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SIGNpost 00689

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00689 HC Waste + Hands + IDU + Abstracts + News 13 March 2013

CONTENTS
1. Abstract: Profile of medical waste management in two healthcare
facilities in Lagos, Nigeria: a case study
2. Abstract: Awareness of biomedical waste management among health care
personnel in Jaipur, India
3. Abstract: Post-exposure prophylaxis in resource-poor settings: review
and recommendations for pre-departure risk assessment and planning for
expatriate healthcare workers
4. Abstract: The origin of hepatitis C virus
5. Abstract: HIV infection risk among injection drug users in a methadone
maintenance treatment program, Taipei, Taiwan 2007-2010
6. Abstract: General principles of infection control
7. Abstract: Impact of the International Nosocomial Infection Control
Consortium (INICC) Multidimensional Hand Hygiene Approach over 13 Years
in 51 Cities of 19 Limited-Resource Countries from Latin America, Asia,
the Middle East, and Europe
8. Abstract: Hand hygiene compliance and irritant dermatitis: a
juxtaposition of healthcare issues
9. Abstract: Use of the International Classification of Diseases, 9th
revision, coding in identifying chronic hepatitis B virus infection in
health system data: implications for national surveillance
11. Abstract: Chronic hepatitis B infection in adolescents who received
primary infantile vaccination
12. Abstract: Preeradication Vaccine Policy Options for Poliovirus
Infection and Disease Control
13. No Abstract: Preventing needlestick injuries
14. ProMED-mail: Fungal Infection, Contaminated Drug – USA (03)
15. News
– Global: International Community Should ‘Strengthen And Sustain’ Efforts
To Prevent GBV, HIV
– India: India takes pentavalent vaccine to 5 million children

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__________________________________________________________________
________________________________*_________________________________

1. Abstract: Profile of medical waste management in two healthcare
facilities in Lagos, Nigeria: a case study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23460544

Waste Manag Res. 2013 Mar 4.

Profile of medical waste management in two healthcare facilities in Lagos,
Nigeria: a case study.

Idowu IA, Alo B, Atherton W, Al Khaddar RM.

BEST Research Institute, School of Built Environment, Liverpool John Moores
University, Liverpool, UK.

Proper management and safe disposal of medical waste (MW) is vital in the
reduction of infection or illness through contact with discarded material
and in the prevention of environmental contamination in hospital
facilities. The management practices for MW in selected healthcare
facilities in Lagos, Nigeria were assessed.

The cross-sectional study involved the use of questionnaires, in-depth
interviews, focused group discussions and participant observation
strategies. It also involved the collection, segregation, identification
and weighing of waste types from wards and units in the representative
facilities in Lagos, Nigeria, for qualitative and quantitative analysis of
the MW streams.

The findings indicated that the selected Nigerian healthcare facilities
were lacking in the adoption of sound MW management (MWM) practices. The
average MW ranged from 0.01 kg/bed/day to 3.98 kg/bed/day. Moreover, about
30% of the domestic waste from the healthcare facilities consisted of MW
due to inappropriate co-disposal practices. Multiple linear regression was
applied to predict the volume of waste generated giving a correlation
coefficient (R2) value of 0.99 confirming a good fit of the data.

This study revealed that the current MWM practices and strategies in Lagos
are weak, and suggests an urgent need for review to achieve vital reversals
in the current trends.
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Awareness of biomedical waste management among health care
personnel in Jaipur, India
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23474579

Oral Health Dent Manag. 2013 Mar;12(1):32-40.

Awareness of biomedical waste management among health care personnel in
Jaipur, India.

Sharma A, Sharma V, Sharma S, Singh P.

Department of Prosthodontics, Jaipur Dental College, Jaipur, India.

Aims: The study aimed to determine the following among the workforce of the
Jaipur Dental College, India: their awareness regarding biomedical (BM)
waste management policy and practices, their attitude towards biomedical
waste management, and their awareness regarding needle-stick injury and its
prevalence among different categories of health care providers.

