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SIGNpost 00702

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00702 War + HepC + Abstracts + Excerpts + News 12 June 2013

CONTENTS
1. The Negative Impact Of The War On Drugs On Public Health: The Hidden
Hepatitis C Epidemic: REPORT OF THE GLOBAL COMMISSION ON DRUG POLICY
2. Global drug policy fuels hepatitis C epidemic, report warn
3. Abstract: Iatrogenic Blood-borne Viral Infections in Refugee Children
from War and Transition Zones
4. Excerpt: WHO Best Practices for Injections and Related Procedures
Toolkit
5. Excerpt: WHO Guidelines on Drawing Blood: Best Practices in Phlebotomy
6. Abstract: Thermostability of seven hepatitis C virus genotypes in vitro
and in vivo
7. Abstract: The changing epidemiology of HIV in 2013
8. Abstract: Determinants of neonatal mortality in rural India, 2007-2008
9. Abstract: Acute hepatitis B outbreaks in 2 skilled nursing facilities
and possible sources of transmission: north Carolina, 2009-2010
10. Abstract: Breaking worse: The emergence of krokodil and excessive
injuries among people who inject drugs in Eurasia
11. Abstract: Risk Prison and Hepatitis B Virus Infection among Inmates
with History of Drug Injection in Isfahan, Iran
12. Abstract: Changing patterns of first injection across key periods of
the French Harm Reduction Policy: PrimInject, a cross sectional
analysis
13. Abstract: A Response to the Opioid Overdose Epidemic: Naloxone Nasal
Spray
14. Abstract: The prevalence of hepatitis C virus in mashhad, iran: a
population-based study
15. Abstract: Feasibility and acceptability of gentamicin in the Uniject
prefilled injection system for community-based treatment of possible
neonatal sepsis: the experience of female community health volunteers
in Nepal
16. Abstract: A Discrete Choice Experiment to Determine Patient Preferences
for Injection Devices in Multiple Sclerosis
17. Abstract: Expert Consensus Statement on achieving self-sufficiency in
safe blood and blood products, based on voluntary non-remunerated blood
donation (VNRBD)
18. Abstract: Association of pertussis and measles infections and
immunizations with asthma and allergic sensitization in ISAAC Phase Two
19. Abstract: Concomitant administration of hepatitis A vaccine with
measles/mumps/rubella/varicella and pneumococcal vaccines in healthy 12
to 23 month-old children
20. Abstract: Evaluating the risk of extraocular tumour spread following
intravitreal injection therapy for retinoblastoma: a systematic review
21. Abstract: Nigerian Dental Therapy Students’ Knowledge, Attitude, and
Willingness to Care for Patients with HIV
22. No Abstract: Treatment as prevention: The breaking of taboos is
required in the fight against hepatitis C among people who inject drugs
23. No Abstract: Global drug policy fuels hepatitis C epidemic, report
warns
24. No Abstract: Joint Practice Guideline for Sterile Technique during
Vascular and Interventional Radiology Procedures
25. News
– Nigeria: N10.5m worth of fake product packaging materials intercepted
– India: Poor uptake of hepatitis B vaccine in India has several causes,
study finds
– Oklahoma USA: 2 new cases of hepatitis in Oklahoma health scare
– New Zealand: Hep C rate lead to calls for rural needle exchanges
– New Hampshire USA: 33rd hepatitis C case tied to NH outbreak confirmed,
believed infected through sexual contact

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1. The Negative Impact Of The War On Drugs On Public Health: The Hidden
Hepatitis C Epidemic: REPORT OF THE GLOBAL COMMISSION ON DRUG POLICY

“Seven Former Presidents, Richard Branson and Other World Leaders:
Criminalization of Drug Use Fuelling the Global Hepatitis C viral time bomb
Global Commission on Drug Policy Calls for Decriminalization of Drug Use
and Expansion of Proven, science-based Solutions to Reduce Hepatitis C –
Including Sterile Syringe Access, Safer Injection Facilities and
Prescription Heroin Programs.”

Download the report and watch the video at:
http://www.globalcommissionondrugs.org/hepatitis/
__________________________________________________________________

The Negative Impact Of The War On Drugs On Public Health: The Hidden
Hepatitis C Epidemic: REPORT OF THE GLOBAL COMMISSION ON DRUG POLICY

Media Release

Download the report and watch the video at:
http://www.globalcommissionondrugs.org/hepatitis/

http://www.globalcommissionondrugs.org/hepatitis/PR_English_final.pdf

Seven Former Presidents, Richard Branson and Other World Leaders:
Criminalization of Drug Use Fuelling the Global Hepatitis C viral time bomb
Global Commission on Drug Policy Calls for Decriminalization of Drug Use
and Expansion of Proven, science-based Solutions to Reduce Hepatitis C –
Including Sterile Syringe Access, Safer Injection Facilities and
Prescription Heroin Programs.

Drug War Policies in U.S., Russia, and China Cause Millions of Needless
Infections – globally, 10 out of 16 million people who inject drugs have
Hepatitis C.

Thursday, 30 May 2013, (Geneva, Switzerland)–A hepatitis C epidemic
fuelled by the “war on drugs” is sweeping amongst injecting drug users
globally, says a new landmark report released today by the Global
Commission on Drug Policy. Of the 16 million people who inject drugs around
the world, an estimated 10 million are living with hepatitis C. The report,
entitled The Negative Impact of the War on Drugs on Public Health: The
Hidden Hepatitis C Epidemic, condemns the drug war as a failure and
recommends immediate, major reforms of the global drug prohibition regime
to halt the spread of hepatitis C infection and other drug war harms.

The launch of the report happens in advance of next week´s 23rd
International Harm Reduction Conference, taking place in Vilnius,
Lithuania. Nearby Eastern Europe end Central Asia are home to the fastest
growing hepatitis C and HIV epidemics and are largely being driven by
injecting drug use. The evidence-based document addresses how the global
war on drugs is fuelling the hepatitis C pandemic among people who use
drugs. Throughout the world, research has consistently shown that
repressive drug law enforcement practices force drug users away from public
health services and into hidden environments where hepatitis C and HIV risk
become markedly elevated. Mass incarceration of nonviolent drug users also
plays a major role in spreading the pandemic.

“Hepatitis C has to be one of the most grossly miscalculated diseases by
governments on the planet,” said Commissioner Michel Kazatchkine, who is
also the UN Secretary General´s Special Envoy on HIV/AIDS in Eastern Europe
and Central Asia. “It is a disgrace that barely a handful of countries can
actually show significant declines in new infections of hepatitis C among
people who inject drugs”

The hepatitis C virus is highly infectious and easily transmitted through
blood-to-blood contact. It therefore disproportionately impacts upon people
who inject drugs, and is more than three times more prevalent than HIV
among this population. In some of the countries with the harshest drug
policies, over 90% of people who inject drugs are living with hepatitis C,
with highest numbers reported in China (1.6 million people), the Russian
Federation (1.3 million people) and the USA (1.5 million people).

Globally, most HIV-infected people who inject drugs are also living with a
hepatitis C infection. The hepatitis C virus causes debilitating and fatal
disease in around a quarter of those who are chronically infected, and is
an increasing cause of premature death among people who inject drugs. Harm
reduction services – such as the provision of sterile needles and syringes
and opioid substitution therapy – can effectively prevent hepatitis C
transmission among people who inject drugs, provided they are accessible
and delivered early and at the required scale. The report launched today
further describes the remarkable failure of drug law enforcement policies
in reducing the global illicit drug market, noting that the worldwide
supply of illicit opiates, such as heroin, has increased by more than 380%
in recent decades. Moreover, the drug war contributes to the growth of
organized crime, violence and to the wide-scale incarceration of nonviolent
drug users.

The report also depicts how a country like Lithuania (with 2,8% of the
general population and 80% per cent of the drug injection population
infected) despite positive progress in terms of the Government´s free
provision of hepatitis C treatment, is in fact only reaching 5% of those in
need. In Ukraine, where 260,000 people who use drugs are infected with HCV,
a National Hepatitis Program has recently been approved for the first time
following intense advocacy efforts by civil society groups. Crucially, the
price for treatments has been more than halved during negotiations with
pharmaceutical companies.

“The war on drugs is a war on common sense”, said Commissioner Ruth
Dreifuss, who is also the former President of Switzerland. “Repressive drug
policies are ineffective, violate basic human rights, generate violence and
expose individuals and communities to unnecessary risks. The Hepatitis C
epidemic, totally preventable and curable, is yet another proof that the
drug policy status quo has failed us all miserably.”

This is the third report published by the Global Commission, the most
distinguished group of high-level leaders to ever call for drug policy
reform, including alternatives to incarceration, greater emphasis on public
health approaches to drug use, decriminalization and experiments in legal
regulation of drugs.

