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Post00708 Hepatitis Day + Supply + Extracts + Abstracts + News 24 July 2013

CONTENTS
1. This is hepatitis. Know it. Confront it World Hepatitis Day, 28 July
2013
2. World Hepatitis Day: Who, What, Where, When and How?
3. Now in French and Spanish: The updated “Logistics Handbook: A Practical
Guide for the Supply Chain Management of Health Commodities”
4. Supply Chain Management: Human Resource Capacity Development in Public
Health SCM: Assessment Guide & Tool
5. Abstract: Reduction in HCV incidence among injection drug users
attending needle and syringe programs in australia: a linkage study
6. Abstract: CDC grand rounds: preventing unsafe injection practices in
the U.S. health-care system
7. Abstract: Preliminary laboratory report of fungal infections associated
with contaminated methylprednisolone injections.
8. Abstract: Fungal Infections Associated with Contaminated
Methylprednisolone Injections — Preliminary Report
9. Extract: A study of the psychological impact of sharps injuries on
health care workers in China
10. Extract: Evaluation of bloodborne pathogen exposures at an urban
hospital
11. Abstract: Long-term efficacy of the hepatitis B Vaccine in a high-risk
group
12. Abstract: Hepatitis B and C: neglected diseases among health care
workers in Cameroon
13. Abstract: The state of hepatitis B and C in the mediterranean and
balkan countries: report from a summit conference
14. Abstract: Report from a Viral Hepatitis Policy Forum on Implementing
the WHO Framework for Global Action on Viral Hepatitis in North Asia
15. Abstract: Awareness of biomedical waste management among health care
personnel in jaipur, India
16. Abstract: Cosmetic Procedures Performed in the United States: A 16-
Year Analysis
17. Abstract: Are major reductions in new HIV infections possible with
people who inject drugs? The case for low dead-space syringes in
highly affected countries
18. Abstract: Could low dead-space syringes really reduce HIV transmission
to low levels?
19. Abstract: HIV and Related Risk Behaviors Among Female Sex Workers in
Iran: Bias-Adjusted Estimates from the 2010 National Bio-Behavoral
Survey
20. Abstract: Novel engineered systems for oral, mucosal and transdermal
drug delivery
21. Abstract: Bacteriological Safety of Blood Collected for Transfusion at
University of Gondar Hospital Blood Bank, Northwest Ethiopia
22. Abstract: Prevalence and factors associated with HCV infection among
elderly individuals in a southern Brazilian city
23. Abstract: Spectral signatures of viewing a needle approaching one’s
body when anticipating pain
24. No Abstract: US Supreme Court strikes down anti-prostitution pledge
25. No Abstract: Fungal infections associated with contaminated
methylprednisolone injections: review and insights
26. No Abstract: Playing it safe: a look at needlestick injuries
27. News
– Australia: No extra cash for needle exchange
– Pakistan: Rise in HIV/Aids cases feared due to non-availability of drug
– India: IAP introduces Safe Injection Environment Campaign in Hyderabad
– HCV decline associated with needle and syringe programs
– Australia: Kids’ Needle Prick Injury Causes HIV, Hepatitis Scare
– Africa: African leaders restate pledge to tackle HIV, TB, malaria
– Pakistan: Hepatitis emerges as major public health problem in Pakistan

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__________________________________________________________________
________________________________*_________________________________

1. This is hepatitis. Know it. Confront it World Hepatitis Day, 28 July
2013
__________________________________________________________________
http://www.who.int/campaigns/hepatitis-day/2013/event/en/index.html

World Hepatitis Day, 28 July 2013

Every year on 28 July, WHO and partners mark World Hepatitis Day to
increase the awareness and understanding of viral hepatitis and the
diseases that it causes.

Hepatitis viruses A, B, C, D and E can cause acute and chronic infection
and inflammation of the liver that can lead to cirrhosis and liver cancer.
These viruses constitute a major global health risk with around 240
million people being chronically infected with hepatitis B and around 150
million people chronically infected with hepatitis C.

For 2013, the overall theme continues to be “This is hepatitis. Know it.
Confront it.” The campaign emphasizes the fact that hepatitis remains
largely unknown as a health threat in much of the world.

Goal: moving from awareness to commitment and action to address the
“silent epidemic” of viral hepatitis

Millions of people are living with viral hepatitis and millions more are
at risk of becoming infected. Most people with chronic infection with
hepatitis B or C are unaware that they continue to carry the virus. They
are therefore at high risk of developing severe chronic liver disease and
can unknowingly transmit the virus to other people. Approximately one
million people die each year from causes related to viral hepatitis, most
commonly cirrhosis and liver cancer.

World Hepatitis Day provides an opportunity to focus on specific actions,
such as:

* strengthening prevention, screening and control of viral hepatitis and
its related diseases;
* increasing hepatitis B vaccine coverage and integration of the vaccine
into national immunization programmes;
* coordinating a global response to viral hepatitis.

Although the burden of disease related to hepatitis infection is very
high, in most countries, the problem has not been addressed in a
comprehensive way for many reasons. These include the fact that most
people do not develop any symptoms when they become infected and that they
remain free of symptoms often for decades until they develop chronic liver
disease. This has largely resulted in “the silent epidemic” we are
experiencing today.

Viral hepatitis also places a heavy burden on the health-care system
because of the high costs of treatment of liver cancer and liver failure
from cirrhosis. In many countries, liver failure from viral hepatitis is
the leading reason for liver transplants. Such end-stage treatments are
expensive, easily costing up to hundreds of thousands of dollars per
person.

The date of 28 July was chosen for World Hepatitis Day in honour of the
birthday of Nobel Laureate Professor Baruch Samuel Blumberg, discoverer of
the hepatitis B virus.

http://www.who.int/topics/hepatitis/en/index.html
__________________________________________________________________
________________________________*_________________________________

2. World Hepatitis Day: Who, What, Where, When and How?

www.worldhepatitisalliance.org/en/who-what-where-when-and-how.html
__________________________________________________________________
The World Hepatitis Alliance

World Hepatitis Day

Who, What, Where, When and How?

World Hepatitis Day is an annual event that each year provides
international focus for patient groups and people living with hepatitis B
and C. It is an opportunity around which interested groups can raise
awareness and influence real change in disease prevention and access to
testing and treatment.

The World Hepatitis Alliance first launched World Hepatitis Day in 2008 in
response to the concern that chronic viral hepatitis did not have the
level of awareness, nor the political priority, seen with other
communicable diseases such as HIV/AIDS, tuberculosis and malaria. Since
then thousands of events have taken place around the world, generating
massive public and media interest. The Alliance has also received support
from governments worldwide, high-profile Non-Governmental Organisations
(NGOs) and supranational bodies, such as Médecins Sans Frontières.

Who organises World Hepatitis Day?

World Hepatitis Day was launched by the World Hepatitis Alliance in 2008
in response to the concern that chronic viral hepatitis did not have the
level of awareness, nor the political priority, seen with other
communicable diseases such as HIV/AIDS, tuberculosis and malaria. Since
2008 World Hepatitis Day has been coordinated by the World Hepatitis
Alliance.

In May 2010 the World Health Assembly passed resolution WHA63.18 on viral
hepatitis which provides official endorsement of World Hepatitis Day as
the primary focus for national and international awareness-raising
efforts. To date, thousands of events have taken place around the world,
from rock concerts and press briefings to ministerial meetings and
fundraising events.

What makes it important?

Shockingly 500 million people worldwide is living with either chronic
hepatitis B or C. While this is far higher than the prevalence of HIV or
any cancer, awareness is inexplicably low and the majority of those
infected are unaware.

The World Hepatitis Alliance hopes that World Hepatitis Day will prompt
people to think about the huge scale of viral hepatitis infection
globally, about whether they may be at risk (and if so, to get tested) and
also about how to avoid becoming infected. The long-term objective of the
campaign is to prevent new infections and to deliver real improvements in
health outcomes for people living with hepatitis B and C.

Where is it?

World Hepatitis Day events take place all over the world. Contact us to
find out details of events near you, or you could even set up an event of
your own! We’ve got all the materials here online to help you get started,
including posters, logos and flier designs – find them here

When is World Hepatitis Day?

Following the World Health Assembly in May 2010, it was agreed that World
Hepatitis Day would be recognised annually on 28 July.

July 28 was chosen to mark the birthday of Professor Baruch Blumberg,
awarded the Nobel Prize for his work in discovering the hepatitis B virus.
He said: ‘It’s good to know that my birthday will be remembered in this
unusual and unexpected way. We never thought this would happen when we
were studying a strange protein from Australia.’

How do I get involved?

Take a look at our World Hepatitis Day 2013 page here. We will soon be
putting up more information about what is going on in your area; if you
have any questions in the meantime please feel free to contact us.
__________________________________________________________________
________________________________*_________________________________

3. Now in French and Spanish: The updated “Logistics Handbook: A Practical
Guide for the Supply Chain Management of Health Commodities”
__________________________________________________________________

Updated Logistics Handbook now also in French and Spanish

The USAID | DELIVER PROJECT has published French and Spanish translations
of the updated Logistics Handbook: A Practical Guide for the Supply Chain
Management of Health Commodities.

The Logistics Handbook, updated in 2011, offers practical guidance for
managing the supply chain, with an emphasis on health commodities. It is
intended to help program managers who design, manage, and assess logistics
systems for health programs. In addition, policymakers, system
stakeholders, and anyone working in logistics will also find it helpful as
a system overview and overall approach.

