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SIGNpost 00699

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00699 Statistics + Supply Chain + Abstracts + News 22 May 2013

CONTENTS
1. World Health Statistics 2013
2. Updated Toolkit for Managing the HIV & AIDS and Laboratory Supply
Chains Now Available
3. Abstract: Drug trafficking, use, and HIV risk: the need for
comprehensive interventions
4. Abstract: Hepatitis B and E viral infections among Nigerian healthcare
workers
5. Abstract: Dual positivity of hepatitis B surface antigen and anti-
hepatitis C virus antibody and associated factors among apparently
healthy patients of Ekiti State, Nigeria
6. Abstract: Notes from the field: transmission of HBV among assisted-
living-facility residents – virginia, 2012
7. Abstract: The risk of blood exposure incidents in dental practices in
the Netherlands
8. Abstract: Prevalence of human immunodeficiency virus/hepatitis C virus
co-infection in Brazil and associated factors: a review
9. Abstract: HIV, hepatitis B and C, and syphilis prevalence and
coinfection among sex workers in Southern Brazil
10. Abstract: The relationship between age and risky injecting behaviours
among a sample of Australian people who inject drugs
11. Abstract: Interest of transfusion safety e-learning for nurses:
assessment after two years
12. Abstract: A Randomized-controlled Trial of Parent-led Tactile
Stimulation to Reduce Pain During Infant Immunization Injections
13. No Abstract: Do patients feel comfortable asking healthcare workers to
wash their hands?
14. No Abstract: Safety culture and hand hygiene: linking attitudes to
behavior
15. No Abstract: Attempted suicide by intrapulmonary self-injection of
White spirit
16. No Abstract: Hepatitis C in the United States
17. News
– USA: Michigan Hit Hard by Spine Infections From Contaminated MPA
– Pakistan: Lack of awareness aggravating HIV/AIDS incidence: Ashrafi
– Australia: HIV nurse slams Australia needle danger
– Latin America: Mexico Becomes The First Latin American Country With An
Accredited Laboratory For Quality Control Of Syringes Used For
Vaccination

The web edition of SIGNpost is online at:
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Visit the WHO injection safety website and the SIGN Alliance Secretariat
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Selected updates and breaking news items on the SIGN Moderator Facebook
page at: http://facebook.com/SIGN.Moderator

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

1. World Health Statistics 2013

Download The Summary Brochure or Download The Full Report
__________________________________________________________________
www.who.int/gho/publications/world_health_statistics/2013/en/index.html

World Health Statistics 2013

World Health Statistics 2013 contains WHO’s annual compilation of health-
related data for its 194 Member States, and includes a summary of the
progress made towards achieving the health-related Millennium Development
Goals (MDGs) and associated targets.

This year, it also includes highlight summaries on the topics of reducing
the gaps between the world’s most-advantaged and least-advantaged
countries, and on current trends in official development assistance (ODA)
for health.

Progress on the health-related Millennium Development Goals (MDGs)
Fact sheet N°290
http://who.int/entity/mediacentre/factsheets/fs290/en/index.html

Download The Summary Brochure
Download The Full Report
http://who.int/gho/publications/world_health_statistics/2013/en/index.html
__________________________________________________________________
________________________________*_________________________________

2. Updated Toolkit for Managing the HIV & AIDS and Laboratory Supply
Chains Now Available
__________________________________________________________________
Updated Toolkit for Managing the HIV & AIDS and Laboratory Supply Chains
Now Available

As part of Global Health Month, the USAID | DELIVER PROJECT joins USAID in
highlighting HIV and AIDS prevention and treatment efforts. The project’s
updated CD toolkit, Resources for Managing the HIV & AIDS and Laboratory
Supply Chains, is now available. The CD contains a selection of tools,
reports, and briefs for supply chain and program managers and advisors
involved in designing, implementing, and managing in-country supply chains
for HIV and AIDS and laboratory commodities.

Learn more at http://j.mp/16Mfahv

Anne Marie Hvid, PMP
Knowledge Management Advisor

USAID | DELIVER PROJECT
John Snow, Inc.