Methods: A cross-sectional study was conducted using a questionnaire with
closed-ended questions. It was distributed to 144 dentists, nurses,
laboratory technicians and Class IV employees (cleaners and maintenance
personnel) at Jaipur Dental College. The questionnaire was used to assess
their knowledge of biomedical medical waste disposal. The resulting answers
were graded and the percentage of correct and incorrect answers for each
question from all the participants was obtained.

Results: Of the 144 questionnaires, 140 were returned and the answers
graded. The results showed that there was a poor level of knowledge and
awareness of biomedical waste generation hazards, legislation and
management among health care personnel.

It was surprising that 36% of the nurses had an extremely poor knowledge of
biomedical waste generation and legislation and just 15% of the Class IV
employees had an excellent awareness of biomedical waste management
practice.

Conclusions: It can be concluded from the present study that there are poor
levels of knowledge and awareness about BM waste generation hazards,
legislation and management among health care personnel in Jaipur Dental
College. Regular monitoring and training are required at all levels.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Post-exposure prophylaxis in resource-poor settings: review
and recommendations for pre-departure risk assessment and planning for
expatriate healthcare workers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23461554

Trop Med Int Health. 2013 Mar 6.

Post-exposure prophylaxis in resource-poor settings: review and
recommendations for pre-departure risk assessment and planning for
expatriate healthcare workers.

Vaid N, Langan KM, Maude RJ.

Department of Acute Medicine, The Royal London Hospital, London, UK.

It is estimated that more than 3 million healthcare workers worldwide
suffer needlestick and splash injuries whilst at work resulting in the
potential transmission of blood-borne pathogens via exposure to bodily
fluids. Under-reporting and the subsequent management of occupational
injuries is a problem both in the United Kingdom and abroad.

Many expatriate health care workers will work in low resource settings
where the risk of transmission is greatest but in contrast to wealthier
countries such as the United Kingdom, there is often a lack of effective
systems for its safe management.

This article provides important information about this risk and how to
minimise it. The reasons for an increased risk in transmission, its
subsequent management and pre-departure planning are discussed, together
with the evidence for initiation of post-exposure prophylaxis; current
National and International guidelines as well as the urgent need for
International standardisation of these is also discussed.

© 2013 Blackwell Publishing Ltd.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: The origin of hepatitis C virus
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23463195

Curr Top Microbiol Immunol. 2013;369:1-15.

The origin of hepatitis C virus.

Simmonds P.

Infection and Immunity Division, Roslin Institute University of Edinburgh
Easter Bush, Edinburgh, EH25 9RG, UK, peter.simmonds@ed.ac.uk.

The origin of hepatitis C virus (HCV) can be conceptualised at several
levels. Firstly, origins might refer to its dramatic spread throughout the
Western world and developing countries throughout the twentieth century.

As a blood-borne virus, this epidemic was fuelled by new parenteral
transmission routes associated with medical treatments, immunisation, blood
transfusion and more recently injecting drug use. At another level,
however, origins might refer to the immediate sources of HCV associated
with its pandemic spread, now identified as areas in Central and West sub-
Saharan Africa and South and South East Asia where genetically diverse
variants of HCV appear to have circulated for hundreds of years.

Going back a final step to the actual source of HCV infection in these
endemic areas, non-human primates have been long suspected as harbouring
viruses related to HCV with potential cross-species transmission of
variants corresponding to the 7 main genotypes into humans.

Although there is tempting analogy between this and the clearly zoonotic
origin of HIV-1 from chimpanzees in Central Africa, no published evidence
to date has been obtained for infection of HCV-like viruses in either apes
or Old World monkey species. Indeed, a radical re-think of both the host
range and host-specificity of hepaciviruses is now required following the
very recent findings of a non- primate hepacivirus (NPHV) in horses and
potentially in dogs.

Further research on a much wider range of mammals is needed to better
understand the true genetic diversity of HCV-like viruses and their host
ranges in the search for the ultimate origin of HCV in humans.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: HIV infection risk among injection drug users in a methadone
maintenance treatment program, Taipei, Taiwan 2007-2010
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22783806

Am J Drug Alcohol Abuse. 2012 Nov;38(6):544-50.

HIV infection risk among injection drug users in a methadone maintenance
treatment program, Taipei, Taiwan 2007-2010.