Released in June 2011, its first report, War on Drugs, generated
unprecedented media coverage and catalyzed international debate about the
urgent need for a paradigm shift on the global drug prohibition regime. The
second report, The War on Drugs and HIV/AIDS, was published in June 2012 in
advance of the International AIDS Conference in Washington D.C. and was
successful on exposing the links between the HIV pandemic and the
criminalization of drug use.

DOWNLOAD THE FULL REPORT AND WATCH VIDEOS WITH STATEMENTS FROM THE
COMMISSIONERS: www.globalcommissionondrugs/hepatitis

RECOMMENDATIONS FROM REPORT
The Negative Impact of the War on Drugs on Public Health: The Hidden
Hepatitis C Epidemic

1. Governments should publicly acknowledge the importance of the hepatitis
C epidemic and its significant human, economic and social costs,
particularly among people who use drugs.

2. Governments must acknowledge that drug policy approaches dominated by
strict law enforcement practices perpetuate the spread of hepatitis C (as
well as HIV and other health harms). They do this by exacerbating the
social marginalisation faced by people who use drugs, and by undermining
their access to essential harm reduction and treatment services.

3. Governments should therefore reform existing drug policies – ending the
criminalisation and mass incarceration of people who use drugs, and the
forced treatment of drug dependence.

4. Governments must immediately redirect resources away from the ‘war on
drugs’ and into public health approaches that maximise hepatitis C
prevention and care, developed with the involvement of, the most affected
communities.

5. Drug policy effectiveness should be measured by indicators that have
real meaning for affected communities, such as reduced rates of HIV and
hepatitis transmission and mortality, increased service coverage and
access, reduced drug market violence, reduced human rights violations, and
reduced incarceration.

6. Governments must remove any legal or de facto restrictions on the
provision of sterile injection equipment and other harm reduction services,
as well as opioid substitution therapy, in line with World Health
Organisation guidance. It is critical that these services are delivered at
the scale required to impact upon hepatitis C transmission – both in the
community but also in prisons and other closed settings.

7. Governments should ensure that people who use drugs are not excluded
from treatment programmes, by establishing national hepatitis C strategies
and action plans with the input of civil society, affected communities, and
actors from across the HIV, public health, social policy, drug control and
criminal justice sectors.

8. Governments must improve the quality and availability of data on
hepatitis C, strengthening surveillance systems and better evaluating
prevention and control programmes. This will, in turn, help to raise
political and public awareness of the epidemic.

9. Governments should enhance their efforts to reduce the costs of new and
existing hepatitis C medicines – including through negotiations with
pharmaceutical companies to ensure greater treatment access for all those
in need. Governments, international bodies and civil society organisations
should seek to replicate the successful reduction in HIV treatment costs
around the world, including the use of patent law flexibilities to make
them more accessible.

10. The Global Commission calls upon the United Nations to demonstrate the
necessary leadership and commitment to promote better national responses
and achieve the reforms listed above.

11. Act urgently: The ‘war on drugs’ has failed, and significant public
health harms can be averted if action is taken now.

EXECUTIVE SUMMARY
Hepatitis C is a highly prevalent chronic viral infection, which poses
major public health, economic and social crises, particularly in low and
middle- income countries. The global hepatitis C epidemic has been
described by the World Health Organization as a ‘viral time bomb’, yet
continues to receive little attention. Access to preventative services is
far too low, while diagnosis and treatment are prohibitively expensive and
remain inaccessible for most people in need.

Public awareness and political will with regard to hepatitis C are also too
low, and national hepatitis surveillance is often non-existent.

The hepatitis C virus is highly infectious and is easily transmitted
through blood-to-blood contact. It therefore disproportionately impacts
upon people who inject drugs: of the 16 million people who inject drugs
around the world, an estimated 10 million are living with hepatitis C. In
some of the countries with the harshest drug policies, the majority of
people who inject drugs are living with hepatitis C – more than 90 percent
in places such as Thailand and parts of the Russian Federation. The
hepatitis C virus causes debilitating and fatal disease in around a quarter
of those who are chronically infected, and is an increasing cause of
premature death among people who inject drugs.

Globally, most HIV-infected people who inject drugs are also living with a
hepatitis C infection. Harm reduction services – such as the provision of
sterile needles and syringes and opioid substitution therapy – can
effectively prevent hepatitis C transmission among people who inject drugs,
provided they are accessible and delivered at the required scale. Instead
of investing in effective prevention and treatment programmes to achieve
the required coverage, governments continue to waste billions of dollars
each year on arresting and punishing drug users – a gross misallocation of
limited resources that could be more efficiently used for public health and
preventive approaches. At the same time, repressive drug policies have
fuelled the stigmatisation, discrimination and mass incarceration of people
who use drugs. As a result, there are very few countries that have reported
significant declines in new infections of hepatitis C among this
population. This failure of governments to prevent and control hepatitis
disease has great significance for future costs to health and welfare
budgets in many countries.

In 2012 the Global Commission on Drug Policy released a report that
outlined how the ‘war on drugs’ is driving the HIV epidemic among people
who use drugs. The present report focuses on hepatitis C as it represents
another massive and deadly epidemic for this population. The report
provides a brief overview of the hepatitis C virus, before exploring how
the ‘war on drugs’ and repressive drug policies are failing to drive
transmission down.

The silence about the harms of repressive drug policies has been broken –
they are ineffective, violate basic human rights, generate violence, and
expose individuals and communities to unnecessary risks. Hepatitis C is one
of these harms – yet it is both preventable and curable when public health
is the focus of the drug response. Now is the time to reform.

THE GLOBAL COMMISSION ON DRUG POLICY
The purpose of the Global Commission on Drug Policy is to promote an
informed, science-based global discussion about humane and effective ways
to reduce the harm caused by drugs to people and societies.

GOALS
* Review the basic assumptions, effectiveness and consequences of the “war
on drugs” approach
* Evaluate the risks and benefits of different national responses to the
drug problem
* Develop actionable, evidence-based recommendations for constructive legal
and policy reform in order to safeguard people’s health and citizen
security.

MEMBERS OF THE GLOBAL COMMISSION ON DRUG POLICY
* Kofi Annan, Former Secretary General of the United Nations, Ghana
* Louise Arbour, Former UN High Commissioner for Human Rights, president of
the International Crisis Group, Canada
* Pavel Bém, Former Mayor of Prague, member of the Parliament, Czech
Republic
* Richard Branson, Entrepreneur, advocate for social causes, founder of the
Virgin Group, cofounder of The Elders, United Kingdom
* Fernando Henrique Cardoso, Former President of Brazil (chair)
* Maria Cattaui, Former Secretary-General of the International Chamber of
Commerce, Switzerland
* Ruth Dreifuss, Former President of Switzerland and Minister of Home
Affairs
* Carlos Fuentes, Writer and public intellectual, Mexico – in memoriam
* César Gaviria, Former President of Colômbia
* Asma Jahangir, Human rights activist, former UN Special Rapporteur on
Arbitrary, Extrajudicial and Summary Executions, Pakistan
* Michel Kazatchkine, UN Secretary General Special Envoy on HIV/AIDS in
Eastern Europe and Central Asia, Professor of medicine, France
* Aleksander Kwasniewski, Former President of Poland
* Ricardo Lagos, Former president of Chile
* George Papandreou, Former Prime Minister of Greece
* Jorge Sampaio, Former President of Portugal
* George Shultz, Former Secretary of State, United States (honorary chair)
* Javier Solana, Former European Union High Representative for the Common
Foreign and Security Policy, Spain
* Thorvald Stoltenberg, Former Minister of Foreign Affairs and UN High
Commissioner for Refugees, Norway
* Mario Vargas Llosa, Writer and public intellectual, Peru
* Paul Volcker, Former Chairman of the US Federal Reserve and of the
Economic Recovery Board, US
* John Whitehead, Banker and civil servant, chair of the World Trade Center
Memorial, United States
* Ernesto Zedillo, Former President of Mexico
__________________________________________________________________
________________________________*_________________________________

2. Global drug policy fuels hepatitis C epidemic, report warn
__________________________________________________________________
Global drug policy fuels hepatitis C epidemic, report warns
Fiona Clark, The Lancet, (01.06.13)

The latest report by the Global Commission on Drug Policy says that the war
on drugs has caused a largely hidden hepatitis C epidemic in people who
inject drugs. Fiona Clark reports.
www.globalcommissionondrugs.org/hepatitis/

Hepatitis C hasn’t been at the top of the health agenda for a while,
eclipsed by HIV/AIDS and tuberculosis as more pressing threats to global
health, but the Global Commission for Drug Policy is set to change that.

