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SIGNPOST 00760

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00760 SIGN + Risk + HBV-HCV-HIV + Abstracts + News 20 August 2014

CONTENTS
1. First Announcement: SIGN Meeting 2014: 30-31 October 2014
2. Abstract: Biological Risk among Hospital Housekeepers
3. Abstract: Application of interval 2-tuple linguistic MULTIMOORA method
for health-care waste treatment technology evaluation and selection
4. Abstract: Hepatitis C virus infection in China: an emerging public
health issue
5. Abstract: Hepatitis B in poland in 2012
6. Abstract: Infection Status of HBV, HCV and HIV in Voluntary Blood
Donors of Chinese Nanjing Area During 2010-2013
7. Abstract: A Comparison of Risk Factors for Hepatitis C Among Young and
Older Adult Prisoners
8. Abstract: Selection of Variables that Influence Drug Injection in
Prison: Comparison of Methods with Multiple Imputed Data Sets
8. Abstract: Risky behavior and correlates of HIV and Hepatitis C Virus
infection among people who inject drugs in three cities in Afghanistan
10. Abstract: Microneedle patches: usability and acceptability for self-
vaccination against influenza
11. Abstract:Safety and immunogenicity of a candidate tuberculosis vaccine
MVA85A delivered by aerosol in BCG-vaccinated healthy adults: a phase
1, double- blind, randomised controlled trial
12. Abstract: Genetic history of hepatitis C virus in Pakistan
13. No Abstract: Keeping Australia’s nurses safe: the importance of
choosing and using gloves correctly
14. No Abstract: The ROI of infection prevention
15. No Abstract: Hepatitis C virus: The 25-year Journey from discovery to
cure
16. USA: FDA approves use of a needle-free injection system for use with
Afluria and issues updated communication to healthcare professionals
on use of jet injectors for inactivated influenza vaccine
17. News
– Some HCWs Lack Gear to Protect From HIV, Other Bloodborne Infections
– USA: Missing the point: Clean needles can control the added health
risks of drug users
– South Africa: Medics get the needle
The web edition of SIGNpost is online at:
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__________________________________________________________________
________________________________*_________________________________

1. First Announcement: SIGN Meeting 2014: 30-31 October 2014
__________________________________________________________________
First Announcement: SIGN Meeting 2014: 30-31 October 2014

The Safe Injection Global Network SIGN meeting will be held on 30-31
October 2014 at WHO/HQ Geneva Switzerland

The main topic of the meeting is the new injection safety policy
recommendation and developing the appropriate strategies for
implementation in countries worldwide.

This policy follows on from the key 1999 policy on the use of Auto-Disable
Syringes.

The Keynote speaker will be Dr Margaret Chan, the Director-General of WHO.

Dr. Chan will launch the new IS policy which recommends the use of safety
engineered injection devices for reuse prevention and sharps injury
protection.

We will provide you with more detailed information about the meeting in
September 2014.

* All SIGN members are welcome to attend this meeting.

Please submit your expressions of interest in participating in this
important meeting to Dr. Selma Khamassi, at the SIGN Secretariat at WHO.

Contact Information

Dr. Selma Khamassi
SIGN Secretariat
Department of Health Systems Policies and Workforce
20 Avenue Appia
1211,Geneva 21
Switzerland

Email: KHAMASSI, Selma <KhamassiS@who.int>

Fax: +41 22 791 4836
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Biological Risk among Hospital Housekeepers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25136771

Arch Environ Occup Health. 2014 Aug 19:0.

Biological Risk among Hospital Housekeepers.

Ream PS1, Tipple AF, Barros DX, Souza AC, Pereira MS.

1a College of Nursing , Federal University of Goias , Goiania , Brazil.

Background: While not directly responsible for patient care, hospital
housekeepers are still susceptible to accidents with biological material.

Objectives: Establish profile and frequency of accidents among hospital
housekeepers, describe behaviors pre- and post-accident, and risk factors.

Methods: Cross-sectional study with hospital housekeepers in Goiania,
Brazil. Data from interviews and vaccination records.

Results: Participating workers: 94.3%. Incomplete hepatitis B vaccination:
1 in 3. Accident rate: 26.5%, mostly percutaneous with hypodermic needles,
and involved blood from an unknown source. Roughly half occurred during
waste management. Upon review, length of service less than five years,
completed Hepatitis B vaccination, and had been tested for anti-HBs
influenced frequency of accidents.

Conclusions: Improper disposal of waste appears to enhance the risk to
hospital housekeepers. All hospital workers should receive continued
training with regard to waste management.

KEYWORDS: Blood-borne pathogens; Hazardous waste; Hospital housekeeping;
Needlestick injuries; Occupational accident
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Application of interval 2-tuple linguistic MULTIMOORA method
for health-care waste treatment technology evaluation and selection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25151443

Waste Manag. 2014 Aug 20. pii: S0956-053X(14)00320-1.

Application of interval 2-tuple linguistic MULTIMOORA method for health-
care waste treatment technology evaluation and selection.

Liu HC1, You JX2, Lu C3, Shan MM4.

1School of Management, Shanghai University, Shanghai 200444, PR China;
School of Economics and Management, Tongji University, Shanghai 200092, PR
China. Electronic address: huchenliu@foxmail.com.
2School of Management, Shanghai University, Shanghai 200444, PR China;
School of Economics and Management, Tongji University, Shanghai 200092, PR
China.
3School of Management, Shanghai University, Shanghai 200444, PR China.
4School of Management, Shanghai University, Shanghai 200444, PR China.
Electronic address: mmshan@shu.edu.cn.

The management of health-care waste (HCW) is a major challenge for
municipalities, particularly in the cities of developing countries.