1616 Fort Myer Drive, 15th floor
Arlington, VA 22209 USA
Phone: +1.703.310.5256

email: ahvid@jsi.com
http://deliver.jsi.com/
__________________________________________________________________
________________________________*_________________________________

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

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

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

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

Tanzania AIDS Prevention Program. jmbwambo@gmail.com

The rapid increase in communication and transportation between Africa and
other continents as well as the erosion of social fabric attended by
poverty, ethnic conflicts, and civil wars has led to increased trafficking
and consumption of illicit drugs. Cannabis dominates illicit trade and
accounts for as much as 40% of global interdiction.

Due to escalating seizures in recent years, the illicit trade in heroin and
cocaine has become a concern that has quickly spread from West Africa to
include Eastern and Southern Africa in the past 10 years. All regions of
Africa are characterized by the use of cannabis, reflecting its entrenched
status all over Africa.

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

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

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

4. Abstract: Hepatitis B and E viral infections among Nigerian healthcare
workers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23672103

Afr J Med Med Sci. 2012 Dec;41(4):387-91.

Hepatitis B and E viral infections among Nigerian healthcare workers.

Ola SO, Odaibo GN, Olaleye OD, Ayoola EA.

Department of Medicine, College of Medicine, University of lbadan,
University College Hospital, Ibadan, Nigeria. soola@comui.edu.ng

BACKGROUND: There is dearth of information on Hepatitis E virus (HEV)
infection and its co-infection with HBV among Nigerian healthcare workers
(HCWs). Hence, there is the need to determine the rate of HEV infection and
its association with HBV among HCWs who are at greater risk of nosocomial
infections.

METHODOLOGY: Sera from 88 HCWs and 44 non-HCWs healthy adults as controls
were tested for the presence of antibody to HEV (anti-HEV). The HCWs were
also tested for HBsAg and antibody to Hepatitis B core antigen (anti-HBc)
using commercially available ELISA kits.

RESULTS: The prevalence of anti-HEV obtained among the HCWs and controls
were 43% and 94% respectively (p<0.005) while those of HBsAg and anti-HBc
in HCWs were respective 13% and 56%. Overall among HCWs, the prevalence of
HBV infection was 65.9%, higher than HEV infection (p<0.005) with only
anti-HBc greater among the male participants (p<0.005) while co-infection
of HBV with HEV was 27.3%. HEV infection was least among the Paediatricians
(18%) and highest among the Surgeons (55%) while HBV infection was similar
in all the different occupational groups of HCWs (44-59%) except among the
Gynecologists and Obstetricians (80%).

CONCLUSION: Infection with HEV is high among Nigerian HCWs but lower than
the rate among non-HCWs. It is also co-infected with HBV especially among
the different groups of the HCWs and could occur with the diverse clinico-
serological patterns of HBV infection.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Dual positivity of hepatitis B surface antigen and anti-
hepatitis C virus antibody and associated factors among apparently
healthy patients of Ekiti State, Nigeria
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23171358

Viral Immunol. 2012 Dec;25(6):448-55.

Dual positivity of hepatitis B surface antigen and anti-hepatitis C virus
antibody and associated factors among apparently healthy patients of Ekiti
State, Nigeria.

Oje OJ, Sule WF, Famurewa D.

Department of Food Technology, The Federal Polytechnic, Ado-Ekiti, Ekiti
State, Nigeria.

There are few studies on health-facility based prevalence rates for dual
hepatitis B virus-hepatitis C virus (HBV-HCV) infection on a state-wide
scale in Nigeria. In this study we determined the state-wide prevalence
rate of dual positivity of hepatitis B surface antigen and anti-HCV
antibody among hospital patients of Ekiti State, Nigeria, and identified
associated factors.

Consenting apparently-healthy patients visiting health centers in all local
government area (LGA) headquarters of Ekiti State were consecutively
selected to a total of 2000 individuals. Patient demographic data pertinent
to HBV and HCV transmission were obtained using a structured questionnaire.
Subsequently, serum samples prepared from the aseptically collected blood
was tested for the presence of both HBsAg and anti-HCV antibody using
DiaSpot test strips. The results were analyzed using binary logistic
regression.