It claims the war on drugs has failed and is fuelling a hepatitis C
epidemic among people who use intravenous drugs. “Hepatitis C has to be one
of the most grossly miscalculated diseases by governments on the planet”,
says Commissioner Michel Kazatchkine, who is also the UN Secretary
General’s Special Envoy on HIV/AIDS in Eastern Europe and Central Asia.

He says “barely a handful” of countries have shown substantial declines in
new infection rates among people who inject drugs, and lays the blame
directly on so-called zero tolerance laws that see drugs users who do no
harm to others incarcerated in prisons where infection risks are high.

The Commission’s new report-The Negative Impact of the War on Drugs on
Public Health: The Hidden Hepatitis C Epidemic-released this week calls for
personal drug use to be decriminalised to stop the spread of the disease,
which kills one in four of those infected.

That’s “a considerable number” of preventable deaths, says Kazatchkine. WHO
says 150 million people have the hepatitis C virus (HCV). The Commission,
which includes the former General Secretary of the UN, Kofi Annan, and the
former Human Rights Commissioner, Louise Arbour, says 10 million people of
the 16 million who inject drugs have hepatitis C.

The report, released ahead of the Harm Reduction International Conference
2013 in Lithuania (June 9-12), states the countries with the worst HCV
infection rates are those with the strictest drug policies. Kazatchkine
estimates that there are 1·6 million infected drug users in China, 1·7
million in Russia, and 1·5 million in the USA.

This is the third time the Commission has called for decriminalisation of
drug use, but is anyone listening? Elena Vovc, WHO’s Russia coordinator for
HIV, STDs and Viral Hepatitis Programmes says she doubts Russia will enact
such a change soon. “If we’re very positive, in 5 years maybe”, she says.

In the USA, Chris Beyrer, director of Johns Hopkins Center for Public
Health and Human Rights, MA, says he’s seeing some positive signs for
change in the USA-the home of zero tolerance-and abroad. First, Colorado’s
vote for the decriminalisation of marijuana use shows that the public
“wants to stop putting teenagers in jail for possession”, he says. Then
Latin and South America want an end to the drug cartel violence engulfing
the region. And third, Portugal, which decriminalised personal drug use
over a decade ago, is showing some evidence of reductions in HCV infection
rates and overall drug use. “It hasn’t been the social disaster people
thought it might be”, says Beyrer.

But for many countries decriminalisation is a long way off as they’re still
grappling with the concept of harm minimisation. “Harm reduction with its
package of measures for an effective complex approach is not fully accepted
in eastern Europe”, says Vovc. “Some countries have accepted it, some have
partially accepted it, and some are still trying to understand its
benefits.”

Russia, however, “doesn’t have national harm reduction programme and it’s
not convinced about syringe and needle exchanges despite evidence of its
effectiveness worldwide. China, on the other hand, has opted for a
methadone programme, but needle exchange is not officially sanctioned.
Russia has opted for neither”, she says.

Kazatchkine goes further: “I see very little if no progress in Asia where
they want a drug-free world by 2015, and parts of Eastern Europe where over
60% of people who inject drugs have HCV. There is no debate open and no
willingness to open the debate.”

But he adds that it is cost effective to adopt harm prevention and
decriminalise personal drug use as treating the virus costs less (US$16
000-31 700) than treating one of its possible outcomes: liver cancer ($44
200). Then, says Beyrer, there’s the cost of incarceration which is putting
a strain on state budgets and leading people to rethink the sentencing
system. “Many US states, including California, have been doing early
release programmes for non-violent drug offences since it is so costly to
incarcerate people.”

Kazatchkine says it’s time countries that can’t afford broad access to
treatment tackled the problem by invoking public health emergency measures
to break patent agreements and make or import generic versions of effective
drugs against hepatitis C. “I see no evidence that it’s not a public health
emergency”, he says. “So the report should be taken as a wake-up call, not
just on decriminalisation, but also on the awareness of hepatitis C and its
treatment.”
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Iatrogenic Blood-borne Viral Infections in Refugee Children
from War and Transition Zones
__________________________________________________________________

Emerg Infect Dis. 2013 Jun;19(6).

Iatrogenic Blood-borne Viral Infections in Refugee Children from War and
Transition Zones.

Goldwater PN.

Pediatric infectious disease clinicians in industrialized countries may
encounter iatrogenically transmitted HIV, hepatitis B virus, and hepatitis
C virus infections in refugee children from Central Asia, Southeast Asia,
and sub-Saharan Africa.

The consequences of political collapse and/or civil war-work migration,
prostitution, intravenous drug use, defective public health resources, and
poor access to good medical care-all contribute to the spread of blood-
borne viruses.

Inadequate infection control practices by medical establishments can lead
to iatrogenic infection of children.

Summaries of 4 cases in refugee children in Australia are a salient
reminder of this problem.

KEYWORDS:
HIV, children, hepatitis B virus, hepatitis C virus, iatrogenic,
infections, pathogenesis, transfusions, viruses, war

Free full text http://wwwnc.cdc.gov/eid/article/19/6/12-0806_intro.htm
or at http://www.medscape.org/viewarticle/804373_6

The complete journal vol19no6 PDF is free at
http://wwwnc.cdc.gov/eid/pdfs/vol19no6_pdf-version.pdf
__________________________________________________________________
________________________________*_________________________________

4. Excerpt: WHO Best Practices for Injections and Related Procedures
Toolkit
__________________________________________________________________
WHO Best Practices for Injections and Related Procedures Toolkit.
Geneva: World Health Organization; 2010 Mar.
Available from: http://www.ncbi.nlm.nih.gov/books/NBK138491/

WHO Best Practices for Injections and Related Procedures Toolkit.

WHO Guidelines Approved by the Guidelines Review Committee.

Excerpt

The new WHO guidelines provide recommended steps for safe phlebotomy and
reiterate accepted principles for drawing, collecting blood and
transporting blood to laboratories/blood banks.

The main areas covered by the toolkit are: bloodborne pathogens transmitted
through unsafe injection practices; relevant elements of standard
precautions and associated barrier protection; best injection and related
infection prevention and control practices; occupational risk factors and
their management.

Copyright © 2010, World Health Organization.

Sections
Preface
Acknowledgements
Acronyms
1. Background
2. Best practices for injection
3. Best practice in phlebotomy and blood collection
4. Occupational risks and management of bloodborne pathogens
References
Annex A Indications for glove use in health care
Annex B Disassembly of needle from syringe or other devices
Glossary

Free full text http://www.ncbi.nlm.nih.gov/books/NBK138491/
__________________________________________________________________
________________________________*_________________________________

5. Excerpt: WHO Guidelines on Drawing Blood: Best Practices in Phlebotomy
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23741774

WHO Guidelines on Drawing Blood: Best Practices in Phlebotomy.

Geneva: World Health Organization; 2010.
WHO Guidelines Approved by the Guidelines Review Committee.

Excerpt

Phlebotomy uses large, hollow needles to remove blood specimens for lab
testing or blood donation. Each step in the process carries risks – both
for patients and health workers. Patients may be bruised. Health workers
may receive needle-stick injuries. Both can become infected with bloodborne
organisms such as hepatitis B, HIV, syphilis or malaria. Moreover, each
step affects the quality of the specimen and the diagnosis. A contaminated
specimen will produce a misdiagnosis. Clerical errors can prove fatal. The
new WHO guidelines provide recommended steps for safe phlebotomy and
reiterate accepted principles for drawing, collecting blood and
transporting blood to laboratories/blood banks.
Copyright © 2010, World Health Organization.

Sections
Acknowledgements
Acronyms
Executive summary

PART I. BACKGROUND
1. Introduction

PART II. ASPECTS OF PHLEBOTOMY
2. Best practices in phlebotomy
3. Blood-sampling systems
4. Venepuncture for blood donaton
5. Arterial blood sampling
6. Paediatric and neonatal blood sampling
7. Capillary sampling

PART III. IMPLEMENTATION, EVALUATION AND MONITORING
8. Implementing best phlebotomy practices
9. Monitoring and evaluation

PART IV. REFERENCES

PART V. ANNEXES
Glossary
Chinese
French
Portuguese

Free full text http://www.ncbi.nlm.nih.gov/books/NBK138650/
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Thermostability of seven hepatitis C virus genotypes in vitro
and in vivo
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23730841

J Viral Hepat. 2013 Jul;20(7):478-85.

Thermostability of seven hepatitis C virus genotypes in vitro and in vivo.

Doerrbecker J, Meuleman P, Kang J, Riebesehl N, Wilhelm C, Friesland M,
Pfaender S, Steinmann J, Pietschmann T, Steinmann E.

Institute of Experimental Virology, Twincore, Centre for Experimental and
Clinical Infection Research; a joint venture between the Medical School
Hannover (MHH) and the Helmholtz Centre for Infection Research (HZI),
Hannover, Germany.