Download English, French and Spanish publications at http://j.mp/1bGeeMh

Anne Marie Hvid
John Snow International
<anne_marie_hvid[at]jsi.com>
__________________________________________________________________
________________________________*_________________________________

4. Supply Chain Management: Human Resource Capacity Development in Public
Health SCM: Assessment Guide & Tool
__________________________________________________________________
Human Resource Capacity Development in Public Health SCM:
Assessment Guide & Tool

by Shega Shala, JSI

Effective public health supply chains require motivated and skilled staff
with competency in various essential logistics functions. In many
countries, a lack of trained staff is a frequent cause of supply chain
system breakdown and poor performance. In an effort to help public health
supply chain managers in developing countries assess and improve the
management of their human resources, the USAID | DELIVER PROJECT and
People that Deliver have developed a new toolkit.

Built around the publication Human Resource Capacity Development in Public
Health Supply Chain Management: Assessment Guide and Tool, the toolkit
provides a structured, rating-based methodology designed to collect data
needed for a rapid, comprehensive assessment of the capacity of the human
resource support system for a country’s supply chain. By strengthening the
capacity of public health supply chain personnel, both supply chains and,
ultimately, health systems will operate more effectively, thus preventing
stockouts and ensuring that clients have improved access to lifesaving
health supplies.

To download or view Human Resource Capacity Development in Public Health
Supply Chain Management: Assessment Guide and Tool and all the components
of the new toolkit, go to http://j.mp/13jQH00

John Snow International
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Reduction in HCV incidence among injection drug users
attending needle and syringe programs in australia: a linkage study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23763399

Am J Public Health. 2013 Aug;103(8):1436-44.

Reduction in HCV incidence among injection drug users attending needle and
syringe programs in australia: a linkage study.

Iversen J, Wand H, Topp L, Kaldor J, Maher L.

Jenny Iversen, Handan Wand, John Kaldor, and Lisa Maher are with the Kirby
Institute, University of New South Wales, Sydney, Australia. Libby Topp is
with Cancer Council NSW, Sydney.

Objectives. We examined trends in HCV incident infection among injection
drug users (IDUs) attending needle and syringe programs (NSPs) in
Australia in 1995 to 2010.

Methods. We created a passive retrospective cohort of 724 IDUs who tested
negative for HCV antibodies by a simple deterministic method linking
partial identifiers to find repeat respondents in annual cross-sectional
serosurveillance.

Results. We identified 180 HCV seroconversions over the study period, for
a pooled incidence density of 17.0 per 100 person-years (95% confidence
interval [CI]?=?14.68, 19.66). Incidence density declined, from a high of
30.8 per 100 person-years (95% CI?=?21.3, 44.6) in 2003 to a low of 4.0
(95% CI?=?1.3, 12.3) in 2009.

Conclusions. A decline in HCV incidence among Australian IDUs attending
NSPs coincided with considerable expansion of harm reduction programs and
a likely reduction in the number of IDUs, associated with significant
changes in drug markets.

Our results demonstrate the capacity of repeat cross-sectional
serosurveillance to monitor trends in HCV incidence and provide a platform
from which to assess the impact of prevention and treatment interventions.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: CDC grand rounds: preventing unsafe injection practices in
the U.S. health-care system
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23718950

MMWR Morb Mortal Wkly Rep. 2013 May 31;62(21):423-5.

CDC grand rounds: preventing unsafe injection practices in the U.S.
health-care system.

Centers for Disease Control and Prevention (CDC).

Injectable medicines commonly are used in health-care settings for the
prevention, diagnosis, and treatment of various illnesses. Examples
include chemotherapy, intravenous antibiotics, vaccinations, and
medications used for sedation and anesthesia.

Medical injections often are administered in conjunction with surgical
procedures, endoscopy, imaging studies, pain control, and cosmetic or
complementary and alternative medicine procedures.

Safe manufacturing and pharmacy practices are essential because every
injection must begin with sterile medication. The appropriate medication
must then be safely prepared (typically drawn up in a syringe), then
administered in a manner that maintains sterility and minimizes risk for
infection.

Safe administration depends on adherence to the practices outlined in
CDC’s evidence-based Standard Precautions guideline.

Health-care providers should never 1) administer medications from the same
syringe to more than one patient, 2) enter a vial with a used syringe or
needle, or 3) administer medications from single-dose vials to multiple
patients.

They also should maintain aseptic technique at all times and properly
dispose of used injection equipment.

Free full text http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6221a3.htm
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Preliminary laboratory report of fungal infections associated
with contaminated methylprednisolone injections
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23761142

J Clin Microbiol. 2013 Aug;51(8):2654-61.

Preliminary laboratory report of fungal infections associated with
contaminated methylprednisolone injections.

Lockhart SR, Pham CD, Gade L, Iqbal N, Scheel CM, Cleveland AA, Whitney
AM, Noble-Wang J, Chiller TM, Park BJ, Litvintseva AP, Brandt ME.

Mycotic Diseases Branch.

In September 2012, the Centers for Disease Control and Prevention (CDC)
initiated an outbreak investigation of fungal infections linked to
injection of contaminated methylprednisolone acetate (MPA). Between 2
October 2012 and 14 February 2013, the CDC laboratory received 799 fungal
isolates or human specimens, including cerebrospinal fluid (CSF), synovial
fluid, and abscess tissue, from 469 case patients in 19 states.

A novel broad-range PCR assay and DNA sequencing were used to evaluate
these specimens.

Although Aspergillus fumigatus was recovered from the index case,
Exserohilum rostratum was the primary pathogen in this outbreak and was
also confirmed from unopened MPA vials. Exserohilum rostratum was detected
or confirmed in 191 specimens or isolates from 150 case patients,
primarily from Michigan (n = 67 patients), Tennessee (n = 26), Virginia (n
= 20), and Indiana (n = 16). Positive specimens from Michigan were
primarily abscess tissues, while positive specimens from Tennessee,
Virginia, and Indiana were primarily CSF. E. rostratum antifungal
susceptibility MIC50 and MIC90 values were determined for voriconazole (1
and 2 µg/ml, respectively), itraconazole (0.5 and 1 µg/ml), posaconazole
(0.5 and 1 µg/ml), isavuconazole (4 and 4 µg/ml), and amphotericin B (0.25
and 0.5 µg/ml).

Thirteen other mold species were identified among case patients, and four
other fungal genera were isolated from the implicated MPA vials. The
clinical significance of these other fungal species remains under
investigation.

The laboratory response provided significant support to case confirmation,
enabled linkage between clinical isolates and injected vials of MPA, and
described significant features of the fungal agents involved in this large
multistate outbreak.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Fungal Infections Associated with Contaminated
Methylprednisolone Injections — Preliminary Report
__________________________________________________________________
http://www.nejm.org/doi/full/10.1056/NEJMoa1213978#t=article

N Engl J Med. 2012 Dec 19

Fungal Infections Associated with Contaminated Methylprednisolone
Injections — Preliminary Report

Rachel M. Smith, M.D., M.P.H., Melissa K. Schaefer, M.D., Marion A.
Kainer, M.B., B.S., M.P.H., Matthew Wise, Ph.D., Jennie Finks, D.V.M.,
M.V.P.H., Joan Duwve, M.D., M.P.H., Elizabeth Fontaine, M.S.P.H., Alvina
Chu, M.H.S., Barbara Carothers, L.P.N., Amy Reilly, R.N., Jay Fiedler,
M.S., Andrew D. Wiese, M.P.H., Christine Feaster, R.M., Lex Gibson, B.S.,
Stephanie Griese, M.D., Anne Purfield, Ph.D., Angela A. Cleveland, M.P.H.,
Kaitlin Benedict, M.P.H., Julie R. Harris, Ph.D., M.P.H., Mary E. Brandt,
Ph.D., Dianna Blau, D.V.M., Ph.D., John Jernigan, M.D., J. Todd Weber,
M.D., and Benjamin J. Park, M.D. for the Multistate Fungal Infection
Outbreak Response Team

December 19, 2012 DOI: 10.1056/NEJMoa1213978

BACKGROUND: Fungal infections are rare complications of injections for
treatment of chronic pain. In September 2012, we initiated an
investigation into fungal infections associated with injections of
preservative-free methylprednisolone acetate that was purchased from a
single compounding pharmacy.

METHODS: Three lots of methylprednisolone acetate were recalled by the
pharmacy; examination of unopened vials later revealed fungus.
Notification of all persons potentially exposed to implicated
methylprednisolone acetate was conducted by federal, state, and local
public health officials and by staff at clinical facilities that
administered the drug. We collected clinical data on standardized case-
report forms, and we tested for the presence of fungi in isolates and
specimens by examining cultures and performing polymerase-chain-reaction
assays and histopathological and immunohistochemical testing.

RESULTS: As of October 19, 2012, more than 99% of 13,534 potentially
exposed persons had been contacted. As of December 10, there were 590
reported cases of infection in 19 states, with 37 deaths (6%). As of
November 26, laboratory evidence of Exserohilum rostratum was present in
specimens from 100 case patients (17%). Additional data were available for
386 case patients (65%); 300 of these patients (78%) had meningitis. Case
patients had received a median of 1 injection (range, 1 to 6) of
implicated methylprednisolone acetate. The median age of the patients was
64 years (range, 16 to 92), and the median incubation period was 20 days
(range, 0 to 120); 33 patients (9%) had a stroke.