Yen YF, Rodwell TC, Yen MY, Hsu YH, Chuang P, Li LH, Su LW, Yang YH, Jiang
XR, Fang YC, Garfein RS.

Section of Infectious Diseases, Taipei City Hospital, Taipei City
Government, No.145 Zhengzhou Rd., Taipei, Taiwan. dam37@tpech.gov.tw

BACKGROUND: Taiwan has a growing HIV/AIDS epidemic that has recently
shifted to an increase among injection drug users (IDUs). This study aimed
to measure the prevalence and incidence and identify the correlates of HIV
infection among IDUs in a large methadone maintenance treatment program
(MMTP) in Taipei, Taiwan.

METHODS: Data from intake interviews and HIV testing completed by IDUs upon
admission to the Taipei City Hospital MMTP in 2007-2010 were included in
this analysis. HIV testing was repeated semi-annually among maintained
clients who were HIV-negative during MMTP admission.

RESULTS: Of 1444 IDUs admitted, 85.9% were male, median age was 40 years,
and mean years of injecting was 14.3 (range: 1-64). The prevalence of HIV,
HCV, and HIV/HCV co-infection was 13.4%, 91.1%, and 13.2%, respectively. In
multivariable analysis, HIV infection was associated with sharing syringes
during the 6 months prior to admission (OR = 14.76, 95% CI 10.31-21.13),
homelessness (OR = 6.46, 95% CI 1.49-28.00), and lifetime number of MMTP
admissions (OR = 1.76, 95% CI 1.30-2.38) and times incarcerated (OR = 1.10,
95% CI 1.03-1.18). HIV seroincidence was 1.15/100 person-years at risk (95%
CI .62-8.77/100 PY) among IDUs who were HIV-negative at first admission.

CONCLUSIONS: Taiwanese IDUs in MMTP have a high HIV prevalence, which was
associated with syringe sharing and other factors related to social
marginalization. Our findings highlight the importance of harm reduction
programs, including syringe exchange, along with HIV-prevention education.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: General principles of infection control
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23469643

J Egypt Soc Parasitol. 2012 Dec;42(3):697-712.

General principles of infection control.

Alqurashi AM.

Health Research Center, Najran University, Kingdom of Saudi Arabia.

The nosocomial infection is a significant problem worldwide. Thus,
hospitals should be aware of it. The hand-washing at a sink is impractical,
unachievable and the hospital subjects always do not comply with it.

The infection control practitioners, consensually, claimed that waterless
alcohol-based hand rubs should be available at the bedside and their use
should be promoted over hand-washing with soap and water.

In this review, the detailed CDC guidelines of antimicrobial ingredients
designed for hand- washing as well as by concerned authorities are
presented.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Impact of the International Nosocomial Infection Control
Consortium (INICC) Multidimensional Hand Hygiene Approach over 13 Years
in 51 Cities of 19 Limited-Resource Countries from Latin America, Asia,
the Middle East, and Europe
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23466916

Infect Control Hosp Epidemiol. 2013 Apr;34(4):415-23.

Impact of the International Nosocomial Infection Control Consortium (INICC)
Multidimensional Hand Hygiene Approach over 13 Years in 51 Cities of 19
Limited-Resource Countries from Latin America, Asia, the Middle East, and
Europe.

Rosenthal VD, Pawar M, Leblebicioglu H, Navoa-Ng JA, Villamil-Gómez W,
Armas-Ruiz A, Cuéllar LE, Medeiros EA, Mitrev Z, Gikas A, Yang Y, Ahmed A,
Kanj SS, Dueñas L, Gurskis V, Mapp T, Guanche-Garcell H, Fernández-Hidalgo
R, Kübler A.

International Nosocomial Infection Control Consortium, Buenos Aires,
Argentina.

Objective. To assess the feasibility and effectiveness of the International
Nosocomial Infection Control Consortium (INICC) multidimensional hand
hygiene approach in 19 limited-resource countries and to analyze predictors
of poor hand hygiene compliance.

Design. An observational, prospective, cohort, interventional, before-and-
after study from April 1999 through December 2011. The study was divided
into 2 periods: a 3-month baseline period and a 7-year follow-up period.

