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SIGNpost 00728

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00728 HC Waste + Data? + Abstracts + News 15 January 2014

CONTENTS
1. New report: Assessment of Health Care Waste Management Practices in
Three Districts in Uganda
2. Comment: Using Bad Data to Obscure Deadly Errors
3. Abstract: Needlestick and sharps injuries among medical undergraduate
students
4. Abstract: Medical graduates’ knowledge of bloodborne viruses and
occupational exposures
5. Abstract: Assessment of injection practice in primary health care
facilities of Shiraz, Iran
6. Abstract: Effects of training course on occupational exposure to
bloodborne pathogens: a controlled interventional study
7. Abstract: The management of needlestick injuries
8. Abstract: In reply. The management of needlestick injuries. Index
patient’s details are important
9. Abstract: US CDC Guidance for Evaluating Health-Care Personnel for
Hepatitis B Virus Protection and for Administering Postexposure
Management
10. Abstract: Impact of a single safety-engineered device on the
occurrence of percutaneous injuries in a general hospital in Brazil
11. Abstract: Knowledge and Attitude of Basic Health Workers (BHWs) toward
HIV/AIDS
12. Abstract: Knowledge, attitude and practice of hospital staff
management
13. Abstract: Decline in incidence of HIV and hepatitis C virus infection
among injecting drug users in Amsterdam; evidence for harm reduction?
14. Abstract: Outcome assessment of a triangular clinic as a harm
reduction intervention in Rajaee-Shahr Prison, Iran
15. Abstract: Drug use as a driver of HIV risks: re-emerging and emerging
issues
16. Abstract: Factors associated with overdose-caused mortality of HIV-
positive patients who were on methadone maintenance treatment program
17. Massachusetts injection drug users: an observational study
18. Abstract: Emergence of cocaine and methamphetamine injection among
HIV-positive injection drug users in Northern and Western India
19. Abstract: Factors associated with recent symptoms of an injection site
infection or injury among people who inject drugs in three English
cities
20. Abstract: Steroid users and the unique challenge they pose to needle
and syringe program workers
21. Abstract: Health care workers’ hand contamination levels and
antibacterial efficacy of different hand hygiene methods used in a
Vietnamese hospital
22. Abstract: Accuracy of physician reporting in routine public health
surveillance for hepatitis C virus infection
23. Abstract: Risk factors for recent nonfatal overdose among HIV-infected
Russians who inject drugs
24. Abstract: Less-established risk factors are common in Asian Americans
with hepatitis C virus: a case-controlled study
25. Abstract: Compliance with hygiene guidelines: the effect of a
multimodal hygiene intervention and validation of direct observations
26. Abstract: Bacterial contamination of mobile phones shared in hospital
wards and the consciousness and behavior of nurses about biological
cleanliness
27. Abstract: Reports to the Vaccine Adverse Event Reporting System after
hepatitis A and hepatitis AB vaccines in pregnant women
28. Abstract: Copper–a weapon in the war on pathogens
29. No Abstract: EASL Clinical Practice Guidelines: Management of
hepatitis C virus infection
30. News
– Canada: The need for prison needle exchange programs
– India: Hepatitis-C outbreak: Ten deaths in two months, and counting
Fear grips South Kashmir villages; Govt fails to keep word on free
treatment to patients; Centre rejects vital proposal
– Arizona USA: More detail given on medical breach at prison
– China: China Says Vaccines Didn’t Cause 9 Kids’ Deaths
– USA: Warren County offering sharps disposal program

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________________________________*_________________________________

1. New report: Assessment of Health Care Waste Management Practices in
Three Districts in Uganda
__________________________________________________________________
From AIDSTAR-One

New: Assessment of Health Care Waste Management Practices in Three
Districts in Uganda

Increasingly, health care waste (HCW) is generated in significantly large
volumes and of diverse types. In order to fully understand the prevailing
practices of managing HCW and methods of final waste disposal at health
facilities in the targeted districts, AIDSTAR-One conducted a cross-
sectional facility-based survey and a record review of the treatment and
disposal facilities to determine benchmarks for HCWM practices in the
project districts.

Please access this resource on the AIDSTAR-One website at:
http://aidstarone.com/focus_areas/prevention/resources/report/hcwm_uganda.

Download the Assessment of Health Care Waste Management Practices in Three
Districts in Uganda (PDF, 566 KB)
http://aidstarone.com/sites/default/files/AIDSTAROne_HCWM_Uganda.pdf
__________________________________________________________________
________________________________*_________________________________

2. Comment: Using Bad Data to Obscure Deadly Errors

Crossposted from http://dontgetstuck.wordpress.com/ with thanks
__________________________________________________________________
http://tinyurl.com/pm9a6bp

http://dontgetstuck.wordpress.com/

Using Bad Data to Obscure Deadly Errors

Posted by David Gisselquist on December 23, 2013

In an article published in early December 2012, Jacques Pepin and
colleagues reported that less than 1 in 20 Africans received an unsafe
injection in 2010.[1] According to them, this was a huge improvement from
the situation in 2000, when more than 1 in 3 got an unsafe injection.

The story sounds good, but let’s put it into context.

First, these rosy estimates distract from facts that need answers. Why do
16%-31% of HIV-positive children in Mozambique, Swaziland, and Uganda,
have HIV-negative mothers (among children with tested mothers; see:
http://dontgetstuck.wordpress.com/cases-unexpected-hiv-infections/). Why
do so many mutually monogamous couples find that one or both partners are
HIV-positive?

Second, the authors accept a double standard. In countries that fund
health aid programs in Africa, governments respond to recognized reuse of
unsterile instruments in health care with investigations to see if
patients have been harmed. For example, after authorities in New Zealand
found that a clinic had reused unsterilized instruments, governments of
New Zealand and Australia issued a public notice warning people who had
attended the clinic during 2010-12 that they might have been exposed to
hepatitis B, C, or HIV and inviting them to come for tests.[2] But if the
clinic with recognized unsafe procedures is in Africa, the response is
entirely different. In Africa, people who present themselves as concerned
and knowledgeable about health care safety, such as Pepin and colleagues,
estimate that percentages of procedures are unsafe without asking for
investigations. Such bland acceptance of deadly errors endorses a double
standard.

Third, what Pepin and others state as facts are weak estimates based on
unreliable data. Most of their data for 2010 comes from national surveys
that asked people – in the midst of several hours of questions[3] about
diet, education, birth control, sexual behavior, and blah, blah, blah –
how many injections they had in the last year and whether the syringe and
needle for the last injection came from a sealed pack. In a long survey,
people are not able to take time to think and remember. Even with time to
think, it’s hard to remember numbers of injections over the past year.
Consider: A survey in India asked people if they had received an injection
in the last 2 weeks and if they had received an injection in the last 3
months. The estimated number of injections per person per year was 5.9
based on 2 week recall, but only 2.9 based on 3 month recall.[4]

A bad manager listens to sycophants who tell him soothing fantasies that
encourage him to ignore uncomfortable facts. I expect there will be many
bad managers in health aid organizations and in African ministries of
health who will be only too ready to cite Pepin and colleagues’ soothing
fantasies rather than to do the right thing – to trace and investigate
sources of HIV infection. Pepin and colleagues are not alone. For decades,
sycophants who can cobble together weak evidence and arguments to say
Africans only rarely get HIV from health care have gotten more attention
than so many HIV-positive children with HIV-negative mothers.

References

[1] Pepin J, Abou Chakra CN, Pepin E, Nault V (2013) Evolution of the
Global Use of Unsafe Medical Injections, 2000–2010. PLoS ONE 8(12):
e80948.

doi:10.1371/journal.pone.0080948. Available at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3851995/pdf/pone.0080948.pdf
(accessed 22 December 2013).

[2] NZers warned over HIV at Sydney clinic. New Zealand: NZCity, 16
December 2013. Available at: http://tinyurl.com/l34v4ab (accessed 22
December 2013).

[3] ICF International. Demographic and Health Surveys Methodology:
Questionnaires: Household, Woman’s, and Man’s. Calverton, Maryland: ICF
International, 2011. Available at:
http://www.measuredhs.com/pubs/pdf/DHSQ6/DHS6_Questionnaires_5Nov2012_DHSQ
6.pdf (accessed 23 December 2013).

[4] See Table II in: Arora N K, et al. Assessment of Injection Practices
in India, Executive Summary. New Delhi: InClen Trust, 2005. Available at:
http://www.inclentrust.org/uploadedbyfck/file/complete%20Project/Executive
%20summaru/15_Main%20Report%20Book%20(29-6-06)%20only.pdf (accessed 22
December 2013).
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Needlestick and sharps injuries among medical undergraduate
students
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24387948

Am J Infect Control. 2014 Jan 2. pii: S0196-6553(13)01213-3.

Needlestick and sharps injuries among medical undergraduate students.

Lauer AC1, Reddemann A1, Meier-Wronski CP2, Bias H2, Gödecke K3, Arendt
M3, Peters H4, Gross M5.

BACKGROUND: Needlestick and sharps injuries (NSIs) can cause a
transmission of bloodborne diseases. In this study, injury rate, accident
mechanisms, and targets for preventive strategies were investigated at a
major university hospital hosting different medical study programs.

