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Post00756 IS + Vials + Ebola + OpEd + Abstracts + News 06 August 2014

1. USA: The Joint Commission Alerts Health Care Industry to Prevalence of
Unsafe Injection Practices
2. USA: TJC: Sentinel Event Alert Issue 52: Preventing infection from the
misuse of vials
3. Link: Lessons from three previous Ebola outbreaks
4. Opinion: Nigeria, Unsafe Healthcare and Bloodborne Virus Epidemics
5. Abstract:Injection practices among practitioners in private medical
clinics of Karachi, Pakistan
6. Abstract: The Joint Commission cracks down on vial misuse in hospitals
7. Abstract: Sharps injuries in the operating room
8. Abstract: Epidemiology of B/C virus infection hepatitis in the Northern
Moldavian correctional facilities risk factors
9. Abstract: Pre-filled syringe – a ready-to-use drug delivery system – a
10. Abstract: Risk of needle-stick injuries associated with the use of
subdermal needle electrodes during intraoperative neurophysiologic
11. No Abstract: Needlestick injuries avoidable
12. News
– Injections and physical therapy equal for treating shoulder pain
– Liberia: Red Cross Condemns Ebola Vaccine Claims
– Liberia: EDITORIAL Prevention – Not Bitter Kola or Vaccine
– Liberia: Fake Ebola Vaccine Causes Panic Monrovia, Parents Warned
– India: Cops raid drug shop in Cuttack

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1. USA: The Joint Commission Alerts Health Care Industry to Prevalence of
Unsafe Injection Practices

The Joint Commission (TJC) is the USA’s oldest and largest standards-
setting and accrediting body in health care.
The Joint Commission Alerts Health Care Industry to Prevalence of Unsafe
Injection Practices

June 16, 2014

By: Elizabeth Eaken Zhani, Media Relations Manager

View the multimedia news release

(OAKBROOK TERRACE, Illinois – June 16, 2014) Patients visiting a clinic
for an injection to relieve their pain or for chemotherapy don’t expect to
leave with a new condition such as hepatitis, but unfortunately thousands
of patients have been adversely affected in this way when they received an
injection at their doctor’s office or in the hospital. Since 2001, at
least 49 outbreaks have occurred due to the mishandling of injectable
medical products, according to the Centers for Disease Control and
Prevention (CDC). In spite of this, adverse events related to unsafe
injection practices and lapses in infection control practices are
underreported, and it remains a challenge to measure the true frequency of
such occurrences.

To raise awareness of the issue, The Joint Commission today released a
Sentinel Event Alert, “Preventing Infection from the Misuse of Vials.” The
free publication was written to educate health care organizations and
health care workers on the risks of misusing vials of injectable medical
products. The alert describes the factors that contribute to the misuse of
vials and recommends strategies for improvement.

The misuse of vials primarily involves the reuse of single-dose vials,
which are intended to be used once for a single patient. Single-dose vials
typically lack preservatives; therefore, using these vials more than once
carries substantial risks for bacterial contamination, growth and
infection. For multiple-dose vials, one survey of health care
practitioners found that 15 percent reported using the same syringe to re-
enter a vial numerous times for the same patient, and of that 15 percent,
6.5 percent reported saving vials for use on other patients. Patients
exposed to these types of vial misuse have become infected with the
hepatitis B or C viruses, meningitis, and other types of infections.

According to the CDC, adverse events caused by this misuse have occurred
in both inpatient and outpatient settings. In outpatient settings, a high
percentage occurred in pain management clinics where injections often are
administered into the spine and other sterile spaces using preservative-
free medications, and in cancer clinics, which typically provide
chemotherapy or other infusion services to patients who may be immuno-

Much of the information and guidance provided in The Joint Commission’s
periodic Sentinel Event Alerts is drawn from its Sentinel Event Database,
one of the nation’s most comprehensive voluntary reporting systems for
serious adverse events in health care. The database includes detailed
information about both adverse events and their underlying causes.
Previous Alerts have addressed risks associated with the use of opioids,
health care worker fatigue, diagnostic imaging risks, violence in health
care facilities, maternal deaths, health care technology, anticoagulants,
wrong-site surgery, medication mix-ups, healthcare-associated infections
and patient suicides, among others. The complete list and text of past
issues of Sentinel Event Alert can be found on The Joint Commission

2. USA: TJC: Sentinel Event Alert Issue 52: Preventing infection from the
misuse of vials

The Joint Commission (TJC) is the USA’s oldest and largest standards-
setting and accrediting body in health care.