Selection of the best treatment technology for HCW can be viewed as a
complicated multi-criteria decision making (MCDM) problem which requires
consideration of a number of alternatives and conflicting evaluation
criteria. Additionally, decision makers often use different linguistic
term sets to express their assessments because of their different
backgrounds and preferences, some of which may be imprecise, uncertain and
incomplete.

In response, this paper proposes a modified MULTIMOORA method based on
interval 2-tuple linguistic variables (named ITL-MULTIMOORA) for
evaluating and selecting HCW treatment technologies. In particular, both
subjective and objective importance coefficients of criteria are taken
into consideration in the developed approach in order to conduct a more
effective analysis.

Finally, an empirical case study in Shanghai, the most crowded metropolis
of China, is presented to demonstrate the proposed method, and results
show that the proposed ITL-MULTIMOORA can solve the HCW treatment
technology selection problem effectively under uncertain and incomplete
information environment.

Copyright © 2014 Elsevier Ltd. All rights reserved.

KEYWORDS:
HCW treatment technology; Health-care waste management; Interval 2-tuple;
MULTIMOORA method
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Hepatitis C virus infection in China: an emerging public
health issue
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25131856

J Viral Hepat. 2014 Aug 18. doi: 10.1111/jvh.12295.

Hepatitis C virus infection in China: an emerging public health issue.

Qin Q1, Smith MK, Wang L, Su Y, Wang L, Guo W, Wang L, Cui Y, Wang N.

1National Center for AIDS/STD Control and Prevention, Chinese Center for
Disease Control and Prevention, Beijing, China.

Hepatitis C virus now represents a global viral pandemic and is the fourth
most commonly reported infectious disease in China. Information on China’s
national HCV epidemic was limited to cross -sectional seroprevalence
studies of special populations, and a national surveillance effort had
been launched to inform prevention and control.

We analysed novel data from two national databases: (i) China’s national
medical HCV case report system and (ii) the national disease sentinel
surveillance system.

Between 1997 and 2012, reporting incidence of medical cases for HCV
infection rose from 0.7 to 15.0 cases per 100 000 with the largest burden
of disease concentrated among individuals over 35 years of age, rural
residents and those tested as part of routine screening. Between 2010 and
2012, disease sentinel surveillance identified the highest HCV
seropositive rates among persons who use drugs and haemodialysis patients,
with far lower but not negligible rates among sexually active population.

The concentration of cases among older age groups is consistent with past
studies of age- specific prevalence rates in Asia. Differences across
regions and testing modes suggest diverse biological and social forces
driving the spread of HCV in China.

Surveillance data show ongoing transmission, particularly among persons
who use drugs and persons undergoing invasive medical treatments,
particularly haemodialysis.

Improvements in case detection and data reporting systems will be critical
for understanding current drivers of transmission and identifying key
areas for prevention.

© 2014 John Wiley & Sons Ltd.

KEYWORDS:
China; disease surveillance; hepatitis C virus infection; medical case
reports
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Hepatitis B in poland in 2012
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25135511

Przegl Epidemiol. 2014;68(2):257-63.

Hepatitis B in poland in 2012.

[Article in English, Polish]

Stepien M, Piwowarow K.

Department of Epidemiology, National Institute of Public Health – National
Institute of Hygiene (NIZP-PZH) in Warsaw.

OBJECTIVES: Evaluation of the epidemiological situation of hepatitis B in
Poland in 2012 in comparison with previous years.

MATERIAL AND METHODS: The evaluation was based on the results of analysis
of individual case reports of acute hepatitis B recorded by the Sanitary-
Epidemiological Stations and aggregate data of national surveillance
published in annual bulletins “Infectious diseases and poisonings in
Poland” for the years 2006-2012.

RESULTS: In Poland, in 2012 a total of 1 583 cases of hepatitis B were
reported, including 33 cases of dualinfection with hepatitis B virus (HBV)
and hepatitis C virus (HCV). The incidence was 4.11 per 100 000
inhabitants and compared to the preceding year its value did not change.
The acute cases accounted for 4.9% of all hepatitis B cases, the incidence
– 0.20 per 100 000 population. Compared to 2011, there was a further
decline in both incidence and share of acute stage of infection in the
total number of cases. The highest incidence of acute and chronic form of
hepatitis B was reported in Opolskie (0.49 per 100 000) and Lódzkie
provinces (8.62 per 100 thousand.), respectively. More frequently men and
urban dwellers were ill. In the age group 0-14 years, which was entirely
covered by universal vaccination of infants, no acute cases were found
while the incidence of chronic hepatitis B in this age group was 0.14 per
100 000. Chronic hepatitis B was most frequently detected in people aged
40-44 years (incidence 7.13 per 100 000) and acute disease – in those aged
45-49 years (incidence 0.46 per 100 000).

* Medical procedures in healthcare settings were still the predominant
route of infection (56% of all acute cases). Infections contracted via
sexual contacts, household contact with an infected person and through
injection drug use accounted together for 14% of all acute hepatitis B
cases. In 2012, 11 and 41 persons died due to acute and chronic stage of
hepatitis B, respectively.

CONCLUSIONS: A clear downward trend of the incidence of acute hepatitis B
with an unchanged mode of HBV transmission in Poland, indicates an
improvement in compliance with recommended infection control procedures at
all levels of medical care. The maintenance of the incidence of acute
hepatitis B at a low level is possible due to the continuation of an
universal vaccination program against HBV in combination with measures
that stop the spread of infections. In view of persistent pattern of
hepatitis B transmission in Poland in medical settings, it is advisable to
recommend immunization not only to individuals at increased risk but also
all previously unvaccinated persons. Simultaneously, activities leading to
the improvement of detectability and the availability of the recommended
treatment of chronic hepatitis B should be strengthened.

