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SIGNpost 00693


Post00693 Supply Chain + RFP + Abstracts + News 10 April 2013
1. HERMES Project: A Computational Tool to Design, Plan and Improve Supply
2. GAVI Request for proposals: Technical support for new vaccine
introductions and to improve immunisation coverage in up to 10 countries
3. Abstract: Community-acquired, non-occupational needlestick injuries
treated in US Emergency Departments
4. Abstract: Sharps injuries: the risks and relevance to plastic surgeons
5. Bull World Health Organ. 2013: Theme: Opioid Substitution Therapy
6. Abstract: Methadone maintenance treatment in Spain: the success of a
harm reduction approach
7. Abstract: Incidence and risk factors on HIV infection among injection
drug users in Dehong prefecture area of Yunnan province
8. Abstract: Drug Use and Sex Work: Competing Risk Factors for Newly
Acquired HIV in Yunnan, China
9. Abstract: Prevalence of hepatitis B virus and hepatitis C virus in
patients with human immunodeficiency virus infection in central China
10. Abstract: Top 10 technology hazards for 2012. The risks that should be
at the top of your prevention list
11. Abstract: Application of copper bactericidal properties in medical
12. Abstract: Alcohol handrubbing and chlorhexidine handwashing protocols
for routine hospital practice: a randomized clinical trial of protocol
efficacy and time effectiveness
13. Abstract: Educational games for health professionals
14. Abstract: Management of wastes from dental amalgam by dentists in
Burkina Faso and Morocco
15. No Abstract: Follow a post-exposure plan after needlestick injury
16. No Abstract: Sharps advice from FDA, CDC
17. News
– The Fight to End Pandemics
– USA: Advocates Push for Syringe-Exchange Program
– Canada: Mom Wants Better Enforcement of Needle Storage
– ‘Sharps’ Injuries Could Pose HIV, Hepatitis Risk To Surgeons
– GPEI Announces ‘Endgame’ Plan To Eradicate Polio By 2018
– USA: Boy Gets Rare Tick Infection from Blood Transfusion
– USA: About 1,200 dental patients in Oklahoma screened for HIV

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1. HERMES Project: A Computational Tool to Design, Plan and Improve Supply

A Computational Tool to Design, Plan and Improve Supply Chains

Supply chains are the series of steps involved in transporting vaccines
from manufacturers all the way to patients. Distributing vaccines (and
other health care products) can be a complex process, integrating many
steps, locations, personnel, and equipment. HERMES (Highly Extensible
Resource for Modeling Supply-chains) is a computational framework for
modeling and optimizing supply chains.

The HERMES Project is a collaboration involving University of Pittsburgh
and Pittsburgh Supercomputing Center with funding from the Bill and Melinda
Gates Foundation and the National Institutes of Health,

Developed at the University of Pittsburgh and Pittsburgh Supercomputing
Center with funding from the Bill and Melinda Gates Foundation and the
National Institutes of Health, HERMES is a software platform that allows
users to generate a detailed discrete event simulation model of any vaccine
supply chain. This simulation model can serve as a “virtual laboratory” for
decision makers (e.g., policy makers, health officials, funders, investors,
vaccine and other technology developers, manufacturers, distributors,
logisticians, scientists, and researchers) to address a variety of
questions such as:

What will be the impact of introducing new technologies (e.g., vaccines,
storage, or monitoring)?

What the effects of altering the characteristics of vaccines and other
technologies (e.g., vaccine vial size, vaccine thermostability, or cold
device capacity)?

How do the configuration and the operations of the supply chain (e.g.,
storage devices, shipping frequency, personnel, or ordering policy) affect
performance and cost?

What may be the effects of differing conditions and circumstances (e.g.,
power outages, delays, inclement weather, transport breakdown, or limited

How should one invest or allocate resources (e.g., adding refrigerators vs.
increasing transport frequency)?

How can vaccine delivery be optimized (e.g., minimize the cost per
immunized child or maximize immunization availability)?

HERMES can work on nearly any laptop computer.

2. GAVI Request for proposals: Technical support for new vaccine
introductions and to improve immunisation coverage in up to 10 countries
Request for proposals (RFPs)

The GAVI Alliance is currently inviting offers for the Request for
Proposals (RFP) listed below. Proposals should be for specific RFP’s for
which proposals meet all the listed criteria.

GAVI Request for Proposal for “Technical support for new vaccine
introductions and to improve immunisation coverage in up to 10 countries”

Objective of the tender:

The GAVI Alliance seeks to tailor and enhance its technical support to
countries in the areas of vaccine introduction, improvement in immunisation
coverage, and health systems strengthening. While GAVI partners – most
notably WHO and UNICEF – already provide tools, technical expertise and
guidance in the various areas of immunisation and health systems, GAVI is
looking to engage with institutions that would provide additional day-to-
day technical and management support to ten countries.

Download the RFP document here for more information

3. Abstract: Community-acquired, non-occupational needlestick injuries
treated in US Emergency Departments

J Public Health (Oxf). 2013 Apr 3.

Community-acquired, non-occupational needlestick injuries treated in US
Emergency Departments.

Jason J.

Jason and Jarvis Associates, LLC, Hilton Head Island, SC 29928, USA.

BACKGROUND: The escalating number of persons self-injecting medications,
predominantly insulin, has generated concerns that the public is at risk of
acquiring blood-borne infections from discarded needles/syringes.
Communities have developed disposal guidelines but a debate continues over
the need for further legislation and/or at-home safety devices. This study
examines the number, characteristics, treatment and costs of community-
acquired needlestick injuries (CANSIs).

METHODS: US-representative CANSI rates and characteristics were derived
from 2001-08 National Electronic Injury Surveillance System All Injury
Program data on product-related injuries treated at US emergency
departments (EDs). CANSI- related medical care was examined using 2003-09
National Hospital Ambulatory Medical Care Surveys, representing all US ED
visits. Cost analyses used 2010 Current Procedural Terminology Coding and
Medicare rates.