Dual positivity of 7.40% was recorded among the study participants, with
9.80% and 12.80%, respectively, testing positive for HBsAg and anti-HCV
antibody. The study patients were, however, most likely to be anti-HCV
antibody positive.

Nine of the 10 factors studied were independently associated with dual
positivity. Five of these, in descending order of odds ratio, were:
illiteracy (15.76, p=0.001); having =4 sexual partners (9.46, p=0.001); age
range of 35-44?y (8.46,p=0.001); farming (7.33, p=0.001); and “not at all”
to use of condoms during sexual intercourse (4.39, p=0.001).

The dual positivity rate was relatively high, with unprotected sexual
intercourse as the most probable mode of acquisition of HBV and HCV by the
seropositive study participants.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Notes from the field: transmission of HBV among assisted-
living-facility residents – virginia, 2012
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23677047

MMWR Morb Mortal Wkly Rep. 2013 May 17;62(19):389.

Notes from the field: transmission of HBV among assisted-living-facility
residents – virginia, 2012.

Centers for Disease Control and Prevention (CDC).

On June 29, 2012, the Rappahannock Area Health District in northwestern
Virginia received a report of an acute hepatitis B virus (HBV) infection in
an elderly resident of an assisted-living facility (ALF). The resident
reported no risk factors for HBV infection except assisted monitoring of
blood glucose (AMBG), which has been implicated in the transmission of HBV
in ALFs and other long-term-care facilities.

Rappahannock Area Health District investigated the source of the infection
and the scope of transmission. Investigators observed facility infection
control practices and procedures and conducted staff interviews.

The facility was scheduled to close July 31, 2012, necessitating prompt
response before residents were transferred.

Free full text
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6219a4.htm
__________________________________________________________________
________________________________*_________________________________

7. Abstract: The risk of blood exposure incidents in dental practices in
the Netherlands
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22712586

Community Dent Oral Epidemiol. 2012 Dec;40(6):567-73.

The risk of blood exposure incidents in dental practices in the
Netherlands.

van Wijk PT, Meiberg AE, Bruers JJ, Groenewold MH, van Raalten AL, Dam BA,
Schneeberger PM.

Department of Medical Microbiology and Infection Control, Jeroen Bosch
Hospital, ‘s-Hertogenbosch, The Netherlands. p.vanwijk@vumc.nl

OBJECTIVES: An awareness of the risk of blood-borne infections among
dentists has been promoted by the Dutch Dental Association (NMT) as part of
their quality and safety programme, and a nationally operating expert
counselling centre was contracted to manage all reported incidents.

METHODS: We analysed data on hepatitis B vaccination status, sex and age
for all reported incidents recorded by this centre during 2008. We compared
this with data collected at same time during a national survey to assess
the performance of the centre. The number of blood exposure injuries among
dentists and their assistants, and reporting behaviour, were also assessed.

RESULTS: In 2008, 387 incidents were reported to the counselling centre.
The percentage of high-risk incidents was 16, with a risk of hepatitis B,
hepatitis C and HIV infections. In the hepatitis B cases, 12% had no or
insufficient immunization. Eight per cent of those injured were unable to
start HIV Post-Exposition Prophylaxis because they reported too late. Of
the 1442 surveys sent, 487 (34%) were returned. Dentists estimated levels
of hepatitis B vaccination at 98%.

Thirty-two per cent reported to have had one or more injuries in their
practice in 2008. Of these, 37% were counselled by the expert centre, 18%
were counselled by others and 45% sought no medical attention. The
performance of the counselling centre received a positive score (95%). A
need for more information about vaccination and blood-borne infections in
dentistry (52%) was reported.

CONCLUSIONS: Nationwide data show blood exposure incidents occur frequently
in dental settings, with a considerable number of high-risk incidents.
Administering anaesthetics and cleaning-up are major risk factors. There is
a need to intensify measures for safe working conditions in dental care
settings in the Netherlands, irrespective of the type of dental practice.