METHODS: In 2009 and 2010, cross-sectional anonymous surveys were carried
out among medical undergraduate students. Furthermore, all NSIs reported
to the accident insurer from 2007 to 2010 were analyzed. This spans the
comprehensive introduction of safety instruments in the university
hospital in 2008.

RESULTS: The online survey was completed by 1,214 students in 2009 and 917
students in 2010. Results show an injury rate of 21.4% per year (mean
value). Accidents are mostly related to vein puncture, surgical
procedures, and instrument disposal. Comparing 2 parallel medical
programs, the educational curriculum using objective structured clinical
examinations, which are associated with significantly lower NSI
incidences. The rate of under-reporting is 53% (mean value). Analysis of
the injury reports made to the accident insurer showed a 50% decrease in
NSIs surrounding the introduction of safe instruments.

CONCLUSION: Undergraduate medical students are at high risk of NSIs. Safe
instruments and university instructions can prevent NSIs. Reporting
procedures should be part of medical undergraduate training.

Copyright © 2014 Association for Professionals in Infection Control and
Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

KEYWORDS: Cross-sectional surveys, Medical education, Prevention,
Reporting rate, Safety instruments
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Medical graduates’ knowledge of bloodborne viruses and
occupational exposures
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24360355

Am J Infect Control. 2013 Dec 17. pii: S0196-6553(13)01197-8.

Medical graduates’ knowledge of bloodborne viruses and occupational
exposures.

Koehler N1, Vujovic O2, Dendle C3, McMenamin C4.

A survey of medical graduates commencing employment as junior doctors was
performed to investigate knowledge of bloodborne viruses and occupational
exposure management, coupled with their experience of occupational
exposures.

There was a mismatch between general knowledge (excellent) and knowledge
of postexposure management (poor), and graduates had commonly experienced
an occupational exposure and not reported it.

The knowledge deficit regarding postexposure management and history of
poor practice (ie, nonreporting) following an exposure implies that the
transition period from student to junior doctor may be associated with
increased occupational health and safety risk.

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

KEYWORDS: Needlestick injury, Occupational exposure management,
Postexposure prophylaxis
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Assessment of injection practice in primary health care
facilities of Shiraz, Iran
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24406260

Am J Infect Control. 2014 Jan 6. pii: S0196-6553(13)01219-4.

Assessment of injection practice in primary health care facilities of
Shiraz, Iran.

McLaws ML1, Ghahramani S2, Palenik CJ3, Keshtkar V4, Askarian M5.

BACKGROUND: Occupational risk for several bloodborne viruses is
attributable to unsafe injection practices. To understand injection
frequency and safety, we surveyed injection rates and factors influencing
injection prescription in primary health care facilities and associated
health clinics in Shiraz, Iran.

METHODS: We used both quantitative and qualitative approaches to study the
frequency and safety of injections delivered in 27 primary health care
facilities. We used observations and 3 data collecting tools. Patterns of
600 general practice physicians’ (GPs) prescriptions were also reviewed.
In-depth interviews to elicit the factors contributing to injection
prescriptions were conducted.

RESULTS: The annual per capita injection rate was 3.12. Corticosteroids
were prescribed more frequently than antibiotics (P < .001). Knowledge of
participants concerning transmission risks for 3 of the most common
bloodborne infections (BBIs) was less than 75%. Factors affecting use of
injections by GPs included strong patient preference for injections over
oral medications and financial benefit for GPs, especially those in
private practice settings.

CONCLUSION: Frequency of therapeutic injections in the participating
facilities in Shiraz was high. Sociocultural factors in the patient
community and their beliefs in the effectiveness of injections exerted
influence on GP prescribing practices. Programs for appropriate and safe
injection practices should target GP and injection providers, as well as
patients, informing them about alternative treatments and possible
complications of unnecessary and unsafe injections.

Copyright © 2014 Association for Professionals in Infection Control and
Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

KEYWORDS: Antibiotic, Medication, Prescribing, Route, Unsafe
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Effects of training course on occupational exposure to
bloodborne pathogens: a controlled interventional study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883246/

Int J Prev Med. 2013 Nov;4(11):1236-42.

Effects of training course on occupational exposure to bloodborne
pathogens: a controlled interventional study.

Mehrdad R, Meshki M, Pouryagub G.

BACKGROUND: One of the serious occupational concerns in health care
workers (HCWs) is exposure to blood/body fluids that can transmit blood
borne pathogens such as human immunodeficiency virus and hepatitis B and C
viruses. We are reporting the effects of training course and surveillance
on the rate of needle stick injuries (NSIs) among HCWs at an educational
hospital in Iran.

AIMS: To evaluate the effects of training course on the rate of NSIs and
its reporting.

METHODS: We selected two hospitals (A&B) based on their similarities in
wards and facilities then asked the managers of these two hospitals to
participate in our study. We established a new occupational health center
and conducted a training course at hospital A on 2010 and compared it with
control group (hospital B). The data from 2009 to 2011 was collected,
analyzed to compare pre and post intervention rates.

RESULTS: DURING STUDY PERIOD NURSES SUSTAINED THE HIGHEST NUMBER OF
INJURIES (HOSPITAL A: n=80; 66.1% and hospital B: n=64; 35.4%). The
incidence rate of NSIs in hospital A was 7.16 NSI/100FTE/YEAR before the
intervention which was increased to 12.06 after the intervention. In
hospital B this rate was 6.05 during three years.

CONCLUSIONS: The study revealed remarkable increase in the incidence rate
of NSIs after the intervention. This is being achieved by meticulous
surveillance, training course and improving awareness.

KEYWORDS: Bloodborne pathogens, health care workers, needle stick injuries

Free full article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883246/
__________________________________________________________________
________________________________*_________________________________

7. Abstract: The management of needlestick injuries
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576594/

Dtsch Arztebl Int. 2013 Feb;110(5):61-7.

The management of needlestick injuries.

Himmelreich H, Rabenau HF, Rindermann M, Stephan C, Bickel M, Marzi I,
Wicker S.

BACKGROUND: An estimated 1 million needlestick injuries (NSIs) occur in
Europe each year. The Council Directive 2010/32/EU on the prevention of
NSIs describes minimum requirements for prevention and calls for the
implementation of local, national and Europe-wide reporting systems. The
Directive is to be implemented by all EU member states by 11 May 2013. The
purpose of this study was to assess (and improve) the procedures for the
reporting and treatment of needlestick injuries in a German tertiary-care
hospital.

METHODS: We carried out a prospective observational study of the NSI
reporting system in the hospital over a period of 18 months and determined
the incidence of NSIs, the prevalence of blood-borne pathogens among index
patients, the rate of initiation of post-exposure prophylaxis, and the
rate of serological testing of the affected health care personnel.

RESULTS: 519 instances of NSI were reported to the accident insurance
doctor over the period of the study, which consisted of 547 working days.
86.5% of the index patients underwent serological study for hepatitis B
and C (HBV and HCV) and for the human immune deficiency virus (HIV); this
resulted in two initial diagnoses (one each of active hepatitis B and
hepatitis C) in the index patient. 92 of 449 index patients, or one in
five, was infected with at least one blood-borne pathogen. HIV post-
exposure prophylaxis was initiated in 41 health care workers. One case of
hepatitis C virus transmission arose and was successfully treated. Other
than that, no infection was transmitted.

CONCLUSION: Complete reporting of NSIs is a prerequisite for the
identification of risky procedures and to ensure optimal treatment of the
affected health care personnel. The accident insurance doctor must possess
a high degree of interdisciplinary competence in order to treat NSI
effectively.

Comment in

In reply. [Dtsch Arztebl Int. 2013]

Index patient’s details are important. [Dtsch Arztebl Int. 2013]

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576594/
__________________________________________________________________
________________________________*_________________________________

8. Abstract: In reply. The management of needlestick injuries. Index
patient’s details are important
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3702028/

Dtsch Arztebl Int. 2013 Jun;110(23-24):420.

In reply.

Wicker S, Marzi I.

Comment on

Index patient’s details are important. [Dtsch Arztebl Int. 2013]
The management of needlestick injuries. [Dtsch Arztebl Int. 2013]

Correspondence (reply): In Reply
Sabine Wicker, PD Dr. med.* and Ingo Marzi, Prof. Dr. med.**

See the article”The Management of Needlestick Injuries” in volume 110 on
page 61.

Testing the index patient after a needlestick injury is the prerequisite
for optimal medical care for affected medical staff. Awareness of the
infectious status of the index patient enables individual therapy and in
case of a negative HIV test result prevents potentially serious adverse
effect due to post-exposure prophylaxis (HIV-PEP).

In routine clinical practice, however, uncertainty often prevails about
the extent to which the patient can be forced to have a blood test in
order to avert possible harm to the affected staff members.

From our interdisciplinary perspective we regard testing the index patient
as appropriate and usually in accordance with their statutory rights (1).

Recent studies have shown that, in addition to the risk of infection,
psychosomatic/psychiatric disorders may develop after a needlestick injury
(2). A negative test result that is communicated as rapidly as possible
unburdens the staff member, whereas a needlestick injury in an infectious
patient should be closely monitored in order to avoid psychological or
physical disorders, or at least identify and treat them quickly.