RESULTS: In 2001-08, an estimated 16 677 CANSIs were treated in US EDs,
with an associated annual rate of 0.7 per 100 000 US citizens (95% CI
0.6-0.8) and no observable temporal trend. The estimated maximum annual
medical cost of ED-treated CANSIs was $9.8 million, or $0.03 per citizen,
$1.66 per insulin-injecting person and $0.0018 per insulin injection.

CONCLUSIONS: US ED-treated CANSI rates are extremely low. Stricter disposal
programs and the at-home use of safety devices do not appear to be needed
at this time.

4. Abstract: Sharps injuries: the risks and relevance to plastic surgeons

Plast Reconstr Surg. 2013 Apr;131(4):784-91.

Sharps injuries: the risks and relevance to plastic surgeons.

Waljee JF, Malay S, Chung KC.

Ann Arbor, Mich. From the Section of Plastic Surgery, Department of
Surgery, University of Michigan Health System.

Surgeons are at risk for injury in the operating room daily. Because of the
ubiquity of occupational hazards, injuries remain prevalent and expensive.

Although occupational hazards can include musculoskeletal conditions,
psychosocial stress, radiation exposure, and the risk of communicable
diseases, sharps injuries remain the most common among surgeons in practice
and the most frequent route of transmission of blood- borne pathogens.

Therefore, increased attention to the health, economic, personal, and
social implications of these injuries is essential for appropriate
management and future prevention.

5. Bull World Health Organ. 2013: Theme: Opioid Substitution Therapy

Bull World Health Organ. 2013 February 1; 91(2): 81.

In this special issue of the Bulletin, Zunyou Wu & Nicolas Clark (82)
introduce the theme of opioid substitution therapy. Sheena Sullivan (83)
explains why methadone maintenance programmes are needed. Fiona Fleck
interviews Robin Room (91–92) about harm reduction and prohibition of
illicit substances. Gary Humphreys (87–88) reports on progress and
obstacles to effective opioid substitution therapy in Ukraine. Fumbuka
Ng’wanakilala (89–90) describes how the United Republic of Tanzania has
launched a national methadone programme to counter heroin use and HIV

Mubashar Sheikh et al. (84) announce an upcoming theme issue on human


Improving outcomes
Yan Zhao et al. (93–101) measure the extent to which the provision of
methadone and antiretroviral treatment has increased the survival of HIV-
infected people who inject drugs.

Going to scale
Jianhua Li et al. (130–135) detail lessons learnt in the staffing of
China’s national methadone maintenance treatment programme.
Bangladesh, India, Maldives & Nepal

Programme models
Ravindra Rao et al. (150–153) describe how opioid substitution therapy is


Reaching prisoners
Jeffrey A Wickersham et al. (124–129) report on supplying methadone in


From prohibition to prescription
Marta Torrens et al. (136–141) describe how a national strategy to reduce
the harms of injected opioids reduced HIV transmission.


Deadly habits
Bradley M Mathers et al. (102–123) review the evidence for early deaths
among people who inject drugs.

Why substitute?
Linda R Gowing et al. (148–149) identify the gaps in research on opioid
substitution to reduce the risk of HIV transmission.

Rights and responsibilities
Zunyou Wu (142–145) argues for compulsory treatment of opioid dependence.
Wayne Hall & Adrian Carter (146) counter that proponents of this approach
need to prove that it is effective and ethical. Nicolas Clark et al.
(146–147) propose that voluntary treatment centers rather than
extrajudicial detention should be used to manage opioid dependence.

A neglected cough
Haileyesus Getahun et al. (154–156) explain why tuberculosis diagnosis and
treatment is a critical component of managing illicit drug use.

Articles from Bulletin of the World Health Organization are provided here
courtesy of World Health Organization

6. Abstract: Methadone maintenance treatment in Spain: the success of a
harm reduction approach

Bull World Health Organ. 2013 Feb 1;91(2):136-41.

Methadone maintenance treatment in Spain: the success of a harm reduction

Torrens M, Fonseca F, Castillo C, Domingo-Salvany A.

Institut de Neuropsiquiatria i Addicions, Hospital del Mar, Institut
Hospital del Mar d’Investigacions Mèdiques, Universitat Autònoma de
Barcelona, Passeig Marítim 25-29, 08003 Barcelona, Spain .
Abstractin English, Arabic, Chinese, French, Russian, Spanish

PROBLEM: During the 1980s, Spain had very strict laws limiting access to
opioid agonist maintenance treatment (OAMT). Because of this, mortality
among people who used illicit opioids and other illicit drugs was high.
Spain was also the European country with the highest number of cases of
acquired immunodeficiency syndrome transmitted through illicit drug

APPROACH: The rapid spread of human immunodeficiency virus (HIV) infection
among people using heroin led to a shift from a drug-free approach to the
treatment of opioid dependence to one focused on harm reduction. A
substantial change in legislation made it possible to meet public health
needs and offer OAMT as part of harm reduction programmes in the public
health system, including prisons.

LOCAL SETTING: Legislative changes were made throughout the country,
although at a different pace in different regions.

RELEVANT CHANGES: Legal changes facilitated the expansion of OAMT, which
has achieved a coverage of 60%. A parallel reduction in the annual
incidence of HIV infection has been reported. Reductions in morbidity and
mortality and improved health-related quality of life have been described
in patients undergoing OAMT.

LESSONS LEARNT: The treatment of opioid dependence has been more heavily
influenced by moral concepts and prejudices that hinder legislation and
interfere with the implementation of OAMT than by scientific evidence. To
fulfil public health needs, OAMT should be integrated in harm reduction
programmes offered primarily in public facilities, including prisons.
Longitudinal studies are needed to detect unmet needs and evaluate
programme impact and suitability.

Free Article

7. Abstract: Incidence and risk factors on HIV infection among injection
drug users in Dehong prefecture area of Yunnan province

Zhonghua Liu Xing Bing Xue Za Zhi. 2009 Dec;30(12):1226-9.

