected with hepatitis C. The patients were
traced and screened for the disease, and 95 of those tested were suspected
to have been infected with the hepatitis C virus. Those patients have been
hospitalized and the case is being investigated.
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