KEYWORDS: 2012; Poland; epidemiology; hepatitis B; immunization;
infectious diseases; public health
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Infection Status of HBV, HCV and HIV in Voluntary Blood
Donors of Chinese Nanjing Area During 2010-2013
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25130834

Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2014 Jul;22(4):1089-93.

[Infection Status of HBV, HCV and HIV in Voluntary Blood Donors of Chinese
Nanjing Area During 2010-2013].

[Article in Chinese]

Cai LN1, Zhu SW2, Zhou C3, Wang YB2, Jiang NZ2, Chen H2, Tang XY2, Wang
JH2, Chen X2, Hu WJ2, Chen BW4, Chen BA5.
Author information
1Department of Hematology, Zhongda Hospital,Southeast University Medical
School, Nanjing 210009, Jiangsu Province, China. Quality Management
Division, Jiangsu Province Blood Center, Nanjing 210042, Jiangsu Province,
China.
2Department of Clinical Laboratorial Examination, Nanjing 210042, Jiangsu
Province, China.
3Office of Administration, Jiangsu Province Blood Center, Nanjing 210042,
Jiangsu Province, China.
4Public Health School of Southeast University, Nanjing 210009, Jiangsu
Province, China.
5Department of Hematology, Zhongda Hospital,Southeast University Medical
School, Nanjing 210009, Jiangsu Province, China. E-mail:
cba8888@hotmail.com.

This study was purposed to understand the infection of HBV, HCV, HIV among
the voluntary blood donors and the epidemic trend in infectious population
in Chinese Nanjing area, and to guide the mobilization and recruitment of
blood donors.

A total of 199777 whole blood samples of voluntary blood donors were
tested by ELISA, the nucleic acid technology (NAT) combined detection
(HBV-DNA, HCV-RNA, HIV-RNA) was added for detection of the samples with
HBsAg,anti-HCV, anti-HIV at least unilateral negative donors from June 10,
2010 to June 9, 2013 years, and these statistic data were analyzed. Every
HIV reactive sample(HIV-antibody and/or HIV-RNA) was sent to be confirmed
in the Centers for Disease Control and Prevention in Nanjing.

The results showed that the voluntary donors’ infection rate of HBsAg,
anti-HCV, anti-HIV were 0.45%, 0.28%, 0.11% respectively; NAT positive
rate was 0.07%, 32 cases were confirmed with anti-HIV positive, in which
30 cases were male (6 cases were repeated blood donors) and 2 cases were
female, 3 cases were unconfirmed, in which 2 cases were males and 1 case
was female.

The statistical analysis demonstrated that the difference of unqualitative
rate of HBsAg, anti-HCV, anti-HIV was statistically significant between
the first-time and repeated blood donors.

It is concluded that the positive rate of anti-HCV and anti-HIV displayed
a declining trend year by year in Nanjing voluntary blood donation
population from June 10,2010 to June 9, 2013 years.

The unqualitative rate of HBsAg and NAT increased with the age increasing,
while that of anti-HCV, anti-HIV decreased with age increasing.

The unqualitative rate of the repeated blood donors is far lower than that
of the first-time blood donors. The ELISA positive rate of anti-HIV
testing in females is higher than that in males, but the confirmed
positive rate of male is significantly higher than that of female.

Therefore the consulting skills before donating should be improved,
concerning the link of recruiting donors, focusing on strengthening the
first-time donors’ consultation, evaluating and developing the fixed
voluntary blood donors, and vigorously popularizing NAT technology in
blood screening to improve the blood safety effectively.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: A Comparison of Risk Factors for Hepatitis C Among Young and
Older Adult Prisoners
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25134604

J Correct Health Care. 2014 Aug 17. pii: 1078345814541536.

A Comparison of Risk Factors for Hepatitis C Among Young and Older Adult
Prisoners.

van Dooren K1, Kinner SA2, Hellard M3.

1Queensland Centre for Intellectual and Developmental Disability, School
of Medicine, The University of Queensland, Brisbane, Australia
k.vandooren@uq.edu.au.
2Melbourne School of Population and Global Health, The University of
Melbourne, Melbourne, Australia School of Medicine, The University of
Queensland, Brisbane, Australia School of Public Health and Preventive
Medicine, Monash University, Melbourne, Australia.
3School of Public Health and Preventive Medicine, Monash University,
Melbourne, Australia Centre for Population Health, Burnet Institute,
Melbourne, Australia The Nossal Institute for Global Health, The
University of Melbourne, Melbourne, Australia.

Internationally, the prevalence of hepatitis C infection is higher among
prisoners when compared to the general population, particularly among
people who inject drugs. This study estimates the prevalence of, and
compares the risk factors for, hepatitis C in young (< 25 years) and older
(= 25 years) prisoners with a history of injection drug use.

Participants were 677 sentenced prisoners in Queensland, Australia, with a
lifetime history of injection drug use, recruited in the 6 weeks prior to
release from custody. The prevalence of hepatitis C exposure was
significantly lower in young prisoners than in older prisoners (20.7% vs.
29.4%, p = .03).

Risk factors for hepatitis C varied between young and older prisoners.
Young people who inject drugs and who have had shorter time at risk of
hepatitis C exposure are an important target group for hepatitis C
prevention efforts.

© The Author(s) 2014.

KEYWORDS: hepatitis C; injection drugs; prevention; prisoners; young
adults
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Selection of Variables that Influence Drug Injection in
Prison: Comparison of Methods with Multiple Imputed Data Sets
__________________________________________________________________

Addict Health. 2014 Winter;6(1-2):36-44.

Selection of Variables that Influence Drug Injection in Prison: Comparison
of Methods with Multiple Imputed Data Sets.

Haji-Maghsoudi S1, Haghdoost AA2, Baneshi MR3.