Sentinel Event Alert Issue 52: Preventing infection from the misuse of

June 16, 2014

Download file:

Sentinel Event Alert Issue 52: Preventing infection from the misuse of
vialsThousands of patients have been adversely affected by the misuse of
single-dose/single-use and multiple-dose vials. The misuse of these vials
has caused harm to individual patients through occurrences and outbreaks
of bloodborne pathogens and associated infections, including hepatitis B
and C virus, meningitis, and epidural abscesses.3 Adverse events caused by
this misuse have occurred in both inpatient and outpatient settings,
according to the Centers for Disease Control and Prevention (CDC).

Additional Resources

Joint Commission requirements relevant to the use of vials

Download graphic: Use safe injection practices for multiple-dose vials

3. Link: Lessons from three previous Ebola outbreaks

Don’t Get Stuck With HIV

Lessons from three previous Ebola outbreaks

by David Gisselquist, (04.08.14) on August 4, 2014

Newspapers, web, and TV have been delivering a crescendo of reports and
comments on West Africa’s Ebola epidemic. A lot of what is available for
public consumption scares people who are not at risk. At the same time,
people at risk are not getting adequate advice from official sources to
make informed decisions about how to protect themselves and their loved

In this situation, it’s useful to take a look back at three well-studied
and well-reported Ebola outbreaks: the first two recognized outbreaks in
1976 in Sudan and Zaire (currently Democratic Republic of the Congo) and a
later outbreak in Kikwit, Zaire, in 1995. Official committees of experts
studied each of these outbreaks and reported what they found in the
Bulletin of the World Health Organization in 1978 and in the Journal of
Infectious Diseases in 1999.

[Mod: This is a longish piece. Please read the complete descriptive
analysis at the link ]


Extract Extract Extract Extract Extract

Yambuku, Zaire, 1976

The first recognized case reported symptoms on 1 September. The last death
occurred just over two months later on 5 November 1976. An International
Commission managed a detailed and thorough investigation of the outbreak,
reporting 318 cases and 280 deaths. The information in this and following
paragraphs is from the Bulletin of the World Health Organization, 1978, pp
271-293, available at:
(accessed 2 August 2014).

“The index case in this outbreak had onset of symptoms on 1 September
1976, five days after receiving an injection of chloroquine for
presumptive malaria at the outpatient clinic at Yambuku Mission Hospital…
[A]lmost all subsequent cases had either received injections at the
hospital or had had close contact with another case. Most of these
occurred during the first four weeks of the epidemic, after which time the
hospital was closed, 11 of the 17 staff members having died of the
disease…” (p 271).

“Five syringes and needles were issued to the nursing staff [at the
Yambuku Mission Hospital] each morning for use at the outpatient
department [with an average of 200-400 outpatients each day], the prenatal
clinic, and the inpatient wards [with 120 beds]. These syringes and
needles were apparently not sterilized between their use on different
patients but rinsed in a pan of warm water. At the end of the day they
were sometimes boiled” (p 273).

“The epidemic reached a peak during the fourth week, at which time the YMH
[Yambuku Mission Hospital] was closed [on 3 October], then it receded over
the next four weeks” (p 279). “[I]t seems likely that closure of YMH
[Yambuku Mission Hospital] was the single event of greatest importance in
the eventual termination of the outbreak” (p 280). The last recognized
transmission occurred in late October.

4. Opinion: Nigeria, Unsafe Healthcare and Bloodborne Virus Epidemics

Nigeria, Unsafe Healthcare and Bloodborne Virus Epidemics

Posted by Simon Collery, (30.07.14)

An article in a Nigerian newspaper highlights the very serious hepatitis
epidemic there, with an estimated 20 million people, about 12% of the
population, infected with either hepatitis B (HBV) or C (HCV). Although
one of the ways HBV can be transmitted, and the way HCV is usually
transmitted, is through blood, it is less common to find explanations of
why or how people come into contact with someone else’s blood, or how to
avoid this.