[Incidence and risk factors on HIV infection among injection drug users in
Dehong prefecture area of Yunnan province].

[Article in Chinese]

Duan S, Xiang LF, Yang YC, Ye RH, Jia MH, Luo HB, Fu LR, Song LJ, Zhao YX,
Yang JH, Wang B, Liu ZY, Pu YC, Han WX, Yang ZJ, Li WM, Wang JB, Zhu WM, He

Dehong Prefecture Center for Disease Control and Prevention, Yunnan 678400,

OBJECTIVE: To determine the incidence and risk factors on HIV infection
among injection drug users (IDU) in Dehong prefecture area of Yunnan

METHODS: An epidemiological cohort of HIV-negative IDU had been developed
and followed since October, 2004. HIV new infections and related behaviors
had been investigated every six months.

RESULTS: By the end of 2008, 760 HIV-negative IDU had been recruited and
followed for a total of 1153.6 person-years. 47 new HIV infections were
identified, with an overall incidence of 4.07/100 person-years during the
follow-up period. The HIV incidence was 4.45/100 person-years during 2004 –
2006, 4.50/100 person-years in 2007 and 2.54/100 person-years in 2008.

Both the behavior of drug injection and the HIV incidence among the cohort
had substantially decreased during the follow-up period. Multiple
regression analysis using Cox proportional hazard model indicated that
people with Jing-po ethnicity (Hazard ratio, HR = 2.56, 95%CI: 1.06 – 6.19)
and other minorities except for Dai (HR = 3.26, 95%CI: 0.89 – 11.96) were
at higher risk for HIV infection than the people with Han ethnicity.

People injecting drugs with (HR = 2.27, 95%CI: 0.98 – 5.25) or without (HR
= 5.27, 95%CI: 2.25 – 12.34) needle sharing were at higher risk for HIV
infection than those reporting having no drug injection behavior during the
follow-up period.

CONCLUSION: Both the behavior of drug injection and the HIV incidence among
former IDU in Dehong prefecture area of Yunnan province had been decreasing
during the four years.

However, needle sharing remained the most important risk factor for HIV new
infection among IDUs. IDUs with different ethnicities seemed to have
different risks towards HIV infection.

8. Abstract: Drug Use and Sex Work: Competing Risk Factors for Newly
Acquired HIV in Yunnan, China

PLoS One. 2013;8(3):e59050.

Drug Use and Sex Work: Competing Risk Factors for Newly Acquired HIV in
Yunnan, China.

Xu J, Smith MK, Ding G, Chu J, Wang H, Li Q, Chang D, Wang G, Shang H,
Jiang Y, Wang N.

Key Laboratory of AIDS Immunology of Ministry of Health, Department of
Laboratory Medicine, No.1 Hospital of China Medical University, Shenyang,
China ; National Center for AIDS/STD Control and Prevention, Chinese Center
for Disease Control and Prevention, Beijing, China.

OBJECTIVE: To investigate the HIV incidence and its related factors among
female sex workers (FSWs) in a high prevalence area where injection drug
use is also widely documented.

METHOD: A cross-sectional study of 1642 female sex workers (FSWs) was
conducted in Honghe Prefecture of Yunnan Province. Interviewed-
questionnaires were administrated to collect information on sexual
partnerships, condom use and illicit drug using behaviors etc. Blood
samples were collected to test for HIV antibodies, and all HIV seropositive
specimens were tested with the BED IgG capture-based enzyme immunosorbent
assay (BED-CEIA) to distinguish between new and established HIV infection
(<153 days).

RESULTS: 15.9% (261/1642) of participants reported ever having used drugs,
and 7.4% had injected in recent 3 months. The overall HIV prevalence was
10.2% (168/1642), among which 16.7% (28/168) were identified as recent
infections using BED-CEIA. The crude HIV incidence estimated from BED-CEIA
results was 4.4 (95%CI 2.8-6.0) /100 person years (PY). Multivariate
logistic analysis showed that an illicit drug using history (by either
self-reporting or urine opiates testing) was both significant risk factors
both for HIV established and recent infection (each p<0.05). Drug using
FSWs (DU-FSW) reported more male clients in the previous week, and had
significantly higher prevalence of HIV, chlamydia trachomatis and HSV-2 as
compared to non DU-FSW (each p<0.05).

CONCLUSION: Our results show that a history of drug use poses significant
risks for both new and established HIV infection among FSWs, and that HIV-
incidence among Honghe FSWs is relatively high compared to similar
populations. Comprehensive interventions targeted at DU-FSWs’ injection
drug using and high risk sexual behaviors are urgently needed to reduce the
rapid spread of HIV epidemic.

Free PMC Article

9. Abstract: Prevalence of hepatitis B virus and hepatitis C virus in
patients with human immunodeficiency virus infection in central China

Arch Virol. 2013 Apr 4.

Prevalence of hepatitis B virus and hepatitis C virus in patients with
human immunodeficiency virus infection in central China.

Chen X, He JM, Ding LS, Zhang GQ, Zou XB, Zheng J.

Hunan Provincial Center for Diseases Control and Prevention, 450
Furongzhong Rd. sec 1, Changsha, 410005, China,

Co-infection of hepatitis B virus (HBV) and/or hepatitis C virus (HCV) with
human immunodeficiency virus (HIV) has an adverse effect on liver disease
progression. This study investigated the prevalence of HBV and/or HCV co-
infection in HIV-infected patients in Central China.

A total of 978 HIV- infected patients from Hunan Province were enrolled.
HBV serum markers, anti-hepatitis-C-virus antibody (anti-HCV), HBV DNA, and
HBV genotypes were analyzed.

The prevalence of hepatitis B surface antigen (HBsAg) and anti- HCV in HIV-
infected patients was 19.4 % and 62.4 %, respectively. The prevalence of
anti-HCV in HIV-positive intravenous drug users was 93.6 %. Among HBsAg-
positive patients, 88.1 % were found to have at least one HBV serum marker.

