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SIGNpost 00780


Post00780 Reminder + No Vax Autism + Abstracts + News 03 December 2014

0. Reminder: SIGN Meeting 2015
1. Evidence Shows Vaccines Unrelated to Autism: IAC updates “Evidence
Shows Vaccines Unrelated to Autism” handout
2. Abstract: Healthcare waste generation and management practice in
government health centers of Addis Ababa, Ethiopia
3. Abstract: Analysis of the healthcare waste management status in Tehran
4. Abstract: The hospitalized patient as a partner in the survey on safe
care in the Czech Republic
5. Abstract: Prevalence of hepatitis B surface antigen (HBsAg) and its
risk factors among individuals visiting Goba General Hospital, South
East Ethiopia, 2012
7. Abstract: Coverage of overdose prevention programs for opiate users and
injectors: a cross-sectional study
8. Abstract: Injection Drug Users’ Perceived Barriers to Using Self-
Initiated Harm Reduction Strategies
9. Abstract: Risk behaviour of prison inmates in relation to HIV/STI
10. Foreward: Research On Risk Behavior Of Prison Inmates In Relation To
HIV/SPI Bosnia And Herzegovina, 2011
11. Abstract: Postpartum Hemorrhage in Uganda: A Double-Blind Randomized
Non-Inferiority Trial
12. Abstract: Patients’ assessment of adalimumab self-injection for
Crohn’s disease: a multicenter questionnaire survey (The PEARL Survey)
13. Abstract: Acupuncture Safety in Patients Receiving Anticoagulants: A
Systematic Review
14. Abstract: Hepatitis C vaccine
15. Abstract: Thimerosal compromises human dendritic cell maturation,
IL-12 production, chemokine release, and T-helper polarization
16. News
– USA: Colorado company develops a flu shot — without a needle
– USA: Needle exchange reduces rate of infectious diseases
– UN: Ebola shows WHO needs revamp, says U.N. reformer Rudd
– Russia: Russia warns of HIV/AIDS epidemic
– Europe and Central Asia failing to curb spread of HIV: WHO
– USA: New report underlines success of City’s ‘Clean Needle Exchange
– Vaccines: Powdered measles vaccine found safe in early clinical trials

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0. Reminder: SIGN Meeting 2015
SIGN Meeting 2015

The Safe Injection Global Network SIGN meeting is 23-24 February 2015 at
WHO Headquarters in Geneva Switzerland

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

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

1. Evidence Shows Vaccines Unrelated to Autism: IAC updates “Evidence
Shows Vaccines Unrelated to Autism” handout

Immunization Action Coalition publishes this handout providing summaries
of the evidence that shows that vaccines are unrelated to Autism.

The summary also discusses thimerosal the vaccine preservative in multi-
dose vials and its non-relationship with Autism.

The printable PDF files is available here:

Crossposted from About IAC Express – the Immunization Action Coalition
weekly news letter. • and • Item #P4028 (11/14)
Immunization Action Coalition

Evidence Shows Vaccines Unrelated to Autism

Claims that vaccines cause autism have led some parents to delay or refuse
vaccines for their children. The most common claims are that autism is
caused by measles-mumps-rubella (MMR) vaccine, vaccines that contain
thimerosal, or too many vaccines. Many studies have been done to test
these claims. None has shown that vaccines cause autism. The real causes
of autism are not fully known, but scientists – working with families –
have made progress.

This sheet lays out the facts to help parents understand why experts do
not think vaccines cause autism.

Medical and legal authorities agree that no evidence exists that vaccines
cause autism.

The Institute of Medicine is an impartial group of the world’s leading
experts that advises Congress on science issues. After reviewing more than
200 studies in 2004 and more than 1,000 studies in 2011, the consensus
report strongly stated that the evidence did not show a link between
vaccines and autism.

In 2014, researchers from the RAND Corporation published an update to the
2011 Institute of Medicine’s report. In a systematic review of the
evidence published on vaccine safety to date, they found the evidence was
strong that MMR vaccine is not associated with autism.

In 2009, the U.S. federal court reviewed 939 medical articles in their
hearings. The court found the evidence was “over-whelmingly contrary” to
the theory that autism is linked to MMR vaccine, thimerosal, or a
combination of the two.