CONCLUSIONS: Analysis of preliminary data from a large multistate outbreak
of fungal infections showed substantial morbidity and mortality. The
infections were associated with injection of a contaminated glucocorticoid
medication from a single compounding pharmacy. Rapid public health actions
included prompt recall of the implicated product, notification of exposed
persons, and early outreach to clinicians.
__________________________________________________________________
________________________________*_________________________________

9. Extract: A study of the psychological impact of sharps injuries on
health care workers in China
__________________________________________________________________
http://www.ajicjournal.org/article/S0196-6553(12)00271-4/fulltext

Am J Infect Control. 2013 Feb;41(2):186-7.

A study of the psychological impact of sharps injuries on health care
workers in China.

Zhang MX, Yu Y.

To the Editor:

Sharps injuries are of great concern for health care workers (HCWs) and
are related to a number of adverse effects, including both physical
problems and economic burdens1, 2 as well as psychological impacts.
However, published research in this area is limited compared with reports
describing incidence, situations when it happens, risk factors, and
economic costs. Consequently, we conducted a study to investigate and
evaluate the psychological impact of sharps injuries on HCWs.

In this cross-sectional study carried out in the Second Affiliated
Hospital of Soochow University, 361 subjects (180 males and 181 females;
186 nurses and 175 doctors) were recruited at random. The mean age of the
subjects was 31.7 ± 7.98 years (range, 20-50 years). All subjects were
asked to complete a questionnaire anonymously, which elicited basic
information (eg, department, sex, age, job and professional rank) and
asked several questions regarding psychological status after sharps
injuries. All statistical analyses were performed using SAS 8.2 (SAS
Institute, Cary, NC). Frequency distributions in each group were analyzed,
and between-group comparisons were performed using the ?2 test. A P value
<.05 was considered to indicate significance.

All 361 respondents had experienced a sharps injury at some point in their
career; of these 184 (51.0%) had 1-5 injuries (average, 1.7 injuries). The
majority of respondents (n = 232; 64.3%) did not report their injury. The
following reasons for nonreporting were cited: complicated report process,
assuming no apparent contamination or lack of time. This is consistent
with the high rates of nonreporting published in other countries.3, 4
Failure to report leads directly to decreased professional knowledge,
insufficient medical treatment after occupational exposure, and even
underestimation of the harm from sharps injuries by safety departments.2

Our data show that 15.2% of respondents reported manifestations of
emotional distress, such as anxiety, worry, frustration, panic, and even
extremity numbness, after experiencing a sharps injury. More than half
(57.6%) reported feeling that they had been or would become infected from
their injury. Sohn et al5 reported significant differences in scores on
the perceived stress scale and Beck depression inventory psychological
questionnaires between HCWs who experienced a sharps injury and those who
did not. We analyzed data stratified by sex, age, and job and found that
all 3 of these factors were associated with negative psychological changes
after sharps injuries. Women, nurses, and individuals aged 20-30 years are
more susceptible to psychological anxiety and frustrations after sharps
injuries (P < .05) (Table 1).

Table 1. Negative psychological effects of sharps injuries
Characteristic Psychological status P value
Negative psychological change rate, %
Sex
Male 63.9 (115 of 180) .001
Female 81.8 (148 of 181)
Job
Doctor 58.3 (102 of 175) .001
Nurse 86.6 (161 of 186)
Age, years
20-30 91.5 (173 of 189) .001
30-40 60.7 (68 of 112)
40-50 36.7 (22 of 60)
Incidence of overexcessive behavior, %
Male 27.8 (50 of 180) .001
Female 51.4 (93 of 181)
Incidence of negative influence on career, %
Age 20-30 years 90.5 (171 of 189) .001
Age 31-40 years 56.3 (63/112)
Age 41-50 years 18.3 (11/60)

Some 93.9% of the respondents indicated that the major factor inducing
negative psychological changes was the fear of infection of themselves or
family members. Another factor that caused frustration in HCWs is the
inability to completely protect their own rights and benefits.
Overexcessive behavior can be induced by psychological stress; 39.6% of
respondents reported engaging in overexcessive behavior, with a
significantly higher incidence in women than in men (P < .05) (Table 1).

As to the question of whether sharps injuries have any influence on HCWs’
careers, 67.9% of respondents reported that their careers had been
affected by their sharps injury, including diminished professional
recognition and reduced professional enthusiasm. These effects were
greater in the younger respondents (aged 20-30 years; P < .05) (Table 1).

HCWs are frequently exposed to sharps injuries during their duties, and
these injuries often have negative psychological effects. Exploring the
optimal type, content, and timing of psychological intervention is crucial
to attenuate these HCWs’ anxiety.

References

Trueman P, Taylor M, Twena N, Chubb B. The cost of needlestick injuries
associated with insulin administration. Br J Commun Nurs. 2008;13:413–417

Lee JM, Botteman MF, Xanthakos N, Nicklasson L. Needlestick injuries in
the United States: epidemiologic, economic, and quality of life issues.
AAOHN J. 2005;53:117–133

JM Botteman MF, Nicklasson L. Needlestick injury in acute care nurses
caring for patients with diabetes mellitus: a retrospective study. Curr
Med Res Opin. 2005;21:741–747

Mangione CM, Gerberding JL, Cummings SR. Occupational exposure to HIV:
frequency and rates of underreporting of percutaneous and mucocutaneous
exposures by medical housestaff. Am J Med. 1991;90:85–90

Sohn JW, Kim BG, Kim SH, Han C. Mental health of healthcare workers who
experience needlestick and sharps injuries. J Occup Health.
2006;48:474–479
Conflict of interest: None to report.

PII: S0196-6553(12)00271-4

doi:10.1016/j.ajic.2012.02.023

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

Free article:
http://www.ajicjournal.org/article/S0196-6553(12)00271-4/fulltext
__________________________________________________________________
________________________________*_________________________________

10. Extract: Evaluation of bloodborne pathogen exposures at an urban
hospital
__________________________________________________________________
http://www.ajicjournal.org/article/S0196-6553(12)00272-6/fulltext

Am J Infect Control. 2013 Feb;41(2):185-6.

Evaluation of bloodborne pathogen exposures at an urban hospital.

Karmon SL, Mehta SA, Brehm A, Dzurenko J, Phillips M.

To the Editor:

Health care workers (HCWs) are at risk for exposure to bloodborne
pathogens, including HIV, hepatitis B virus, and hepatitis C virus.1
Although several studies have attempted to describe this risk, those
studies relied primarily on incident reports and employee health
records,2, 3, 4, 5 which are known to miss unreported exposures and to
contain limited data. We conducted a survey of our nursing staff to better
assess the incidence and causes of blood and body fluid exposures, rates
of follow-up according to institutional protocol, and perceived barriers
to follow-up.

An anonymous electronic survey was distributed to the 3,500 members of the
Department of Nursing at New York University’s Langone Medical Center,
750-bed academic medical center in New York City. To reduce response bias,
the survey questions were appended to a widely circulated general survey
about preferences for nonsterile gloves. In the survey introduction, risk
of bloodborne pathogen transmission was described, based on Centers for
Disease Control and Prevention guidelines.6 Those who recalled an exposure
within the preceding year were subsequently asked a series of questions to
characterize the event and describe postexposure care.

We received a total of 746 survey responses. Seventy of these 746
respondents (9.4%) reported exposure to potentially infectious blood or
body fluids within the preceding year, including 28 (40%) who reported
sharps exposures, 39 (56%) who reported splash exposures, and 3 (4%) who
reported both. The frequency of exposure varied by primary work location
(Table 1), with the highest rate (14.3%) seen in HCWs working in intensive
care units and the lowest rate (2.1%) seen in HCWs working in outpatient
clinics.

Table 1. Blood or body fluid exposures by work location and provider role
Exposed/total respondents Percent exposed
Primary work location
Critical care unit 17 or 119 14.3
OR or PACU 13 or 102 12.7
Adult ward 33 or 376 8.8
Procedure suite 2 or 28 7.1
Pediatric ward 2 or 38 5.3
Outpatient clinic 1 or 48 2.1
Emergency room 0 or 6 0
Other 2 or 29 6.9
Total 70 or 746* 9.4
Provider role
Registered nurse 61 or 566 10.8
Nursing assistant 3 or 56 5.4
Patient care technician 3 or 65 4.6
Nurse practitioner 1 or 24 4.2
Nursing manager 0 or 12 0
Other 2 or 22 9.1
Total 70 or 745 9.4
NOTE. For primary work location, “other” includes blank responses (n = 6),
multiple units (n = 6), and rehabilitation/administration (n = 17) For
provider role, “other” includes blank responses (n = 3), unit clerks,
surgical technicians, and anesthesia technicians.

OR, operating room; PACU, postanesthesia care unit.

*One respondent did not indicate provider role.

A total of 31 HCWs reported at least one exposure involving a needle or
blade during the prior year. Of these, 13 (42%) reported sustaining a
needlestick injury while attempting to deploy the needle’s safety device.
This finding is consistent with published data showing a higher rate of
needlestick injuries in HCWs who used manual safety devices.7 In addition,
43 respondents reported a splash exposure to potentially infectious blood
or body fluids. Thirty-three respondents (75%) reported that personal
protective equipment (PPE) was available but not used, because of a low
perception of risk. Only 5 respondents (11%) reported that PPE was not
readily available at the time of exposure.