The rates of HIV mono-infection, HBV/HIV dual infection, HCV/HIV dual
infection, and HBV/HCV/HIV triple infection were 30.4 %, 7.2 %, 50.2 %, and
12.2 %, respectively. Antibody to HBsAg (Anti-HBs) was more common in anti-
HCV-positive than anti-HCV-negative patients (53.3 % vs 40.2 %, P = 0.000),
but isolated hepatitis B core antibody (anti-HBc) was more common in anti-
HCV-negative than anti-HCV-positive patients (24.2 % vs 12.3 %, P = 0.000).
Hepatitis B e antigen (HBeAg) and sexual transmission were independent risk
factors for active HBV replication.

Intravenous drug use and male sex were independent risk factors, but old
age and presence of HBeAg were independent protective factors for anti-HCV.

Co-infection of HBV and/or HCV with HIV infection is common in central
China. HCV status is associated with anti-HBs and isolated anti-HBc in co-
infected patients.

10. Abstract: Top 10 technology hazards for 2012. The risks that should be
at the top of your prevention list
Health Devices. 2011 Nov;40(11):358-73.

Top 10 technology hazards for 2012. The risks that should be at the top of
your prevention list.

[No authors listed]

Health technology offers countless benefits. It also presents numerous
risks. Most of these can be avoided–with work. But in a constantly
changing environment, it’s not always easy to know where best to
concentrate your efforts. Our annual list will help you make smart
decisions about your safety initiatives during 2012.

Free PDF at:

11. Abstract: Application of copper bactericidal properties in medical
Rev Med Chil. 2012 Oct;140(10):1325-32.

[Application of copper bactericidal properties in medical practice].

[Article in Spanish]
Prado J V, Vidal A R, Durán T C.

Programa de Microbiología, Instituto de Ciencias Biomédicas, Facultad de
Medicina, Universidad de Chile, Santiago, Chile.

Background: Copper is essential for cell metabolism in animals and plants
and thus for life. Along centuries, copper has been identified as a metal
containing antimicrobial properties.

In recent years, laboratory assays and clinical studies have revealed that
surfaces of metallic copper or its alloys, containing at least 70% copper,
eliminate in a few hours several pathogenic organisms including bacterial
strains associated with nosocomial infections, influenza virus, HIV, and
fungi such as Candida albicans.

In March 2008, the American Environmental Protection Agency (EPA),
supported by scientific evidence gathered to date, registered copper as the
first and only metal with antimicrobial properties.

We herein review certain mechanisms proposed for the antibacterial,
antiviral and antifungal activity of copper. We also discuss in vitro and
clinical efficacy studies developed world wide and in Chile, focusing on
bactericidal activity of copper surface areas in comparison to materials
typically used in hospital environments such as stainless steel and

Scientific evidence gathered to date, consistently shows that the use of
copper surface areas in high contact critical points in hospitals,
significantly reduces environmental bacterial load.

This is associated with a decreased risk of pathogen transmission to
patients and represents therefore an interesting complement to infection
control programs.

Free full text: link from

12. Abstract: Alcohol handrubbing and chlorhexidine handwashing protocols
for routine hospital practice: a randomized clinical trial of protocol
efficacy and time effectiveness

Am J Infect Control. 2012 Nov;40(9):800-5.

Alcohol handrubbing and chlorhexidine handwashing protocols for routine
hospital practice: a randomized clinical trial of protocol efficacy and
time effectiveness.

Chow A, Arah OA, Chan SP, Poh BF, Krishnan P, Ng WK, Choudhury S, Chan J,
Ang B.

Department of Epidemiology, School of Public Health, University of
California, Los Angeles, CA 90095-1772, USA.

BACKGROUND: The World Health Organization (WHO) and the Centers for Disease
Control and Prevention (CDC) recommend the use of alcohol handrubs to
prevent health care-associated infections. However, the efficacy and time
effectiveness of different alcohol handrubbing protocols have yet to be

METHODS: We conducted a randomized controlled trial in the general wards of
a 1,300-bed, acute, tertiary care hospital to compare the effectiveness of
3 hand hygiene protocols during routine inpatient care: (1) handrubbing
with alcohol covering all hand surfaces, (2) handrubbing with alcohol using
the standard 7-step technique, and (3) handwashing with chlorhexidine using
the standard 7-step technique. Hand samples were obtained from 60 medical
and 60 nursing staff, before and after hand hygiene. Quantitative and
qualitative bacterial evaluations were carried out by microbiologists
blinded to the protocol.

RESULTS: All 3 protocols were effective in reducing hand bacterial load (P
< .01). During routine patient care, alcohol handrubbing covering all hand
surfaces required less time (median, 26.0 seconds) than alcohol handrubbing
using the 7-step technique (median 38.5 seconds; P = .04) and chlorhexidine
handwashing (median, 75.5 seconds; P < .001).

CONCLUSION: Alcohol handrubbing protocols are as efficacious as
chlorhexidine handwashing. Alcohol handrubbing covering all hand surfaces
is the most time-effective protocol for routine patient care activities in
busy general wards.

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

13. Abstract: Educational games for health professionals

Cochrane Database Syst Rev. 2013 Mar 28;3:CD006411.

Educational games for health professionals.

Akl EA, Kairouz VF, Sackett KM, Erdley WS, Mustafa RA, Fiander M, Gabriel
C, Schünemann H.

Department of Internal Medicine, American University of Beirut, Riad El
Solh St, Beirut, Lebanon.

BACKGROUND: The use of games as an educational strategy has the potential
to improve health professionals’ performance (e.g. adherence to standards
of care) through improving their knowledge, skills and attitudes.

OBJECTIVES: The objective was to assess the effect of educational games on
health professionals’ performance, knowledge, skills, attitude and
satisfaction, and on patient outcomes.