The scenarios described by Dr Teterin outside the hospital require a legal
clarification as a first step and as a second step, appropriate
communication and organization, in order to also treat non-medical staff
(for example, first aiders or police) appropriately.

Acknowledgments: Professor Marzi declares that no conflict of interest
exists

Footnotes

Conflict of interest statement

PD Dr Wicker has received reimbursement of travel and accommodation
expenses and received lecture fees from B Braun, BD, BV-Med, and pfm.

Go to:
References
1. Wicker S, Gottschalk R, Spickhoff A, Rabenau HF. HIV-Test nach
Nadelstichverletzung: Muss der Indexpatient zugestimmt haben? Dtsch Med
Wochenschrift. 2008;133:1517–1520. [PubMed]
2. Green B, Griffiths EC. Psychiatric consequences of needlestick injury.
Occup Med. 2013;631:83–88.
3. Himmelreich H, Rabenau HF, Rindermann M, Stephan C, Bickel M, Marzi I,
Wicker S. The management of needlestick injuries. Dtsch Arztebl Int.
2013;110(5):61–67. [PMC free article] [PubMed]
Articles from Deutsches Ärzteblatt International are provided here
courtesy of Deutscher Arzte-Verlag GmbH
__________________________________________________________________
________________________________*_________________________________

9. Abstract: US CDC Guidance for Evaluating Health-Care Personnel for
Hepatitis B Virus Protection and for Administering Postexposure
Management
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24352112

MMWR Recomm Rep. 2013 Dec 20;62(RR-10):1-19.

CDC Guidance for Evaluating Health-Care Personnel for Hepatitis B Virus
Protection and for Administering Postexposure Management.

1National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention,
CDC.

This report contains CDC guidance that augments the 2011 recommendations
of the Advisory Committee on Immunization Practices (ACIP) for evaluating
hepatitis B protection among health-care personnel (HCP) and administering
post-exposure prophylaxis.

Explicit guidance is provided for persons working, training, or
volunteering in health-care settings who have documented hepatitis B
(HepB) vaccination years before hire or matriculation (e.g., when HepB
vaccination was received as part of routine infant [recommended since
1991] or catch-up adolescent [recommended since 1995] vaccination).

In the United States, 2,890 cases of acute hepatitis B were reported to
CDC in 2011, and an estimated 18,800 new cases of hepatitis B occurred
after accounting for underreporting of cases and asymptomatic infection.
Although the rate of acute hepatitis B virus (HBV) infections have
declined approximately 89% during 1990-2011, from 8.5 to 0.9 cases per
100,000 population in the United States, the risk for occupationally
acquired HBV among HCP persists, largely from exposures to patients with
chronic HBV infection.

ACIP recommends HepB vaccination for unvaccinated or incompletely
vaccinated HCP with reasonably anticipated risk for blood or body fluid
exposure. ACIP also recommends that vaccinated HCP receive postvaccination
serologic testing (antibody to hepatitis B surface antigen [anti-HBs]) 1-2
months after the final dose of vaccine is administered (CDC. Immunization
of health-care personnel: recommendations of the Advisory Committee on
Immunization Practices [ACIP]. MMWR 2011;60 [No. RR-7]).

Increasing numbers of HCP have received routine HepB vaccination either as
infants (recommended since 1991) or as catch-up vaccination (recommended
since 1995) in adolescence. HepB vaccination results in protective anti-
HBs responses among approximately 95% of healthy-term infants. Certain
institutions test vaccinated HCP by measuring anti-HBs upon hire or
matriculation, even when anti-HBs testing occurs greater than 2 months
after vaccination. This guidance can assist clinicians, occupational
health and student health providers, infection- control specialists,
hospital and health-care training program administrators, and others in
selection of an approach for assessing HBV protection for vaccinated HCP.

This report emphasizes the importance of administering HepB vaccination
for all HCP, provides explicit guidance for evaluating hepatitis B
protection among previously vaccinated HCP (particularly those who were
vaccinated in infancy or adolescence), and clarifies recommendations for
postexposure management of HCP exposed to blood or body fluids.

Free full text http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6210a1.htm
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Impact of a single safety-engineered device on the
occurrence of percutaneous injuries in a general hospital in Brazil
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24360640

Am J Infect Control. 2013 Dec 19. pii: S0196-6553(13)01154-1.

Impact of a single safety-engineered device on the occurrence of
percutaneous injuries in a general hospital in Brazil.

Menezes JA1, Bandeira CS2, Quintana M3, de Lima E Silva JC3, Calvet GA4,
Brasil P4.

BACKGROUND: Health care workers are exposed to bloodborne pathogens
through occupational injuries, and the replacement of sharps by safety-
engineered devices has been recommended as a key preventive measure. This
recommendation has been difficult to implement in Brazil.

METHODS: We conducted a retrospective study of selected data from a
database of blood and body fluid exposures reported from January 2007
through December 2011 in a public general hospital in Rio de Janeiro
where, from the end of 2009, a safety lancet for blood glucose testing
(BGT) was introduced. A log-binomial model was used to evaluate the effect
of the introduction of the safety lancet on the proportion of percutaneous
injuries (PIs) during BGT in the nursing staff.

RESULTS: Nursing staff had a significant reduction in rate of PIs per 100
full-time equivalents from 2007 to 2011 (P < .001), and medical residents
had the highest rate throughout the same period. A reduction of PIs by
small-gauge needles was observed since 2009, and injuries during BGT fell
abruptly in 2010 and 2011 paralleling the number of purchased safety
lancets (P < .001).

CONCLUSION: The adoption of a single safety device, which required no
training, significantly reduced PIs among the nursing team.

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

KEYWORDS: Blood glucose testing, Health care workers, Nurses, Safety
lancet
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Knowledge and Attitude of Basic Health Workers (BHWs) toward
HIV/AIDS
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24362608

J Nepal Health Res Counc. 2013 May;11(24):182-6.

Knowledge and Attitude of Basic Health Workers (BHWs) toward HIV/AIDS.

Timilshina N1, Ansari MA2.

Background: The incidence of HIV infection and AIDS is rising in Nepal.
The Basic Health Workers (BHWs) are front-line services providers in rural
community. The aim of this study was to ascertain BHWs concerns regarding
risk awareness, knowledge and attitude toward HIV/AIDS.

Methods: A stratified random sample was used to select the BHWs from two
districts. Data were collected using well-structured self-administrated
questionnaire. It was consists of knowledge and attitude related question.
Knowledge was assessed by asking several questions concerning issues on
HIV/AIDS. Attitude was measured on a five-point Likert scale. Collected
data were analyzed using the Epi-Info Software.

Results: A total of 100 BHWs were participated in this study. The mean age
of Basic Health Workers were 39 years. Out of all the participants 69
(69%) were male and 31 (31%) were female. The present study revealed that
only 46 (46%) had good knowledge and 59 (59%) differentiate between HIV
and AIDS.

Only 22 (22%) BHWs had accurate knowledge of Universal Precaution.

Only 38 (38%) participants showed positive and rationalized feeling
towards HIV/AIDS patients and 51 (51%) BHWs agreed that HIV/AIDS patients
have right to live as we do. 41 (41%) were uncertain that universal
precaution can prevent transmission of HIV.

Conclusions: This study suggested that the Basic Health workers who
participated in this study study possess basic knowledge but inadequate,
although majority of them have poor attitudes toward persons with
HIV/AIDS. Most incorrect answers were related to universal precaution.
Ministry of Health Services, Nepal should consider the potential benefits
to be gained from improving knowledge, attitude and practice of Basic
Health Workers in prevention and control of rapidly increasing health
problem of HIV/AIDS.

Keywords: attitude; basic health workers; HIV/AIDS; knowledge; universal
precaution.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Knowledge, attitude and practice of hospital staff
management
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23585502

Waste Manag Res. 2013 Jul;31(7):729-32.

Knowledge, attitude and practice of hospital staff management.

Lakbala P, Lakbala M.

The proper handling and disposal of biomedical waste (BMW) is very
imperative. There is a defined set of rules for handling BMW worldwide.
Unfortunately, laxity and lack of adequate training and awareness in the
execution of these rules leads to staid health and environment
apprehension.

The objective of the study was to assess the knowledge and attitude of
hospital staff to BMW management. The cross-sectional study was conducted
on 261 healthcare workers from 9 hospitals, which were randomized from 32
hospitals.

The most important finding was a significant (P < 0.05) relationship
between the level of education attainments and training in BMW management.
Twenty-nine (19.9%) members of government hospital staff and 37 (32.2%)
members of staff from the private sector agreed that BMW management is not
just the government’s responsibility, but one that every member of
personnel should share.

This finding will help to address the issue more appropriately, and plan
for better training programs and monitoring of BMW management systems in
hospitals.

KEYWORDS: Knowledge, attitude, hospital, management, personnel
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Decline in incidence of HIV and hepatitis C virus infection
among injecting drug users in Amsterdam; evidence for harm reduction?
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23347124

Addiction. 2013 Jun;108(6):1070-81.

Decline in incidence of HIV and hepatitis C virus infection among
injecting drug users in Amsterdam; evidence for harm reduction?

de Vos AS, van der Helm JJ, Matser A, Prins M, Kretzschmar ME.