Hepatitis C virus (HCV) is transmitted primarily through percutaneous
exposure to contaminated blood especially in healthcare settings and among
people who inject drugs. The environmental stability of HCV has been
extrapolated from studies with the bovine viral diarrhoea virus or was so
far only addressed with HCV genotype 2a viruses. The aim of this study was
to compare the environmental and thermostability of all so far known seven
HCV genotypes in vitro and in vivo.

Incubation experiments at room temperature revealed that all HCV genotypes
showed similar environmental stabilities in suspension with viral
infectivity detectable for up to 28 days.

The risk of HCV infection may not accurately be reflected by determination
of HCV RNA levels. However, viral stability and transmission risks assessed
from in vitro experiments correlated with viral infectivity in transgenic
mice containing human liver xenografts.

A reduced viral stability for up to 2 days was observed at 37 °C with
comparable decays for all HCV genotypes confirmed by thermodynamic
analysis. These results demonstrate that different HCV genotypes possess
comparable stability in the environment and that noninfectious particles
after incubation in vitro do not cause infection in an HCV in vivo model.

These findings are important for estimation of HCV cross-transmission in
the environment and indicate that different HCV genotypes do not display an
altered stability or resistance at certain temperatures.

© 2013 John Wiley & Sons Ltd.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: The changing epidemiology of HIV in 2013
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23743721

Curr Opin HIV AIDS. 2013 Jul;8(4):306-10.

The changing epidemiology of HIV in 2013.

Beyrer C, Abdool Karim Q.

aCenter for Public Health and Human Rights and Center for AIDS Research,
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA bCenter
for the AIDS Programme of Research in South Africa, University of KwaZulu-
Natal, Durban, South Africa cDepartment of Epidemiology, Mailman School of
Public Health, Columbia University, New York, NY, USA.

PURPOSE OF REVIEW: We sought to review the recent epidemiology of HIV-1 and
to identify emerging challenges in HIV surveillance and epidemic control.

RECENT FINDINGS: There is increasing evidence that HIV epidemics are in
decline among general populations worldwide. Critical exceptions to these
trends are HIV epidemics among key populations globally; the HIV epidemics
in Eastern Europe and Central Asia in injecting drug using populations; the
continued high burden epidemics of sexually transmitted HIV among young
women and girls in southern sub-Saharan Africa, and young men who have sex
in men (MSM) in the America, Asia, and Africa. In the new era of ART
access, prevalence measures over time are less reliable and new approaches
to the measurement of incident infection will be critical to assess trends.
The implementation of expanded options for HIV prevention, reducing
vertical transmission, and treatment as prevention, will shift focus from
individuals to population-level impact. Strong surveillance and information
systems will be necessary to meet these expanded surveillance needs.

SUMMARY: The epidemiology of HIV infection is changing, dynamic, complex,
and progress in epidemic control remains markedly uneven. Without
addressing the components of global HIV, in which disease rates continue to
expand, current efforts are unlikely to succeed.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Determinants of neonatal mortality in rural India, 2007-2008
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23734339

PeerJ. 2013 May 28;1:e75.

Determinants of neonatal mortality in rural India, 2007-2008.

Singh A, Kumar A, Kumar A.

Global Health and Social Care Unit, School of Health Sciences and Social
Work, University of Portsmouth , Portsmouth , United Kingdom.

Background. Despite the growing share of neonatal mortality in under-5
mortality in the recent decades in India, most studies have focused on
infant and child mortality putting neonatal mortality on the back seat. The
development of focused and evidence-based health interventions to reduce
neonatal mortality warrants an examination of factors affecting it.
Therefore, this study attempt to examine individual, household, and
community level factors affecting neonatal mortality in rural India.

Data and methods. We analysed information on 171,529 singleton live births
using the data from the most recent round of the District Level Household
Survey conducted in 2007-08. Principal component analysis was used to
create an asset index. Two-level logistic regression was performed to
analyse the factors associated with neonatal deaths in rural India.

Results. The odds of neonatal death were lower for neonates born to mothers
with secondary level education (O R = 0.60, p = 0.01) compared to those
born to illiterate mothers. A progressive reduction in the odds occurred as
the level of fathers’ education increased. The odds of neonatal death were
lower for infants born to unemployed mothers (O R = 0.89, p = 0.00)
compared to those who worked as agricultural worker/farmer/laborer. The
odds decreased if neonates belonged to Scheduled Tribes (O R = 0.72, p =
0.00) or ‘Others’ caste group (O R = 0.87, p = 0.04) and to the households
with access to improved sanitation (O R = 0.87, p = 0.02), pucca house (O R
= 0.87, p = 0.03) and electricity (O R = 0.84, p = 0.00). The odds were
higher for male infants (O R = 1.21, p = 0.00) and whose mother experienced
delivery complications (O R = 1.20, p = 0.00).

Infants whose mothers received two tetanus toxoid injections (O R = 0.65, p
= 0.00) were less likely to die in the neonatal period. Children of higher
birth order were less likely to die compared to first birth order.

Conclusion. Ensuring the consumption of an adequate quantity of Tetanus
Toxoid (TT) injections by pregnant mothers, targeting vulnerable groups
like young, first time and Scheduled Caste mothers, and improving overall
household environment by increasing access to improved toilets,
electricity, and pucca houses could also contribute to further reductions
in neonatal mortality in rural India. Any public health interventions aimed
at reducing neonatal death in rural India should consider these factors.

KEYWORDS: District Level Household Survey-3, Neonatal mortality, Rural
India, Social determinants of health

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3669267/
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Acute hepatitis B outbreaks in 2 skilled nursing facilities
and possible sources of transmission: north Carolina, 2009-2010
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23739075

Infect Control Hosp Epidemiol. 2013 Jul;34(7):709-16.

Acute hepatitis B outbreaks in 2 skilled nursing facilities and possible
sources of transmission: north Carolina, 2009-2010.

Seña AC, Moorman A, Njord L, Williams RE, Colborn J, Khudyakov Y, Drobenuic
J, Xia GL, Wood H, Moore Z.

Durham County Department of Public Health, Durham, North Carolina.

Objective. Acute hepatitis B virus (HBV) infections have been reported in
long-term care facilities (LTCFs), primarily associated with infection
control breaks during assisted blood glucose monitoring. We investigated
HBV outbreaks that occurred in separate skilled nursing facilities (SNFs)
to determine factors associated with transmission.

Design. Outbreak investigation with case-control studies.

Setting. Two SNFs (facilities A and B) in Durham, North Carolina, during
2009-2010.

Patients. Residents with acute HBV infection and controls randomly selected
from HBV- susceptible residents during the outbreak period.

Methods. After initial cases were identified, screening was offered to all
residents, with repeat testing 3 months later for HBV-susceptible
residents. Molecular testing was performed to assess viral relatedness.
Infection control practices were observed. Case-control studies were
conducted to evaluate associations between exposures and acute HBV
infection in each facility.

Results. Six acute HBV cases were identified in each SNF. Viral
phylogenetic analysis revealed a high degree of HBV relatedness within, but
not between, facilities. No evaluated exposures were significantly
associated with acute HBV infection in facility A; those associated with
infection in facility B (all odds ratios >20) included injections, hospital
or emergency room visits, and daily blood glucose monitoring.

Observations revealed absence of trained infection control staff at
facility A and suboptimal hand hygiene practices during blood glucose
monitoring and insulin injections at facility B.

Conclusions. These outbreaks underscore the vulnerability of LTCF residents
to acute HBV infection, the importance of surveillance and prompt
investigation of incident cases, and the need for improved infection
control education to prevent transmission.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Breaking worse: The emergence of krokodil and excessive
injuries among people who inject drugs in Eurasia
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23726898

Int J Drug Policy. 2013 May 30. pii: S0955-3959(13)00051-0.

Breaking worse: The emergence of krokodil and excessive injuries among
people who inject drugs in Eurasia.

Grund JP, Latypov A, Harris M.

CVO – Addiction Research Centre, Utrecht, The Netherlands; Department of
Addictology, 1st Faculty of Medicine, Charles University in Prague and
General University Hospital in Prague, Czech Republic. Electronic address:
jpgrund@drugresearch.nl.

BACKGROUND: Krokodil, a homemade injectable opioid, gained its moniker from
the excessive harms associated with its use, such as ulcerations,
amputations and discolored scale-like skin. While a relatively new
phenomenon, krokodil use is prevalent in Russia and the Ukraine, with at
least 100,000 and around 20,000 people respectively estimated to have
injected the drug in 2011. In this paper we review the existing information
on the production and use of krokodil, within the context of the region’s
recent social history.

METHODS: We searched PubMed, Google Advanced Search, Google Scholar,
YouTube and the media search engine www.Mool.com for peer reviewed or media
reports, grey literature and video reports. Survey data from HIV prevention
and treatment NGOs was consulted, as well as regional experts and NGO
representatives.