1PhD Student, Regional Knowledge Hub and WHO Collaborating Centre for HIV
Surveillance, Institute for Futures Studies in Health, Kerman University
of Medical Sciences, Kerman, Iran.
2Professor, Regional Knowledge Hub and WHO Collaborating Centre for HIV
Surveillance, Institute for Futures Studies in Health, Kerman University
of Medical Sciences, Kerman, Iran.
3Associate Professor, Research Center for Modeling in Health, Institute
for Futures Studies in Health, Kerman University of Medical Sciences,
Kerman, Iran.

BACKGROUND: Prisoners, compared to the general population, are at greater
risk of infection. Drug injection is the main route of human
immunodeficiency virus ý(HIV) transmission, in particular in Iran. What
would be of interest is to determine variables that govern drug injection
among prisoners. However, one of the issues that challenge model building
is incomplete national data sets. In this paper, we addressed the process
of model development when missing data exist.

METHODS: Complete data on 2720 prisoners was available. A logistic
regression model was fitted and served as gold standard. We then randomly
omitted 20%, and 50% of data. Missing date were imputed 10 times, applying
multiple imputation by chained equations (MICE). Rubin’s rule (RR) was
applied to select candidate variables and to combine the results across
imputed data sets. In S1, S2, and S3 methods, variables retained
significant in one, five, and ten imputed data sets and were candidate for
the multifactorial model. Two weighting approaches were also applied.

FINDINGS: Age of onset of drug use, recent use of drug before
imprisonment, being single, and length of imprisonment were significantly
associated with drug injection among prisoners. All variable selection
schemes were able to detect significance of these variables.

CONCLUSION: We have seen that the performances of easier variable
selection methods were comparable with RR. This indicates that the
screening step can be used to select candidate variables for the
multifactorial model.

KEYWORDS: Drug injection; Missing data; Multiple imputation; Prison;
Variable selection

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4137438/
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Risky behavior and correlates of HIV and Hepatitis C Virus
infection among people who inject drugs in three cities in Afghanistan
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25131717

Drug Alcohol Depend. 2014 Jul 30. pii: S0376-8716(14)00994-6.

Risky behavior and correlates of HIV and Hepatitis C Virus infection among
people who inject drugs in three cities in Afghanistan.

Ruiseñor-Escudero H1, Wirtz AL2, Berry M3, Mfochive-Njindan I4, Paikan F5,
Yousufi HA5, Yadav RS6, Burnham G4, Vu A7.

1Department of Psychiatry, Michigan State University, 965 E Fee Hall Suite
A227, East Lansing, MI, 48824, USA; Department of International Health,
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205,
USA. Electronic address: horaciore@gmail.com.
2Department of Emergency Medicine, Johns Hopkins Medical Institution,
Baltimore, MD, 21205, USA; Center for Public Health and Human Rights,
Department of Epidemiology, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD, 21205, USA.
3Centers for Disease Control and Prevention, Atlanta, GA, USA.
4Department of International Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, 21205, USA.
5National AIDS Control Program, Ministry of Public Health, Kabul,
Afghanistan.
6ChildFund, New Delhi, 110048, India.
7Department of Emergency Medicine, Johns Hopkins Medical Institution,
Baltimore, MD, 21205, USA; Department of International Health, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.

BACKGROUND: Injecting drug use is the primary mode of HIV transmission and
acquisition in Afghanistan. People who inject drugs (PWID) in the country
have been characterized by high risk injecting behavior and a high burden
of HCV infection. We aimed to estimate the burden of HIV, HCV, and other
infectious diseases and to identify the correlates of HIV and HCV
infection among PWID living in three major Afghan cities in 2009.

METHODS: Epidemiologic data was collected among PWID for the integrated
biological and behavioral surveillance (IBBS) survey between May and
August, 2009 in three Afghan cities. Data were collected using a
structured questionnaire and biologic specimens to screen for HIV, HBV,
HCV, syphilis, and HSV-2 using rapid testing kits. Multiple logistic
regression models were constructed to identify correlates of infection.

RESULTS: Among 548 participants, pooled HIV prevalence was 7.1% (Mazar-i-
Sharif: 1.0%, Kabul: 3.1%, Herat: 18.4%) and HCV prevalence was 40.3%.
Almost all participants with HIV infection were co-infected with HCV
(94.9%). Pooled prevalence estimates for other diseases included 7.1% for
HBV, 5.5% for syphilis; and 9.3% for HSV-2. Living in Herat, ever in
prison and time injecting were independently associated with HIV
infection. Living in Kabul, Herat and time injecting were independently
associated with HCV infection.

CONCLUSIONS: There is a high and heterogeneous burden of HIV and HCV among
PWID in Afghan cities. Provision of comprehensive harm reduction services
to PWID in Afghanistan is warranted to reduce exposures associated with
HIV and HCV infection, especially in the city of Herat.

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

KEYWORDS: Afghanistan; HBV; HCV; HIV; HSV; PWID
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Microneedle patches: usability and acceptability for self-
vaccination against influenza
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24530146

Vaccine. 2014 Apr 1;32(16):1856-62.

Microneedle patches: usability and acceptability for self-vaccination
against influenza.