SEARCH METHODS: We searched the following databases in January 2012:
MEDLINE, AMED, CINAHL, Cochrane Central Database of Controlled Trials,
EMBASE, EPOC Register, ERIC, Proquest Dissertations & Theses Database, and
PsycINFO. Related reviews were sought in DARE and the above named
databases. Database searches identified 1546 citations. We also screened
the reference lists of included studies in relevant reviews, contacted
authors of relevant papers and reviews, and searched ISI Web of Science for
papers citing studies included in the review. These search methods
identified an additional 62 unique citations for a total of 1608 for this

SELECTION CRITERIA: We included randomized controlled trials (RCT),
controlled clinical trials (CCT), controlled before and after (CBA) and
interrupted time-series analysis (ITS). Study participants were qualified
health professionals or in postgraduate training. The intervention was an
educational game with “a form of competitive activity or sport played
according to rules”.

DATA COLLECTION AND ANALYSIS: Using a standardized data form we extracted
data on methodological quality, participants, interventions and outcomes of
interest that included patient outcomes, professional behavior (process of
care outcomes), and professional’s knowledge, skills, attitude and

MAIN RESULTS: The search strategy identified a total of 2079 unique
citations. Out of 84 potentially eligible citations, we included two RCTs.
The game evaluated in the first study used as a reinforcement technique,
was based on the television game show “Family Feud” and focused on
infection control. The study did not assess any patient or process of care
outcomes. The group that was randomized to the game had statistically
higher scores on the knowledge test (P = 0.02). The second study compared
game-based learning (“Snakes and Ladders” board game) with traditional
case-based learning of stroke prevention and management. The effect on
knowledge was not statistically different between the two groups
immediately and 3 months after the intervention. The level of reported
enjoyment was higher in the game-based group.

AUTHORS’ CONCLUSIONS: The findings of this systematic review neither
confirm nor refute the utility of games as a teaching strategy for health
professionals. There is a need for additional high-quality research to
explore the impact of educational games on patient and performance

Complete text:

14. Abstract: Management of wastes from dental amalgam by dentists in
Burkina Faso and Morocco

Odontostomatol Trop. 2012 Dec;35(140):31-7.

[Management of wastes from dental amalgam by dentists in Burkina Faso and

[Article in French]

Chala S, Sawadogo A, Sakout M, Abdallaoui F.

Dpt odontologie conservatrice et endodontie, Fac. médecine dentaire de
Rabat, Univ. Mohammed V Soussi.

Dental amalgam is a metallic restorative material that is used for direct
filling of carious lesions since many years. The use of this material
generates solid and particulate wastes that present potential challenges to
the environment.

This study was carried out to assess amalgam use and waste management
protocols practiced by Moroccan and Burkinabe dentists. A cross- sectional
study was made of 79 in Rabat, Sale and Temara in Morocco and 56 in
Ouagadougou, Bobo-Dioulasso in Burkina-Faso.

The results showed that 69.5% of dental amalgam waste in Morocco vs 49.9%
in Burkina-Faso was disposed with household waste which is a problem for
both the environment and a risk to human being.

Proper methods of dental amalgam waste disposal should be carried out to
prevent indirect mercury poisoning for human.

15. No Abstract: Follow a post-exposure plan after needlestick injury

HDA Now. 2013 Winter:19.

Follow a post-exposure plan after needlestick injury.

TDIC Risk Management Staff.

16. No Abstract: Sharps advice from FDA, CDC

Health Devices. 2012 Feb;41(2):66.

Sharps advice from FDA, CDC.

[No authors listed]

17. News

– The Fight to End Pandemics
– USA: Advocates Push for Syringe-Exchange Program
– Canada: Mom Wants Better Enforcement of Needle Storage
– ‘Sharps’ Injuries Could Pose HIV, Hepatitis Risk To Surgeons
– GPEI Announces ‘Endgame’ Plan To Eradicate Polio By 2018
– USA: Boy Gets Rare Tick Infection from Blood Transfusion
– USA: About 1,200 dental patients in Oklahoma screened for HIV

Selected news items reprinted under the fair use doctrine of international
copyright law:

The Fight to End Pandemics
Larry Brilliant, Forbes, USA (07.04.13)

Editor’s Note: Larry Brilliant is CEO of Skoll Global Threats Fund which
works on climate, nuclear, pandemic, water and Middle East conflicts.
Brilliant helped lead the successful WHO smallpox eradication programme in

This article was published as part of a special series for World Health Day
and in advance of the 2013 Skoll World Forum. Watch the live stream April
10-12 by clicking here.

World Health Day – April 7 – honors the creation of the World Health
Organization (WHO) in 1948. Each year, we celebrate the advances in global
health and the role that the WHO plays both in improving health and
elevating health on the global agenda.

Today, even as many had thought we could finally turn our attention to the
increasing importance of chronic diseases like diabetes, cancer and heart
disease, infectious diseases like malaria and tuberculosis, as well as the
continuing pandemic of HIV/AIDS, remain stubbornly high on the global

We are reminded daily of the role that the WHO plays in fighting these top
three infectious disease killers. At the same time, an alphabet soup of
influenzas, including the new H7N9 outbreak in China, smoldering incidents
of H5N1 bird flu in Southeast Asia, and even periodic reminders of the 2009
H1NI swine flu pandemic, remain front of mind. On top of that, global
health workers must confront other zoonotic diseases, including new SARS-
like coronaviruses detected from countries as diverse as Saudi Arabia and
the UK, as well as old nemeses like Hantavirus, which recently showed up
unexpectedly in California’s Yosemite National Park, and countless other

For historical importance on today’s WHO birthday list, however, nothing
tops the heroic struggle to eradicate polio. This ancient scourge has been
beaten back, village by village, country by country, so that, remarkably,
it is now endemic in only three countries: Pakistan, Afghanistan and
Nigeria. India, one of the ancient homes for polio, has mustered millions
of volunteers to join a national polio eradication campaign supported by
the WHO, UNICEF, Rotary, the Bill and Melinda Gates Foundation and others.
It has had remarkable recent success: there has not been a single case of
polio in India in two years. While eradicating polio is a huge, complex,
global team effort, we cannot overstate the importance of the WHO’s
leadership role in the polio eradication campaign.