FINDINGS: Krokodil production emerged in an atypical homemade drug
production and injecting risk environment that predates the fall of
communism. Made from codeine, the active ingredient is reportedly
desomorphine, but – given the rudimentary ‘laboratory’ conditions – the
solution injected may include various opioid alkaloids as well as high
concentrations of processing chemicals, responsible for the localized and
systemic injuries reported here. Links between health care and law
enforcement, stigma and maltreatment by medical providers are likely to
thwart users seeking timely medical help.

CONCLUSION: A comprehensive response to the emergence of krokodil and
associated harms should focus both on the substance itself and its
rudimentary production methods, as well as on its micro and macro risk
environments – that of the on-going syndemic of drug injecting, HIV, HCV,
TB and STIs in the region and the recent upheaval in local and
international heroin supply. The feasibility of harm reduction strategies
for people who inject krokodil may depend more on political will than on
the practical implementation of interventions. The legal status of opioid
substitution treatment in Russia is a point in case.

Copyright © 2013 Elsevier B.V. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Risk Prison and Hepatitis B Virus Infection among Inmates
with History of Drug Injection in Isfahan, Iran
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23737725

ScientificWorldJournal. 2013 Apr 22;2013:735761.

Risk Prison and Hepatitis B Virus Infection among Inmates with History of
Drug Injection in Isfahan, Iran.

Dana D, Zary N, Peyman A, Behrooz A.

Infectious Diseases and Tropical Medicine Research Center, Isfahan
University of Medical Sciences, Isfahan, Iran.

Objectives. Hepatitis B virus (HBV) is a health problem among injection
drug users (IDUs) in prison. The aim of this study is to evaluate the
association of factors of incarceration with HBV infection in prisoners
with history of drug injection in Isfahan, Iran.

Methods. In a cross-sectional study, all IDUs inmates were enrolled.
Sociodemographic characteristics and associated risk factors were obtained.
Blood samples were collected and serological markers for HBV were analyzed.
For data analysis, odds ratio and logistic regression were used.

Results. Of the IDUs inmates, 970 subjects participated in the study.
History of imprisonment (OR: 1.82, 95% CI: 1.28-2.57), multiple
incarceration (OR: 1.43, 95% CI: 1.01-2.02), and total duration of
imprisonment (OR: 2.70, 95% CI: 1.94-3.74) were significantly associated
with prevalence of HBV among IDUs inmates. Multivariate analysis of
associated factors showed that only total duration of incarceration is
significantly associated with HBV infection.

Conclusion. In conclusion, according to our results, multiple and duration
of incarcerations will be considered as important risk factors of HBV
infection in IDUs inmates. This fact makes it important to set some
screening and prevention programs in prisons to decrease the risk of being
infected and prevent the transmission of these diseases.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655682/
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Changing patterns of first injection across key periods of
the French Harm Reduction Policy: PrimInject, a cross sectional
analysis
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23726980

Drug Alcohol Depend. 2013 May 30. pii: S0376-8716(13)00155-5.

Changing patterns of first injection across key periods of the French Harm
Reduction Policy: PrimInject, a cross sectional analysis.

Guichard A, Guignard R, Michels D, Beck F, Arwidson P, Lert F, Roy E.

French National Institute of Prevention and Health Education, Scientific
Affairs Department, 42 boulevard de la Libération, 93203 Saint-Denis cedex,
France. Electronic address: anne.guichard@inpes.sante.fr.

BACKGROUND: Monitoring of emerging modes of drug consumption in France has
identified new patterns of injection among youths with diverse social
backgrounds, which may explain the persistence of high rates of hepatitis C
virus infection. The circumstances surrounding the first injection have
been poorly documented in the group of heavy drug users and in the context
of the French opioid substitution treatment (OST) policy that provides
expanded access to high-dosage buprenorphine (BHD) METHODS: An Internet
survey (Priminject) was conducted from October 2010 to March 2011 with
French drug users. Four time periods were compared based on critical dates
throughout the implementation of the Harm Reduction Policy in France.

RESULTS: Compared with drug users who injected for the first time prior to
1995, the aspects of drug use for users who recently injected for the first
time were as follows: (1) experimentation with miscellaneous drugs before
the first injection; (2) an older age at the time of first injection; (3)
heroin as the drug of choice for an individual’s first injection,
notwithstanding the increased usage of stimulant drugs; (4) BHD did not
appear to be a pathway to injection; and (5) an increased number of users
who injected their first time alone, without the help or presence of
another individual.

CONCLUSION: The PrimInject study showed that there is a group of injection
drug users that is larger than the group of injection drug users observed
in previous studies; therefore, it is necessary to diversify programs to
reach the entire spectrum of high-risk users.

Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: A Response to the Opioid Overdose Epidemic: Naloxone Nasal
Spray
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23734342

Drug Deliv Transl Res. 2013 Feb 1;3(1):63-74.

A Response to the Opioid Overdose Epidemic: Naloxone Nasal Spray.

Wermeling DP.

Professor, University of Kentucky College of Pharmacy, 789 South Limestone
Street, Lexington, KY USA, 40536-0596.

Opioid overdose morbidity and mortality is recognized to have epidemic
proportions. Medical and public health agencies are adopting opioid harm
reduction strategies to reduce the morbidity and mortality associated with
overdose.

One strategy developed by emergency medical services and public health
agencies is to deliver the opioid antidote naloxone injection intranasally
to reverse the effects of opioids. Paramedics have used this route to
quickly administer naloxone in a needle-free system and avoiding needle-
stick injuries and contracting a blood-born pathogen disease such as
hepatitis or human immunodeficiency virus.

Public health officials advocate broader lay person access since civilians
are likely witnesses or first responders to an opioid overdose in a time-
acute setting. The barrier to greater use of naloxone is that a suitable
and optimized needlefree drug delivery system is unavailable.

The scientific basis for design and study of an intranasal naloxone product
is described. Lessons from nasal delivery of opioid analgesics are applied
to the consideration of naloxone nasal spray.

KEYWORDS: Antidote, Intranasal, Naloxone, Opioid, Overdose
__________________________________________________________________
________________________________*_________________________________

14. Abstract: The prevalence of hepatitis C virus in mashhad, iran: a
population-based study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23745128

Hepat Mon. 2013 Mar 12;13(3):e7723.

The prevalence of hepatitis C virus in mashhad, iran: a population-based
study.

Shakeri MT, Nomani H, Ghayour Mobarhan M, Sima HR, Gerayli S, Shahbazi S,
Rostami S, Meshkat Z.

Department of Biostatistics, Public Health School, Mashhad University of
Medical Sciences, Mashhad, IR Iran.

BACKGROUND: Hepatitis C virus (HCV) infection is a significant health
problem throughout the world. Chronic form of the disease is found in about
75% to 85% of the newly infected individuals. The chronic infection may
lead to severe forms including chronic liver disease, cirrhosis and with a
higher mortality rate, hepatocellular carcinoma. Since no vaccine has yet
been developed against HCV, there is an increasing need to take measures to
control the spread of the infection. Therefore, epidemiologic study of the
virus is important to manage and monitor the spread of the virus in the
community.

OBJECTIVES: The aim of this study was to determine the prevalence of
hepatitis C seropositivity in the general population of Mashhad, northeast
of Iran.

PATIENTS AND METHODS: Three thousand, eight hundred and seventy (3870)
individuals living in the city of Mashhad were recruited using cluster
sampling method. HCV seropositivity was determined with HCV antibody
detection ELISA kit and was confirmed by reverse transcriptase polymerase
chain reaction (RT-PCR) method.

RESULTS: In this study the overall seroprevalence of hepatitis C was
founded to be 0.2% by using ELISA method. However, the overall Hepatitis C
virus infection prevalence was found to be 0.13% with RT-PCR method.

CONCLUSIONS: Our study suggested that the prevalence rate of Hepatitis C
virus is below 1% in the general population of Mashhad.

KEYWORDS: Hepatitis C, Iran, Population Groups, Prevalence
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Feasibility and acceptability of gentamicin in the Uniject
prefilled injection system for community-based treatment of possible
neonatal sepsis: the experience of female community health volunteers
in Nepal
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22422117

J Perinatol. 2012 Dec;32(12):959-65.

Feasibility and acceptability of gentamicin in the Uniject prefilled
injection system for community-based treatment of possible neonatal sepsis:
the experience of female community health volunteers in Nepal.

Coffey PS, Sharma J, Gargi KC, Neupane D, Dawson P, Pradhan YV.

PATH, Seattle, WA 98109, USA. pcoffey@path.org

OBJECTIVE: Explore feasibility and acceptability of gentamicin in the
Uniject prefilled injection system, in combination with oral cotrimoxazole-
p and an appropriate newborn weighing scale, for treatment of possible
neonatal sepsis when administered in the community by female community
health volunteers.