© 2012 John Wiley & Sons A/S.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Prevalence of human immunodeficiency virus/hepatitis C virus
co-infection in Brazil and associated factors: a review
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23680064

Braz J Infect Dis. 2013 May 13. pii: S1413-8670(13)00063-9.

Prevalence of human immunodeficiency virus/hepatitis C virus
co-infection in Brazil and associated factors: a review.

Kuehlkamp VM, Schuelter-Trevisol F.

Postgraduate Program in Health Sciences, Universidade do Sul de Santa
Catarina (UNISUL), Tubarão, SC, Brazil.

The hepatitis C virus and human immunodeficiency virus share the same
transmission routes, which makes co-infection an unfavorable condition for
the natural history of both viral diseases. In this context, it should be
highlighted that the knowledge of the extent of co-infection and associated
risk factors is a vital tool for prevention and control over infectious
diseases.

The aim of this study was to review the literature, seeking to examine the
prevalence of human immunodeficiency virus/hepatitis C virus co-infection
reported in studies conducted in Brazil, and identify the main risk factors
associated with co-infection. The electronic search was conducted in the
Medline, Lilacs and SciELO databases. The following keywords were used:
human immunodeficiency virus and Hepatitis C or hepatitis C virus and
Brazil.

The search led to 376 articles, of which 69 were selected for data
extraction. We excluded animal studies, reports or case series, review
articles, letters to the editor, other types of hepatitis and those studies
in which co-infected patients were intentionally selected for comparison to
single infected individuals. As a result, 40 articles were reviewed. The
majority of the population in these studies was male (71%) and young
adults, with a mean age of 26.7 years. The prevalence of hepatitis C virus
co-infection among individuals living with human immunodeficiency virus in
the studies conducted in Brazil ranged from 3.3% (serum samples) to 82.4%
(drug users), with an average of 20.3%.

The findings reveal that the prevalence of human immunodeficiency
virus/hepatitis C virus co-infection is highly variable, depending on the
characteristics of the study population. Risk factors associated with human
immunodeficiency virus/hepatitis C virus co-infection were injection drug
use and blood transfusion.

Copyright © 2013 Elsevier Editora Ltda. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: HIV, hepatitis B and C, and syphilis prevalence and
coinfection among sex workers in Southern Brazil
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23681430

Rev Soc Bras Med Trop. 2013 May 10:0.

HIV, hepatitis B and C, and syphilis prevalence and coinfection among sex
workers in Southern Brazil.

Schuelter-Trevisol F, Custódio G, Silva AC, Oliveira MB, Wolfart A,
Trevisol DJ.

Introduction Sex workers (SWs) are vulnerable to HIV, hepatitis, and
syphilis coinfection. Methods A cross-sectional study was conducted in
Tubarão, Laguna, and Imbituba, Southern Brazil.

We surveyed 147 SWs using face-to-face interviews and blood sampling for
serological evaluation. Results Prevalence of hepatitis B (HBV) was 23.1%,
syphilis 19.7%, hepatitis C (HCV) 8.8%, and HIV 8.8%.

Of 13 HIV-infected patients, 3 were co-infected with HCV, 4 with syphilis,
and 5 with HBV. Conclusions SWs had high HIV infection rates, and
coinfection with viral hepatitis and syphilis.

Free full text http://dx.doi.org/10.1590/0037-8682-1364-2013
__________________________________________________________________
________________________________*_________________________________

10. Abstract: The relationship between age and risky injecting behaviours
among a sample of Australian people who inject drugs
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23664499

Drug Alcohol Depend. 2013 May 9. pii: S0376-8716(13)00116-6.

The relationship between age and risky injecting behaviours among a sample
of Australian people who inject drugs.

Horyniak D, Dietze P, Degenhardt L, Higgs P, McIlwraith F, Alati R, Bruno
R, Lenton S, Burns L.

Centre for Population Health, Burnet Institute, Melbourne, Victoria 3004,
Australia; Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Victoria 3004, Australia. Electronic address:
danielle@burnet.edu.au.