The Don’t Get Stuck With HIV site gives details of numerous ways you can
come into contact with someone else’s blood through healthcare, cosmetic
and traditional practices. Healthcare practices include antenatal care,
birth control injections and implants, transfusions, child delivery,
dental care, donating blood, injections for curative and preventive
reasons, catheters, male circumcision and others.

Cosmetic practices include manicures and pedicures, shaving, tattooing,
body piercing, use of Botox and other products, performance enhancing
drugs and perhaps colonic irrigation. Traditional practices include male
and female genital cutting (FGM and MGM), traditional medicine,
scarification and various other skin-piercing practices.

The Don’t Get Stuck with HIV site also lists some of the steps you can
take to protect yourself from exposure to HIV, HBV, HCV or other
bloodborne pathogens, even ebola. The site also links to articles and
sources of data about unsafe healthcare, unexplained HIV infections and
other indications that risks for bloodborne transmission of various
viruses are not always so widely recognized.

As a result, people often don’t know there is a risk and they don’t know
how to protect themselves. This is as true of HIV in high prevalence
countries with inadequate health services, HBV and HCV in countries where
those viruses are common, and even ebola or other haemorrhagic viruses,
when such an outbreak occurs. Indeed, ebola epidemics have only occurred
in countries where healthcare is known to be unsafe, such as Democratic
Republic of Congo, Sudan, Uganda, Guinea, Sierra Leone, Liberia and most
recently Nigeria.

Two lengthy reports on healthcare safety in Nigeria have been published in
the last few years. The second was a survey using the WHO’s ‘Tool C’, also
used for the survey from Philippines mentioned in a recent blog. Bearing
in mind the warnings we are currently hearing about ebola, and the
warnings we should have been hearing about HIV and hepatitis:

“Of the health facilities observed, only 23 (28.8 percent) had soap and
running water for cleansing hands, and no facility had alcohol-based hand
rub available.

Overall, fewer than half of all injections observed were prepared on a
clean surface…

They found that injection providers only washed their hands in 13 percent
of cases; none used an alcohol-based hand rub…

Fewer than half of the providers were seen to use water or a clean wet
swab to clean the skin before vaccination, therapeutic, and family
planning injections…

For vaccination, in 79.7 percent of cases, auto-disable syringes were

However, for dental procedures, there were two observations where
providers used sterilizable syringes, and of these two, one of them also
used a sterilizable needle…

18.7 percent had a needle left in the diaphragm of a multi-dose vial.

When glass ampoules were used during vaccination, the providers used a
clean barrier in 1 of the 11 vaccination injections observed. Providers
used a clean barrier in the only such dental injection observed, 3 of 11
family planning injections, and 4 of 43 therapeutic injections observed
(9.3 percent).

Providers generally used standard disposable needles and syringes (70
percent) for phlebotomy procedures, and lancets for procedures requiring
lancing (78.6 percent). Providers were rarely seen to use safety devices
such as auto-disable and retractable syringes…

62.6 percent of procedures were prepared on a clean, dedicated table or
tray where contamination of the equipment with blood, body fluids, or
dirty swabs was unlikely (in 42 out of 67 hospitals and 20 out of 32
lower-level facilities).

[for blood draws and intravenous procedures] Overall, providers washed
their hands with soap and running water in only 2 of the 99 observations.

Data collectors observed that patients shared a bed or stretcher with
another patient in 17.6 percent of IV infusions. This was also the case
for 4.5 percent of IV injection patients.

Data collectors observed that in 69.3 percent of cases, the provider used
a clean gauze pad and gently applied pressure to the puncture site to stop
bleeding after the procedure.

Only 10.5 percent of providers cleaned their hands with soap and water or
an alcohol-based hand rub following the observed procedures. In the 35
cases in which there was blood or body fluid contamination in the work
area, the area was cleaned with disinfectant in 20 percent of observations
(see Table 14).

During interviews, five percent of providers (11 out of 217) reported that
they used sterilizable needles in injections, phlebotomies, IV injections,
or infusions. Of the 5 out of 187 supervisors who reported use of
sterilizable syringes and needles, three said that fuel was always
available to run the sterilizer, while the remaining two reported that
fuel had been unavailable for less than one month at some point.

Half of the 80 health facilities had infectious waste (non-sharps) outside
of an appropriate container.”

This list includes only some of the risks to patients. There is also a
section on risks to the provider, risks to other health staff, such as
waste handlers, and risks to the community. Nigeria is unlikely to have
the worst health facility conditions in Africa and there are many areas of
healthcare safety requiring urgent attention.