STUDY DESIGN: In a community-based program in Nepal, 45 volunteers recorded
422 live births. Among these, 82 infants were identified as having possible
severe bacterial infection. In all, 67 of these infants were treated with
gentamicin in Uniject and 15 were referred to the health facility. Mixed
methods were used to collect data about Uniject performance, acceptability
and safety.

RESULT: Volunteers successfully treated 67 infants with gentamicin in
Uniject. Gentamicin in Uniject performed well and was acceptable.

CONCLUSION: Gentamicin in Uniject, in combination with cotrimoxazole-p and
an appropriate newborn weighing scale, is a feasible and acceptable option
for treatment of possible neonatal sepsis in the community by female
community health volunteers.
__________________________________________________________________
________________________________*_________________________________

16. Abstract: A Discrete Choice Experiment to Determine Patient Preferences
for Injection Devices in Multiple Sclerosis
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23730944

J Med Econ. 2013 Jun 4.

A Discrete Choice Experiment to Determine Patient Preferences for Injection
Devices in Multiple Sclerosis.

Shingler S, Swinburn P, Ali S, Perard R, Lloyd A.

Oxford Outcomes, An ICON plc Company, Oxford, UK.

Objective Relapsing-remitting multiple sclerosis (MS) is usually managed
with disease modifying drugs (DMDs), most commonly administered via self-
injection.

The aim of this study was to estimate the influence that different
treatment related attributes have for MS patients on their choice of MS DMD
device. By establishing the relative importance of these characteristics
for patients it should be possible to better understand the acceptability
of a given device and to optimise the development of future devices.

Methods A discrete choice experiment (DCE) survey was developed on the
basis of a review of published literature. Attributes identified for
inclusion in the survey were: ease of use; comfort of use; presence of
additional functions, needle visibility; practicality and efficacy. Choice
sets were presented as pairs of hypothetical treatments based upon a
fractional factorial design. One-hundred device-using MS patients completed
the survey online. Analysis was conducted using a mixed-logit approach.

Results Analysis of the DCE data revealed that all attributes significantly
predicted treatment choice. Efficacy exhibited the largest effect on
treatment selection and this provided context for understanding the
magnitude of impact for the other attributes. Reducing the discomfort
associated with device use and eliminating the necessity for assembly or
drug reconstitution were highly valued. The addition of reminder and time-
stamping functions, improved needlestick injury prevention and reduction in
device size were secondary concerns but still deemed desirable.

Conclusion Efficacy is of primary importance to MS patients, but
characteristics of drug delivery devices can play an important role in
treatment decision-making. Not all device characteristics could be
included, and results are based upon 100 participants only.

Findings suggest there is significant potential value in developing self-
injection devices that are not only efficacious but also convenient and
comfortable to use. Reducing barriers to adherence could potentially
translate into improved treatment outcomes for patients with MS.
__________________________________________________________________
________________________________*_________________________________

17. Abstract: Expert Consensus Statement on achieving self-sufficiency in
safe blood and blood products, based on voluntary non-remunerated blood
donation (VNRBD)
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22690746

Vox Sang. 2012 Nov;103(4):337-42.

Expert Consensus Statement on achieving self-sufficiency in safe blood and
blood products, based on voluntary non-remunerated blood donation (VNRBD).

WHO Expert Group.

Collaborators (37)

All countries face challenges in making sufficient supplies of blood and
blood products available and sustainable, while also ensuring the quality
and safety of these products in the face of known and emerging threats to
public health. Since 1975, the World Health Assembly (WHA) has highlighted
the global need for blood safety and availability. WHA resolutions 63·12,
58·13 and 28·72,

The Melbourne Declaration on 100% Voluntary Non-Remunerated Donation of
Blood and Blood Components and WHO Global Blood Safety Network
recommendations have reaffirmed the achievement of ‘Self-sufficiency in
blood and blood products based on voluntary non-remunerated blood donation
(VNRBD)’ as the important national policy direction for ensuring a safe,
secure and sufficient supply of blood and blood products, including labile
blood components and plasma-derived medicinal products.

Despite some successes, self-sufficiency is not yet a reality in many
countries.

A consultation of experts, convened by the World Health Organization (WHO)
in September 2011 in Geneva, Switzerland, addressed the urgent need to
establish strategies and mechanisms for achieving self-sufficiency.
Information on the current situation, and country perspectives and
experiences were shared. Factors influencing the global implementation of
self-sufficiency, including safety, ethics, security and sustainability of
supply, trade and its potential impact on public health, availability and
access for patients, were analysed to define strategies and mechanisms and
provide practical guidance on achieving self-sufficiency.

Experts developed a consensus statement outlining the rationale and
definition of self-sufficiency in safe blood and blood products based on
VNRBD and made recommendations to national health authorities and WHO.

© 2012 World Health Organization. Vox Sanguinis © 2012 International
Society of Blood Transfusion.
__________________________________________________________________
________________________________*_________________________________

18. Abstract: Association of pertussis and measles infections and
immunizations with asthma and allergic sensitization in ISAAC Phase Two
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23005697

Pediatr Allergy Immunol. 2012 Dec;23(8):737-46.

Association of pertussis and measles infections and immunizations with
asthma and allergic sensitization in ISAAC Phase Two.

Nagel G, Weinmayr G, Flohr C, Kleiner A, Strachan DP; ISAAC Phase Two Study
Group. Collaborators (148)

Institute of Epidemiology and Medical Biometry, Ulm University, Ulm,
Germany. gabriele.nagel@uni-ulm.de

BACKGROUND: Pertussis and measles infection as well as vaccination have
been suspected as possible mediating factors of allergic disease in
childhood.

METHODS: Between 1995 and 2005 cross-sectional studies were performed in 29
centers in 21 countries. Parental questionnaires were used to collect
information on allergic diseases and exposures. We analyzed data from
54,943 randomly selected schoolchildren aged 8-12 yr. A subgroup of 31,759
children was also skin prick tested (SPT) to common environmental
allergens. Combined odds ratios were calculated by random effect models for
meta-analysis.

RESULTS: Pertussis and measles vaccination were not significantly
associated with any of the allergy outcomes or SPT positivity. However,
pertussis infection was associated with wheeze (OR(ad) 1.68; 95% CI
1.44-1.97) and rhinoconjunctivitis (OR(ad) 1.63; 95% 1.33-2.00). Pertussis
infection was also significantly associated with a higher prevalence of
reported eczema during the past year in non-affluent countries. Measles
infection was associated with a higher prevalence of wheeze (OR(ad) 1.26;
95% 1.10-1.43) and reported eczema (OR(ad) 1.22; 95% 1.08-1.39). No
association with SPT positivity was found, suggesting that these
associations are unlikely to be mediated by an allergic component.

CONCLUSIONS: Associations of pertussis and measles infection with symptoms
of asthma, rhinoconjunctivitis and eczema were found in both affluent and
non-affluent countries and are unlikely to be mediated by IgE.

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

19. Abstract: Concomitant administration of hepatitis A vaccine with
measles/mumps/rubella/varicella and pneumococcal vaccines in healthy 12
to 23 month-old children
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23744509

Hum Vaccin Immunother. 2013 Jun 6;9(8).

Concomitant administration of hepatitis A vaccine with
measles/mumps/rubella/varicella and pneumococcal vaccines in healthy 12 to
23 month-old children.

Yetman RJ, Shepard JS, Duke A, Stek JE, Petrecz M, Klopfer SO, Kuter BJ,
Schödel FP, Lee AW.

University of Texas, Houston; Houston, TX USA.

This open-label, multicenter, randomized, comparative study evaluated
immunogenicity, safety and tolerability of concomitant (Group 1; n = 330)
vs. non-concomitant (Group 2; n = 323) Vaqta™ (25U/0.5 mL) (hepatitis A
vaccine; HAV) with ProQuad™ (measles/mumps/rubella/varicella; MMRV) and
Prevnar™ (7-valent pneumococcal; PCV-7) in healthy, 12-23 mo old children.
Group 1 received HAV/MMRV/PCV-7 concomitantly on Day 1 and second doses of
HAV/MMRV at Week 24. Group 2 received MMRV/PCV-7 on Day 1, HAV at Weeks 6
and 30 and MMRV at Week 34. Hepatitis A seropositivity rate (SPR: =10
mIU/mL; 4 weeks postdose 2), varicella zoster-virus (VZV) SPR (=5 gpELISA
units/mL) and geometric mean titers (GMT) to S. pneumoniae were examined.