Setting. Ninety-nine intensive care unit (ICU) members of the INICC in
Argentina, Brazil, China, Colombia, Costa Rica, Cuba, El Salvador, Greece,
India, Lebanon, Lithuania, Macedonia, Mexico, Pakistan, Panama, Peru,
Philippines, Poland, and Turkey. Participants. Healthcare workers at 99 ICU
members of the INICC.

Methods. A multidimensional hand hygiene approach was used, including (1)
administrative support, (2) supplies availability, (3) education and
training, (4) reminders in the workplace, (5) process surveillance, and (6)
performance feedback. Observations were made for hand hygiene compliance in
each ICU, during randomly selected 30-minute periods.

Results. A total of 149,727 opportunities for hand hygiene were observed.
Overall hand hygiene compliance increased from 48.3% to 71.4% ([Formula:
see text]). Univariate analysis indicated that several variables were
significantly associated with poor hand hygiene compliance, including males
versus females (63% vs 70%; [Formula: see text]), physicians versus nurses
(62% vs 72%; [Formula: see text]), and adult versus neonatal ICUs (67% vs
81%; [Formula: see text]), among others.

Conclusions. Adherence to hand hygiene increased by 48% with the INICC
approach. Specific programs directed to improve hand hygiene for variables
found to be predictors of poor hand hygiene compliance should be
implemented.

http://www.ncbi.nlm.nih.gov/pubmed/23466916
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Hand hygiene compliance and irritant dermatitis: a
juxtaposition of healthcare issues
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22691060

Int J Cosmet Sci. 2012 Oct;34(5):402-15.

Hand hygiene compliance and irritant dermatitis: a juxtaposition of
healthcare issues.

Visscher MO, Randall Wickett R.

Skin Sciences Program, Division of Pediatric Plastic Surgery, Cincinnati
Children’s Hospital Medical Center, Cincinnati, OH, 45229, USA.
Marty.Visscher@cchmc.org

Reduction and prevention of health care-associated infections is a
worldwide priority with emphasis on increasing hand hygiene compliance.
Repetitive exposure to hand hygiene products and procedures is a
significant factor in the development of occupational irritant hand
dermatitis.

Compliance has been difficult to achieve often due to skin irritation. The
introduction of alcohol hand rubs has positively influenced compliance but
rates remain lower than required. Genetic and environmental factors to the
frequency and severity of irritant contact dermatitis have been identified.

Because of the skin’s role in innate immunity, maintenance of epidermal
integrity is a key strategy for reducing health care-associated infections.
In this review, we examine the interdependence of the two issues and the
challenges of simultaneously accomplishing both goals.

We emphasize research conducted among healthcare workers in their clinical
settings. The factors that influence skin integrity and the challenges in
meeting both goals simultaneously are explored.

Cosmetic scientists have played key roles in the development of improved
skin care products, and the issues present an excellent opportunity for
them to provide potentially life-saving contributions to health care.

© 2012 Society of Cosmetic Scientists and the Société Française de
Cosmétologie.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Use of the International Classification of Diseases, 9th
revision, coding in identifying chronic hepatitis B virus infection in
health system data: implications for national surveillance
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23462875

J Am Med Inform Assoc. 2013 Mar 5.

Use of the International Classification of Diseases, 9th revision, coding
in identifying chronic hepatitis B virus infection in health system data:
implications for national surveillance.

Mahajan R, Moorman AC, Liu SJ, Rupp L, Klevens RM; for the Chronic
Hepatitis Cohort Study (CHeCS) investigators*.

Collaborators (26)

Division of Viral Hepatitis, Centers for Disease Control and Prevention,
Atlanta, Georgia, USA.

OBJECTIVE: With increasing use electronic health records (EHR) in the USA,
we looked at the predictive values of the International Classification of
Diseases, 9th revision (ICD-9) coding system for surveillance of chronic
hepatitis B virus (HBV) infection.

MATERIALS AND METHODS: The chronic HBV cohort from the Chronic Hepatitis
Cohort Study was created based on electronic health records (EHR) of adult
patients who accessed services from 2006 to 2008 from four healthcare
systems in the USA. Using the gold standard of abstractor review to confirm
HBV cases, we calculated the sensitivity, specificity, positive and
negative predictive values using one qualifying ICD-9 code versus using two
qualifying ICD-9 codes separated by 6 months or greater.