When news reports about ebola constantly emphasize things like eating
bushmeat and ‘traditional’ practices at funerals, think of the kind of
conditions that can be found in Nigerian hospitals even when healthcare
personnel are aware that an inspection is taking place. When reports about
hepatitis concentrate on intravenous drug use and other illicit practices,
and when reports about HIV seem to be almost entirely about sexual
behavior, conditions in health and cosmetic facilities and contexts where
traditional practices take place must also be relevant.

5. Abstract:Injection practices among practitioners in private medical
clinics of Karachi, Pakistan

East Mediterr Health J. 2013 Jun;19(6):570-5.

Injection practices among practitioners in private medical clinics of
Karachi, Pakistan.

Yousafzai MT, Nisar N, Kakakhel MF, Qadri MH, Khalil R, Hazara SM.

Abstracts in English, Arabic, French [at the link]

The aim of this study was to determine the frequency and determinants of
sharps injuries among private health practitioners in slum areas of
Karachi, Pakistan.

All practitioners with at least 1 year of experience in a private medical
clinic were asked to complete a self-administered, structured
questionnaire (317/397 responded).

Only 7.9% of practitioners were qualified from medical school, 12.3% were
registered nurses and 8.8% lacked any professional qualifications.

At least 1 sharps injury in the previous 12 months was reported by 26.7%,
mostly due to needle recapping.

Only 25.2% reported using a new syringe for each patient.

In multivariate regression analysis shorter work experience, < 14 years of
schooling, > 20 patients per day, administering > or = 30 injections per
day, reuse of syringes and needle recapping after use were significantly
associated with sharps injury in the past year.

Better awareness and training on standard precautions is needed for
private practitioners in slum areas of Karachi.

6. Abstract: The Joint Commission cracks down on vial misuse in hospitals

ED Manag. 2014 Aug;26(8):85-8.

The Joint Commission cracks down on vial misuse in hospitals.

[No authors listed]

Unsafe injection practices with respect to the misuse and unsafe use of
vials is being targeted by The Joint Commission (TJC). The accrediting
agency has issued a Sentinel Event Alert, putting hospitals on notice that
they need to take strong steps to insure that health care workers fully
understand and are carrying out practices that protect patients from the
dangers of vial misuse.

According to the Centers for Disease Control (CDC) in Atlanta, since 2001,
at least 49 outbreaks related to the mishandling of injectable medical
products have occurred, and during this time period, more than 150,000
patients have had to be notified to undergo blood-borne pathogen testing
because of their potential exposure to unsafe injections. TJC cites a
survey of 5,446 health care practitioners, which reveals significant gaps
in basic infection control practices related to vial use.

Experts suggest vial misuse is often due to a lack of understanding of how
to apply safe injection practices.

To make improvements, experts recommend that hospital administrators first
take steps to observe what is happening in their care environments, and
then develop targeted action plans.

7. Abstract: Sharps injuries in the operating room

Environ Health Prev Med. 2014 Aug 1.

Sharps injuries in the operating room.

Lakbala P1, Sobhani G, Lakbala M, Inaloo KD, Mahmoodi H.

1Infectious and Tropical Diseases Research Center, Hormozgan University of
Medical Sciences, Bandar Abbas, Iran,

OBJECTIVES: We aimed to identify who sustains needlestick and sharps
injuries, under what circumstances and what actions are taken to minimize
the risk and in response to intraoperative NSSIs.

METHODS: The cross-sectional study was conducted in 2013 on 215 operation
room personnel in 14 hospitals of the Hormozgan province, Iran.

RESULTS: Two hundred and fifty appropriate responders completed the
questionnaire (86 %). Anaesthesia 59 (27.4 %) and operation room
technicians 55 (25.6 %) sustained the greatest numbers of NSSIs over the
past year. Awareness of local protocols was significantly worse in the
residents group. The commonest reasons for noncompliance with NSSIs local
protocols were not sure of the local protocols 44 (20.4 %) and prolonged
operation so unable to leave operation table 37 (17.3 %).

CONCLUSIONS: A revision of the local protocol to reduce the time it takes
to complete may improve compliance. Education is of paramount importance
in making health care workers aware of this issue. The application of
safety devices led to a reduction in NSSIs and reduces the risk of blood
borne infection as well.