BACKGROUND: Limited evidence suggests that younger people who inject drugs
(PWID) engage in high-risk injecting behaviours. This study aims to better
understand the relationships between age and risky injecting behaviours.

METHODS: Data were taken from 11 years of a repeat cross-sectional study of
sentinel samples of regular PWID (The Australian Illicit Drug Reporting
System, 2001-2011). Multivariable Poisson regression was used to explore
the relationship between age and four outcomes of interest: last drug
injection occurred in public, receptive needle sharing (past month),
experiencing injecting-related problems (e.g. abscess, dirty hit; past
month), and non-fatal heroin overdose (past six months).

RESULTS: Data from 6795 first-time study participants were analysed (median
age: 33 years, interquartile range [IQR]: 27-40; median duration of
injecting: 13 years [IQR: 7-20]). After adjusting for factors including
duration of injecting, each five year increase in age was associated with
significant reductions in public injecting (adjusted incidence rate ratio
[AIRR]: 0.90, 95% confidence interval [CI]: 0.88-0.92), needle sharing
(AIRR: 0.84, 95% CI: 0.79-0.89) and injecting-related problems (AIRR: 0.96,
95% CI: 0.95-0.97). Among those who had injected heroin in the six months
preceding interview, each five year increase in age was associated with an
average 10% reduction in the risk of heroin overdose (AIRR: 0.90, 95% CI:
0.85-0.96).

CONCLUSIONS: Older PWID report significantly lower levels of high-risk
injecting practices than younger PWID. Although they make up a small
proportion of the current PWID population, younger PWID remain an important
group for prevention and harm reduction.

Copyright © 2013. Published by Elsevier Ireland Ltd.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Interest of transfusion safety e-learning for nurses:
assessment after two years
__________________________________________________________________
Transfus Clin Biol. 2012 Nov;19(4-5):241-3.

[Interest of transfusion safety e-learning for nurses: assessment after two
years].

[Article in French]

Trophilme C, Cabaud JJ, Vessière S.

Hôpital Bichat, 46, rue Henri-Huchard, 75877 Paris cedex 18, France.
catherine.trophilme@bch.aphp.fr

In front of increasing organizational difficulties, health institutions
opted for a transfusion safety e-learning training. Hindsight of two years,
an initial assessment highlights success factors and desirable
improvements.

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

12. Abstract: A Randomized-controlled Trial of Parent-led Tactile
Stimulation to Reduce Pain During Infant Immunization Injections
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23669452

Clin J Pain. 2013 May 9.

A Randomized-controlled Trial of Parent-led Tactile Stimulation to Reduce
Pain During Infant Immunization Injections.

Hogan ME, Probst J, Wong K, Riddell RP, Katz J, Taddio A.

*Leslie Dan Faculty of Pharmacy, University of Toronto †Women’s College
Hospital Family Practice Health Centre ‡Department of Psychology, York
University §Department of Psychiatry Research, Hospital for Sick Children
?Toronto General Research Institute ¶Department of Anesthesia and Pain
Management, University Health Network #Department of Child Health
Evaluative Sciences, Pharmacy, Hospital for Sick Children, Toronto, ON,
Canada.

OBJECTIVE:: To determine the effectiveness of parent-led tactile
stimulation for pain reduction when added to a combination of evidence-
based pain-reducing interventions in infants undergoing immunization
injections.

METHODS:: Healthy infants aged 4 to 6 months undergoing routine
immunization at a primary care practice were eligible. Infants were
randomized to tactile stimulation by a parent or usual care. Parents in the
tactile stimulation group rubbed the ipsilateral thigh distal to the site
for 15 seconds before, during, and after injections. In addition, all
infants received evidence-based pain-relieving interventions including:
sucrose solution, holding by a parent, and intramuscular injection without
aspiration. The primary outcome was pain, measured by a validated tool, the
Modified Behavioral Pain Scale (MBPS), by an observer unaware of treatment
allocation using videotapes of the procedure. MBPS scores could range from
0 (no pain) to 10 (maximum pain). Parents, unaware of the study hypothesis,
also rated infant pain in real time using a 100 mm visual analogue scale.