Norman JJ1, Arya JM2, McClain MA3, Frew PM4, Meltzer MI5, Prausnitz MR6.
Author information
1Georgia Institute of Technology, School of Chemical and Biomolecular
Engineering, 315 Ferst Drive, Atlanta, GA 30332, USA. Electronic address:
jnorman3@gatech.edu.
2Georgia Institute of Technology, School of Chemical and Biomolecular
Engineering, 315 Ferst Drive, Atlanta, GA 30332, USA. Electronic address:
jarya3@gatech.edu.
3Georgia Institute of Technology, School of Chemical and Biomolecular
Engineering, 315 Ferst Drive, Atlanta, GA 30332, USA. Electronic address:
mx.mcclain@gmail.com.
4Emory University, School of Medicine, Division of Infectious Diseases,
1364 Clifton Road, Atlanta, GA 30322, USA; Emory University, Rollins
School of Public Health, Department of Behavioral Sciences & Health
Education, 1518 Clifton Road, Atlanta, GA 30332, USA. Electronic address:
pfrew@emory.edu.
5Centers for Disease Control and Prevention, National Center for Emerging
and Zoonotic Infectious Diseases, 1600 Clifton Road, Atlanta, GA 30333,
USA. Electronic address: qzm4@cdc.gov.
6Georgia Institute of Technology, School of Chemical and Biomolecular
Engineering, 315 Ferst Drive, Atlanta, GA 30332, USA. Electronic address:
prausnitz@gatech.edu.

While therapeutic drugs are routinely self-administered by patients, there
is little precedent for self-vaccination. Convenient self-vaccination may
expand vaccination coverage and reduce administration costs. Microneedle
patches are in development for many vaccines, but no reports exist on
usability or acceptability.

We hypothesized that naïve patients could apply patches and that self-
administered patches would improve stated intent to receive an influenza
vaccine. We conducted a randomized, repeated measures study with 91 venue-
recruited adults.

To simulate vaccination, subjects received placebo microneedle patches
given three times by self-administration and once by the investigator, as
well as an intramuscular injection of saline. Seventy participants
inserted patches with thumb pressure alone and the remainder used snap-
based devices that closed shut at a certain force. Usability was assessed
by skin staining and acceptability was measured with an adaptive-choice
analysis. The best usability was seen with the snap device, with users
inserting a median value of 93-96% of microneedles over three repetitions.
When a self- administered microneedle patch was offered, intent to
vaccinate increased from 44% to 65% (CI: 55-74%). The majority of those
intending vaccination would prefer to self-vaccinate: 64% (CI: 51-75%).

There were no serious adverse events associated with use of microneedle
patches. The findings from this initial study indicate that microneedle
patches for self- vaccination against influenza are usable and may lead to
improved vaccination coverage.

Copyright © 2014 Elsevier Ltd. All rights reserved.

KEYWORDS: Acceptability; Influenza; Microneedle, Human study; Usability
__________________________________________________________________
________________________________*_________________________________

11. Abstract:Safety and immunogenicity of a candidate tuberculosis vaccine
MVA85A delivered by aerosol in BCG-vaccinated healthy adults: a phase
1, double- blind, randomised controlled trial
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25151225

Lancet Infect Dis. 2014 Aug 20. pii: S1473-3099(14)70845-X.

Safety and immunogenicity of a candidate tuberculosis vaccine MVA85A
delivered by aerosol in BCG-vaccinated healthy adults: a phase 1, double-
blind, randomised controlled trial.

Satti I1, Meyer J1, Harris SA1, Thomas ZR1, Griffiths K1, Antrobus RD1,
Rowland R1, Ramon RL1, Smith M1, Sheehan S1, Bettinson H2, McShane H3.

1The Jenner Institute, University of Oxford, Oxford, UK.
2Oxford Centre for Respiratory Medicine, The Churchill Hospital, Oxford,
UK.
3The Jenner Institute, University of Oxford, Oxford, UK. Electronic
address: helen.mcshane@ndm.ox.ac.uk.

BACKGROUND: Intradermal MVA85A, a candidate vaccine against tuberculosis,
induces high amounts of Ag85A-specific CD4 T cells in adults who have
already received the BCG vaccine, but aerosol delivery of this vaccine
might offer immunological and logistical advantages.

We did a phase 1 double-blind trial to compare the safety and
immunogenicity of aerosol- administered and intradermally administered
MVA85A METHODS: In this phase 1, double-blind, proof-of-concept trial, 24
eligible BCG-vaccinated healthy UK adults were randomly allocated (1:1) by
sequentially numbered, sealed, opaque envelopes into two groups: aerosol
MVA85A and intradermal saline placebo or intradermal MVA85A and aerosol
saline placebo. Participants, the bronchoscopist, and immunologists were
masked to treatment assignment.

The primary outcome was safety, assessed by the frequency and severity of
vaccine-related local and systemic adverse events. The secondary outcome
was immunogenicity assessed with laboratory markers of cell-mediated
immunity in blood and bronchoalveolar lavage samples. Safety and
immunogenicity were assessed for 24 weeks after vaccination.
Immunogenicity to both insert Ag85A and vector modified vaccinia virus
Ankara (MVA) was assessed by ex-vivo interferon-? ELISpot and serum
ELISAs. Since all participants were randomised and vaccinated according to
protocol, our analyses were per protocol. This trial is registered with
ClinicalTrials.gov, number NCT01497769.

FINDINGS: Both administration routes were well tolerated and immunogenic.
Respiratory adverse events were rare and mild. Intradermal MVA85A was
associated with expected mild local injection-site reactions. Systemic
adverse events did not differ significantly between the two groups. Three
participants in each group had no vaccine-related systemic adverse events;
fatigue (11/24 [46%]) and headache (10/24 [42%]) were the most frequently
reported symptoms. Ag85A-specific systemic responses were similar across
groups. Ag85A-specific CD4 T cells were detected in bronchoalveolar lavage
cells from both groups and responses were higher in the aerosol group than
in the intradermal group.

MVA-specific cellular responses were detected in both groups, whereas
serum antibodies to MVA were only detectable after intradermal
administration of the vaccine.

INTERPRETATION: Further clinical trials assessing the aerosol route of
vaccine delivery are merited for tuberculosis and other respiratory
pathogens.

FUNDING: The Wellcome Trust and Oxford Radcliffe Hospitals Biomedical
Research Centre.