Our institution has a clearly defined protocol to guide evaluation of
potential exposure to infectious body fluids. The potentially exposed HCW
first informs a supervisor, who arranges for immediate first aid and then
directs the individual to the appropriate location for further care.
During business hours, the exposed HCW goes to Employee Health Services;
after hours, the initial evaluation is performed at the hospital’s
Emergency Department). Of the 70 HCWs who reported an exposure within the
preceding year, only 53 (76%) informed their supervisor of the exposure.
Fewer than two-thirds (44 respondents; 63%) reported to the Emergency
Department or to Employee Health Services for evaluation. A lower
percentage of respondents reporting splash exposures presented for further
evaluation compared with those reporting a sharps exposure (47.6% vs
83.9%). The 2 most common reported reasons for not seeking evaluation were
low perceived risk and being too busy with work. No respondent reported
ignorance of the appropriate steps to take after an exposure.

Our survey study retrospectively identified high-risk exposures to
potentially infectious blood or body fluids among our nursing staff that
would have been missed had we used incident reports alone. Limitations of
this study include potential response bias and recall bias. In addition,
because the majority of our respondents were registered nurses, the
responses might not reflect the perceptions or practices of other types of
HCWs. Nonetheless, this survey provides direction to enhance prevention
efforts and further optimize postexposure evaluation at our institution.
Specifically, an evaluation of safety devices was undertaken, the need for
prompt postexposure evaluation was emphasized, postexposure prophylactic
medication was prepositioned near clinical areas, and a 24/7 hotline
number was instituted. Further evaluation of the impact of these
interventions on improving postexposure evaluation of exposed HCWs at our
institution is planned.

References

Cardo DM, Bell DM. Bloodborne pathogen transmission in health care
workers: risks and prevention strategies. Infect Dis Clin North Am.
1997;11:331–346

Lynch P, White MC. Perioperative blood contact and exposures: a comparison
of incident reports and focused studies. Am J Infect Control.
1993;21:357–363

Bakaeen F, Awad S, Albo D, Bellows CF, Huh J, Kistner C, et al.
Epidemiology of exposure to blood borne pathogens on a surgical service.
Am J Surg. 2006;192:e18–e21

Davanzo E, Frasson C, Morandin M, Trevisan A. Occupational blood and body
fluid exposure of university health care workers. Am J Infect Control.
2008;36:753–756

Behrman AJ, Shofer FS, Green-McKenzie J. Trends in bloodborne pathogen
exposure and follow-up at an urban teaching hospital: 1987 to 1997. J
Occup Environ Med. 2001;43:370–376

Centers for Disease Control and Prevention. Bloodborne infectious
diseases: HIV/AIDS, hepatitis B, hepatitis C. Available from:
http://www.cdc.gov/niosh/topics/bbp/genres.html. Accessed January 20,
2012.

Tosini W, Ciotti C, Goyer F, Lolom I, L’Heriteau F, Abiteboul D, et al.
Needlestick injury rates according to different types of safety-engineered
devices: results of a French multicenter study. Infect Control Hosp
Epidemiol. 2010;31:402–407

Previously presented as Poster 407 at the 48th Annual Meeting of the
Infectious Diseases Society of America, Vancouver, BC, Canada, October 23,
2010.

Conflicts of interest: None to report.

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

Free article:
http://www.ajicjournal.org/article/S0196-6553(12)00272-6/fulltext
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Long-term efficacy of the hepatitis B Vaccine in a high-risk
group
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23852676

J Med Virol. 2013 Sep;85(9):1518-22.

Long-term efficacy of the hepatitis B Vaccine in a high-risk group.

Al Ghamdi SS, Fallatah HI, Fetyani DM, Al-Mughales JA, Gelaidan AT.

Department of Internal Medicine, Faculty of Medicine, King Abdulaziz
University, Jeddah, Saudi Arabia.

Chronic infection with hepatitis B virus (HBV) is a global health problem.
In an attempt to control infection, worldwide HBV vaccination programs
have been established. Saudi Arabia, an endemic area for HBV infection,
established an HBV immunization program in 1989.

This cross-sectional study evaluates the long-term protection of HBV
vaccination 14-24 years after primary immunization in a high-risk group
(clinical year medical students) at King Abdulaziz University Hospital in
Jeddah, Saudi Arabia. All participants had complete HBV immunization at
birth or in early childhood. Hepatitis B surface antibody (anti-HBs)
levels were obtained. An anti-HBs titer of <10?mIU/ml indicated no
protection, while a titer of >10?mIU/ml was considered to represent
protective immune status.

A total of 238 students were included; they were predominantly females
(n?=?182, 76.5%). Mean age was 22.2?±?1.1 years. Duration since primary
vaccination was 19.8?±?2.3 years. Female students were more likely to
maintain long- term protection compared to males (62.1% and 58.8%,
respectively). Anti- HBs levels were significantly low in many students
after primary immunization.

Testing medical students for anti-HBs levels may be warranted as they
represent a high-risk population.

The higher rate of vaccine failure in males than females requires further
investigation as it may explain the higher prevalence of HBV in the male
population.

J. Med. Virol. 85:1518-1522, 2013. © 2013 Wiley Periodicals, Inc.
Copyright © 2013 Wiley Periodicals, Inc.

KEYWORDS: Saudi Arabia, anti-hepatitis B antibodies, immunity
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Hepatitis B and C: neglected diseases among health care
workers in Cameroon
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23303802

Trans R Soc Trop Med Hyg. 2013 Mar;107(3):158-64. d

Hepatitis B and C: neglected diseases among health care workers in
Cameroon.

Fritzsche C, Becker F, Hemmer CJ, Riebold D, Klammt S, Hufert F, Akam W,
Kinge TN, Reisinger EC.

Division of Tropical Medicine and Infectious Diseases, Department of
Medicine, University of Rostock Medical School, Ernst-Heydemann-Strasse 6,
D-18057 Rostock, Germany. Carlos.Fritzsche@med.uni-rostock.de

BACKGROUND: Healthcare workers (HCW) are at risk of acquiring blood-borne
viral infections, particularly hepatitis B (HBV), hepatitis C (HCV), and
HIV, especially in high endemic regions such as sub-Saharan Africa.

METHODS: Sera from 237 hospital workers in Southwest Cameroon were tested
for anti- hepatitis B core antigen (anti-HBc), hepatitis B surface antigen
(HBsAg), anti-hepatitis B surface antigen (anti-HBs), anti-HCV and (on a
voluntary basis) for anti-HIV. Information on pre-study testing for HBV,
HCV and HIV and pre-study HBV vaccination status was collected from these
individuals.

RESULTS: The pre-study testing rate among participating hospital staff for
HBV was 23.6% (56/237), for HCV 16% (38/237), and for HIV 91.6% (217/237).
The pre-study HBV vaccination rate was 12.3% (29/237). Analysis of anti-
HBc revealed that 73.4% (174/237) of the hospital staff had been infected
by HBV. Active HBV infection (HBsAg positivity) was detected in 15
participants. Anti-HCV was found in four of 237 participants, HIV
antibodies were detected in four of 200 participants tested.

CONCLUSION: HBV and HCV are neglected diseases among HCW in sub-Saharan
Africa. The vaccination rate against HBV was very low at 12.3%, and
therefore anti-HBc testing should be mandatory to identify HCW requiring
HBV vaccination. Testing for HBV and routine HBV vaccination for HBV-
negative HCW should be strongly enforced in Cameroon.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: The state of hepatitis B and C in the mediterranean and
balkan countries: report from a summit conference
__________________________________________________________________
J Viral Hepat. 2013 Aug;20 Suppl 2:1-20.

The state of hepatitis B and C in the mediterranean and balkan countries:
report from a summit conference.

Hatzakis A, Van Damme P, Alcorn K, Gore C, Benazzouz M, Berkane S, Buti M,
Carballo M, Cortes Martins H, Deuffic-Burban S, Dominguez A, Donoghoe M,
Elzouki AN, Ben-Alaya Bouafif N, Esmat G, Esteban R, Fabri M, Fenton K,
Goldberg D, Goulis I, Hadjichristodoulou T, Hatzigeorgiou T, Hamouda O,
Hasurdjiev S, Hughes S, Kautz A, Malik M, Manolakopoulos S, Maticic M,
Papatheodoridis G, Peck R, Peterle A, Potamitis G, Prati D, Roudot-
Thoraval F, Reic T, Sharara A, Shennak M, Shiha G, Shouval D, Socan M,
Thomas H, Thursz M, Tosti M, Trépo C, Vince A, Vounou E, Wiessing L, Manns
M.

Athens University Medical School, Athens, Greece.

The burden of disease due to chronic viral hepatitis constitutes a global
threat. In many Balkan and Mediterranean countries, the disease burden due
to viral hepatitis remains largely unrecognized, including in high-risk
groups and migrants, because of a lack of reliable epidemiological data,
suggesting the need for better and targeted surveillance for public health
gains.

In many countries, the burden of chronic liver disease due to hepatitis B
and C is increasing due to ageing of unvaccinated populations and
migration, and a probable increase in drug injecting. Targeted vaccination
strategies for hepatitis B virus (HBV) among risk groups and harm
reduction interventions at adequate scale and coverage for injecting drug
users are needed.

* Transmission of HBV and hepatitis C virus (HCV) in healthcare settings
and a higher prevalence of HBV and HCV among recipients of blood and blood
products in the Balkan and North African countries highlight the need to
implement and monitor universal precautions in these settings and use
voluntary, nonremunerated, repeat donors.