RESULTS:: One hundred twenty infants participated. Infant characteristics
did not differ (P>0.05) between the tactile stimulation and control groups.
Mean MBPS scores and parent visual analogue scale scores did not differ
between groups [8.2 (1.1) vs. 8.0 (1.3); P=0.57] and [60 (20) vs. 53 (22)
mm; P=0.10], respectively.

DISCUSSION:: Parent-led tactile stimulation did not reduce pain in infants
undergoing immunization injections when combined with other pain-relieving
interventions. Potential reasons for the lack of effectiveness are
discussed. Investigation of the effectiveness of clinician-led tactile
stimulation in this population is recommended.
__________________________________________________________________
________________________________*_________________________________

13. No Abstract: Do patients feel comfortable asking healthcare workers to
wash their hands?
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/23143376

Infect Control Hosp Epidemiol. 2012 Dec;33(12):1282-4.

Do patients feel comfortable asking healthcare workers to wash their hands?

Ottum A, Sethi AK, Jacobs EA, Zerbel S, Gaines ME, Safdar N.

Department of Population Health Sciences, University of Wisconsin, Madison,
Wisconsin, USA.
__________________________________________________________________
________________________________*_________________________________

14. No Abstract: Safety culture and hand hygiene: linking attitudes to
behavior
__________________________________________________________________
Infect Control Hosp Epidemiol. 2012 Dec;33(12):1280-2.

Safety culture and hand hygiene: linking attitudes to behavior.

Daugherty EL, Paine LA, Maragakis LL, Sexton JB, Rand CS.

Department of Medicine, Johns Hopkins University School of Medicine,
Baltimore, Maryland 21205, USA. edaughe2@jhmi.edu
__________________________________________________________________
________________________________*_________________________________

15. No Abstract: Attempted suicide by intrapulmonary self-injection of
White spirit
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23159516

Ann Fr Anesth Reanim. 2012 Dec;31(12):975-7.

[Attempted suicide by intrapulmonary self-injection of White spirit®].

[Article in French]

Godard A, Labalette M, Lenot B, Lepitre N.
__________________________________________________________________
________________________________*_________________________________

16. No Abstract: Hepatitis C in the United States
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23675657

N Engl J Med. 2013 May 16;368(20):1859-61.

Hepatitis C in the United States.

Holmberg SD, Spradling PR, Moorman AC, Denniston MM.

Epidemiology and Surveillance Branch, Division of Viral Hepatitis, Centers
for Disease Control and Prevention, Atlanta, USA.
__________________________________________________________________
________________________________*_________________________________

17. News

– USA: Michigan Hit Hard by Spine Infections From Contaminated MPA
– Pakistan: Lack of awareness aggravating HIV/AIDS incidence: Ashrafi
– Australia: HIV nurse slams Australia needle danger
– Latin America: Mexico Becomes The First Latin American Country With An
Accredited Laboratory For Quality Control Of Syringes Used For
Vaccination

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
http://www.medscape.com/viewarticle/804501

USA: Michigan Hit Hard by Spine Infections From Contaminated MPA
Megan Brooks, Medscape.com (21.05.13)

Michigan has had most of spinal and paraspinal infections associated with
contaminated methylprednisolone acetate (MPA) from the New England
Compounding Center (NECC) in Framingham, Massachusetts, according to the
Centers for Disease Control and Prevention (CDC).

As of May 6, 2013, 52% of paraspinal and spinal infections have been
reported in Michigan even though only 13% of potentially contaminated vials
were shipped to the state, the CDC said May 17 in the Morbidity and
Mortality Weekly Report (MMWR).

Increased case-finding efforts by Michigan health officials, higher levels
of contamination in the vials shipped to Michigan, and a specific injection
technique preferred at 1 hospital are 3 possible reasons, an editorial note
points out.

The first case of fungal meningitis associated with contaminated MPA
injection was reported in Tennessee on September 18, 2012, as reported by
Medscape Medical News.