AIMS: In Amsterdam, HIV prevalence has nearly halved among injecting drug
users (IDU) since 1990. Hepatitis C virus (HCV) prevalence also declined;
HIV and HCV incidence dropped to nearly zero. We examined possible
explanations for these time trends, among which the implementation of harm
reduction measures aimed at reducing the risk behaviour of IDU.

DESIGN: We used individual-based modelling of the spread of HIV and HCV.
Information about demographic parameters was obtained from the Amsterdam
Cohort Study (ACS) among drug users. The model included changes in inflow
of new IDU and death rates over time, the latter dependent on age and time
since HIV seroconversion. We considered different scenarios of risk
behaviour.

SETTING: IDU in Amsterdam.

MEASUREMENTS: Simulated HIV and HCV incidence and prevalence were compared
with ACS data.

FINDINGS: Assuming that harm reduction measures had led to a strong
decrease in risk behaviour over time improved the model fit (squared
residuals decreased by 30%). However, substantial incidence and HIV
prevalence decline were already reproduced by incorporating demographic
changes into the model. In particular, lowered disease spread might be a
result of depletion of high- risk IDU among those at risk for disease, and
a decrease in the number of high-risk individuals in the population due to
HIV-related mortality.

CONCLUSIONS: Marked decreases in HIV and HCV in Amsterdam since 1990 could
be due partly to harm reduction measures; however, they may also be
attributable largely to changes in the IDU population. Future research
aimed at quantifying the benefits of interventions should not neglect the
impact of natural epidemic progression and demographic changes.

© 2013 The Authors, Addiction © 2013 Society for the Study of Addiction.

Comment in

Commentary on de Vos et al. (2013): can ecological trends in HIV or HCV
incidence be used to assess intervention impact? [Addiction. 2013]
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Outcome assessment of a triangular clinic as a harm
reduction intervention in Rajaee-Shahr Prison, Iran
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24369092

Harm Reduct J. 2013 Dec 26;10:41.

Outcome assessment of a triangular clinic as a harm reduction intervention
in Rajaee-Shahr Prison, Iran.

Asl RT, Eshrati B, Dell CA, Taylor K, Afshar P, Kamali M, Mirzazadeh A.

BACKGROUND: Transmission of the human immunodeficiency virus (HIV) among
incarcerated injection drug users (IDU) is a health epidemic in the
Islamic Republic of Iran. Triangular clinics (TCs) were established in
prisons as a harm reduction measure to decrease the risk of HIV
transmission and other blood-borne infections. The objective of this study
was to assess the immediate outcomes of one TC among male IDUs in Iran’s
Rajaee-Shahr prison.

METHODS: This study was conducted in two stages between 2003 and 2005. In
the preparatory stage, focus group data was collected to update the
prison’s TC education and medical interventions and construct the self-
report questionnaire. In stage two, 150 male IDUs were recruited in a
closed cohort study design to assess the immediate outcome of the TC.
Participants were measured at baseline and followed up to six months to
measure their drug use, attitude toward and knowledge of high risk
behaviours, serological conversion for HIV, HBV and HCV, and engagement in
risky behaviors. The TC outcomes were determined through random urine
analysis testing, a self-administered questionnaire and behaviour report
cards, and viral infection testing.

RESULTS: The findings of the urine analyses indicated a minimal yet
consistent decrease in drug use over the six months. The pre and post-
self- administered questionnaire data relayed a modest change in IDU risky
behaviours associated with sexual practices; this was greater in
comparison to the knowledge and attitude measures. It was determined that
age may have a detrimental effect as may viral infections (HIV and HBV) on
knowledge, attitude and behavior change. Both education and employment may
have a protective effect. Data collected from the self-report behaviour
cards similarly showed a modest reduction in high risk practices. At the
six month follow-up, only one case became HIV positive, 9 HCV and 17 HBV.

CONCLUSIONS: Considering that HIV is concentrated among Iranian prisoners
who inject drugs at a high level, the results of this study indicate that
TCs are a possible effective intervention. However, many prisoners
continued with risky behaviors even if they were participating in harm
reduction measures, such as methadone maintenance therapy.

Free Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3883467/
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Drug use as a driver of HIV risks: re-emerging and emerging
issues
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24406532

Curr Opin HIV AIDS. 2014 Jan 8.

Drug use as a driver of HIV risks: re-emerging and emerging issues.

El-Bassel N, Shaw SA, Dasgupta A, Strathdee SA.

PURPOSE OF REVIEW: We reviewed the studies published in 2012-2013 that
focused on re-emerging and emerging injection and noninjection drug use
trends driving HIV risk behaviors and transmission in some parts of the
world.

RECENT FINDINGS: Although HIV incidence has declined in many countries,
HIV epidemics remain at troubling levels among key drug-using populations,
including females who inject drugs (FWIDs), FWIDs who trade sex, sex
partners of people who inject drugs, young people who inject drugs, and
people who use noninjection drugs in a number of low-income and middle-
income countries such as in Central Asia, Eastern Europe, Southeast Asia,
and parts of Africa.

SUMMARY: HIV epidemics occur within the contexts of global economic and
political forces, including poverty, human rights violations,
discrimination, drug policies, trafficking, and other multilevel risk
environments. Trends of injection and noninjection drug use and risk
environments driving HIV epidemics in Central Asia, Eastern Europe,
Southeast Asia, and parts of Africa call for political will to improve HIV
and substance use service delivery, access to combination HIV prevention,
and harm reduction programs.
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Factors associated with overdose-caused mortality of HIV-
positive patients who were on methadone maintenance treatment program
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24377986

Zhonghua Liu Xing Bing Xue Za Zhi. 2013 Oct;34(10):961-3.

[Factors associated with overdose-caused mortality of HIV-positive
patients who were on methadone maintenance treatment program].

[Article in Chinese]

Cui N1, Cao XB2, Wang CH2, Luo W2, Pang L2, Rou KM2, Wu ZY3.

OBJECTIVE: To study the factors that associated with the mortality of
overdose on methadone maintenance treatment(MMT)among HIV-positive
patients.

METHODS: A 1 : 1 matched case-control design was used to identify the
relationship between factors related to demography, drug use,
characteristics of treatment and the mortality of overdose. 110 HIV-
positive patients who died of drug overdose from March 2004 to September
2012 were defined as cases. Controls were another 110 patients who were
still alive and paired with the cases, according to the same gender,
similar date of MMT initiation and from the same clinics.

RESULTS: Multivariate conditional logistic regression analyses indicated
that risk factors as sharing needles before enrolled in the MMT program(OR
= 5.19, 95% CI:1.39-19.33), HIV infection because of injecting drug-use
(OR = 3.08, 95% CI: 1.16-8.21), and off from the treatment before the end
point of the program(OR = 2.54, 95% CI: 1.23-5.23)were associated with
mortality caused by overdose. Higher adherence(OR = 0.31, 95%CI:
0.10-0.95)appeared to be associated with lower mortality when compared
with the control group.

CONCLUSION: In order to reduce the mortality rate, comprehensive
intervention could be introduced to improve the compliance of retention on
MMT among patients. Intervention efforts should be focused on those
patients who shared needle/syringes.
__________________________________________________________________
________________________________*_________________________________

17. Massachusetts injection drug users: an observational study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24330568

Addict Sci Clin Pract. 2013 Dec 13;8(1):20.

Age and sharing of needle injection equipment in a cohort of Massachusetts
injection drug users: an observational study.

Tassiopoulos K, Bernstein J, Bernstein E.

BACKGROUND: Hepatitis C infection (HCV) among individuals aged 15-24 years
has increased in Massachusetts, likely due to injection drug use. The
prevalence of injection equipment sharing (sharing) and its association
with age was examined in a cohort of out-of-treatment Massachusetts
substance users.

METHODS: This analysis included baseline data from a behavioral
intervention with substance users. Younger and older (<25 versus =25
years) injection drug users were compared on demographic characteristics,
substance use practices, including factors present during the most recent
sharing event (“event-level factors”), and HCV testing history.

RESULTS: Sharing was reported by 41% of the 484 individuals who reported
injection drug use in the past 30 days. Prevalence of sharing varied by
age (50% <25 years old versus 38% =25 years, p?=?0.02). In a multivariable
logistic regression model younger versus older individuals had twice the
odds of sharing (95% CI?=?1.26, 3.19). During their most recent sharing
event, fewer younger individuals than older had their own drugs available
(50% versus 75%, p?<?0.001); other injection event-level factors did not
vary by age. In the presence of PTSD, history of exchanging sex for money,
or not being US born, prevalence of sharing by older users was higher and
was similar to that of younger users, such that there was no association
between age and sharing.

CONCLUSIONS: In this cohort of injection drug users, younger age was
associated with higher prevalence of sharing, but only in the absence of
certain stressors. Harm reduction efforts might benefit from intervening
on mental health and other stressors in addition to substance use. Study
findings suggest a particular need to address the dangers of sharing with
young individuals initiating injection drug use.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3880095/
__________________________________________________________________
________________________________*_________________________________

18. Abstract: Emergence of cocaine and methamphetamine injection among
HIV-positive injection drug users in Northern and Western India
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24382362

Drug Alcohol Depend. 2014 Feb 1;135:160-5.

Emergence of cocaine and methamphetamine injection among HIV-positive
injection drug users in Northern and Western India.