Progress in drug discovery has improved outcomes of treatment for both HBV
and HCV, although access is limited by the high costs of these drugs and
resources available for health care. Egypt, with the highest burden of
hepatitis C in the world, provides treatment through its National Control
Strategy.

Addressing the burden of viral hepatitis in the Balkan and Mediterranean
regions will require national commitments in the form of strategic plans,
financial and human resources, normative guidance and technical support
from regional agencies and research.

© 2013 John Wiley & Sons Ltd.

KEYWORDS: Balkan region, Mediterranean, hepatitis B, hepatitis C,
hepatocellular carcinoma, northern Africa, surveillance

Full free article:
http://onlinelibrary.wiley.com/doi/10.1111/jvh.12120/full
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Report from a Viral Hepatitis Policy Forum on Implementing
the WHO Framework for Global Action on Viral Hepatitis in North Asia
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23850942

J Hepatol. 2013 Jul 11. pii: S0168-8278(13)00447-9.

Report from a Viral Hepatitis Policy Forum on Implementing the WHO
Framework for Global Action on Viral Hepatitis in North Asia.

Chen DS, Locarnini S, Wait S, Bae SH, Chen PJ, Fung JY, Kim HS, Lu SN,
Sung J, Tanaka J, Wakita T, Ward J, Wallace J; CEVHAP North Asia Workshop
on Viral Hepatitis.

National Taiwan University College of Medicine, Taipei, Taiwan.

BACKGROUND AND AIMS: The World Health Organisation [WHO] Prevention &
Control of Viral Hepatitis Infection: Framework for Global Action offers a
global vision for the prevention and control of viral hepatitis. In
October 2012, the Coalition to Eradicate Viral Hepatitis in Asia Pacific
[CEVHAP] organised the North Asia Workshop on Viral Hepatitis in Taipei to
discuss how to implement the WHO Framework in the North Asia region. This
paper presents outcomes from this workshop.

METHODS: Twenty-eight representatives from local liver associations,
patient organisations and centres of excellence in Hong Kong, Japan, Korea
and Taiwan participated in the workshop.

FINDINGS: Priority areas for action were described along the four axes of
the WHO Framework: 1. Awareness, advocacy and resources; 2: Evidence and
data; 3: Prevention of transmission; and 4: Screening and treatment.
Priorities included: Axis 1: Greater public and professional awareness,
particularly among primary care physicians and local advocacy networks.
Axis 2: Better economic data and identifying barriers to screening and
treatment uptake. Axis 3: Monitoring of vaccination outcomes and targeted
harm reduction strategies. Axis 4: Strengthening links between hospitals
and primary care providers, and secure funding of screening and treatment,
including for hepatocellular carcinoma.

CONCLUSIONS: The WHO Framework provides an opportunity to develop
comprehensive and cohesive policies in North Asia and the broader region.
A partnership between clinical specialists, primary care physicians,
policy makers, and people with or at risk of viral hepatitis is essential
in shaping future policies.

Copyright © 2013. Published by Elsevier B.V. All rights reserved.

KEYWORDS: Asia, Hepatitis B, Hepatitis C, Policy
__________________________________________________________________
________________________________*_________________________________

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

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

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

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

Department of Prosthodontics, Jaipur Dental College, Jaipur, India.
draloksharmamds@gmail.com

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

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

RESULTS: Of the 144 questionnaires, 140 were returned and the answers
graded. The results showed that there was a poor level of knowledge and
awareness of biomedical waste generation hazards, legislation and
management among health care personnel. It was surprising that 36% of the
nurses had an extremely poor knowledge of biomedical waste generation and
legislation and just 15% of the Class IV employees had an excellent
awareness of biomedical waste management practice.

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

16. Abstract: Cosmetic Procedures Performed in the United States: A 16-
Year Analysis
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23866015

Dermatol Surg. 2013 Jul 18.

Cosmetic Procedures Performed in the United States: A 16-Year Analysis.

Ahn CS, Davis SA, Dabade TS, Williford PM, Feldman SR.

Department of Dermatology, Center for Dermatology Research, School of
Medicine, Wake Forest University, Winston-Salem, North Carolina.

BACKGROUND: Cosmetic procedures, particularly those that are minimally
invasive, are in demand. The physician specialties performing these
procedures are not well-characterized.

OBJECTIVE: To examine changes in the frequency of cosmetic dermatologic
procedures performed in the United States from 1995 to 2010 and the
physician specialties performing them.

METHODS: The volume of cosmetic procedures performed by physician
specialties and the types of cosmetic procedures performed were determined
from data from the National Ambulatory Medical Care Survey (NAMCS) from
1995 to 2010.

RESULTS: Cosmetic procedures constituted 8.7% of all skin procedures and
have increased since 1995 (p < .001). *** Botulinum toxin injections were
the most frequently performed cosmetic procedure and increased at the
greatest rate over time. Plastic surgeons performed the largest proportion
of cosmetic procedures (36.1%), followed by dermatologists (33.7%), but
other specialties have been performing an increasing proportion of
cosmetic procedures. This study was limited to the provision of outpatient
procedures, and the nationally representative data of the NAMCS is subject
to sample bias.

CONCLUSIONS: Plastic surgeons and other physicians performed the majority
of outpatient cosmetic procedures. Dermatologists performed one-third of
ambulatory cosmetic procedures from 1995 to 2010. This broadening spectrum
of physicians and nonphysicians providing cosmetic procedures may have
important implications for patient safety.

© 2013 by the American Society for Dermatologic Surgery, Inc. Published by
Wiley Periodicals, Inc.
__________________________________________________________________
________________________________*_________________________________

17. Abstract: Are major reductions in new HIV infections possible with
people who inject drugs? The case for low dead-space syringes in
highly affected countries
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22884539

Int J Drug Policy. 2013 Jan;24(1):1-7.

Are major reductions in new HIV infections possible with people who inject
drugs? The case for low dead-space syringes in highly affected countries.

Zule WA, Cross HE, Stover J, Pretorius C.

Substance Abuse, Treatment, Evaluations and Interventions Program, RTI
International, 3040 Cornwallis Road, Research Triangle Park, NC
27709-2194, United States. zule@rti.org

Circumstantial evidence from laboratory studies, mathematical models,
ecological studies and bio behavioural surveys, suggests that injection-
related HIV epidemics may be averted or reversed if people who inject
drugs (PWID) switch from using high dead-space to using low dead-space
syringes.

In laboratory experiments that simulated the injection process and rinsing
with water, low dead space syringes retained 1000 times less blood than
high dead space syringes.

In mathematical models, switching PWID from high dead space to low dead
space syringes prevents or reverses injection-related HIV epidemics.

No one knows if such an intervention is feasible or what effect it would
have on HIV transmission among PWID. Feasibility studies and randomized
controlled trials (RCTs) will be needed to answer these questions
definitively, but these studies will be very expensive and take years to
complete.

Rather than waiting for them to be completed, we argue for an approach
similar to that used with needle and syringe programs (NSP), which were
promoted and implemented before being tested more rigorously.

Before implementation, rapid assessments that involve PWID will need to be
conducted to ensure buy-in from PWID and other local stakeholders.

This commentary summarizes the existing evidence regarding the protective
effects of low dead space syringes and estimates potential impacts on HIV
transmission; it describes potential barriers to transitioning PWID from
high dead space to low dead space needles and syringes; and it presents
strategies for overcoming these barriers.

Copyright © 2012 Elsevier B.V. All rights reserved.

Comment in

Implementation of low dead-space syringes needs consultation and
engagement with drug users. [Int J Drug Policy. 2013]
http://www.ncbi.nlm.nih.gov/pubmed/23127667

Saying goodbye to high-dead-space syringes. [Int J Drug Policy. 2013]
http://www.ncbi.nlm.nih.gov/pubmed/23127666

How to encourage use of low dead space syringes? The Viet Nam experience.
[Int J Drug Policy. 2013] http://www.ncbi.nlm.nih.gov/pubmed/23122053

Low Dead-Space Syringes for HIV prevention among people who inject drugs:
interesting, but a much stronger case is required. [Int J Drug Policy.
2013] http://www.ncbi.nlm.nih.gov/pubmed/23127665

Dead space: a risk factor we did not see. [Int J Drug Policy. 2013]
http://www.ncbi.nlm.nih.gov/pubmed/23127663

Could low dead-space syringes really reduce HIV transmission to low
levels? [Int J Drug Policy. 2013]
http://www.ncbi.nlm.nih.gov/pubmed/23206493

Low dead space syringes: authors’ response.
http://www.ncbi.nlm.nih.gov/pubmed/23246189
__________________________________________________________________
________________________________*_________________________________

18. Abstract: Could low dead-space syringes really reduce HIV transmission
to low levels?
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23206493

Int J Drug Policy. 2013 Jan;24(1):8-14.

Could low dead-space syringes really reduce HIV transmission to low
levels?

Vickerman P, Martin NK, Hickman M.

Social and Mathematical Epidemiology group and Centre for Research on
Drugs and Health Behaviour, London School of Hygiene and Tropical
Medicine, London, UK. Peter.Vickerman@Lshtm.ac.uk

Studies published by Zule and colleagues have suggested that use of low
dead-space syringes (LDSS) instead of high dead-space syringes (HDSS) by
injecting drug users (IDUs) could dramatically reduce HIV transmission.
However, evidence is limited because experiments have considered a small
range of syringe types and have been unable to reliably estimate the
efficacy of using LDSS for reducing HIV transmission.