As someone who is almost the same age as the WHO, and whose first job out
of medical school was working for the WHO smallpox program, I reflect with
collective pride on the success of the WHO program that eradicated smallpox
three decades ago, the organization’s crowing achievement to date. But
eradicating polio would mean “two” instead of “one” disease eliminated from
the list of humanity’s woes–proving that eradication is not a unique event.
So this second disease eradicated might be even be sweeter. It has taken a
very long time, cost a great amount of treasure, and no small number of
public health workers lives. But we are getting very close on polio, and I
am optimistic.

In fact, I’m optimistic broadly about our ability to effectively tackle
nearly all of our communicable diseases foes, old and new. Why?

The arc of my career – from physician to public health practitioner, from
government to business to philanthropy – has given me a unique view into
public health trends over the last four decades. One key change in global
public health over this time has been the rise of non-state actors. Decades
ago, global public health was almost synonymous with the annual World
Health Assembly in Geneva, largely the domain of health ministers setting
goals and policies for WHO staff to implement. It would have been
unthinkable for the NGO sector, let alone individuals, foundations,
companies or even universities to play much of a role. Today, it’s vastly
different, with public advocacy groups, civil society players that span the
globe, and foundations like Bill and Melinda Gates, Rockefeller and others
joining UN agencies and bilateral donors in the global health conversation.
Over the last ten years, much innovation has come from these newer players.
Social entrepreneurs, advocacy groups, and nimble non-profits are creating
new systems, new technologies and developing new models for delivering
health care, particularly to underserved populations.

Thanks to recent changes in the International Health Regulations, we’ve
seen another type of non-state actor emerge: digital data players. Since
2007, countries have been obligated to increase their reporting on a wide
range of newly emergent diseases with the potential to spread beyond
borders. For cash starved health ministries, this additional obligation
might have been an economic burden. But the new rules also provided new
tools: countries can now tap into informal sources of disease information
as part of their official reporting. This has spurred the creation of new
tools and new organizations, ramping up disease surveillance capacity

Examples of these digital data players include:

GPHIN, which scrapes the web for media reports on diseases outbreaks;
ProMed, an Internet based expert community that reports on and organizes
responses to outbreaks;
Google Flu Trends, which maps flu based on Internet search terms;
INSTEDD, which builds epidemic control and communication systems;
and HealthMap, which combines elements of several of these systems to
display real time maps of diseases around the world.

These are a few of dozens of examples of the new tools that can help piece
together what’s happening worldwide on contagious diseases. They and others
like them have helped reduce the lag between a disease outbreak and its
detection. A study published several years ago in the Proceedings of the
National Academy of Sciences reported that the lag time from the first
occurrence of a new pandemic potential disease was over 5 months—167 days
—in 1996; but by 2009 it had dropped to 23 days, just over 3 weeks. When we
find outbreaks faster, we can limit their spread.

At the Skoll Global Threats Fund, we’ve recently helped launch (in
partnership with the APHA and HealthMap) a tool that goes one step further
– getting people to actively participate in public health by self reporting
each week on symptoms. Flu Near You now has nearly 80,000 users in the US.
Each week, participants receive an email (or mobile app notification) where
they click on a link to report whether they’ve experienced any of eight
symptoms related to flu, or, alternatively, were symptom free. This then
populates a map showing flu prevalence geographically in real time, as well
as pointing users to nearby flu resources, for example, pharmacies with
vaccines. This follows other similar systems, FluTracking in Australia
andInfluenzanet in Europe. We’re exploring together whether this type of
participatory surveillance can help us find and react to outbreaks even
more quickly. Of course, it is not just about flu; the hope is to learn how
to work worldwide with a host of diseases in the next few years.

As far as infectious diseases, global public health has never been stronger
than it is today. But our challenges remain substantial. The speed of
travel and just-in-time global supply chains means a pandemic can spread
faster than ever before, with greater economic and health impacts than even
before. But advances in surveillance tools like the ones I’ve mentioned,
improvement in point of care diagnostics, and the emergence of regional
surveillance structures in key regions, all give us a more than fighting
chance against new and old communicable disease.

At the Prince Mahidol Awards Conference in Bangkok this January, a new
organization was launched called CORDS (Connecting Organizations for
Regional Disease Surveillance). Made up of six regional disease
surveillance networks in the Middle East, Southern and East Africa, South
East Asia and Eastern Europe (each of which are in turn partnerships of
several national health ministries), CORDS has the potential to speed best
practices and help innovate rapid disease detection and response. The group
that funded and partnered to create CORDS includes the Rockefeller
Foundation, NTI,Fondation Merieux, Peter G. Peterson Foundation, the Bill
and Melinda Gates Foundation, and our own Skoll Global Threats Fund. And
getting back to World Health Day, key multilateral organizations working
together with CORDS include the Food and Agriculture Organization, the
World Organization for Animal Health, and the most important global health
agency of all, the WHO.

That WHO, global foundations, NGOs, government health ministries and
regional networks around the world are all working together is a great
take-away for today’s World Health Day. While there may be a never-ending
supply of new viruses jumping from animals to humans, we now have
innovations in technology and governance more than equal to the challenge.
In fact, we may be at a stage where we can realistically talk about not
only eradicating our “second” disease, polio, but even ending pandemics.

And that is something worth celebrating. So join me today on World Health
Day, put 65 candles on that birthday cake, make a wish that polio joins
smallpox in the dustbin of history and that we work together to prevent any
new infectious disease nightmares, and let’s celebrate WHO and the role it
has played–and will continue to play–year after year, birthday after

Happy World Health Day to all of us!
USA: Advocates Push for Syringe-Exchange Program
Mark Curnutte, Ohio USA (07.04.13)

Advocates for a syringe-exchange program, alarmed by increases in HIV and
hepatitis C cases in the city of Cincinnati and Hamilton County, are taking
their case to the Hamilton County Public Health Board on April 8. Mostly
white male injection drug users are causing the rise in intravenous heroin
use. In 2011, Hamilton County recorded 189 drug overdose deaths, primarily
from opioids such as heroin and prescription painkillers such as Percocet
and OxyContin. In 2012, Hamilton County reported 108 new HIV cases,
compared to 65 new cases in 2011.