According to the CDC, as of May 6, 2013, the outbreak of fungal meningitis
and other fungal infections associated with contaminated MPA from NECC had
resulted in 741 reported cases and 55 deaths in 20 states. The total case
count in Michigan was 261 and included 16 deaths, the report notes.

During the first 4 weeks of the outbreak, September 7 to October 5, 2012,
nearly all of the reported cases involved meningitis. But then some states,
including Michigan, began seeing cases of localized spinal and paraspinal
infections, including epidural abscesses, phlegmon, arachnoiditis,
discitis, or vertebral osteomyelitis.

As of May 6, these localized infections, without concurrent meningitis, had
accounted for 320 (43%) of the 741 total reported cases. And Michigan had
the highest number of spinal and paraspinal infection cases (167 in total),
accounting for 52% of the 320 cases reported across the United States.
Michigan also had an additional 43 spinal and paraspinal infection cases
with meningitis, the report notes.

The editorial note says increased case-finding might partly explain the
increased spinal or paraspinal infections in Michigan. Early experience
with patients who received diagnoses of localized spinal or paraspinal
infections despite minimal or no new symptoms and no prior diagnosis of
meningitis prompted clinicians at St. Joseph Mercy Hospital in Ann Arbor to
use an expanded diagnostic approach, offering spinal MRI to patients who
had received injections but had no symptoms of infection, the note
explains. “Repeat MRIs were offered every 2–3 weeks to all persons who had
received injections whether or not they had previously undergone care.”

It’s also possible that the vials of MPA shipped to Michigan had higher
levels of contamination with fungus, predisposing patients to localized
infection or tissue reaction, the CDC said. The agency notes that 4 pain
management facilities in Michigan received 2225 of the approximately 17,000
vials of MPA that came from the 3 contaminated lots distributed in the
United States. One lot has been associated with a significantly greater
risk for fungal infection compared with the other 2 lots. All 3
contaminated lots have been recalled by the NECC, which is no longer in
business.

The CDC also notes that among Michigan patients who had localized
infections without meningitis, 80% received contaminated MPA injections
from Michigan Pain Specialists, which was shipped 400 5-mL vials from the
lot associated with an increased risk for infection. “The 400 5-mL vials
represented the largest shipment of 5-mL vials to any single state,” the
CDC writes.

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Alternatively, a specific injection technique (a transforaminal rather than
translaminar approach) preferred by clinicians at St. Joseph Mercy Hospital
might, in part, explain the difference.

The meningitis outbreak associated with contaminated MPA has “presented
multiple challenges, including unknown incubation periods, a broader
spectrum of clinical presentations than initially anticipated, latent
disease, and a wide range in the number of days from the last contaminated
injection to the first positive MRI finding, especially among patients with
spinal or paraspinal infections without meningitis,” the CDC notes.

“Clinicians should continue to maintain a higher index of suspicion for
patients who received injections with contaminated MPA but have not
developed infection,” the agency advises.

MMWR Morb Mortal Wkly Rep. 2013;62:377-381. Free Full text
www.cdc.gov/mmwr/preview/mmwrhtml/mm6219a1.htm?s_cid=mm6219a1_w
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http://www.brecorder.com/general-news/172/1187643/

Pakistan: Lack of awareness aggravating HIV/AIDS incidence: Ashrafi
Business Recorder Report, Pakistan (20.05.13)

Chairman, Pakistan Ulema Council, Hafiz Muhammad Tahir Mehmood Ashrafi, has
said that poor understanding about AIDS among people is causing its spread
in the country. Registering his concern on Sunday about sharp increase in
HIV/ AIDS cases in the country during last two years, he regretted the
denial about the disease among the country-men, according to a statement
issued here.

For a long time even the health policy makers remained under the impression
that either HIV incidence are non-existent or too low, which led to a
progressive increase in HIV cases.