Mehta SH1, Srikrishnan AK2, Noble E3, Vasudevan CK2, Solomon S2, Kumar
MS2, Solomon SS4.

BACKGROUND: Little is known regarding the epidemiology of drug injection
and risk behaviors among injection drug users (IDUs) across India. In
particular, there is limited data on the prevalence of stimulant
injection.

METHODS: We sampled 801 HIV positive IDUs from 14 locations throughout
India to represent the geography of India as well as the diversity in IDU
epidemic stage (established epidemics, emerging epidemics and large
cities). All participants underwent a behavioral survey and blood draw.
Given prior associations with stimulant injection and HIV risk, we
compared stimulant injectors (cocaine and/or methamphetamine) to those who
injected opiates and/or pharmaceuticals only.

RESULTS: The median age was 33; 86% were male. The primary drugs injected
were heroin, buprenorphine and other pharmaceuticals. In all but four
sites, > 50% of those actively injecting reported needle sharing.
Stimulant injection was most common in emerging epidemics. Compared to
exclusive opiate injectors, stimulant injectors were significantly
younger, more likely to be educated and employed, more likely to report
non-injection use of heroin, crack/cocaine and amphetamines, heavy alcohol
use, recent needle sharing (71% vs. 57%), sex with a casual partner (57%
vs. 31%) and men having sex with other men (33% vs. 9%; p<0.01 for all).

CONCLUSIONS: Emerging IDU epidemics have a drug/sexual risk profile not
previously been observed in India. Given the high prevalence of stimulant
injection in these populations, HIV prevention/treatment programs may need
to be redesigned to maximize effectiveness. The high levels of injection
sharing overall reinforce the need to ensure access to harm-reduction
services for all.

Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

KEYWORDS: Amphetamine-type stimulants, Cocaine, HIV/AIDS, India, Injection
drug use
__________________________________________________________________
________________________________*_________________________________

19. Abstract: Factors associated with recent symptoms of an injection site
infection or injury among people who inject drugs in three English
cities
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24388664

Int J Drug Policy. 2013 Dec 1. pii: S0955-3959(13)00215-6.

Factors associated with recent symptoms of an injection site infection or
injury among people who inject drugs in three English cities.

Hope VD1, Hickman M2, Parry JV3, Ncube F4.

BACKGROUND: People who inject drugs (PWID) are at risk of injection site
infections and injuries. The factors associated with recent symptoms of
these problems are examined.

METHOD: PWID recruited using respondent driven sampling, underwent a
computer- assisted interview and provided a dried-blood spot sample.
Weight data were examined using logistic regression.

RESULTS: The mean age of the 855 participants was 32 years, and 25% were
women. During the preceding 28 days, 94% had injected heroin and 50%
crack- cocaine; with 41% injecting into their arms and 47% their groin.
The passing on of used needles/syringes was reported by 9.7% and receiving
by 8.0%. During the preceding 28 days, 21% reported having redness,
swelling and tenderness, 6.1% an abscess, and 5.2% a sore/open wound at an
injection site; with a quarter (24%) reporting one or more of these. A
range of factors were associated with these symptoms; all three symptoms
were associated with more frequent injection and the use of multiple
injection sites; two of the symptoms were also associated with having
recently overdosed and the use of particular injection sites.

CONCLUSIONS: Injection site infections and injuries are common among PWID
and targeted interventions are needed to reduce risk. Crown Copyright ©
2013. Published by Elsevier B.V. All rights reserved.

KEYWORDS: England, Injection site infections and injuries, People who
inject drugs
__________________________________________________________________
________________________________*_________________________________

20. Abstract: Steroid users and the unique challenge they pose to needle
and syringe program workers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24400704

Drug Alcohol Rev. 2014 Jan;33(1):71-7.

Steroid users and the unique challenge they pose to needle and syringe
program workers.

Dunn M, McKay FH, Iversen J.

INTRODUCTION AND AIMS: Needle and syringe programs (NSP), which provide
sterile injecting equipment, are a cornerstone of Australia’s drug harm
reduction strategy and assist in reducing the spread of blood-borne virus
infections, such as HIV and hepatitis C, among people who inject drugs.
Some reports suggest that steroid users are an increasing proportion of
clientele at NSPs. In this research, we investigate the experience of NSP
workers who come into contact with people who use steroids and other
performance- and image- enhancing drugs (PIED).

DESIGN AND METHOD: Thirteen NSP workers were recruited using purposive
sampling strategies. Participants were interviewed using a semi-structured
interview guide. Interviews were recorded, transcribed and coded for
themes.

RESULTS: There are three key findings of this study. Firstly, NSP workers
do not feel well informed about the substances that PIED users are
injecting. Secondly, they were unsure what equipment PIED users required.
Thirdly, PIED users were perceived to differ from other client groups, and
these differences impacted upon the level of rapport staff could build
with this group.

DISCUSSION AND CONCLUSION: PIED users pose unique challenges for NSP
workers compared with other NSP client groups. The PIEDs used and the way
in which they are used are substantially different compared with other NSP
clients, and there appears to be a lack of knowledge within the workforce
about these substances. This study highlights the need to engage in
workforce training, but also the need to more effectively engage with PIED
users in relation to effective harm reduction strategies. [Dunn M, McKay
FH, Iversen J. Steroid users and the unique challenge they pose to needle
and syringe program workers. Drug Alcohol Rev 2014;33:71-77].

© 2014 Australasian Professional Society on Alcohol and other Drugs.

KEYWORDS: injecting, needle and syringe program, performance- and image-
enhancing drug, policy, steroid
__________________________________________________________________
________________________________*_________________________________

21. Abstract: Health care workers’ hand contamination levels and
antibacterial efficacy of different hand hygiene methods used in a
Vietnamese hospital
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24360520

Am J Infect Control. 2013 Dec 18. pii: S0196-6553(13)01149-8.

Health care workers’ hand contamination levels and antibacterial efficacy
of different hand hygiene methods used in a Vietnamese hospital.

Salmon S1, Truong AT2, Nguyen VH2, Pittet D3, McLaws ML4.

BACKGROUND: Handwashing with soap or another antisepsis disinfectant
solution is a common practice in Vietnam, but the availability and quality
of tap water is unpredictable. We assessed the risk for hand contamination
and compared the efficacy of 5 hand hygiene methods in a tertiary
Vietnamese hospital.

METHODS: Five fingertip imprints of the dominant hand of 134 health care
workers (HCWs) were sampled to establish the average bacterial count
before and after hand hygiene action using (1) alcohol-based handrub
(ABHR), (2) plain soap and water handwashing with filtered and unfiltered
water, or (3) 4% chlorhexidine gluconate hand antisepsis with filtered and
unfiltered water.

RESULTS: Average bacterial contamination of hands before hand hygiene was
1.65 log10. Acinetobacter baumannii, Klebsiella pneumoniae, and
Staphylococcus aureus were the most commonly isolated bacterial pathogens.
The highest average count before hand hygiene was recovered from HCWs
without direct patient contact (2.10 ± 0.11 log10). Bacterial counts were
markedly reduced after hand hygiene with ABHR (1.4 log10; P < .0001) and
4% chlorhexidine gluconate with filtered water (0.8 log10; P < .0001). Use
of unfiltered water was associated with minimal nonsignificant bacterial
reduction.

CONCLUSIONS: HCWs carry high levels of bacteria on their dominant hand,
even without direct patient contact. ABHR as an additional step may
overcome the effect of high bacterial counts in unfiltered water when soap
and water handwashing is indicated.

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

KEYWORDS: Alcohol-based hand rub, Antimicrobial efficacy, Handwashing,
Water quality
__________________________________________________________________
________________________________*_________________________________

22. Abstract: Accuracy of physician reporting in routine public health
surveillance for hepatitis C virus infection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24381361

Public Health Rep. 2014 Jan;129(1):64-72.

Accuracy of physician reporting in routine public health surveillance for
hepatitis C virus infection.

Jochem K1, Leclerc P2, Maurais E1, Tremblay C1, Cox J3.

OBJECTIVE: From January 2007 to December 2008, the Montréal Public Health
Department sent postal questionnaires to physicians and conducted patient
interviews for all those newly diagnosed with hepatitis C virus (HCV)
infection. We evaluated physician responses to risk factor questions for
non-acute HCV cases.

METHODS: We compared physician and patient responses with each of nine
risk factor questions, determined the sensitivity and specificity of
physician responses compared with patient responses, and evaluated
agreement using Gwet’s agreement coefficient (AC1). We ranked risk factors
and compared the distributions by principal exposure category according to
physician reporting vs. patient interview using the Chi-square test.

RESULTS: The completeness of physicians’ responses (yes, no, or unknown)
varied by risk factor question from 90.8% to 96.7%. For risk factors
present among more than 5% of cases, sensitivity of physician responses
ranged from 26.9% to 87.7% and specificity ranged from 93.0% to 98.6%. The
AC1 coefficients for agreement between physician and patient responses to
lifetime risk factors considered most important in HCV acquisition were
0.80 for injection drug use, 0.95 for blood transfusion before 1990, and
0.86 for birth in a country with high HCV prevalence. Risk distributions
by principal exposure category according to physician reporting vs.
patient interview were not statistically different (?(2)[4] = 2.17, p=
0.704).