RESULTS: Of 1 652 055 adult patients, 2202 (0.1%) were confirmed as having
chronic HBV. Use of one ICD-9 code had a sensitivity of 83.9%, positive
predictive value of 61.0%, and specificity and negative predictive values
greater than 99%. Use of two hepatitis B-specific ICD-9 codes resulted in a
sensitivity of 58.4% and a positive predictive value of 89.9%.

DISCUSSION: Use of one or two hepatitis B ICD-9 codes can identify cases
with chronic HBV infection with varying sensitivity and positive predictive
values.

CONCLUSIONS: As the USA increases the use of EHR, surveillance using ICD-9
codes may be reliable to determine the burden of chronic HBV infection and
would be useful to improve reporting by state and local health departments.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Chronic hepatitis B infection in adolescents who received
primary infantile vaccination
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22858989

Hepatology. 2013 Jan;57(1):37-45.

Chronic hepatitis B infection in adolescents who received primary infantile
vaccination.

Wu TW, Lin HH, Wang LY.

Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.

Hepatitis B virus (HBV) infection is a global health issue. Universal
infantile hepatitis B (HB) vaccination is very efficacious. However, HBV
infections among those immunized subjects have been reported. The long-term
efficacy of postnatal passive-active HB vaccination in high-risk subjects
is not well explored.

A total of 8,733 senior high school students who were
born after July 1987 were assayed for hepatitis B surface antigen (HBsAg)
and antibodies to HBsAg (anti-HBs). The overall HBsAg and anti-HBs-positive
rates were 1.9% and 48.3%, respectively. The HBsAg-positive rate was 15% in
HB immunoglobulin (HBIG) recipients (adjusted odds ratio [OR]: 15.63; 95%
confidence interval [CI]: 10.99-22.22). Among students who did not receive
HBIG, there was a significantly negative association between HB vaccination
dosage and HBsAg-positive rate (P for trend = 0.011). Adjusted ORs for
those who received 4, 3, and 1 to 2 doses were 1.00, 1.52 (95% CI:
0.91-2.53), and 2.85 (95% CI: 1.39-5.81), respectively. Among HBIG
recipients, the HBsAg-positive rate was significantly higher in subjects
with maternal hepatitis B e antigen (HBeAg) positivity and who received
HBIG off-schedule.

A booster dose of HB vaccination was administered to
1974 HBsAg- and anti-HBs-negative subjects. Prebooster and a postbooster
blood samples were drawn for anti-HBs quantification. The proportions of
postbooster anti-HBs titer <10 mIU/mL was 27.9%. Subjects with prebooster
anti-HBs titers of 1.0-9.9 mIU/mL had significantly higher postbooster
anti-HBs titers than those with prebooster anti-HBs titers of <1.0 mIU/mL
(P < 0.0001).

CONCLUSION: Having maternal HBeAg positivity is the most
important determinant for HBsAg positivity in adolescents who received
postnatal passive-active HB vaccination 15 years before. A significant
proportion of complete vaccinees may have lost their immunological memories
against HBsAg.

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

12. Abstract: Preeradication Vaccine Policy Options for Poliovirus
Infection and Disease Control
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23461599

Risk Anal. 2013 Mar 5. doi: 10.1111/risa.12019.

Preeradication Vaccine Policy Options for Poliovirus Infection and Disease
Control.

Thompson KM, Pallansch MA, Duintjer Tebbens RJ, Wassilak SG, Kim JH, Cochi
SL.

Kid Risk, Inc., 10524 Moss Park Rd., Ste. 204-364, Orlando, FL, USA;
University of Central Florida, College of Medicine, Orlando, FL, USA.

With the circulation of wild poliovirus (WPV) types 1 and 3 continuing more
than a decade after the original goal of eradicating all three types of
WPVs by 2000, policymakers consider many immunization options as they
strive to stop transmission in the remaining endemic and outbreak areas and
prevent reintroductions of live polioviruses into nonendemic areas.

While polio vaccination choices may appear simple, our analysis of current
options shows remarkable complexity.