Maulana Ashrafi said that in Pakistan’s context it is not only the
promiscuity but also infected blood transfusions and sharing of infected
needles that contribute towards its spread, he said. Elaborating his
stance, he said it was urgently needed to make people understand that the
virus does not persist in our environs. According to UNAIDS 2011 estimates,
in Pakistan about 130,000 people were affected with AIDS.

The findings moved Pakistan up from “low prevalence – high risk” category
to a “concentrated epidemic” and initiated campaigns and studies.

Over the time, the epidemic has spread from urban centres to smaller cities
and towns.

“I believe, we have to save our people through awareness campaigns and tell
them that they could be protected and guarded well against AIDS and other
such deadly diseases,” said the scholar. Hafiz Ashrafi reiterated that due
to unawareness, sometimes people come across such accidents that let them
fall prey to the deadly diseases and they lose their precious lives in the
process.

HIV is not only transmitted through promiscuity with an HIV infected
partner but also because of transfusion of HIV infected blood and sharing
of unsterilised syringes or needles with HIV positive person; HIV infected
mother to child during pregnancy and breast feeding.

Copyright Associated Press of Pakistan, 2013
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Australia: HIV nurse slams Australia needle danger
Clifford Fram, AAP, Herald Sun Australia (17.05.13)

AUSTRALIA is way behind the US and Europe in protecting medical workers
from sharp objects, says a former US nurse who contracted HIV and hepatitis
C through a needle injury.

Dr Karen Daley, in Melbourne to attend a nursing conference, says it is
“surprising and distressing” that Australia does not have safety
regulations.

The US made safety devices mandatory in 2001, and the UK and European Union
also have regulations.

Around 18,000 Australians, mainly nurses, report needle injuries each year,
according to 2008 figures.

Although individual hospitals are making an effort to improve safety,
“there is limited progress in making safe devices available to the
workforce”, Dr Daley says.

“It is distressing to find that a wealthy, forward-thinking country like
Australia, with a first-class health system, is so far behind.”

Dr Daley, who has a PhD in nursing, has been campaigning for safety since
she was infected by a needle protruding from a container in 1998.

“At the beginning I didn’t know if I would survive. What I did know was
that my injury was preventable.”

Needle injuries are among the most prevalent and potentially most dangerous
injuries in medical settings.

Dr Daley, president of the American Nurses Association, says a major
international concern is safety in the operating theatre, but surgeons can
be resistant to change.

“It is important the whole team gets engaged in the conversation.”

Australian safety campaigner Anne Trimmer says there are a number of
devices that significantly reduce the risk of injuries.

A report by the Medical Technology Association of Australia shows around
three-quarters of injuries could be prevented through the use of safety-
engineered medical devices, she says.

Lee Thomas, the federal secretary of the Australian Nursing Federation,
says the health sector should align its safety protocols with legislation
that requires the use of engineering controls to eliminate foreseeable
workplace hazards.

“Hospitals and the health sector need to take up the challenge to be
proactive in protecting their staff,” she says, calling for safety-
engineered devices to be made available “sooner rather than later”.
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Latin America: Mexico Becomes The First Latin American Country With An
Accredited Laboratory For Quality Control Of Syringes Used For Vaccination
from Nora Lucia Rodriguez, WHO PAHO, WHO Global Immunization News, April
2013 Issue (30.04.13)

On 17 April 2013, the Pan American Health Organization (PAHO) recognized
Mexican authorities for having the first accredited laboratory for quality
control of syringes used for vaccination in Latin America and the
Caribbean.

PAHO considers the quality, safety and effectiveness of syringes used for
vaccination of public health importance. Since 2005, the PAHO Immunization
Programme (FCH/IM) has a quality control programme for syringes used for
vaccination in national immunization programmes, particularly those
purchased through the Revolving Fund for vaccine procurement.

Following an assessment that supported that the laboratory CCAyAC/COFEPRIS
(Comisionado Federal para la Protección contra Riesgos Sanitarios) met the
International Norms ISO 17025, the laboratory received its accreditation.
COFEPRIS has the capacity to analyze around 130 million syringes for
vaccination per year.
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The SIGN 2010 meeting report pdf, 1.36Mb is available on line at:
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