CONCLUSION: Postal questionnaires completed by physicians appear valid for
determining the principal exposure category among non-acute HCV cases.
Physician reporting can be a useful and low-cost component of routine HCV
surveillance.
__________________________________________________________________
________________________________*_________________________________

23. Abstract: Risk factors for recent nonfatal overdose among HIV-infected
Russians who inject drugs
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24382133

AIDS Care. 2014 Jan 2.

Risk factors for recent nonfatal overdose among HIV-infected Russians who
inject drugs.

Walley AY, Cheng DM, Coleman SM, Krupitsky E, Raj A, Blokhina E, Bridden
C, Chaisson CE, Lira MC, Samet JH.

Overdoses and HIV infection are common among Russians who inject drugs,
yet risk factors have not been studied.

We analyzed baseline data of 294 participants with 30-day injection drug
use from an HIV secondary prevention trial for persons reporting “heavy”
alcohol use (National Institute on Alcohol Abuse and Alcoholism [NIAAA]
risky drinking definition) and risky sex in the past 6 months. The outcome
was any self- reported overdose in the previous 3 months. We examined
demographic, HIV- related, criminal justice, mental health, substance use,
and injection risk factors.

Participants’ characteristics included median age 29 years, 117/294 (40%)
female, and median CD4 cell count 345/µl. Over three quarters 223/294
(76%) reported a history of overdose and 47/294 (16%) reported overdose in
the past 3 months.

Past month injection frequency (adjusted odds ratio [AOR] 4.77, 95%
confidence interval [CI]: 1.63-14.0 highest vs. lowest quartile; AOR 3.58,
95% CI: 1.20-10.69 second highest vs. lowest quartile) and anti-retroviral
therapy (ART) at time of interview (AOR 3.96 95% CI: 1.33-11.83) were
associated with 3-month overdose.

Nonfatal overdose among HIV-infected Russians who inject drugs is common.
Risk factors include injection frequency and anti-retroviral therapy
(ART), which warrant further study. Overdose prevention efforts are needed
among HIV-infected Russians who inject drugs.

__________________________________________________________________
________________________________*_________________________________

24. Abstract: Less-established risk factors are common in Asian Americans
with hepatitis C virus: a case-controlled study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24081641

Dig Dis Sci. 2013 Nov;58(11):3342-7.

Less-established risk factors are common in Asian Americans with hepatitis
C virus: a case-controlled study.

Kin KC, Lin B, Chaung KT, Ha NB, Trinh HN, Garcia RT, Nguyen HA, Nguyen
KK, Levitt BS, da Silveira EB, Nguyen MH.

BACKGROUND AND AIMS: The Centers for Disease Control and Prevention
recommend screening for hepatitis C virus (HCV) in patients with injection
drug use, blood transfusion before 1992, stigmata of liver disease, or
born between 1945 and 1965. The purpose of this study was to examine risk
factors for HCV acquisition in Asian Americans.

METHODS: This was a case-controlled study, with 471 consecutive patients
testing positive for anti-HCV between January 2001 and December 2008.
Controls included 471 patients with negative HCV matched at a one-to-one
ratio for sex, age (±5 years), and ethnicity.

RESULTS: For Asian patients, the most common risk factors were blood
transfusion and acupuncture or exposure to dirty needles (27 and 20 %,
respectively). On multiple logistic regression, potential predictors for a
positive anti- HCV test in Asians were acupuncture or exposure to dirty
needles (OR = 12.9, P < 0.0001), body tattoo (OR = 12.0, P = 0.001), and
history of blood transfusion (OR = 5.7, P < 0.0001).

DISCUSSION: Acupuncture and exposure to dirty needles are independent risk
factors of HCV infection. Asians coming from endemic areas should be
screened for HCV even when commonly-known risk factors for Western
patients are not present.
__________________________________________________________________
________________________________*_________________________________

25. Abstract: Compliance with hygiene guidelines: the effect of a
multimodal hygiene intervention and validation of direct observations
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23337307

Am J Infect Control. 2013 May;41(5):e45-8.

Compliance with hygiene guidelines: the effect of a multimodal hygiene
intervention and validation of direct observations.

Mernelius S, Svensson PO, Rensfeldt G, Davidsson E, Isaksson B, Löfgren S,
Matussek A.

BACKGROUND: Good compliance with hygiene guidelines is essential to
prevent bacterial transmission and health care-associated infections.
However, the compliance is usually <50%.

METHODS: A multimodal and multidisciplinary hygiene intervention was
launched once the baseline compliance was determined through direct
observations in 4 departments of obstetrics and gynecology. Detailed
evaluations of the compliance rates were performed at point of stability
(at 80%) and follow- up (3 years after hygiene intervention). Validation
of direct observations was performed using blinded double appraisal and
multiappraisal.

RESULTS: At baseline, the compliance with barrier precautions and the
dress code at the 4 departments were 39% to 47% and 79% to 98%,
respectively. Point of stability was reached approximately 1 year after
the hygiene intervention was launched. The compliance with barrier
precautions was significantly higher at follow-up compared with baseline
in 3 departments. In the validation by double appraisal, 471 of 483
components were judged identical between observers. In the multiappraisal,
95% to 100% of the observers correctly judged the 7 components.

CONCLUSION: It is possible to improve compliance with hygiene guidelines,
but, to ensure a long-lasting effect, a continuous focus on barrier
precautions is required. Observation is a valid method to monitor
compliance.

Copyright © 2013 Association for Professionals in Infection Control and
Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

26. Abstract: Bacterial contamination of mobile phones shared in hospital
wards and the consciousness and behavior of nurses about biological
cleanliness
__________________________________________________________________
https://www.jstage.jst.go.jp/article/jjh/66/1/66_1_115/_article

Nihon Eiseigaku Zasshi. 2011 Jan;66(1):115-21.

[Bacterial contamination of mobile phones shared in hospital wards and the
consciousness and behavior of nurses about biological cleanliness].

[Article in Japanese]

Morioka I, Tabuchi Y, Takahashi Y, Oda Y, Nakai M, Yanase A, Watazu C.

OBJECTIVES: The purpose of this study was to clarify the contamination of
mobile phones shared in hospital wards and its relationship with the
consciousness and behavior of nurses about biological cleanliness.

METHODS: Samples from mobile phones were cultured to detect viable
bacteria (n=110) and Staphylococcus aureus (n=54). A questionnaire survey
was conducted on 110 nurses carrying mobile phones on the day of sampling.

RESULTS: Viable bacteria were detected on 79.1% of the mobile phones,
whereas S. aureus was detected on 68.6%. All the nurses were aware of hand
washing with water or alcohol after regular work, but 33.6% of the nurses
were not conscious of hand washing with water or alcohol after using a
mobile phone. There was a significant positive relationship between the
frequency of using mobile phones and the number of hand washings with
water or alcohol. A significant negative relationship was found between
the detection of viable bacteria and the number of hand washings with
alcohol. The results of logistic regression analysis showed that the
detection of viable bacteria was related significantly with the number of
hand washings with alcohol (Odds ratio, 0.350; 95%CI, 0.143-0.857) and
that the detection of S. aureus was related significantly with the
frequency of using mobile phones (Odds ratio, 0.183; 95%CI, 0.036-0.933).

CONCLUSIONS: It is important to be conscious of the fact that mobile
phones shared in hospital wards are easily contaminated. Because hand
washing with water or alcohol prevents the contamination of the mobile
phones, nurses should take standard precautions after using mobile phones.

Free full text
https://www.jstage.jst.go.jp/article/jjh/66/1/66_1_115/_article
__________________________________________________________________
________________________________*_________________________________

27. Abstract: Reports to the Vaccine Adverse Event Reporting System after
hepatitis A and hepatitis AB vaccines in pregnant women
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24378675

Am J Obstet Gynecol. 2013 Dec 27. pii: S0002-9378(13)02247-3.

Reports to the Vaccine Adverse Event Reporting System after hepatitis A
and hepatitis AB vaccines in pregnant women.

Moro PL1, Museru OI2, Niu M3, Lewis P2, Broder K2.

OBJECTIVE: To characterize adverse events (AEs) after Hepatitis A vaccines
(Hep A) and Hepatitis A and Hepatitis B combination vaccine (Hep AB) in
pregnant women reported to the Vaccine Adverse Event Reporting System
(VAERS), a spontaneous reporting surveillance system.

STUDY DESIGN: We searched VAERS for AEs reports in pregnant women who
received Hep A or Hep AB from 01/01/1996-04/05/2013. Clinicians reviewed
all reports and available medical records.

RESULTS: VAERS received 139 reports of AEs in pregnant women; 7 (5.0%)
were serious; No maternal or infant deaths were identified. Sixty-five
(46.8%) did not describe an AE. For those women whose gestational age was
available, most were vaccinated during the first trimester, 50/60 (83.3%)
for Hep A and 18/21 (85.7%) for Hep AB. The most common pregnancy-specific
outcomes following Hep A or Hep AB vaccinations were spontaneous abortion
in 15 (10.8%) reports, elective termination in 10 (7.2%), and pre-term
delivery in 7 (5.0%) reports. The most common non-pregnancy specific
outcome was urinary tract infection and nausea vomiting with 3 (2.2%)
reports each. One case of amelia of the lower extremities was reported in
an infant following maternal Hep A immunization.