We offer important context for current and future polio vaccine decisions
and policy analyses by developing decision trees that clearly identify
potential options currently used by countries as they evaluate national
polio vaccine choices. Based on a comprehensive review of the literature we

(1) identify the current vaccination options that national health leaders
consider for polio vaccination,
(2) characterize current practices and factors that appear to influence
national and international choices, and
(3) assess the evidence of vaccine effectiveness considering sources of
variability between countries and uncertainties associated with limitations
of the data.

With low numbers of cases occurring globally, the management of polio risks
might seem like a relatively low priority, but stopping live poliovirus
circulation requires making proactive and intentional choices to manage
population immunity in the remaining endemic areas and to prevent
reestablishment in nonendemic areas.

Our analysis shows remarkable variability in the current national polio
vaccine product choices and schedules, with combination vaccine options
containing inactivated poliovirus vaccine and different formulations of
oral poliovirus vaccine making choices increasingly difficult for national
health leaders.

© 2013 Society for Risk Analysis.
http://www.ncbi.nlm.nih.gov/pubmed/23461599
__________________________________________________________________
________________________________*_________________________________

13. No Abstract: Preventing needlestick injuries
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/23469514

Br J Nurs. 2012 Nov 22-Dec 12;21(21):S4.

Preventing needlestick injuries.

Aziz AM.

Pennine Care NHS Foundation Trust.
__________________________________________________________________
________________________________*_________________________________

14. ProMED-mail: Fungal Infection, Contaminated Drug – USA (03)

Crossposted from ProMED-mail <http://www.promedmail.org> with thanks.
__________________________________________________________________

FUNGAL INFECTION, CONTAMINATED DRUG – USA (03)
**********************************************
A ProMED-mail post <http://www.promedmail.org>
ProMED-mail is a program of the International Society for Infectious
Diseases <http://www.isid.org>

Date: Mon 11 Mar 2013
Source: CDC [edited]
<http://www.cdc.gov/HAI/outbreaks/meningitis.html>

At-a-glance
– ———–
Status: ongoing investigation
Infection: fungal
Facility type: outpatient setting
Case count: 722
States: 20
Deaths: 50

Cases and deaths with fungal infections linked to steroid injections
State / Total case counts / CNS infections / Joint only / Deaths
– —————————————————————-
Florida / 25 / 25 / 0 / 3
Georgia / 1 / 1 / 0 / 0
Idaho / 1 / 1 / 0 / 0
Illinois / 2 / 2 / 0 / 0
Indiana / 84 / 84 / 0 / 11
Maryland / 25 / 25 / 0 / 3
Michigan / 255 / 231 / 24 / 14
Minnesota / 12 / 12 / 0 / 1
North Carolina / 17 / 17 / 0 / 1
New Hampshire / 14 / 9 / 5 / 0
New Jersey / 49 / 48 / 1 / 0
New York / 1 / 1 / 0 / 0
Ohio / 20 / 20 / 0 / 1
Pennsylvania / 1 / 1 / 0 / 0
Rhode Island / 3 / 3 / 0 / 0
South Carolina / 2 / 2 / 0 / 0
Tennessee / 150 / 148 / 2 / 14
Texas / 2 / 2 / 0 / 0
Virginia / 53 / 53 / 0 / 2
West Virginia / 5 / 5 / 0 / 0
– ——————————–
TOTALS = 722 / 690 / 32 / 50

– —

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

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

Although the date of onset of the newly reported cases is not given,
it is likely that the increase is not due to newly presenting cases
but rather just newly reported cases. Based on a report regarding the
1st 346 cases (Smith RM, Schaefer MK, Kainer MA, et al.

Fungal infections associated with contaminated methylprednisolone
injections – preliminary report. N Engl J Med 2012. doi:
10.1056/NEJMoa1213978; available at
http://www.nejm.org/doi/full/10.1056/NEJMoa1213978 , the weekly cases count
peaked in mid-October 2012 and the peak incubation period from last
injection was approximately 28 days with only 8 (2.3 per cent) having an
incubation period from last injection of more than 40 days.