We critically appraise available evidence to determine whether using LDSS
is likely to dramatically reduce HIV transmission. We systematically
review the literature on the dead-space volume of syringes and estimate
the factor difference in blood volume transferred from sharing LDSS or
HDSS. Existing data on the relationship between host viral load and HIV
transmission risk is used to evaluate the likely efficacy of using LDSS
instead of HDSS. An HIV transmission model is used to make conservative
impact projections for switching to using LDSS, and explore the
implications of heterogeneity in IDU transmission risk and syringe
preferences.

Although highly variable, reviewed studies suggest that HDSS have on
average 10 times the dead-space volume of LDSS and could result in
6/54/489 times more blood being transferred after 0/1/2 water rinses.
Assuming a conservative 2-fold increase in HIV transmission risk per 10-
fold increase in infected blood inoculum, HDSS use could be associated
with a mean 1.7/3.6/6.5-fold increase in transmission risk compared to
LDSS for 0/1/2 rinses.

However, even for a low efficacy estimate, modelling suggests that
partially transferring to LDSS use from using HDSS could dramatically
reduce HIV prevalence (generally >33% if LDSS use is 50%), but impact will
depend on IDU behavioural heterogeneity and syringe preference.

Indirect evidence suggests that encouraging HDSS users to use LDSS could
be a powerful HIV prevention strategy. There is an urgent need to evaluate
the real life effectiveness of this strategy.

Copyright © 2012 Elsevier B.V. All rights reserved.

Comment in
Low dead space syringes: authors’ response. [Int J Drug Policy. 2013]
Comment on

Are major reductions in new HIV infections possible with people who inject
drugs? The case for low dead-space syringes in highly affected countries.
[Int J Drug Policy. 2013]
__________________________________________________________________
________________________________*_________________________________

19. Abstract: HIV and Related Risk Behaviors Among Female Sex Workers in
Iran: Bias-Adjusted Estimates from the 2010 National Bio-Behavoral
Survey
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23857356

AIDS Behav. 2013 Jul 16.

HIV and Related Risk Behaviors Among Female Sex Workers in Iran: Bias-
Adjusted Estimates from the 2010 National Bio-Behavoral Survey.

Mirzazadeh A, Nedjat S, Navadeh S, Haghdoost A, Mansournia MA, McFarland
W, Mohammad K.

Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance,
Institute for Futures Studies in Health, Kerman University of Medical
Sciences, Kerman, Iran, ali.mirzazadeh@hivhub.ir.

In a national, facility-based survey of female sex workers in 14 cities of
Iran (N = 872), HIV prevalence was measured at 4.5 % (95 % CI, 2.4-8.3)
overall and at 11.2 % (95 % CI, 3.4-18.9) for FSW with a history of
injection drug use.

Using methods to correct for biases in reporting sensitive information,
the estimate of unprotected sex in last act was 35.8 %, ever injecting
drugs was 37.6 %, sexually transmitted disease symptoms was 82.1 %, and
not testing for HIV in the last year was 64.0 %. The amount of bias
correction ranged from <1 to >30 %, in parallel with the level of stigma
associated with each behavior.

Considering the current upward trajectory of HIV infection in the Middle
East and North Africa region, as well as the ongoing high level of risky
behaviors and considerable underreporting of many such behaviors in
surveys, bias corrections may be needed, especially in the context of
Iran, to obtain more accurate information to guide prevention and care
responses to stop the growing HIV epidemic in this vulnerable group of
women.
__________________________________________________________________
________________________________*_________________________________

20. Abstract: Novel engineered systems for oral, mucosal and transdermal
drug delivery
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23869879

J Drug Target. 2013 Aug;21(7):611-29.

Novel engineered systems for oral, mucosal and transdermal drug delivery.

Li H, Yu Y, Faraji Dana S, Li B, Lee CY, Kang L.

Department of Pharmacy, National University of Singapore , Singapore and.

Technological advances in drug discovery have resulted in increasing
number of molecules including proteins and peptides as drug candidates.
However, how to deliver drugs with satisfactory therapeutic effect,
minimal side effects and increased patient compliance is a question posted
before researchers, especially for those drugs with poor solubility, large
molecular weight or instability.

Microfabrication technology, polymer science and bioconjugate chemistry
combine to address these problems and generate a number of novel
engineered drug delivery systems.

Injection routes usually have poor patient compliance due to their
invasive nature and potential safety concerns over needle reuse. The
alternative non-invasive routes, such as oral, mucosal (pulmonary, nasal,
ocular, buccal, rectal, vaginal), and transdermal drug delivery have thus
attracted many attentions.

Here, we review the applications of the novel engineered systems for oral,
mucosal and transdermal drug delivery.
__________________________________________________________________
________________________________*_________________________________

21. Abstract: Bacteriological Safety of Blood Collected for Transfusion at
University of Gondar Hospital Blood Bank, Northwest Ethiopia
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/23864956

ISRN Hematol. 2013 Jun 20;2013:308204.

Bacteriological Safety of Blood Collected for Transfusion at University of
Gondar Hospital Blood Bank, Northwest Ethiopia

Wondimu H, Addis Z, Moges F, Shiferaw Y.

Debre Tabor Health Science College, P.O. Box 83, Debre Tabor, Ethiopia.

Background. Transfusion associated bacterial infection has remained more
frequent with a sever risk of morbidity and mortality. This study assessed
the bacteriological safety of blood collected for transfusion.

Method. A cross-sectional study was conducted at University of Gondar
hospital blood bank from December 2011 to June 2012. Bacterial isolation,
identification, and antimicrobial susceptibility tests were done as per
the standard procedure. Chi-square test and P value were used to assess
associations between risk factors and the bacterial isolation rate.

Results. Twenty-one (15.33%) blood units were found contaminated with
bacteria, and 95.24% contamination was due to external sources. The
commonly isolated bacteria were Staphylococcus aureus, Coagulase negative
Staphylococci, Escherichia coli, Klebsiella species, Streptococci species,
Enterobacter species, and Citrobacter species. All of the bacteria
isolated were 100% sensitive to Gentamicin, Chloramphenicol, Amoxicillin,
and Doxycycline. Multiple antimicrobial resistances were observed in 66.7%
of the isolates. Not using glove by phlebotomist, touching disinfected
phlebotomy site and double puncture at the same hand or both hands of a
donor were found to be risk factors for bacterial contamination.

Conclusion. Bacterial contamination of blood to be transfused is a common
problem in the hospital. So attention should be given to activities
performed at the blood bank for safe transfusion practices.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705748/
__________________________________________________________________
________________________________*_________________________________

22. Abstract: Prevalence and factors associated with HCV infection among
elderly individuals in a southern Brazilian city
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23856863

Rev Soc Bras Med Trop. 2013;46(3).

Prevalence and factors associated with HCV infection among elderly
individuals in a southern Brazilian city.

Martins T, Machado DF, Schuelter-Trevisol F, Trevisol DJ, Silva RA,
Narciso-Schiavon JL, Schiavon Lde L.

Programa de Pós-Graduação em Ciências da Saúde, Universidade do Sul de
Santa Catarina, TubarãoSC.

Introduction Few Latin American studies have assessed the prevalence of
hepatitis C virus (HCV) infection in elderly individuals, in whom the
highest rates are expected. We aimed to investigate the prevalence of and
factors associated with HCV infection in elderly residents in the
municipality of Tubarão, Santa Catarina.

Methods This cross-sectional study included 820 individuals (aged = 60
years) who were selected by simple random sampling. The presence of anti-
HCV antibodies was tested by chemiluminescence, and HCV RNA detection was
performed for the anti-HCV- reactive subjects. Those individuals who were
anti-HCV reactive but had undetectable HCV RNA levels were tested using a
third-generation recombinant immunoblot assay. The variables were compared
using the chi- squared test or Fisher’s exact test, and those variables
with p < 0.05 were included in the logistic regression model.

Results The mean patient age was 68.6 years (SD 7.0 years); 39% were men,
and 92% were Caucasian. Eighteen subjects were anti-HCV positive. Among
these individuals, 4 were characterized as false-positives, leaving 14
(1.7%) individuals with confirmed infections for analysis. HCV infection
was associated with an age older than 65 years, households with 3 or more
residents and the previous transfusion of blood products. In the logistic
regression analysis, the following variables were independently associated
with HCV infection: households with 3 or more residents (OR 7.9, 95% CI
1.7-35.9, p = 0.008) and previous blood transfusion (OR 6.2, 95% CI
2.1-18.6, p = 0.001).

Conclusions The HCV prevalence in the elderly population in the
municipality of Tubarão was higher than that found in previous studies of
blood donors in the same region. Although exposure to contaminated blood
products remained important, other transmission routes, such as household
transmission, could play a role in HCV infection.

Free full text http://dx.doi.org/10.1590/0037-8682-0026-2013
__________________________________________________________________
________________________________*_________________________________

23. Abstract: Spectral signatures of viewing a needle approaching one’s
body when anticipating pain
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23859421

Eur J Neurosci. 2013 Jul 17.

Spectral signatures of viewing a needle approaching one’s body when
anticipating pain.

Höfle M, Pomper U, Hauck M, Engel AK, Senkowski D.