8. Abstract: Epidemiology of B/C virus infection hepatitis in the Northern
Moldavian correctional facilities risk factors

Rev Med Chir Soc Med Nat Iasi. 2014 Apr-Jun;118(2):463-70.

Epidemiology of B/C virus infection hepatitis in the Northern Moldavian
correctional facilities risk factors.

Bacusca AI, Coman AE, Felea D, Petrovanu R, Ioan B.

AIM: To identify the specific risk factors for chronic hepatitis B/C virus
infections in the correctional system in Moldova (Romania).

MATERIAL AND METHODS: The study included 533 subjects imprisoned in three
correctional facilities located in the Northern region of Moldova. The
subjects were divided into 2 groups: HBV/HBC group–108; Control

RESULTS: The risk factor for transfusion-contracted HBV/HCV was 3.73; the
empirical treatment of the HBV/HBC group resulted in a relative infection
risk of 2.62; syringe sharing in the HBV/HBC group accounted for a risk
factor of over 4 (OR = 4.33); tattooing induced a relative risk factor of
1.25, and piercing was a risk factor of approximately 2 (OR = 1.97);
sharing personal care items represented a risk factor of over 2 (OR =
2.02). Injection drugs induced a relative risk of over 4 (OR = 4.33). In
the HBV/HCV group, self-aggression represented a risk factor of 1.65.

CONCLUSIONS: Prison environment, by its specific and nonspecific
contamination modalities (shared with the rest of the population but more
common) causes that inmates to be 2-4 times more exposed to hepatitis B/C

9. Abstract: Pre-filled syringe – a ready-to-use drug delivery system – a

Expert Opin Drug Deliv. 2014 Aug 1:1-9.

Pre-filled syringe – a ready-to-use drug delivery system – a review.

Ingle RG1, Agarwal AS.

1Roselabs Bioscience Ltd , Ahmedabad, 380051 , India +91 90672 06793 ;

Introduction: Fueled by a growing global expectation of the health and
medical fields, billions of dollars/euros/pounds are invested every year
in the research of new biological and chemical entities. However, little
interest is seen in the development of novel drug delivery systems. One
such system, pre-filled syringe (PFS), was invented decades ago but is
still a rare mode of delivery in many therapeutic segments.

Areas covered: This review comprises properties and effects of
extractables, leachables and discuss the characteristics of PFS
technology; its composition, glass and polymer types, configuration of
PFS, advantages over glass, technical and commercial applicability; its
significance against patient, industry, quality, environment and cost; and
its business potential. We discuss in brief about PFS used in various
major and life-threatening disorders and future prospects. It provides
showers of knowledge in the field of PFS drug delivery technology to the
reader’s, industrialist’s and researcher’s point of view.

Expert opinion: The PFS drug delivery system offers a wonderful panorama
to lifesaving drugs that are currently only available in conventional
vials and ampoules in the market. A novel approach of Form Fill Seal
technology can be adopted for this particular ready-to-use dosage form
also, which opens the new global doors for budding researchers in the
field of pre-filled drug delivery system.

KEYWORDS: business; drug delivery; extractables; leachables; needlestick
injury; pre-filled syringe

10. Abstract: Risk of needle-stick injuries associated with the use of
subdermal needle electrodes during intraoperative neurophysiologic

J Neurosurg Anesthesiol. 2014 Jan;26(1):65-8.

Risk of needle-stick injuries associated with the use of subdermal needle
electrodes during intraoperative neurophysiologic monitoring.

Tamkus A1, Rice K.

1Biotronic NeuroNetwork, Ann Arbor, MI.

BACKGROUND: Subdermal needle electrodes are commonly used during
intraoperative neurophysiologic monitoring (IONM). However, there is an
associated risk of needle-stick exposure to the IONM technologist as well
as other operating room personnel. We performed a retrospective study to
investigate the incidence and circumstances of needle sticks related to
the use of subdermal needle electrodes.

METHODS: IONM was performed on 50,665 consecutive surgeries with an
estimated use of approximately 2,000,000 needle electrodes. Incident
reports of needle exposures were analyzed for personnel, location, and
circumstances. Associated Worker’s Compensation expenses for the
technologists were analyzed.