Copyright © 2014 Satti et al. Open Access article distributed under the
terms of CC BY. Published by Elsevier Ltd. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Genetic history of hepatitis C virus in Pakistan
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25131452

Infect Genet Evol. 2014 Aug 13. pii: S1567-1348(14)00292-5.

Genetic history of hepatitis C virus in Pakistan.

Ur Rehman I1, Vaughan G2, Purdy MA3, Xia GL3, Forbi JC3, Rossi LM4, Butt
S1, Idrees M1, Khudyakov YE3.

1National Centre of Excellence in Molecular Biology, Division of Molecular
Virology and Molecular Diagnostics, University of the Punjab, Genome
Center for Molecular Diagnosis & Research, Lahore, Pakistan.
2Division of Viral Hepatitis, Centers for Disease Control and Prevention,
Atlanta, GA, USA. Electronic address: GVaughan@cdc.gov.
3Division of Viral Hepatitis, Centers for Disease Control and Prevention,
Atlanta, GA, USA.
4Division of Viral Hepatitis, Centers for Disease Control and Prevention,
Atlanta, GA, USA; Department of Biology, Institute of Bioscience, Language
and Exact Science, São Paulo State University, São José do Rio Preto, SP,
Brazil.

Hepatitis C virus (HCV) genotype 3a accounts for ~80% of HCV infections in
Pakistan, where ~10 million people are HCV-infected. Here, we report
analysis of the genetic heterogeneity of HCV NS3 and NS5b subgenomic
regions from genotype 3a variants obtained from Pakistan.

Phylogenetic analyses showed that Pakistani genotype 3a variants were as
genetically diverse as global variants, with extensive intermixing.
Bayesian estimates showed that the most recent ancestor for genotype 3a in
Pakistan was last extant in ~1896-1914 C.E. (range: 1851-1932). This
genotype experienced a population expansion starting from ~1905 to ~1970
after which the effective population leveled.

Death/birth models suggest that HCV 3a has reached saturating diversity
with decreasing turnover rate and positive extinction. Taken together,
these observations are consistent with a long and complex history of HCV
3a infection in Pakistan.

Published by Elsevier B.V.

KEYWORDS: Genetic diversity; Hepatitis C Virus; Pakistan
__________________________________________________________________
________________________________*_________________________________

13. No Abstract: Keeping Australia’s nurses safe: the importance of
choosing and using gloves correctly
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24812784

Aust Nurs Midwifery J. 2014 Apr;21(9):44-5.

Keeping Australia’s nurses safe: the importance of choosing and using
gloves correctly.

Murphy C.
__________________________________________________________________
________________________________*_________________________________

14. No Abstract: The ROI of infection prevention
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25033628

Mod Healthc. 2014 May 5;44(18):28.

The ROI of infection prevention.

Murphy D.
__________________________________________________________________
________________________________*_________________________________

15. No Abstract: Hepatitis C virus: The 25-year Journey from discovery to
cure
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25131647

Hepatology. 2014 Aug 18.

Hepatitis C virus: The 25-year Journey from discovery to cure.

Ward J.

See the display of page 1
http://onlinelibrary.wiley.com/doi/10.1002/hep.27377/abstract
__________________________________________________________________
________________________________*_________________________________

16. USA: FDA approves use of a needle-free injection system for use with
Afluria and issues updated communication to healthcare professionals
on use of jet injectors for inactivated influenza vaccine

Crossposted with thanks from IAC Express Issue 1139: August 26, 2014
http://www.immunize.org/express/
__________________________________________________________________
FDA approves use of a needle-free injection system for use with Afluria
and issues updated communication to healthcare professionals on use of jet
injectors for inactivated influenza vaccine

On August 15, FDA approved the administration of Afluria for use with one
jet injector device, the PharmaJet Stratis Needle-free Injection System
(manufactured by PharmaJet Inc.) for intramuscular injection in adults 18
through 64 years of age. On the same day, the FDA issued related
information for healthcare professionals titled “FDA Updated Communication
on Use of Jet Injectors with Inactivated Influenza Vaccines,” which
includes guidance on the use of one jet injector device for the
administration of the inactivated influenza vaccine, Afluria. The section
“Recommendations/Actions” is reprinted below.

Recommendations/Actions

Afluria may be administered to adults ages 18 through 64 intramuscularly
via the PharmaJet Stratis Needle-Free Injection System or by sterile
needle and syringe.

Afluria, for use in children and adolescents 5 through 17 years of age, is
approved for intramuscular injection with a sterile needle and syringe
only.

Afluria, for use in adults 65 years of age and older, is approved for
intramuscular injection with a sterile needle and syringe only.

If a vaccine is approved for administration with a jet injector,
information specifically addressing vaccine use with the specific jet
injector will appear in the vaccine labeling.

FDA recommends that all approved vaccines, including influenza, be
administered in accordance with their approved labeling.
>> Link to the FDA Updated Communication on Use of Jet Injectors with
Inactivated Influenza Vaccines http://tinyurl.com/3q46mgz
__________________________________________________________________
________________________________*_________________________________

17. News

– Some HCWs Lack Gear to Protect From HIV, Other Bloodborne Infections
– USA: Missing the point: Clean needles can control the added health
risks of drug users
– South Africa: Medics get the needle

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
http://tinyurl.com/k5egnp3

Some HCWs Lack Gear to Protect From HIV, Other Bloodborne Infections

Infection Control Today, USA (26.08.14)

Source: Johns Hopkins Bloomberg School of Public Health

Healthcare workers in some of the world’s poorest countries lack basic
equipment to shield them from HIV and other bloodborne infections during
surgical and other procedures, new research from the Johns Hopkins
Bloomberg School of Public Health suggests. The findings underscore the
lack of adequate protective supplies in nations at the center of the
current Ebola outbreak.