CONCLUSIONS: This review of VAERS reports did not identify any concerning
pattern of AEs in pregnant women or their infants following maternal HepA
or HepAB immunizations during pregnancy.

Copyright © 2013 Mosby, Inc. All rights reserved.

KEYWORDS: hepatitis A hepatitis B combined vaccine, hepatitis A vaccine,
pregnancy, surveillance, vaccine safety
__________________________________________________________________
________________________________*_________________________________

28. Abstract: Copper–a weapon in the war on pathogens
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24137999

Health Estate. 2013 Sep;67(8):65-9.

Copper–a weapon in the war on pathogens.

Vessey A.

The bacteria responsible for healthcare-associated infections can survive
for anything from days to weeks on the fabricated surfaces, typically made
from stainless steel and polymeric materials, that surround patients in
our hospitals.

Here Angela Vessey, director of the Copper Development Association (CDA)
in the UK, describes some of the latest evidence from installations and
studies worldwide of how using anti-microbial copper for common hospital
items and surfaces can help to reduce environmental contamination, and
thus lower healthcare-acquired infection rates.
__________________________________________________________________
________________________________*_________________________________

29. No Abstract: EASL Clinical Practice Guidelines: Management of
hepatitis C virus infection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24331294

J Hepatol. 2013 Dec 4. pii: S0168-8278(13)00794-0.

EASL Clinical Practice Guidelines: Management of hepatitis C virus
infection.

European Association For The Study Of The Liver.

KEYWORDS: AE, ALT, BMI, BOC, BT, CPGs, CYP3A4, Clinical Practice
Guidelines, DAA, DVR, EIA, EPO, EVR, G-CSF, GRADE, Grading of
Recommendations Assessment, Development and Evaluation, HBV, HCC, HCV,
IDU, IFN, IU, LSM, LT, OST, PI, PWID, PegIFN/RBV, RVR, SCAR, SVR, TSH,
TVR, adverse event, alanine aminotransferase, boceprevir, body mass index,
cytochrome p450 3A4, delayed virological response, direct-acting
antiviral, eRVR, early virological response, enzyme immunoassays,
erythropoietin, extended rapid virological response, granulocyte colony
stimulating factor, hepatitis B virus, hepatitis C virus, hepatocellular
carcinoma, interferon, international units, intravenous/injecting drug
use, liver stiffness measurement, liver transplant, opiate/opioid
substitution treatment/therapy, pegylated interferon-a and ribavirin,
people who inject drugs, protease inhibitor, rapid virological response,
severe cutaneous adverse reaction, sustained virological response,
telaprevir, thyroid stimulating hormone, viral breakthrough
__________________________________________________________________
________________________________*_________________________________

30. News

– Canada: The need for prison needle exchange programs
– India: Hepatitis-C outbreak: Ten deaths in two months, and counting
Fear grips South Kashmir villages; Govt fails to keep word on free
treatment to patients; Centre rejects vital proposal
– Arizona USA: More detail given on medical breach at prison
– China: China Says Vaccines Didn’t Cause 9 Kids’ Deaths
– USA: Warren County offering sharps disposal program

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
www.brockpress.com/2014/01/the-need-for-prison-needle-exchange-programs/

Canada: The need for prison needle exchange programs

Ellie Donahue-Miller,Brock Press, Canada (14.01.14)

A recent study by the B.C. Centre for Excellence in HIV/AIDS discusses the
need for better health care programs for inmates living with HIV. Nearly
20 per cent of inmates are HIV positive, yet lack of proper health care
and lack of harm reduction programs leaves these inmates vulnerable.

“The law over prisoners says prisoners should have just as good health
care in prison as in the community, but that isn’t happening,” said M-J
Milloy, a principal investigator at the centre and a lead author on the
study. “A treatment-as-prevention strategy would engage people in their
health care and drastically reduce the chance they can spread the virus to
others.”

While in prison, individuals with HIV are often unable to take their
medication as prescribed and the percentage of detectable HIV in their
bloodstream increases. In prison, HIV rates in their bloodstream averages
83 per cent, but this number drops to 62 per cent when individuals are not
in jail.

The study ran from May 1996 to March 2012. Researchers interviewed 657
people living in jail who inject drugs and are HIV positive.

The study concludes that prisons require needle exchange programs to
reduce the risk of transmission. Milloy states that Canada does not have
any such programs in its provincial or federal prisons.

Harm reduction programs in Central Asia and Western Europe have proven
effective in reducing the number of people engaging in risk-taking
behaviour that could transmit HIV to others. Many social workers, health
care providers and advocates for people living with HIV argue that Canada
needs to implement these proactive strategies.

“There is absolutely no reason why incarcerated individuals should not
receive the same level of medical care as those in the public,” said Terry
Howard, Director of Community Based Research at Positive Living B.C. and
former prison outreach program coordinator.

Even though a large number of people in prisons are HIV positive, many do
not feel safe disclosing due to stigma and potential repercussions. “I’ve
also heard horror stories about them being beaten up (for being HIV
positive) and stigmatized by guards who will make a big show of snapping
on gloves when transporting prisoners who are HIV positive,” Howard said.

Even though harm reduction and risk prevention programs exist in other
jurisdictions, many Canadian prison guards insist against these programs.
Guards state that the clean needles distributed to inmates could be used
as weapons. However, this argument disregards the fact that in countries
that have needle distribution programs, there have been no incidents of
these needles being as weapons against guards.

“It’s a red herring they fly but the government buys it, and our
government doesn’t want to tolerate drug use in prison,” Howard said.

Both Milloy and Howard argue that the government needs to take a critical
look at how the lack of appropriate risk prevention strategies leaves
people in prisons vulnerable to preventable HIV infections.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/ogc4c5b

India: Hepatitis-C outbreak: Ten deaths in two months, and counting Fear
grips South Kashmir villages; Govt fails to keep word on free treatment to
patients; Centre rejects vital proposal

Khalid Gul, Greater Kashmir, Srinagar, India (09.01.14)

Islamabad (Anantnag), Jan 9: The State and Central governments have failed
to provide any treatment to patients diagnosed with Hepatitis-C in
Kokernag villages of this South Kashmir district even as the ‘silent
killer’ continues to consume precious lives.

At least 10 patients have died in the past two months because of
Hepatitis-C in these villages while few others are battling for life in
various Kashmir hospitals, reports said.

The lives of hundreds of patients in Takia Magam, Sonabarie and some
adjacent villages are at risk, with governments failing to provide them
any medicine or monetary assistance.

The Hepatitis-C was detected in Takia Magam and Sonabarie villages and
some adjacent areas in February last year. After the collection of
samples, almost 60 percent of the population from the twin villages was
diagnosed with Hepatitis-C. Some isolated cases were detected in other
villages of Kokernag as well.

The state government later sent a proposal to the Centre for providing
costly medicine to the patients. The proposal, however, has not been
approved even as Health experts declared a large-scale epidemic in the
area. They also warned of further spread of the infection in case
precautionary measures were not taken.

Abdul Aziz Bhat son of Habib Bhat, 48, of Magam village—who was diagnosed
with Hepatitis-C last year—died in November after he was admitted to SK
Institute of Medical Sciences here.

“The doctors at SKIMS told us that Aziz is suffering from Hepatitis-C
infection from many years,” said his family members. They said due to
their poor financial condition, they could not afford to treat him
outside.

Another patient, Ghulam Hassan Bhat, 55, of the same village reportedly
died last month after he was battling for his life at a hospital. “Bhat
was complaining of severe abdominal pain for eight months and after
conducting investigations doctors found his liver completely damaged,”
said his family members.

Reports said many other people f rom the same village, who were infected
with Hepatitis-C, lost their lives this month. These include Muhammad
Ahsan Kumar son of Kamal Kumar, 65; Ghulam Hassan Najar son of Ali Muhmad
Najar, 50. Among the dead was also a 35-year-old married woman.

Another middle-aged man from adjacent Drawai village, according to
reports, was taken to PGI Chandigarh following his deteriorating health
condition at SKIMS and his liver was found to be completely damaged. Many
other patients from Takia Magam, Sonabarie and some other villages,
according to reports, are undergoing treatment at various hospitals in
Kashmir and the condition of few of them is slated to be critical. “A
woman is undergoing treatment at SMHS hospital for the past one week,”
sources said. Her family members say doctors have termed her condition as
“critical”.

Another woman, 45, is battling for her life in the hospital even as her
husband and three children have also been diagnosed with Hepatitis-C.
“There is grave fear in Magam and Sonabarie villages as a result of
outbreak of the disease and the consequent deaths,” says a villager,
Habibullah Mir.

He said Hepatitis-C patients are now directly referred to SKIMS or SMHS
from district hospital Anantnag (Islamabad).

“Last year when media reported the infection, ministers and Health
department officials made beelines to the affected areas and promised free
treatment. But now patients have been left at the mercy of God. Nobody is
coming forward to help them,” Mir rued.

Another resident Syed Masood said since many villagers are not financially
sound, they are unable to get themselves treated or even examined.

“Few families have sold their land for treatment of their patients,” said
Masood.