Injection-site and systemic adverse experiences (AEs) and daily
temperatures were collected. Hepatitis A SPR were 100% for Group 1 and
99.4% for Group 2 after two HAV doses; risk difference = 0.7 (95%CI:
-1.4,3.8, non-inferior) regardless of initial serostatus. VZV SPR was 93.3%
for Group 1 and 98.3% for Group 2; risk difference = -5.1 (95%CI: -9.3,
-1.4; non-inferior). S. pneumoniae GMT fold-difference (7 serotypes) ranged
from 0.9 to 1.1; non-inferior.

No statistically significant differences in the incidence of individual AEs
were seen when HAV was administered concomitantly vs. non-concomitantly.

Three (all Group 2 post-administration of MMRV/PCV-7) of 11 serious AEs
were considered possibly vaccine-related: dehydration and gastroenteritis
(same subject) on Day 52; febrile seizure on Day 9. No deaths were
reported.

Antibody responses to each vaccine given concomitantly were non-inferior to
HAV given non-concomitantly with MMRV and PCV-7.

Administration of HAV with PCV-7 and MMRV had an acceptable safety profile
in 12- to 23-mo-old children.

KEYWORDS: concomitant use, hepatitis A, immunogenicity, measles, mumps,
pneumococcal, rubella, safety, vaccine, varicella
__________________________________________________________________
________________________________*_________________________________

20. Abstract: Evaluating the risk of extraocular tumour spread following
intravitreal injection therapy for retinoblastoma: a systematic review
__________________________________________________________________
Br J Ophthalmol. 2013 Jun 5.

Evaluating the risk of extraocular tumour spread following intravitreal
injection therapy for retinoblastoma: a systematic review.

Smith SJ, Smith BD.

Department of Medicine, Transitional Year Internship, Bassett Medical
Center and Columbia University, Cooperstown, New York, USA.

BACKGROUND: Intravitreal injection therapy (IViT) for retinoblastoma has
shown promise in the treatment of vitreous seeds; however, the potential
for tumour dissemination following intravitreal penetration has limited its
use. This review evaluates the risk of extraocular tumour spread in
patients receiving therapeutic intravitreal injections for retinoblastoma.

METHODS: PUBMED (1946-present), SCOPUS (all years), Science Citation Index
(1900- present) and Conference Proceedings Citation Index-Science (1990-
present) electronic databases were searched to identify all published
reports of IViT for retinoblastoma in humans.

RESULTS: 14 studies with original IViT data were included in this review. A
total of 1304 intravitreal injections were given in 315 eyes of 304
patients, with one report of extraocular tumour spread and one patient in
whom intravitreal treatment could not be excluded as a contributor to
metastatic disease. The proportion of subjects with extraocular tumour
spread potentially due to IViT in these combined reports was 0.007 (95% CI
0.0008 to 0.0236), with a mean follow-up of 72.1 months. In a subset of 61
patients receiving IViT via safety enhancing injection techniques (347
injections, 19.6 months mean follow-up), there were no reports of tumour
spread.

CONCLUSIONS: Local and systemic tumour spread following IViT in cases of
retinoblastoma is rare, and this risk is potentially reduced by the use of
safety enhancing injection techniques. These results suggest that the risk
of tumour spread should not preclude IViT use for carefully selected
patients as part of multi-modal globe salvaging therapy.

KEYWORDS: Neoplasia, Retina, Vitreous
__________________________________________________________________
________________________________*_________________________________

21. Abstract: Nigerian Dental Therapy Students’ Knowledge, Attitude, and
Willingness to Care for Patients with HIV
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23740916

J Dent Educ. 2013 Jun;77(6):793-800.

Nigerian Dental Therapy Students’ Knowledge, Attitude, and Willingness to
Care for Patients with HIV.

Azodo CC, Ehizele AO, Umoh A, Okechukwu R.

Department of Periodontics, New Dental Complex, University of Benin
Teaching Hospital, P.M.B. 1111 Ugbowo, Benin City, Edo State, Nigeria
300001; clementazodo@yahoo.com.

The objective of this study was to assess Nigerian dental therapy students’
knowledge, attitudes, and willingness to care for patients with HIV. A
twenty-six-item questionnaire was used to conduct a cross-sectional study
of the dental therapy students of Federal School of Dental Therapy and
Technology, Enugu State, Nigeria.

* The level of knowledge of HIV transmission and prevention among the
respondents was high. However, misconceptions about the transmission of HIV
through blood donation, mosquito bite, and sharing cups and plates were
noted. Erroneous descriptions of HIV as harmless, self-limiting, antibiotic
sensitive infection, punishment virus, and contagious infection were also
reported.

More than half (56.2 percent) and 25.2 percent of the respondents,
respectively, expressed feelings of empathy and sympathy towards
individuals with HIV. About three-quarters (74.3 percent) expressed
willingness to treat patients with HIV, and 87.6 percent expressed
confidence in their ability to prevent occupational HIV acquisition. This
expressed confidence was significantly associated with their willingness to
treat patients with HIV. More than half (55.7 percent) of the respondents
reported they can adequately deliver HIV-related information to patients.

A total of 86.2 percent said there is a need for training dental therapists
in the clinical care of patients with HIV, and 89.0 percent said that
dental therapists can play a significant role in the dissemination of HIV-
related information.

The vast majority (90.0 percent) expressed willingness to disseminate HIV-
related information, and the majority (70.5 percent) considered the dental
therapist the most suitable dental professional to give HIV-related
information to patients.

KEYWORDS: HIV/AIDS, Nigeria, dental hygiene students, dental therapy
students
__________________________________________________________________
________________________________*_________________________________

22. No Abstract: Treatment as prevention: The breaking of taboos is
required in the fight against hepatitis C among people who inject drugs
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23728921

Hepatology. 2013 May 31.

Treatment as prevention: The breaking of taboos is required in the fight
against hepatitis C among people who inject drugs.

Bruggmann P.

Arud Centres for Addiction Medicine, Switzerland. p.bruggmann@arud.ch.
__________________________________________________________________
________________________________*_________________________________

23. No Abstract: Global drug policy fuels hepatitis C epidemic, report
warns
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23734391

Lancet. 2013 Jun 1;381(9881):1891.

Global drug policy fuels hepatitis C epidemic, report warns.

Clark F.
__________________________________________________________________
________________________________*_________________________________

24. No Abstract: Joint Practice Guideline for Sterile Technique during
Vascular and Interventional Radiology Procedures
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23177106

J Vasc Interv Radiol. 2012 Dec;23(12):1603-12. d

Joint Practice Guideline for Sterile Technique during Vascular and
Interventional Radiology Procedures: From the Society of Interventional
Radiology, Association of periOperative Registered Nurses, and Association
for Radiologic and Imaging Nursing, for the Society of Interventional
Radiology (Wael Saad, MD, Chair), Standards of Practice Committee, and
Endorsed by the Cardiovascular Interventional Radiological Society of
Europe and the Canadian Interventional Radiology Association.

Chan D, Downing D, Keough CE, Saad WA, Annamalai G, d’Othee BJ, Ganguli S,
Itkin M, Kalva SP, Khan AA, Krishnamurthy V, Nikolic B, Owens CA, Postoak
D, Roberts AC, Rose SC, Sacks D, Siddiqi NH, Swan TL, Thornton RH, Towbin
R, Wallace MJ, Walker TG, Wojak JC, Wardrope RR, Cardella JF; Society of
Interventional Radiology; Association of periOperative Registered Nurses.
__________________________________________________________________
________________________________*_________________________________

25. News

– Nigeria: N10.5m worth of fake product packaging materials intercepted
– India: Poor uptake of hepatitis B vaccine in India has several causes,
study finds
– Oklahoma USA: 2 new cases of hepatitis in Oklahoma health scare
– New Zealand: Hep C rate lead to calls for rural needle exchanges
– New Hampshire USA: 33rd hepatitis C case tied to NH outbreak confirmed,
believed infected through sexual contact

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
Nigeria: N10.5m worth of fake product packaging materials intercepted
By dailytimes.com.ng, Nigeria (10.06.13)

The National Agency for Food Drug Administration and Control (NAFDAC) said
in Abuja on Monday that it had intercepted packaging materials worth N10.5
million intended for fake products manufacturers.

The Director-General of the agency, Dr Paul Orhii, who said this at a news
conference, noted that counterfeiters had devised another means by
importing packaging materials rather than the finished products.

“Two large packages of 20,000 units of fake NGC Codeine bottle caps worth
about N5 million imported by Kaba and Kachi cleared by Gojeb Global
Resources were intercepted by vigilant PID officers, the packaging material
which is an anti-tussive/analgesic product was imported with the intention
of faking codeine syrup.

“Three packages containing 15,000 pieces of packaging materials for the
manufacture of fake Olay carrot lightening shower cream, 15,000 pieces of
packaging material for the manufacture of fake Olay Goat milk lightening
shower cream and 5,000 piece of packaging material for the manufacture of
fake Avon perfume body spray with an estimated market value of N4.5 million
was intercepted.