In Liberia, one of the countries most affected by Ebola, 56 percent of
hospitals had protective eyewear for its doctors and nurses, while 63
percent had sterile gloves, the study found. In Sierra Leone, just 30
percent of hospitals had protective eyewear, while 70 percent had sterile
gloves. The results of the research are reported online this month in the
journal Tropical Medicine and International Health, and are based on data
compiled between 2008 and 2013, before the current outbreak.

The Ebola virus is spread through direct contact through broken skin or
mucous membranes with the blood, secretions, organs or other bodily fluids
of infected people, and indirect contact with environments contaminated
with such fluids. More than 1,300 have died during the current West-
African outbreak and transmission has frequently occurred when health care
workers treating patients with suspected or confirmed Ebola have been
infected. This has often occurred through close contact with patients when
infection control precautions are not strictly practiced.

“Sadly, one of the only benefits of the Ebola crisis in West Africa may be
to highlight the baseline lack of personal protective equipment such as
eye protection, gloves and aprons for health care workers,” says study
leader Adam L. Kushner, MD, MPH, an associate in the Johns Hopkins
Bloomberg School of Public Health’s Department of International Health.
“These items are crucial to protect healthcare workers today, but were
lacking long before the current crisis. We’ve seen this for many years
with HIV.”

Despite the billions of dollars that have been spent on HIV, one area that
has remained relatively ignored is protective gear, the researchers write.
In west and central Africa, as many as 5 percent of the population are HIV
positive, making the dearth of protective gear all the more striking.

For their study, Kushner and his colleagues reviewed surveys from 399
hospitals in 13 low- and middle-income countries – Afghanistan, Bolivia,
Gambia, Ghana, Liberia, Mongolia, Nigeria, Sierra Leone, Solomon Islands,
Somalia, Sri Lanka, Tanzania and Zambia.

Overall, only 29 percent of hospitals always had eye protection, 64
percent always had sterilizing equipment and 75 percent always had sterile
gloves. The range was wide among countries. For example, in Afghanistan,
only one-quarter of hospitals had sterile gloves, while 100 percent of
facilities in Nigeria and Bolivia had sterile gloves.

No country surveyed had 100 percent availability of all items. In the
United States, this type of protective equipment is standard.

The necessity of protection for healthcare workers, especially those in
surgical settings, has been well documented. One study showed that double
gloving of health care workers during surgery resulted in an 80 percent
reduction in perforations to the inner glove, preventing exposure to blood
through openings in the skin. The same study found that more than half of
the exposures to blood in sites other than the hand would have been
prevented by the use of face shields, waterproof gowns and waterproof
boots.

The World Health Organization has made it a priority to combat HIV,
malaria and other bloodborne diseases. One neglected area in that effort
is protecting healthcare workers from being placed at risk for infection,
Kushner says. The Ebola outbreak highlights this dearth of critical and
basic medical supplies. While the focus of the new study was HIV, Ebola
can be spread in the same manner and the findings are just as relevant –
if not more so – during the current epidemic, he says.

“We can all learn from this new epidemic and be better prepared for the
next one by remembering that inexpensive protective equipment can keep
doctors and nurses safe from infection – and better able to care for
patients who need them,” Kushner says. “It is imperative that we make this
a priority.”

“Scarcity of protective items against HIV and other bloodborne infections
in 13 low- and middle-income countries,” was written by Shailvi Gupta,
Evan G. Wong and Adam L. Kushner.

Source: Johns Hopkins Bloomberg School of Public Health

Posted in News, Occupational Health, Personal Protective Equipment (PPE),
Bloodborne Pathogens, Ebola Virus, Public Health, Research
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/lyayo3e

USA: Missing the point: Clean needles can control the added health risks
of drug users

By Eric Boodman / Pittsburgh Post-Gazette, Pittsburg PA USA (26.08.14)

Photo Caption: Different pharmacy chains have different policies about the
sale of syringes. A CVS spokesperson said that the 2009 change in
regulation was for the express purpose of ensuring clean needle access,
and that the company would look into the matter if a customer complained.

When he needed syringes to shoot up, Nick Stamerra would walk into a
pharmacy and ask for a 10-pack. But he knew that many pharmacists would
refuse, so he hid his used needles at the top of his closet, or in the
upholstery of his car, where his 10-year-old sister wouldn’t find them.
And, sometimes, when he needed a fix and didn’t have a needle, he would
borrow a used one from a friend.

The re-use of syringes should have been curbed in 2009, when the
Pennsylvania Board of Pharmacy revised its rules to allow pharmacists to
sell needles without a prescription. Yet addiction specialists and their
patients report that the change in regulation has not had the desired
effect: Many heroin users still have to use dirty needles, exposing
themselves to HIV, hepatitis C and a whole list of bacterial infections.

And as heroin use in Pennsylvania continues to increase — both in cities
but also in small towns and rural areas — experts worry that there will
be a public health crisis. Between 80 percent and 90 percent of injection
drug users get hepatitis C within the first year of injecting, say public
health specialists, and the virus is the most common reason for liver
transplants.

“Rural counties suddenly have high rates of hepatitis C, and it’s a very
expensive disease to treat,” says Alice Bell, a coordinator at Prevention
Point Pittsburgh, a needle exchange program that disperses clean needles.
“It’s going to bankrupt the local health departments.”

Ms. Bell has heard many stories like Mr. Stamerra’s. The people who come
into the needle exchange often report being turned away from pharmacies.
Some people — especially in small towns — are afraid to go in and ask
for syringes because of the stigma surrounding heroin addiction. But for
those who do go in, the sale often depends on how you look.

“If you are in a suit and tie, they’ll sell you syringes, but if you look
bedraggled, they won’t,” Ms. Bell says.