Department of Neurophysiology and Pathophysiology, University Medical
Center Hamburg-Eppendorf, Hamburg, Germany; Department of Psychiatry and
Psychotherapy, St. Hedwig Hospital, Charité – Universitätsmedizin Berlin,
St Hedwig Hospital, Berlin, Germany.

When viewing the needle of a syringe approaching your skin, anticipation
of a painful prick may lead to increased arousal. How this anticipation is
reflected in neural oscillatory activity and how it relates to activity
within the autonomic nervous system is thus far unknown.

Recently, we found that viewing needle pricks compared with Q-tip touches
increases the pupil dilation response (PDR) and perceived unpleasantness
of electrical stimuli. Here, we used high-density electroencephalography
to investigate whether anticipatory oscillatory activity predicts the
unpleasantness of electrical stimuli and PDR while viewing a needle
approaching a hand that is perceived as one’s own. We presented video
clips of needle pricks and Q-tip touches, and delivered spatiotemporally
aligned painful and nonpainful intracutaneous electrical stimuli.

The perceived unpleasantness of electrical stimuli and the PDR were
enhanced when participants viewed needle pricks compared with Q-tip
touches.

Source reconstruction using linear beamforming revealed reduced alpha-band
activity in the posterior cingulate cortex (PCC) and fusiform gyrus before
the onset of electrical stimuli when participants viewed needle pricks
compared with Q-tip touches. Moreover, alpha-band activity in the PCC
predicted PDR on a single trial level.

The anticipatory reduction of alpha-band activity in the PCC may reflect a
neural mechanism that serves to protect the body from forthcoming harm by
facilitating the preparation of adequate defense responses.

© 2013 Federation of European Neuroscience Societies and John Wiley & Sons
Ltd.

KEYWORDS: autonomic nervous system, beamforming, electroencephalography,
human, oscillations, pupil dilation response
__________________________________________________________________
________________________________*_________________________________

24. No Abstract: US Supreme Court strikes down anti-prostitution pledge
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23819154

Lancet. 2013 Jun 29;381(9885):2241.

US Supreme Court strikes down anti-prostitution pledge.

Devi S.
__________________________________________________________________
________________________________*_________________________________

25. No Abstract: Fungal infections associated with contaminated
methylprednisolone injections: review and insights
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23617220

N J Nurse. 2013 Apr;43(2):12.

Fungal infections associated with contaminated methylprednisolone
injections: review and insights.

Fowler SB, Carothers B.
__________________________________________________________________
________________________________*_________________________________

26. No Abstract: Playing it safe: a look at needlestick injuries
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23617047

Imprint. 2013 Feb-Mar;60(2):38-41.

Playing it safe: a look at needlestick injuries.

Foley M.

Center for Nursing Research and Innovation, University of California San
Francisco School of Nursing, USA.
__________________________________________________________________
________________________________*_________________________________

27. News

– Australia: No extra cash for needle exchange
– Pakistan: Rise in HIV/Aids cases feared due to non-availability of drug
– India: IAP introduces Safe Injection Environment Campaign in Hyderabad
– HCV decline associated with needle and syringe programs
– Australia: Kids’ Needle Prick Injury Causes HIV, Hepatitis Scare
– Africa: African leaders restate pledge to tackle HIV, TB, malaria
– Pakistan: Hepatitis emerges as major public health problem in Pakistan

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
www.examiner.com.au/story/1652490/no-extra-cash-for-needle-exchange/

Australia: No extra cash for needle exchange

By Michael Lowe, Tasmania Examiner, Tasmania Australia (22.07.13)

NEEDLE exchange funding is not keeping up with inflation but the state
government will not commit more money.

Yesterday marked the start of Hepatitis Awareness Week and a health group
has called for action to reduce incidence of the disease.

Alcohol, Tobacco and other Drugs Council Tasmania chief executive Jann
Smith said a council report showed that providing clean needles and
syringes to drug users was an effective way to reduce transmission of
blood-borne viruses such as hepatitis.

“It is difficult to understand the logic of not investing in harm-
reduction strategies such as the NSP (needle and syringe program) when
this reports highlights that needle and syringe programs return $4 for
every $1 invested through the avoidance of costs linked to treatment,” she
said.

But she said funding had recently declined in real terms and there were
availability gaps – including after hours, in regional areas and in
prisons.

Health Minister Michelle O’Byrne said yesterday that the state and federal
governments spent a total of $880,000 a year on needle exchanges, with
$540,000 coming from the state government. She would not commit to more
money.

Ms O’Byrne said the money went mainly to contracted providers, including
Anglicare, and those groups should talk to the department if there were
problems.

She said for prisoners, needles were provided for health processes and
there was a prison hospital.

“I think the needle exchange program is really important, it means that
people who live with an addiction can do so in a safe and healthy way,” Ms
O’Byrne said.

“We can help transition people off addictions or sometimes manage that
addiction in an appropriate manner and also the money we spend in this
space actually saves us money elsewhere.”

A hepatitis C education and awareness forum for service providers will be
held in Launceston tomorrow from noon at Anglicare, 116 Elizabeth Street.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/l34jyyv

Pakistan: Rise in HIV/Aids cases feared due to non-availability of drug

Ashfaq Yusufzai, Dawn, Pakistan (22.07.13)

PESHAWAR: Unavailability of Buprenorphine medicine could lead to increase
in the number of HIV/Aids patients in Khyber Pakhtunkhwa and nearby
Federally Administered Tribal Areas, officials said.

They said that shortage of the medicine had also been hampering
detoxification plan of the injection drug users in the province.

“We have in Pakistan Buprenorphine in 0.2mg strength while the dose given
to the drug-addicts is between 4 to 6mg, which means that those undergoing
detoxification will take 150 tablets in one time, which was not
appropriate medically,” officials of the health department told Dawn.

They said that the Global Fund had signed an MoU with the government under
which the latter would start running a 12-bed ward adjacent to the
psychiatry ward at the Lady Reading Hospital within a month.

However, its seems that the proposed ward is unlikely to start its
function concerning detoxification due to unavailability of medicines for
oral consumption of addicts during the treatment regime.

The officials said that the health authorities had planned to import the
drug in required strength and make it possible to treat the people using
heroin through injections.

“For Opium Substitute Therapy, we need Buprenorphine because it is the
only option in such cases,” they said and added that the Drug Regulatory
Authority was spearheading the effort to make the drug available in the
country.

A recent survey conducted by the UNODC a month ago found that 11 per cent
population of Khyber Pakhtunkhwa have used different forms of drugs,
including heroin, cannabis etc. The officials said that another study done
in 2012 on injection drugs users saw presence of HIV/Aids in 20 per cent
of them.

They said that only Peshawar had 1,850 drug users who shared needles while
consuming the drug in groups. Non-existence of the UN’s Needle Syringe
Programme is another factor that could flare up the disease.

“Not only this but cases in police, jail and recently a positive case from
University of Peshawar are a cause of concern,” the officials said.
According to them, the Provincial Aids Control Programme has also stopped
provision of services for targeted invention due to non-availability of
funds. Targeted intervention, for example, with drug users could deliver
desired results, they said.

The officials said that a new PC-1 was being submitted with the Planning
and Development Department after the PACP completed its first phase on
June 30 and another Rs358 million had been allocated in the current’s year
annual development programme.

They said that the province and Fata had 1,200 cases of HIV/Aids, but the
matter of concern was that the disease which was considered to be imported
by immigrant workers from Middle Eastern countries had been found in
people who had no travel history abroad.

The health department detects 20-30 cases of HIV/Aids every month. The
department has also requested the social welfare department to establish
the rehabilitation and detoxification centres in Peshawar instead of
Swabi, Malakand and Dera Ismail Khan, they said.

The officials said that the department had argued that it would provide
detoxification services to the addicts under international protocols and
coordinate with the social welfare department for their rehabilitation.

They said that immediate steps were needed to control the virus in
circulation before it reached more people.
__________________________________________________________________
__________________________________________________________________
http://www.pharmabiz.com/NewsDetails.aspx?aid=76533&sid=1

India: IAP introduces Safe Injection Environment Campaign in Hyderabad

pharmabiz.com, Our Bureau, Hyderabad India (18.07.13)

The Indian Academy of Paediatrics (IAP), in association with Becton,
Dickinson & Co. (BD India), a leading medical technology company, has
launched Safe Injection Environment (SIE) programme in Hyderabad.

Targeted at paediatricians and healthcare professionals, the main aim of
the SIE programme is to train safe injection practices among healthcare
professionals and help protect patients from infections caused by unsafe
practices.

While releasing a guide book of safe injection practices, Dr Himabindu
Singh, IAP president, Hyderabad, said, “IAP’s objective is to protect
children from greater risks and health threats caused due to unsafe
injections. One of the safest options to guarantee the safety of an
injection is to use auto-disable syringes that block the plunger after a
single use. They are the safest devices for injections because they can be
used only once.”

Apart from Dr Himabindu Singh, Dr Sailesh Gupta, secretary general, IAP,
along with dozens of paediatricians took part at the launch of the SIE
programme. The organisers have designed SIE campaign to conduct training
workshops across 12 cities in India.

In addition to creating awareness about safe injection practices among
healthcare professionals, the SIE programme also aims at working with
government bodies and NGOs to ensure adoption of training curriculum of
health workers. “The safe injection environment programme is aligned with
BD’s purpose of helping all people live healthy lives,” said Dr Bhaskar
Sonowal, technical advisor – Infection Control and Patient Safety, BD in
India.