“One Mr Osita Mbakwe imported four packages of packaging materials for the
manufacture of fake Sure White lightening shower cream. The product which
has an estimated market value of N1 million was intercepted at the Murtala
Mohammed International Airport, NAHCO cargo.’’

Orhii said recent discovery had revealed that the success in stopping the
importation of finished counterfeit medicines had forced counterfeiters to
now operate by importing packaging materials.

“They have shifted from shipment of container loads of counterfeit drugs
through the seaports to clandestine importation of small and portable
packages of counterfeit drugs through airports that can easily evade the
eagle eyes of law enforcement agencies.’’

Orhii said the agency would look out for illegal counterfeit drug
production sites and then take decisive steps to nip them in the bud.

He called on Nigerians to be vigilant and report to the agency any
clandestine and murderous production sites for quick action, saying: “Any
counterfeiter arrested will be prosecuted speedily in accordance to the
extant laws.

“Landlords of warehouses stocked with counterfeit products and other
substandard regulated products will henceforth be arrested and prosecuted
as accomplices.’’

**** Orhii said the agency also intercepted rabies vaccine injection and
tetanus vaccine injection totaling 47,091 packs with an estimated market
value of N3 million.

**** He said the vaccine was for vaccination against rabies and tetanus and
was illegally imported in an inappropriate storage condition, which could
have affected the potency of the vaccine.

Other interceptions included that of 0.25g of Amoxycillin capsules and PSKL
Herbal tea in two large packages, with an estimated market value of N1.5
million.

The director said the fake herbal tea products had been implicated in
certain disease conditions of the liver and kidney.

He said the agency was determined to achieve the zero tolerance target for
counterfeit drugs and other unwholesome regulated products.
__________________________________________________________________
__________________________________________________________________
http://www.bmj.com/content/346/bmj.f3596

India: Poor uptake of hepatitis B vaccine in India has several causes,
study finds
Cheryl Travasso, BMJ 2013; 346 (06.06.13)

Poor management of vaccine stocks, poor record keeping, lack of staff
training, and use of multidose vials were among the main reasons for low
coverage of the hepatitis B vaccine in 10 states across India, researchers
have found.

India is home to 11% of the world’s people with chronic hepatitis B and has
between 100?000 and 200?000 deaths from hepatocellular carcinoma or
cirrhosis each year. To tackle the disease, India introduced the hepatitis
B vaccine across 10 states in …

Access to the full text of this article requires a subscription or payment.
__________________________________________________________________
__________________________________________________________________
Oklahoma USA: 2 new cases of hepatitis in Oklahoma health scare
Associated Press, USA (06.06.13)

TULSA (AP) — Two new cases of hepatitis have been reported in a health
scare involving patients of a Tulsa oral surgeon whose clinics were found
to be unsanitary.

The Tulsa Health Department says two new cases of hepatitis C were found
among the thousands of Dr. W. Scott Harrington’s patients who have been
tested since March.

A total of 73 patients have tested positive for hepatitis C, five for
hepatitis B and three for HIV, but there is no indication the diseases
spread at the clinics. Health experts also say the spread of disease in
dental clinics is extremely rare.

More than 4,000 of Harrington’s patients have been tested so far.

Inspectors said they found unsanitary conditions inside Harrington’s
clinics at Tulsa and Owasso.

Harrington is cooperating with the investigation.
__________________________________________________________________
__________________________________________________________________
New Zealand: Hep C rate lead to calls for rural needle exchanges
Gwyneth Hyndman, Southland Times, New Zealand (06.06.13)

Intravenous drug use and unregulated tattoos have led to the Southern
District Health Board area having the highest rate of new infections of
hepatitis C in New Zealand, sparking a push for needle exchanges to begin
in the rural communities.

Public Health South public health physician Keith Reid said the single most
common risk factor in the 13 new Hepatitis C cases in Southland and Otago
in 2012 was a history of personal IV drug use or of sexual contact with an
IV drug user.

The second most common risk factor was getting a tattoo in an unregulated
setting, Dr Reid told the joint health and disability/public health
committee at Dunedin yesterday.

Eradicating hepatitis C through expensive and sometimes ineffective
treatments was costing the health board up to $1.5 million annually,
despite preventive programmes in place and needle exchanges established in
Invercargill and Dunedin.

“We are taking it seriously,” he told committee members. “The question is,
are we taking it seriously enough?

“Further preventive measures need to be taken . . . needle exchanges aren’t
as effective as they should be. [The Health Ministry] should be looking at
expanding exchanges across the rural communities.”

About 3600 adults in both Southland and Otago – an estimated 1.5 per cent
of the population – are believed to carry hepatitis C and many might not
know, Dr Reid said. Only one in four of those infected are thought to be
aware they have the disease.

There is currently no vaccination against hepatitis C, which is a leading
cause for liver transplants.

In 2012, figures show that Southern had 13 out of the 29 newly reported
cases in New Zealand. This is up from nine out of 27 cases in 2011.

Dr Reid said there was a possibility of more needle exchanges being
established in the rural communities through a “multi-prong” approach from
different government departments working together.

Needle Exchange Services National Trust manager Charles Henderson said
yesterday the lack of needle exchange services in rural areas presented
challenges, but they could be addressed with funding.

Between $50,000 and $80,000 of government funding was required annually to
provide a sustainable mobile outreach service which targeted intravenous
drug users in the rural areas of the Southern District Health Board area.

The cost paled in comparison to the cost of treating people who contracted
HIV or hepatitis C when using dirty needles, he said.

Household drug surveys showed between 15,000 and 20,000 people in New
Zealand injected drugs and it was logical that some of them lived in rural
areas.

“It’s about ensuring we are reaching a hidden (rural) population. It’s an
illegal behaviour so we have to think of innovative and effective ways to
reach that population.”

– © Fairfax NZ News
__________________________________________________________________
__________________________________________________________________
New Hampshire USA: 33rd hepatitis C case tied to NH outbreak confirmed,
believed infected through sexual contact
By HOLLY RAMER Associated Press, USA (06.06.13)

CONCORD, New Hampshire — The hepatitis C outbreak associated with a former
Exeter Hospital technician has spread beyond his patients to a person who
is believed to have had sexual contact with one of them, state health
officials said Thursday.

David Kwiatkowski, who is accused of stealing drugs and infecting patients
with hepatitis C through syringes tainted with his blood, is scheduled to
face trial on 14 federal drug charges in January. He has pleaded not
guilty.

Since his arrest in July, 32 patients in New Hampshire and a dozen people
in other states have been diagnosed with the strain of hepatitis C — a
blood-borne viral infection that can cause liver disease and chronic health
issues — carried by Kwiatkowski.

A 33rd New Hampshire case has been confirmed, the Division of Public Health
Services announced Thursday, but that person is believed to have been
infected through sexual contact with one of the other infected individuals.

Public Health Director Dr. Jose Montero said that while sexual transmission
of hepatitis C is very uncommon, in this case, there were medical
circumstances that increased the risk.

Kwiatkowski, who has been in jail since his arrest, is accused of stealing
painkiller syringes from Exeter Hospital’s cardiac catheterization lab and
replacing them with saline-filled syringes that were later used on
patients.

Before being hired in Exeter in April 2011, he worked at 18 hospitals in
seven states, moving from job to job despite having been fired twice over
allegations of drug use and theft.

One of Kwiatkowski’s lawyers, Bjorn Lange, said Thursday that he would
carefully review the new information. In April, a judge partially agreed
with the defense team’s request to delay the trial, given the complexity of
the case and the fact that as federal public defenders, they will lose time
when they have to take furlough days under the automatic budget cuts that
began in March.

Defense attorneys had sought to delay the trial until April, but
prosecutors and the judge were unwilling to move it beyond January.
__________________________________________________________________
__________________________________________________________________
Ukraine: Hepatitis C Most Often Detected in Potential Donors Blood
forUm (03.06.2013)

Vasyl Novak, director of Ukraine’s Institute of Blood Pathology and
Transfusion Medicine of NAMS, recently reported during a roundtable on
“Infectious Safety of Donor Blood and Its Components in Ukraine” that
hepatitis C is the most commonly detected virus found in the blood of
potential donors in Ukraine.

Negating the common misconception that infections are spread through blood
donation, Novak explained that the institute often identifies individuals
with infections through the blood donation process.

Citing statistics for 2012, Novak reported that blood screening led to the
institute rejecting 1,054 liters of donor blood due to HIV detection; 1,161
liters due to hepatitis B detection; 1,619 liters due to syphilis
detection; and 3,024 liters due to hepatitis C detection.
__________________________________________________________________
________________________________*_________________________________
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