RESULTS: There were 174 reported needle-stick exposures (0.34% incidence)
occurring during 173 surgeries, which included 75 IONM technologists
(43.1%), 38 anesthesia personnel (21.8%), 34 nurses (19.5%), 16 surgeons
(9.2%), and 11 other staff (6.3%). No infectious disease transmission was
reported. Fifty-seven technologists incurred expenses totaling $24,174
(average $424 per exposure). The cost for non-IONM personnel was not
available. Most needle sticks for technologists occurred during the
removal of needles (52.0%) and during patient positioning (67.7%) for non-
IONM personnel.

CONCLUSIONS: Needle-stick exposure from subdermal needle electrodes during
IONM is an infrequent but distressing event occurring in 0.34% of our
study group and was not limited to the IONM technologist. Although no
infections occurred as a result of needle-stick exposure in this study,
steps to minimize needle sticks should be taken during IONM.

11. No Abstract: Needlestick injuries avoidable

Aust Nurs Midwifery J. 2014 Jun;21(11):9.

Needlestick injuries avoidable.

[No authors listed]

12. News

– Injections and physical therapy equal for treating shoulder pain
– Liberia: Red Cross Condemns Ebola Vaccine Claims
– Liberia: EDITORIAL Prevention – Not Bitter Kola or Vaccine
– Liberia: Fake Ebola Vaccine Causes Panic Monrovia, Parents Warned
– India: Cops raid drug shop in Cuttack

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

Injections and physical therapy equal for treating shoulder pain

BY Kathryn Doyle, Reuters Health (04.08.14)

NEW YORK (Reuters Health) – Physical therapy and steroid injections work
equally well for shoulder pain, according to a new study.

Researchers compared the treatments for people with shoulder impingement
syndrome, a common type of persistent pain that can be caused by
tendonitis, bursitis or other inflammation in the shoulder joint.

“Interestingly, there is not standardized treatment for this and it can
vary,” said lead author Daniel I. Rhon, a physical therapist at the Center
for the Intrepid at Brooke Army Medical Center in Fort Sam Houston, Texas.

“I think there is a strong consensus that exercises can help, and patients
may also get a referral to physical therapy for this condition,” Rhon told
Reuters Health in an email. “Because of the pain and inflammation that is
sometimes present with shoulder impingement, corticosteroid injections are
also a very common treatment used by general practitioners, orthopedists,
and rheumatologists.”

Some doctors send patients to physical therapy and others don’t, while
still others will give a shot and also recommend physical therapy, he
said. Patients have some say in which treatment they get, but doctors
usually influence the choice.

Rhon and his team randomly divided 104 patients with this kind of pain
into two groups. One group received physical therapy twice a week for
three weeks. The therapists evaluated weakness, mobility and pain and
performed stretches, contract-relax techniques and reinforcing exercises
on the shoulder or upper spine area. They also prescribed at-home
exercises for the patients.

Patients in the other group were offered up to three injections of
corticosteroids over the course of a year. They also received printed
instructions for gentle exercises to do at home.

Both groups had significant improvement in symptoms after one month, which
continued over the one-year period of the study, the research team
reported in the Annals of Internal Medicine. Patients’ scores on pain and
disability were reduced by half with either treatment.

By the end of the year, 60 percent of the steroid injection group had
returned to their primary care doctor for shoulder pain again, compared to
37 percent of the physical therapy group. The injection group was also
more likely to end up having more injections or additional physical

The research was supported by funding from the American Academy of
Orthopaedic Manual Therapists.

“In the clinic I often see patients that have had multiple injections and
continue to have persistent pain – thus their referral to physical
therapy,” Rhon said. “I was curious to understand a little more about

“Only half of all new episodes (of shoulder impingement) end in complete
recovery after six months, indicating it is a serious health problem,”
said Brooke K. Coombes, who coauthored an editorial accompanying the

Coombes studies rehabilitation medicine in the physiotherapy department of
the University of Queensland in Brisbane, Australia.

She was not surprised that steroid injections and physical therapy worked
about equally well. The relief from an injection may not last as long,
leading to more treatments, or the physical therapy appointments may give
doctors more time to educate patients about dealing with shoulder pain,
Coombes told Reuters Health by email.

“Physical therapy involves more patient-clinician contact than a single
consultation at which an injection is given,” she said. “This may allow
for advice or reassurance about the condition and self-management

Injections are less costly than therapy because they only involve one
visit to the doctor rather than several therapy sessions, but if they also
result in more doctor visits down the line, that may end up balancing out
costs, she said.