The advocacy group, Hamilton County Response to the Opioid Epidemic, has
worked six years to establish a syringe exchange program, just as Scioto
and Cuyahoga counties already have. Dr. Judith Feinberg, a professor at the
University of Cincinnati’s College of Medicine and an infectious diseases
specialist, declares, “The program would protect the public, reduce
infections, and encourage involvement in (addictions) treatment.”

Since 2009, Hamilton County numbers for men’s and women’s hepatitis C cases
have risen steadily. The total number of cases in the county is approaching
1,200, the highest since 2005. Hepatitis C case numbers among African
Americans has been mainly steady since 2003; however, hepatitis C cases
among whites in Hamilton County increased from approximately 200 in 2009 to
approximately 500 in 2012. The highest case concentration has occurred in
Green and Colerain townships, Norwood, and the city neighborhoods of
Westwood, East and West Price Hill, Downtown, Over-the-Rhine, Walnut Hills,
and Avondale.

Advocates envision a program using a van that would focus immediately on
three neighborhoods: Over-the-Rhine, Westwood, and Lower Price Hill. Heroin
users frequently discard used needles in public spaces in those areas, said
Adam Reilly, a program advocate and HIV specialist. Cincinnati Health
Commissioner Noble Maseru executed an emergency order for a needle-exchange
program in February 2012, but neither public health boards nor Maseru has
the authority to create a program; only county and city lawmakers can do
so. Cincinnati City Manager Milton Dohoney Jr. has opposed the syringe
program, citing that possession of drug paraphernalia is illegal.

The Hamilton County Public Health Board will hold its monthly public
meeting Monday, April 8, at 6:30 p.m. at 250 William Howard Taft Road,
Cincinnati, Ohio. Syringe-exchange program advocates Adam Reilly and Dr.
Judith Feinberg will present.
Canada: Mom Wants Better Enforcement of Needle Storage
CJOB News Team, Winnipeg Canada (04.04.13)

A mother in Winnipeg says she’s not alone, after a horrifying incident with
her two toddlers.

“Started yelling, so I turned around, she had blood and he had pricks.”
Lisa Kasdorf had been visiting a dietician at a private clinic. She thought
the small examination room was safe – when her children found a Sharps
bucket on the floor behind a desk.

“It has a lid, I couldn’t get my hand in there, you couldn’t get your hand
in there for sure. But… for a child…”

Kasdorf says she’s heard of a similar incident with another family. The
College of Physicians and Surgeons of Manitoba investigated and did find
that bucket being used by the clinic was not the kind recomended by the
Canadian Standards Assocation.

Meanwhile, her children were put on anti-virals and have been checked every
six weeks for HIV and Hepatitis.

“It could happen to someone else’s kid, and they might contract something.
I felt sick and I blamed myself for the longest time.”
‘Sharps’ Injuries Could Pose HIV, Hepatitis Risk To Surgeons
Huffington Post (04.04.13)

All those sharp medical instruments and needles used during surgery can
pose a health hazard to surgeons, according to a new study in the journal
Plastic and Reconstructive Surgery.

There are nearly 400,000 injuries from these instruments, called “sharps”
injuries, each year, and 25 percent of people injured by these instruments
are surgeons, according to the article. The health risks are largely from
potential spread of communicable diseases, such as HIV or hepatitis B.

The most common injuries of this type are from syringe needles, making up
36 percent of “sharps” injuries. Suture needle injuries are the second most
common, making up 18.5 percent. Researchers found that fatigue and
inexperience are huge risk factors for experiencing a “sharps” injury.

The cost for immediate testing for these diseases after a “sharps” injury
is high, and can range from hundreds of dollars to thousands. If a patient
is not known to have any sort of blood-borne disease, the cost for testing,
follow-up and treatment after a “sharps” injury can be as much as $376. But
if the patient has HIV, that cost can go up to $2,456.

And beyond the financial, mental burdens — such as anxiety, fear and even
depression — can follow people who have experienced a “sharps” injury.

“Physicians and nurses frequently report feeling anger regarding their
exposure, and resentment regarding the risks of working in health care for
up to one year after the injury,” the University of Michigan Health System
researchers wrote in the study.

Because of the potential risks from “sharps” injuries, legislation was
passed in 2000 in an effort to try to reduce such injuries. The Needlestick
Safety & Prevention Act of 2000 involved maintaining injury logs, training
employees properly, putting controls in place for disposal or use of
needles, and using safer medical devices.

However, a 2010 study in the Journal of the American College of Surgeons
showed that even though “sharps” injuries in nonsurgical settings decreased
by 31.6 percent after the passing of the act, surgical-setting “sharps”
injuries increased by 6.5 percent.

“Hospitals should comply with requirements for the adoption of safer
surgical technologies, and promote policies and practices shown to
substantially reduce blood exposures to surgeons, their coworkers, and
patients,” those researchers, from the International Healthcare Worker
Safety Center, wrote in the study.
GPEI Announces ‘Endgame’ Plan To Eradicate Polio By 2018
Kaiser Daily Global Health Policy Report, USA (03.04.13)

“A new global plan aims to end most cases of polio by late next year, and
essentially eradicate the paralyzing disease by 2018 — if authorities can
raise the $5.5 billion needed to do the work, health officials said
Tuesday,” the Associated Press reports (Neergaard, 4/2). “The new plan,
endorsed by the World Health Organization, is designed to capitalize on
momentum against the crippling disease and formally declare all parts of
the world polio-free by 2018,” Agence France-Presse/GlobalPost writes
(4/2). “The new Global Polio Eradication and Endgame Strategic Plan aims to
bring the number of new wild polio cases down to zero by 2015 and eradicate
the virus entirely by 2018,” NPR’s “All Things Considered” notes, adding,
“The plan calls for an orchestrated global transition from the oral
vaccine, which contains live polio virus (and thus can cause ‘vaccine-
derived’ polio paralysis), to an injected vaccine made from dead virus”
(Beaubien, 4/2).