Date of report / Cases / States / Deaths
– —————————————-
2 Oct 2012 / 12 / 2 / 2
4 Oct 2012 / 26 / 5 / 4
5 Oct 2012 / 35 / 5 / 5 (9 more cases, 1 more death)
6 Oct 2012 / 64 / 9 / 7 (29 more cases, 2 more deaths)
7 Oct 2012 / 91 / 9 / 7 (27 more cases, 0 more deaths)
8 Oct 2012 / 101 / 9 / 8 (10 more cases, 1 more death)
9 Oct 2012 / 119 / 10 / 11 (18 more cases, 3 more deaths)
10 Oct 2012 / 137 / 10 / 12 (28 more cases, 1 more death)
11 Oct 2012 / 170 / 11 / 14 (33 more cases, 2 more deaths)
12 Oct 2012 / 185 / 11 / 14 (14 more CNS, 1st joint, 0 more deaths)
13 Oct 2012 / 198 / 13 / 15 (13 more CNS cases, 1 more death)
14 Oct 2012 / 205 / 14 / 15 (6 more CNS cases, 2nd joint, 0 more
deaths)
15 Oct 2012 / 214 / 15 / 15 (9 more CNS cases, 0 more deaths)
16 Oct 2012 / 233 / 15 / 15 (19 more CNS cases, 0 more deaths)
17 Oct 2012 / 247 / 15 / 19 (14 more CNS cases, 4 more deaths)
18 Oct 2012 / 257 / 16 / 20 (9 more CNS cases, 3rd joint, 1 more
death)
19 Oct 2012 / 271 / 16 / 21 (14 more CNS cases, 1 more death)
20 Oct 2012 / 284 / 16 / 23 (13 more CNS cases, 2 more death)
21 Oct 2012 / 285 / 16 / 23 ( 1 more CNS case, 0 more deaths)
22 Oct 2012 / 297 / 16 / 23 (12 more CNS cases, 0 more deaths)
23 Oct 2012 / 308 / 17 / 23 (10 more CNS cases, 4th joint, 0 more
deaths)
2 Nov 2012 / 404 / 19 / 29 (10 more days, 91 more CNS cases, 9 joint
cases, 4 more deaths)
5 Nov 2012 / 419 / 19 / 30 (3 more days, 14 more CNS cases, 10 joint
cases, 1 more death)
9 Nov 2012 / 438 / 19 / 32 (4 more days, 19 more CNS cases, 10 joint
cases, 2 more deaths
14 Nov 2012 / 461 / 19 / 32 (5 more days, 23 more CNS cases, 10 joint
cases, 0 more deaths)
26 Nov 2012 / 510 / 19 / 36 (12 days, 44 more CNS cases, 14 joint
cases total, 4 more deaths)
3 Dec 2012 / 541 / 19 / 36 (7 more days, 28 more CNS cases, 17 joint
cases total, 0 more deaths)
10 Dec 2012 / 590 / 19 / 37 (7 more days, 45 more CNS cases, 21 joint
cases total, 0 more deaths)
17 Dec 2012 / 620 / 19 / 39 (7 more days, 25 more CNS cases, 2 more
joint only cases, 2 more deaths)
28 Dec 2012 / 656 / 19 / 39 (11 more days, 35 more CNS cases, 1 more
joint only case, 0 more deaths
28 Jan 2013 / 693 / 19 / 45 (4 more weeks, 33 more CNS cases, 6 more
joint only cases, 6 more deaths)
11 Mar 2013 / 722 / 20 / 50 (6 more weeks, 28 more CNS cases, 1 more
joint only case, 5 more deaths)
Case fatality rate (for CNS cases) = 50/690 = 7.2 per cent. – Mod.LL

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/r/1hiS>.]
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15. News

– Global: International Community Should ‘Strengthen And Sustain’ Efforts
To Prevent GBV, HIV
– India: India takes pentavalent vaccine to 5 million children
Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
Global: International Community Should ‘Strengthen And Sustain’ Efforts To
Prevent GBV, HIV
Kaiser Daily Global Health Policy Report (08.03.13)

Noting the ongoing 57th session of the U.N. Commission on the Status of
Women (CSW) and International Women’s Day, recognized today, Ambassador
Eric Goosby, U.S. global AIDS coordinator and head of the State
Department’s Office of Global Health Diplomacy, and UNAIDS Executive
Director Michel Sidibé write in the Huffington Post’s “Global Motherhood”
blog, “It is therefore a fitting moment for the global community to reflect
on the collective progress we have made in improving the status of women
and girls around the world, and to recommit ourselves to realizing a day
when all women and girls have the opportunity to fulfill their potential
and contribute fully to their societies.” They continue, “[W]e are firmly
committed to advancing gender equality and responding to the unique health
needs of women and girls.”