Certain people may benefit more from steroid injections than physical
therapy, or vice versa, but that will need to be researched more, she

“One thing to point out is that the number one reason that patients turned
down participation in this study was because they did not want to be
randomized into a group that might receive an injection,” Rhon said. “This
suggests that there is a number of patients that really don’t want to get
an injection.”

Physical therapy is an excellent treatment option to consider for these
patients, he said.

SOURCE: Annals of Internal Medicine, online August 4, 2014.

Liberia: Red Cross Condemns Ebola Vaccine Claims

By Winston W. Parley, The New Dawn, Monrovia Liberia (22.07.14)

The Liberian Red Cross says it is not providing vaccination to any Ebola
patient, and terms as evil, the act of people wanting to use the
institution’s identity to carry out clandestine their deed. A Red Cross’
statement dated July 17, 2014 says it has been speculated in some quarters
that Red Cross’ staffs are in communities vaccinating suspected or
confirmed patients with the deadly Ebola virus.

Though the Red Cross did not identify those it says are carrying on the
speculation, the clarity was however made about a day after government
alarmed to the public last week that unknown inviduals posing as health
workers were issuing fake Ebola vaccine in communities.

The Deputy Health Minister for Research Planning, Ms. Yah Zolia told UNMIL
radio last Wednesday, July 16 that the Health Ministry was receiving
reports of imposters offering Ebola vaccine in some communities. Ms. Zolia
said one of her staff and the health promotion director at the ministry
had informed her about imposters delivering what they claimed is an Ebola

The deputy health minister additionally said she personally received two
calls from Paynesville and one from Brewerville, of complaints that
unidentified individuals posing as health workers were delivering the fake
Ebola vaccine. She said the action by the alleged imposters is intended to
create false hope within the public that there is a vaccine for Ebola,
which she dismissed as unfounded.

Ms. Zolia told UNMIL Radio that her staff did not name a specific
community in which the false Ebola vaccine was being administered. However
no suspect has since been identified as it relates to the alleged issuance
of fake Ebola vaccine in Monrovia and its environs.

“The Liberian Red Cross says it is NOT providing vaccination to any Ebola
patient as being speculated in the public,” the statement read. Recently,
the Liberian Red Cross Secretary General, Fayiah Tamba, said the
institution is not vaccinating anyone against Ebola and repeated emphssis
that the virus has no vaccine.

Mr. Tamba said he continues to receive calls from friends and partners on
the speculation, but clarified that those involved are not Red Cross
Staff. He demands the arrest and prosecution of anyone caught in the
process, professing to be a Red Cross staff. Mr. Tamba said the rumor of
Ebola vaccination by the Red Cross is false and misleading.

He said the Red Cross is strongly collaborating with the Government in the
areas of Social Mobilization and awareness, psychosocial counseling,
contact tracing, and the provision of survival kits to victims. Mr. Tamba
finally said discussion is undergoing with the Ministry of Health as to
how the Liberian Red Cross and its Movement partners can provide support
also in the area of dead body management of Ebola victims.

The Health Ministry’s update last week says the Ebola death toll in
Liberia is 105 with 48 confirmed deaths since the second wave of outbreak
here. The Ministry had said 179 cases have been reported throughout
Liberia, and 67 of them have been confirmed so far.

Liberia: EDITORIAL Prevention – Not Bitter Kola or Vaccine

The Inquirer, Monrovia Liberia via (21.07.14)


ASSISTANT HEALTH MINISTER for Preventive Services, Tolbert Nyenswah, has
disputed media reports that the nut, ‘Garcinia Kola’, commonly known as
bitter kola, is a cure for Ebola.

HE SAID TO date no vaccine or cure has been found for Ebola. A local daily
reported recently that the nut had stopped the Ebola virus in test tubes
in initial laboratory experiments and experts, including a Nigerian
pharmacologist, revealed.

MINISTER NYENSWAH THEN called on the public to report anyone or group of
people administering vaccines supposedly for the prevention of Ebola or
any form of drug or tablets, herbs or injections in the communities to the
nearest police station.

AT THE SAME time, the Health Ministry has called on the public not to
listen to any information from unknown individuals or groups, except that
provided by the Ministry of Health and partners.