Dr Sailesh Gupta, the National IAP Coordinator of Safe Injection
Programme, said, “Injections are one of the most common healthcare
interventions globally, yet they do not receive as much attention in the
medical world as they should. Healthcare practitioners are vulnerable to
needle-stick injuries. This workshop focuses on sensitizing them about the
latest standards and best practices in safe injection techniques.”

Over 16 billion injections are administered annually in the world. The
journey of children with injections starts in their first few months
through preventive immunization. Healthcare professionals often reuse
syringes or needles assuming that they are safe. They also recap the
needles after use and throw the plastic and sharps waste in a single
container. Such wrong practices need to be corrected through regular
sensitization and training about the best practices for safe injections.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/mb5sj9z

HCV decline associated with needle and syringe programs

By Jenny Iversen, Healio.com (18.07.13)

Iversen J. Am J Public Health. 2013;103:1436-1444.

There was a significant reduction in hepatitis C incidence in Australia
among injection drug users who attended needle and syringe programs,
according to data published in the American Journal of Public Health.

“The decline in new cases of hepatitis C among people who inject drugs
coincided with the expansion of programs like opioid substitution therapy
and needle and syringe programs, which aim to minimize the spread of
bloodborne viruses,” Jenny Iversen, a PhD candidate at the Kirby Institute
at the University of New South Wales in Sydney, said in a press release.
“We also found that fewer young people are starting to inject drugs and
that the types of drugs people are injecting have changed, which may have
contributed to a decline in the number of people contracting the virus.”

Iversen and colleagues conducted a passive retrospective study that
included a cohort of 724 injection drug users who tested negative for HCV
antibodies. The participants had been part of the annual Australian Needle
and Syringe Programs Survey and had completed the survey for consecutive
years or with only a 1-year gap from 1995 to 2010.

Among the 724 participants, 180 had HCV seroconversions, for a pooled
incidence density of 17 per 100 person-years (95% CI, 14.68-19.66). The
incidence density varied each year, peaking at 30.8 per 100 person-years
in 2003 (95% CI, 21.3-44.6), then declining to 4 per 100 person-years in
2009 (95% CI, 1.3-12.3). In a multivariable analysis, independent
predictors of HCV seroconversion included imprisonment in the previous 12
months, daily or more frequent injection, residence in mainland eastern
Australia and injection of cocaine, heroin or other drugs, compared with
injection of methamphetamine.

“These results demonstrate the value of ongoing investment in Australia’s
internationally recognized system for the surveillance of HIV and
hepatitis C among people who inject drugs,” Lisa Maher, PhD, head of the
viral hepatitis epidemiology and prevention program at Kirby Institute,
said in a press release. “This is the first time in the world this method
has been used to estimate hepatitis C incidence and the first report of
incidence in a national sample of people who inject drugs. It allows us to
assess the uptake and impact of prevention and treatment interventions in
this group.”

Disclosure: Iversen and Maher report no relevant financial disclosures.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/k5e66zb

Australia: Kids’ Needle Prick Injury Causes HIV, Hepatitis Scare

By Sam Rigney, Newcastle Herald, Australia (18.07.13)

MORE than a dozen children are being tested for HIV and hepatitis after
they were pricked by a blood glucose monitor at a Hunter Valley school.

A boy in year 5 has told staff he brought the “diabetic tester” to school
on Wednesday after paramedics, who came to his home to treat his ill
sister, left it behind.

The pricking began on the school bus and grew into a running game where
the boy asked unsuspecting students to “show us how small your hand is”, a
parent at the school told the Newcastle Herald last night. When the
children put out their hand, they were jabbed with the small hand-held
device, which pierces the skin to test the concentration of glucose in the
blood for diabetes sufferers.

The parent said as many as 14 children – some as young as five – were
pricked on their hands, arms and fingers. She said she wasn’t notified
until her daughter returned fromschool on Wednesday afternoon. She was one
of about 15 parents who confronted staff at the school early yesterday.
“My daughter was pricked and we didn’t find out until she got home from
school because she didn’t tell anyone. “She just told teachers she felt
sick and went into the sick bay,” she said. “We were disgusted when we
first found out, we were shocked, it was horrible. It’s every parent’s
nightmare. “The parents are angry. The school hasn’t told us much at all,
they’ve just brushed it off at the moment.” She said the group of parents
were told they would only be addressed one by one.

The Newcastle Herald has chosen not to name the school to avoid
identifying the children. She said her daughter went to the doctor on
Wednesday and had blood tests yesterday. “It’s really scary.

“She’s been tested for AIDS and hepatitis B and C and she will have to
have another test in three months,” she said. “They are saying there is
not much chance she’s going to catch it but it’s alarming all the same.”

The parent said her daughter and a number of the other children had
returned to school. A Department of Education spokesman said students had
undergone an “age-appropriate discussion” since the incident on Wednesday.

“[On Wednesday] a male student brought a diabetics tester that he says
paramedics left at his home after treating a sibling,” he said. “He and
other students played a game imitating the paramedics that he had
observed. “When staff became aware of the game they immediately took
possession of the tester.

“They went from class to class seeking to identify any student who had
been involved in the game and commenced the precautionary protocol.
“Parents of students who were identified as being involved in the game
were notified yesterday. “[Yesterday] each class conducted an age-
appropriate discussion so the students better understand the potential
risk of such games.” The same statement was published in the school’s
newsletter yesterday and attributed to the relieving principal.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/o9p4kdh

Africa: African leaders restate pledge to tackle HIV, TB, malaria

By Mohammed Abubakar, Chukwuma Muanya, Emeka Anuforo, John Okeke

The Guardian Nigeria (16.07.13)

THE Special Summit of the African Union on HIV/ AIDS, Tuberculosis and
Malaria ended in Abuja Tuesday with the leaders recommitting themselves to
the declaration they made at a similar meeting in 2001, to increase
funding towards finding solution to the diseases.

In April 2001, African Union countries meeting in Abuja, Nigeria, pledged
to increase government funding for health to at least 15 per cent, and
urged donor countries to scale up support. Statistics from the World
Health Organisation (WHO) indicate that one African country has reached
that target as at 2011.

With little evidence to proof that more African countries have met the
budgeting targets, the member countries again promised to work towards
achieving the initial declaration.

They also agreed to pay greater attention to domestic funding and private
sector support.

During a briefing at the end of the Summit, Nigerian President Goodluck
Jonathan, Chairperson of the African Union, Dr. Hailemariam Dessalegn and
Chairperson of the African Union Commission, Dr. Nkosazana Zuma, spoke on
the declaration of the 2013 Summit and promised, on behalf of AU member
countries, to accelerate the implementation of the earlier ‘Abuja
Commitments’ and step up the mobilisation of domestic resources to
strengthen the health system.

They agreed to ensure that strategies are in place for diversified,
balanced and sustainable financing for health, in particular AIDS, TB and
Malaria, through development of strategic health investment plans and
strategies for innovative financing, by also the private sector. They also
agreed to implement effective and targeted poverty elimination strategies
and social protection programmes that integrate HIV and AIDS, TB and
Malaria for all, particularly vulnerable populations.

It was agreed that the leaders will review relevant laws and policies at
national and regional levels to strengthen rights-based protection for all
vulnerable and key populations in the context of the three diseases, and
increase access to prevention programmes targeting the youth, especially
young women, to ensure an AIDS-free generation.

The Summit resolved to set up national, regional and continental
monitoring and evaluation system for better implementation of commitments
as well as ownership and accountability, accelerate HIV Prevention
Programmes, using a combination of effective evidence-based prevention, in
particular for young people, women, girls and other vulnerable populations
to successfully reduce the number of new HIV infections towards the goal
of zero new infections by 2030. The leaders pledged to eliminate mother-
to-child transmission of HIV, while keeping mothers alive and addressing
the disproportionate impact of the three diseases on children, girls and
women.
__________________________________________________________________
__________________________________________________________________
http://www.thenews.com.pk/NewsDetail.aspx?ID=108757

Pakistan: Hepatitis emerges as major public health problem in Pakistan

By APP (10.07.13)

KARACHI: Hepatitis has emerged as a major public health problem in the
country with an estimated number of six million suffering from Hepatitis B
and another seven million suffering from Hepatitis C.

Dr Syed Hussain Askary, Head of Public and Dental Health Department,
Fatima Jinnah Dental College (FJDC) addressing a seminar on Wednesday said
Pakistan is currently facing an epidemic of viral hepatitis.

“Fifteen million people somehow harbor hepatitis viruses in their bodies,”
he said.

Dr Askary also FJDC Director Academics and Administration said 4.9%
country’s population is inflicted with hepatitis C and 2.4% for hepatitis
B, besides those who at one or the other point of time had been exposed to
Hepatitis A and E.

“The given situation demands a comprehensive approach for prevention of
the ailment as well as timely and proper intervention to it,” he said.

FJDC Director for Academics said that Fatima Jinnah Dental College and
Hospital has chalked out a month long series of activities to raise public
awareness about prevention and early diagnosis for treatment of Hepatitis.

The seminar was attended by more than 200 young doctors and senior
hepatologists (experts in liver diseases).
__________________________________________________________________
________________________________*_________________________________
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__________________________________________________________________
________________________________*_________________________________

The 2010 annual Safe Injection Global Network meeting to aid collaboration
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The SIGN 2010 meeting report pdf, 1.36Mb is available on line at:
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