Goosby and Sidibé describe the work of PEPFAR and UNAIDS to eliminate and
prevent violence against women and girls, which is the theme of this year’s
CSW. “Despite this encouraging progress, much more remains to be done.
Today, we call on the global community, including leaders from government,
civil society, and the United Nations to strengthen and sustain its
commitment to and leadership on gender-based violence and HIV,” they write.
“This requires accelerating progress towards reaching MDGs 3 and 6, and
ensuring that HIV, gender inequality, and gender-based violence are firmly
positioned on the post-2015 agenda,” they continue, concluding, “Only
through a global commitment to zero tolerance to violence and achieving an
AIDS-free generation, including for women and girls, will we enable
individuals, families, and communities to achieve their fullest potential”
(3/7).
__________________________________________________________________
__________________________________________________________________
India: India takes pentavalent vaccine to 5 million children
India: India takes pentavalent vaccine to 5 million children, The Hindu,
CHENNAI (06.03.13)

Five million Indian children were vaccinated with the five-in-one
pentavalent shots in just over a year. Jammu and Kashmir became the sixth
State to introduce the vaccines as part of the universal immunisation
programme.

The vaccine, with one shot, offers protection against diphtheria, tetanus,
whooping cough, hepatitis B and Haemophilus influenzae B (Hib). “This will
bring down child mortality and morbidity drastically,” says Ajay Khera,
Deputy Commissioner, Child Health and Immunisation, Ministry of Health.

There are about 27 million children under one year in the country at any
given point of time, and the intention is to take the benefits of the
pentavalent to all of them, he adds.

The pentavalent vaccine was introduced in Tamil Nadu and Kerala in December
of 2011, the two States with high vaccine coverage and solid public health
systems.

After an evaluation of the two States in August 2012, the decision to
expand was taken.

The pentavalent vaccine was then introduced in phases in Haryana,
Puducherry, Goa, and Gujarat, with Jammu and Kashmir being the latest to
join the list.

At present, the vaccines are being procured by UNICEF, with funding from
GAVI. The operational costs are borne by the government, Dr. Khera points
out. “We need to preserve the vaccine in a good cold chain system, use
single use auto disable syringes and provide manpower support to the
administration of the vaccine,” he explains. The vaccines are provided free
of cost under the public health scheme, while in the public sector, between
Rs. 400 and Rs. 700 is charged per dose. Infants are given three doses of
the pentavalent vaccine at six, ten and 14 weeks of age.

Replying to an RTI application by Kerala-based doctor K.V. Babu, the
Ministry indicated that Kerala had a total of 11 deaths in 2012, and Tamil
Nadu four, listed under ‘Adverse Effects Following Immunisation’ (AEFI)
using the pentavalent vaccine. In 2011, the year of introduction, there was
one death in Kerala. “We need to ask whether the vaccine is safe after all,
with periodic assessments. The life of every child is precious, and we
cannot afford to lose children from vaccination,” Dr. Babu says.

Responding to this, Dr. Khera explains, “The vaccine safety surveillance
system enables us to understand whether programmatic errors are happening.
That does not mean that whatever AEFIs are reported do not have a direct
association with the vaccine administration. Since we are keen on tracking
the pentavalent, we allow even deaths occurring a week after the
vaccination to be reported.”

He points out that on an average 3,600 children under the age of five years
die every day in the country, due to various factors. “The point is that
there can be many factors causing the death of children, the vaccine might
be incidental. However, we investigate every reported case of death or even
other adverse effects.”

In fact, the vaccine has been available in the private sector in India for
over a decade now, he said. The vaccine has been demonstrated to be
efficacious and effective in numerous studies and is widely supported by
global and Indian health communities.
__________________________________________________________________
________________________________*_________________________________
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