ACCORDING TO MR. Nyenswuah, anyone caught administering fake vaccine or
tablets and even spreading wrong information on the Ebola disease would
face prosecution.

THE OUTBREAK OF the deadly Ebola epidemic which has now spread to seven
counties is something to be very worried about because it is claiming
lives and rapidly spreading in our country.

IN THE MIDST of the outbreak, there are some unscrupulous individuals who
are claiming that the ‘Garcinia Kola’ otherwise known as Bitter Kola is
the cure for Ebola. Some of these individuals are also going around
administering fake vaccine which they said could contain the deadly virus.

WE CALL ON the public not to listen to any information from unknown
individuals or groups that bitter kola or vaccine can cure the Ebola
virus.Those are false information and only intended to give our people
false hope. Only information provided by the Ministry of Health and
partners should be embraced by the public.

THE BEST THING to do in the midst of the rapid spread of the virus is to
take preventive measures and not to give credence to the false
information. Beware that there is no cure yet for Ebola and nothing else,
but can be prevented if the proper instructions are followed to the

DO NOT ALLOW anyone claiming to have vaccine for Ebola to administer it to
you, your children or family members because this is dangerous and only
intended to worsen the situation. Let us prevent ourselves against this
deadly virus in accordance with the Health Ministry’s advice and not to
follow information that are only intended to provide false hope.

AGAIN, ACCORDING TO experts, no known cure has been discovered for Ebola
except preventive measures therefore, let us not allow anyone to lie to us
that there is a vaccine against it or bitter kola can cure it. Let us do
the best thing by preventing ourselves and families against this deadly
Liberia: Fake Ebola Vaccine Causes Panic Monrovia, Parents Warned

By Kennedy L. Yangian, FrontPageAfrica, Monrovia Liberia (18.07.14)
via AllAfrica,com

Monrovia — Rumors that some people are moving around from one community to
another in Monrovia and its environs administering vaccines to children to
prevent the deadly Ebola vaccine, caused uneasiness for parents in the
Paynesville Community Wednesday.

At the densely populated Red-light Market where the information first
started according to eyewitnesses who hinted FrontPageAfrica, the rumor
caused shockwaves when it hit the densely populated market center like
wild fire. Most of the marketers who received the information were seen
rushing back home to tell their children to avoid the vaccine, while some
placed calls back home to sound the warning.

In the Pipeline Community, which was another scene of the rumor, an
elderly disabled man believed to be in his late fifties, was seen moving
from one home to another telling his neighbors to avoid anyone who may
come to their doorsteps under the pretense of administering Ebola vaccine
to children.

“When the government was about to administer the polio vaccine, everyone
was informed through the radio, but why are they making the Ebola vaccine
secret? The man only identified as Kerkulah wondered.

According to a FrontPageAfrica investigation conducted in the Paynesville
Community following the circulation of the rumor, parents of the various
communities have warned their children to avoid taking the Ebola vaccine
for fear that it may lead to their early death.

“Whether Ebola is here or not I don’t want any of my children to take this
Ebola vaccine. I told my children that while we are away, they should
avoid anyone that will come here to administer Ebola vaccine because we
are not informed of any Ebola vaccine” one parent Ma Fatu Konneh told FPA.
Health authorities are yet to comment on the rumor that continues to scare

India: Cops raid drug shop in Cuttack

TNN, Times of India (15.07.14)

BHUBANESWAR: A joint squad of directorate of drug control administration
(DDCA) and police on Monday raided a retail medicine outlet at Mangalabag
in Cuttack in connection with the alleged fake vaccine racket.

Drugs inspector SK Sinha said the particular shop came under a cloud as it
had purchased vaccine from a stockist, whose premises at Bidanasi were
raided on July 7. “We have seized some documents, including purchase
bills. These will help trail the route of the vaccine. Quizzing of the
chemist will also help know doctors who used the vaccine,” he said.

Sinha said though the probe team is yet to lay its hands on any fake
vaccine vial, it is relying on discrepancies in purchase bills, mismatch
in batch numbers and doctors’ statement to establish the case. The DDCA-
police team will soon interrogate two Mumbai-based representatives of the
vaccine maker. They had emerged as the contact points of the company with
Balasore-based doctor who had apprised DDCA about receiving 20 vials of
the bogus vaccine.
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