Noted gastroenterologist Dr MS Khuroo had declared the infection as
epidemic. He had warned that if the authorities did not wake up, the
situation could worsen in years to come.

Health experts had also declared the infection as decades-old transmitted
by some specific source.

“The mode of transmission is same as HIV and as such, besides necessary
treatment of the already infected, educating and creating awareness among
the people is equally important to prevent the further spread of this
silent disease,” said a medico, wishing anonymity.

Director Health Services Kashmir, Dr Saleem-U-Rehman said, “Till now we
have not received any assistance from the Union Health Ministry for the
treatment of the Hepatitis-C patients.”

However, official sources said the proposal of the state government was
rejected by the Centre. “The central government does not have any specific
program for the treatment of the disease which is prevalent in Punjab and
Haryana too. Also, it will need crores of rupees for treatment of the
affected people. So the central government has been reluctant to approve
the proposal,” said an official.

Director SKIMS Dr Showkat Zargar also said they have not received any
assistance from the Union Health Ministry for treatment of the affected
villagers.

However, about the reports of deaths, Dr Zargar said, “Deaths can occur in
advanced stage only. The infection is decades old, may be even 30 years.
So the infection might have lead to some deaths.”

He, however, said attributing every death to the infection cannot be right
as the infection is not fatal in initial stages which may go even up to 20
years.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/p4kd8cq

Arizona USA: More detail given on medical breach at prison

BY Jacques Billeaud, Associated Press, Kansas City Star (09.01.14)

PHOENIX — A nurse at an Arizona prison may have contaminated insulin vials
with a needle that she used to test several prisoners’ blood sugar,
officials said Thursday as they released more details about 24 inmates’
potential exposure to hepatitis and HIV.

Corrections officials and the company that provides health care services
at the state’s prisons had released few details Wednesday when the
medical-procedure breach at the Arizona State Prison Complex-Lewis in
Buckeye was first publicly disclosed.

The health care provider, Brentwood, Tenn.-based Corizon Health Inc., said
in a statement that the nurse used the same needle Sunday to test the
blood sugar of five inmates and cleaned the needle with alcohol between
patients.

The nurse then cleaned the same needle again and used it to draw insulin
from vials for one patient, leading to the potential contamination. She
used new needles to inject other patients and threw them out after their
injections were complete, the company said.

After that, she gave insulin to inmates in other units using the
potentially contaminated vials. And the next morning, the nursing staff
used those same vials to give insulin to inmates, the company said.

The company says there is no indication that anyone was exposed to viruses
that can be transmitted through blood or other bodily fluids. It also said
the nurse who committed the breach has admitted the error, was suspended
and is cooperating in its investigation. The Arizona Board of Nursing also
was notified.

The company didn’t identify the nurse.

Ten of the 24 inmates were among a group of inmates who were involved in a
similar scare at the same prison in August 2012.

“Every indication is that the incident (Sunday) is the result of the
failure by one individual nurse to follow specific, standard and well-
established nursing protocols when dispensing injected insulin to 24
inmates,” Corrections Director Charles Ryan said in a statement.

State prison officials said changes will be made to prevent future
breaches, such as making sure each patient who needs insulin has his own
insulin vial, rather than using the same vial to draw insulin for multiple
inmates.

The similar scare at the Lewis prison in August 2012 arose when inmates
were given medication with a potentially contaminated needle.

A nurse had contaminated an insulin vial while injecting insulin into an
inmate who had Hepatitis C. The nurse later used the contaminated vial to
give insulin to other inmates, according to state prison records. Prison
officials say none of the 112 inmates in question contracted any disease
as a result of the exposure.

The nurse who committed the 2012 violation isn’t the same nurse who was
involved in Sunday’s breach.

The 2012 incident involved a nurse who was working on behalf of
Pittsburgh-based Wexford Health Sources Inc. State prison officials
severed its ties with Wexford and then hired Corizon to handle health
services at prisons in early 2013.

Prison health care is the subject of a lawsuit by inmates who alleged
Arizona’s prisons don’t meet the basic requirements for providing adequate
care and that corrections officials failed to correct problems after they
were brought to their attention.

Dan Pochoda, legal director for the American Civil Liberties Union of
Arizona, one of the groups representing the prisoners who filed the class-
action lawsuit, said Sunday’s breach will be a factor in the lawsuit but
that it’s not the worst health care problem in the prisons.

Arizona Department of Corrections spokesman Doug Nick declined to comment
on how Sunday’s breach could factor into the lawsuit.

http://tinyurl.com/p4kd8cq
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/ok8j48p

USA: Warren County offering sharps disposal program

Daily Review Atlas,Monmouth, Il.USA (01.08.2014)

PHOTO: A container located at the Warren County Health Department, 240 S.
Main St., where residents can now dispose of home-generated sharps.

MONMOUTH — Residents can now take advantage of a new city program for the
disposal of home-generated sharps.

The Warren County Health Department, city officials and Waste Management
announced this week that the program will begin immediately. Warren County
residents can obtain 1.4-quart sharps waste containers at the Warren
County Health Department, 240 S. Main St.

The Waste Management-provided container is for the storage and disposal of
wastes related to self-injections, including syringes, lancets, test
strips and needles. Wastes from the injection of pet medications are also
included.

Residents can deposit their full containers at a kiosk located inside the
health department.

A new empty container may be obtained at the health department office
during regular business hours from 8 a.m. to 4 p.m. Monday through Friday.
Sharps generated in the home typically are used by patients with diabetes
to inject insulin or by others who self-administer medications for
diseases or conditions such as allergies, arthritis, osteoporosis,
multiple sclerosis, hepatitis B and HIV.

“The new sharps disposal program is important because it helps remove
sharps waste from the municipal waste stream and diverts the material to
approved medical waste disposal facilities,” said Jenna Link, Warren
County Health Department director. “Our service will help limit the
improper disposal of sharps and, importantly, help to prevent injury or
the transmission of disease to the public in general who could otherwise
be subject to needles sticks.”

Improper disposal of sharps exposes collection drivers and waste handlers
to the risk of sticks and punctures from used syringes, hypodermic and
intravenous needles and lancets, said Dave Schaab, municipal marketing
manager for Waste Management.

These wastes can transmit blood-borne pathogens such as hepatitis B and C
and the HIV virus, presenting a public health hazard to waste handlers or
others who could come in contact with them, he said. Schaab said the
program offers an alternative for county residents who may unknowingly
place out containers such as beverage cans, bottles or plastic food boxes
that have been used to dispose of sharps. These containers can break when
compacted in collection trucks and their contents spilled onto conveyor
lines at recycling plants, exposing workers.

For more information on the sharps disposal program, contact the Warren
County Health Department at 734-1314.

http://tinyurl.com/ok8j48p
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/oxyy24c

China: China Says Vaccines Didn’t Cause 9 Kids’ Deaths

By Associated Press, Washington Post (03.01.14)

BEIJING — Vaccines did not cause the deaths of nine children shortly after
they were inoculated for hepatitis in a Chinese government program and no
links have been found in eight other cases still being investigated,
health officials said Friday after safety concerns arose.

At the same time, China’s national product safety watchdog said three drug
makers — one of whom was scrutinized over the recent deaths — had
suspended production because they failed to meet new manufacturing
standards.

Public confidence in Chinese health authorities and the country’s drug
safety regime is shaky at best, though improvements have been made in
recent years since government agencies withheld information about the
spread of SARS and bird flu.

Concerns over vaccine safety have surfaced after reported problems with
vaccines for encephalitis, hepatitis B and other diseases. In those cases,
the health ministry said the vaccines had been improperly stored but were
unrelated to subsequent illnesses that were reported.

In the recent cases, China’s National Health and Family Planning
Commission investigated 17 deaths of children between Dec. 13 and Tuesday
shortly after they received shots for the liver disease hepatitis B, the
commission said in a statement on its website.

Nine were clearly unrelated to the vaccines, the commission said, while a
preliminary investigation found no links in the remaining cases. The cause
of those eight deaths would only be confirmed after autopsies are
completed.

The causes of the deaths instead were acute pneumonia, suffocation, kidney
failure, severe diarrhea, death of intestinal tissue, sudden infant death,
congenital heart disease and so on, the commission said. The children were
all younger than 5 and lived in nine provinces across China, the
commission said without further details.

Late last month after the first few deaths were reported, Chinese
authorities sent health experts to investigate the manufacturer of most of
the hepatitis B vaccines, Biokangtai, a drug maker based in the southern
city of Shenzhen.

The China Food and Drug Administration said Friday that Biokangtai and two
other manufacturers of hepatitis B vaccines had to suspend production
because they failed to meet new safety and quality standards for
manufacturing. It said the companies could resume production after
obtaining the new certification.

Copyright 2014 The Associated Press. All rights reserved.
__________________________________________________________________
________________________________*_________________________________
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Facsimile: +41 22 791 4836 E- mail: sign@who.int
__________________________________________________________________
________________________________*_________________________________

The 2010 annual Safe Injection Global Network meeting to aid collaboration
and synergy among SIGN network participants worldwide was held from 9
to 11 November 2010 in Dubai, The United Arab Emirates.

The SIGN 2010 meeting report pdf, 1.36Mb is available on line at:
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