“But key hurdles include overcoming threats against vaccine workers in
Nigeria and Pakistan and raising the $5.5 billion needed for the next six
years of work, said experts from the Global Polio Eradication Initiative,”
who announced the plan at the Bill & Melinda Gates Foundation in
Washington, D.C., AFP reports. “Despite recent lethal attacks on vaccine
stations in Nigeria and Pakistan, those two countries and Afghanistan all
made progress in vaccinating more people and reducing polio cases in 2012,
the GPEI said,” the news agency writes (4/2). “The WHO, UNICEF and the Bill
& Melinda Gates Foundation, among others, have been pouring resources in to
attack polio in these three countries,” according to NPR (4/2). “Last year,
authorities counted 223 cases of polio worldwide, down from 650 the year
before,” the AP notes (4/2).
USA: Boy Gets Rare Tick Infection from Blood Transfusion
Karen Rowan, MyHealthNewsDaily, USA (03.03.13)

A 9-year-old Georgia boy who developed a rare tick-borne disease got the
infection from a blood transfusion, according to a report of his case.

The case is the first time this infection, called ehrlichiosis, was spread
by a transfusion, said Dr. Joanna Regan of the Centers for Disease Control
and Prevention.

The bacterial infection, though rare, is serious and can be fatal, Regan
said. Ehrlichiosis can go undetected because routine tests don’t look for
it, and many people do not realize they were bitten by a tick. In this
case, which occurred during the summer of 2011, the boy’s condition
deteriorated over the course of 10 days until a pathologist discovered the

While ehrlichiosis is easily treatable with the antibiotic doxycycline, the
drug is generally less powerful than other options, so it is often not the
first treatment doctors give when they suspect a patient has some type of
infection, Regan said. Indeed, the boy in this case was treated with broad-
spectrum antibiotics when he was admitted to the hospital, but he remained

The child’s family had no reason to suspect a tick-borne infection — he had
acute lymphoblastic leukemia and had not been playing outside. The cancer
is the most common cancer among children and is highly curable — 85 percent
of children who are treated for the condition are cured.

But chemotherapy treatments had left the boy suffering from anemia, and he
had received three transfusions in the previous month. He went to his
oncologist with fever, vomiting and a rash.

“He had classic signs — rash, low white blood cell count, low platelets —
but with no possibility of tick exposure, they didn’t think of this,” Regan
said. “There are many things that were more likely to be making him sick,”
such as common bacterial infections, or pneumonia, she said.

Finally, a pathologist found the telltale sign of bacteria within the boy’s
white blood cells. As soon as doctors administered doxycycline, the boy
rapidly improved and went home.

Health officials tracked down the donors of the three transfusions, and one
of those donors reported frequent tick bites. That donor lived in Florida,
and further tests showed the person had antibodies against Ehrlichia
bacteria, according to the report. Eight other people had received
transfusions from the donor; three died within a few days of unrelated
causes, the other five tested negative for Ehrlichia, according to the

“The donor had no symptoms — that’s what made it so difficult,” Regan said.
Routine lab tests of the donor’s blood appeared normal, although the person
reported being bitten by ticks repeatedly, she said.

The case shows that doctors should be aware that this infection can be
transmitted through blood transfusions. In 2011, the CDC reported that 162
cases of the tick-borne disease babesiosis over three decades were traced
to blood transfusions. Lyme disease could also theoretically be transmitted
via a transfusion, but no case of this has been reported, according to the
CDC. [Read: How Safe Is the Nation’s Blood Supply?]

Cases of ehrlichiosis have risen in recent years, from 200 in 2000 to 740
in 2010. The condition is fatal in 1 to 2 percent of cases, according to
the CDC. The infection is most common in the southeastern and south-central
United States.

People should try to avoid tick bites, Regan said. The CDC recommends using
repellant products that contain at least 20 percent DEET, examining the
skin for ticks after being outside and showering soon after outdoor

The case report was published March 19 in the journal Clinical Infectious

Pass it on: A tick-borne infection was passed on through a blood
USA: About 1,200 dental patients in Oklahoma screened for HIV
By Steve Olafsonm, Reuters ()2.04.13)

OKLAHOMA CITY | (Reuters) – About 1,200 patients have been screened for
exposure to HIV and hepatitis in Oklahoma after authorities found a Tulsa
dentist using improper sterilization procedures and rusty surgical tools, a
public health official said on Tuesday.

More than 6,000 patients have yet to be tested and officials have not
located all the exposed patients, said Kaitlin Snider, spokeswoman for the
Tulsa Health Department.

Testing is free and patients should get results in two weeks.

Dr. Scott Harrington practiced in Tulsa for 35 years before he surrendered
his license on March 20.

Harrington’s oral surgery came under scrutiny last month after one of his
patients tested positive for Hepatitis C, a contagious liver disease
transmitted through contact with the blood of an infected person.

After concluding the patient had no typical risk factors, state
investigators visited Harrington’s office and found multiple health and
safety violations that created cross-contamination and sterilization risks,
according the administrative complaint filed against him by the state
dentistry board.

Harrington’s attorney was not immediately available to comment.

Drug vials and needles were used multiple times on different patients and
instruments set aside for disease carriers appeared to be rusty, according
to the complaint.

Harrington’s practice served a large number of infectious disease carriers,
according to the complaint against him.

Harrington, who delegated many of his duties to two assistants, is accused
of 17 violations of Oklahoma dental regulations, including eight counts of
“being a menace to the public health” by practicing unsafe and unsanitary

The harshest sanction the dental board can levy is revocation of his

The Tulsa County District Attorney’s office has not said whether it will
file criminal charges against Harrington.

(Editing by Corrie MacLaggan and Lisa Shumaker)
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