Mr. Stamerra is 22, and lives in North Huntingdon. He has been clean for
almost eight months, but his memory of what it is like to need a fix is
crystal-clear: “It’s the worst feeling you’ve ever had. It’s the worst flu
you’ve ever had, multiplied by 1,000, coupled with terrible anxiety.”

Like for many others, his heroin addiction began with other, softer drugs.
When he did begin to use heroin, in 2010, during his senior year of high
school, he began by snorting it. As his addiction grew, he needed more and
more of the drug to get his fix.

Neil Capretto, medical director at Gateway Rehabilitation Center, explains
that when you snort a drug, not all of it gets through the membrane in
your nose, and when you swallow it, the acid in your stomach begins to
break it down. “When you inject a drug directly into the blood system, you
maximize the effect,” he says. It means that injection is the cheapest way
to satisfy a heroin addiction. And once you go from snorting to injecting
— as Mr. Stamerra did in July 2010 — you almost never go back.

“It became a cost-analysis thing,” says Mr. Stamerra.

He remembers getting into arguments with pharmacists when they asked why
he wanted syringes. But he also remembers pharmacists jacking up the price
of syringes so that people with addiction would not be able to afford
them. What was listed as $2 or $3 would be sold for $15, he says.

Different pharmacy chains have different policies about the sale of
syringes. None of them prevent their pharmacists from selling syringes
without prescriptions, but both Rite Aid and Giant Eagle leave it up to
the discretion of the pharmacist. A CVS spokesperson said that the 2009
change in regulation was for the express purpose of ensuring clean needle
access, and that the company would look into the matter if a customer
complained.

Many independent pharmacists refuse outright when they think customers
want syringes for heroin use. If customers claim the needles are for
insulin injections but can’t produce a prescription, they are out of luck.
Other pharmacists pretend there are no syringes behind the counter.

“I don’t care what the law says. If a 21- or 22-year-old comes in ratty
and unkempt, I just tell them to get their syringes where they get their
insulin,” says an independent pharmacist in Belle Vernon, who did not want
to be identified. “I’m not going to contribute to the downfall of
society.”

These pharmacists feel that to sell syringes without prescriptions is to
encourage drug use. But research shows that those who are addicted will
simply find another, less safe way of injecting the drug, says Ms. Bell.

“You’re not going to stop addicts from using drugs,” says Mr. Stamerra of
pharmacists who would not sell him syringes. “You’re just making it more
dangerous.”

In Allegheny County and Philadelphia, needle exchange programs make it a
little easier to find clean syringes, but not that much easier. There is a
ban on both federal and state funding for needle exchanges to purchase
sterile injection equipment, and the lack of funds means that Prevention
Point Pittsburgh relies heavily on grants and donations and can only offer
very limited services. (The nonprofit hands out needles noon to 3 p.m.
Sundays at the Allegheny County Health Department building, 3441 Forbes
Ave., Oakland; and 1 to 3 p.m. Wednesdays at Kirkpatrick Street and
Bentley Drive in the Hill District; other opportunities by appointment,
412-758-4257.)

“Our type of program should be implemented statewide if Pennsylvania is
serious about addressing this issue,” says Renee Cox, executive director
of Prevention Point Pittsburgh.

Over the summer, state Sen. Gene Yaw, R-Lycoming, and the Center for Rural
Pennsylvania have been holding hearings to learn more about the spike in
rural heroin use. They have discussed legislation that would grant wider
access to naloxone, a drug known as Narcan that can reverse overdoses.
They have also discussed Good Samaritan laws, which would protect someone
from being arrested for drug possession and use if he or she calls 911 for
a friend who is overdosing.

But clean needle access has only been mentioned in passing, says Mr. Yaw.
The last of the hearings on rural heroin use was held last week in Clarion
County. As Ms. Cox put it, “When drug use goes into the realm of death and
disease, you’ve got a far worse problem than the drug use itself.”

Eric Boodman, a senior at Yale University, was a Post-Gazette summer
intern.
__________________________________________________________________
__________________________________________________________________
http://www.timeslive.co.za/thetimes/2014/08/21/medics-get-the-needle

South Africa: Medics get the needle

Rea Khoabane, Times LIVE, Johannesburg South Africa (21.08.14)

Globally, out of 35 million healthcare workers, two million contract
infectious diseases through these injuries every year.

File photo: South Africa has the highest number of needle-stick injuries
in Africa, amounting to 25% of all reported cases.

According to a recent World Health Organisation report most healthcare
workers experience more than one needle-stick injury a year.

Globally, out of 35million healthcare workers, two million contract
infectious diseases through these injuries every year.

The report states that “37.6% of hepatitis B, 39% of hepatitis C and 4.4%
of HIV in health workers around the world are due to needle-stick
injuries”.

At the second Becton Dickinson safety summit yesterday, it was reported
that in 2001 over 69% of interns working at Chris Hani- Baragwanath
Hospital in Soweto sustained needle-stick injuries and 91% of junior
doctors at Tygerberg Hospital reported having suffered a needle-stick
injury.

Of that, 91% a third said the injury occurred while they were treating an
HIV-positive patient.

Executive director of National Institute for Occupational Health Dr Barry
Kistnasamy said South Africa did not have the occupational therapy
resources to treat needle-stick injuries.

Kistnasamy reported that out of 100000 doctors in the country, South
Africa only had 712 occupational specialists. Out of 100000 nurses, only
2000 of them were occupational nurses.

He said health workers faced a number of issues relating to proper safety
wear.

Professor Sabine Wicker, head of Occupational Health at Goethe University
Hospital in Germany, said in her country a healthcare worker was stuck
with a needle every minute.
__________________________________________________________________
________________________________*_________________________________
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