Based on the research, the World Health Organization, the European
Medicines Agency, Health Canada, and other national and international
health groups have concluded that no link can be found between vaccines
and autism.


Immunization Action Coalition. Decisions in the Omnibus Autism Proceeding.

Institute of Medicine. Adverse Effects of Vaccines: Evidence and
Causality. National Academies Press 2011.

Institute of Medicine. Immunization Safety Review: Vaccines and Autism.
National Academies Press. 2004.

Maglione MA, Das L, Raaen L, et al. Safety of Vaccines Used for Routine
Immunization of U.S. Children: A Systematic Review. Pediatrics, published
ahead of print July 1, 2014.
The causes of autism are not fully understood, but the evidence does not
point toward vaccines.

Parents often first notice the behaviors of autism when their child is
18–24 months old – the age by which most childhood vaccines have been
given. Because of this, many parents incorrectly associate vaccination
with the onset of autism. Developmental specialists, however, can identify
early signs of autism in children when they are much younger, before their
parents have noticed anything unusual. This research supports the
scientific consensus that, in most cases, the precursors of autism are
present before a child is born.

The influence of vaccines on a child cannot explain the measurable
differences in brain structure and brain function that exist between
autistic and non-autistic children. Starting in the first six months of
life, many autistic children experience unusually rapid growth in areas of
the brain that are responsible for the skills typically impaired in
autism. Researchers have used “functional” MRI scans to study the
connections of nerve cells within the brains of autistic individuals.

These scans show – in very young autistic infants and toddlers – abnormal
connections in areas of the brain that control language, social, and
emotional processes, suggesting that these abnormalities contribute to the
development of autism. The results of these and other studies provide
promising clues for future research on the causes of autism and emphasize
that finding its causes will not be as simple as pointing to vaccines as
the cause.

What is known with great certainty is that genetics play a major role in
determining whether a child will be autistic. The study of twins bears
this out. Identical twins have 100% of their genes in common; fraternal
twins have 50% in common (like any other pair of siblings).

In more than three out of four cases, when one identical twin has a form
of autism, the other one does too. Among fraternal twins, though, this is
true for one out of about seven pairs, at most. A child who has one or
more older siblings with autism is between 20 and 50 times more likely to
be diagnosed with a form of autism, compared with a child who has no
autistic older siblings. In addition, in families affected by autism, many
parents and non-autistic siblings display mild autistic-like traits. The
inherited or spontaneous mutations that seem to be associated with autism
are in genes that control the development of the brain – including how
brain cells develop and make circuits that operate correctly. This finding
agrees with the discovery of abnormalities in the way the brain operates
even in very young infants and toddlers with autism.

Eric Courchesne and his colleagues at the University of California, San
Diego, recently confirmed that the brains of children with autism have
distinct patches of architectural disorganization in their prefrontal and
temporal cortical tissue. Because the organization of the cortex begins in
the second trimester of pregnancy, the researchers conclude that the
events leading to the malformation of the cortex must begin around this
time or earlier, certainly well before a child is born or ever receives a


Autism Science Foundation. Centers for
Disease Control and Prevention (CDC), National Center for Birth Defects
and Developmental Disabilities. Autism Spectrum Disorders.

National Institutes of Health. National Institute of Child Health and
Development: Autism Spectrum Disorder (ASD): NICHD Research Information.
A baby’s immune system can easily handle the vaccines recommended for
infants and toddlers.

Some people worry that receiving too many vaccines early in life can
overwhelm a baby’s immune system and that this might somehow lead to
autism. This doesn’t fit with what we know about the remarkable capacity
of the immune system. From the moment of a baby’s birth, the immune system
begins coping with microorganisms in the form of bacteria, viruses, and

Like vaccines, these microorganisms contain foreign antigens –
proteins that stimulate the immune system. When you realize that a single
bacterium contains a larger variety and number of antigens than are found
in all the recommended early childhood vaccines combined, you can see that
a baby’s immune system, which copes with exposure to countless bacteria
each day, can easily withstand exposure to the antigens in vaccines.


Offit PA, Quarles J, Gerber MA, et al. Addressing parents’ concerns: do
multiple vaccines overwhelm or weaken the infant’s immune system?
Pediatrics. 2002;109(1):124–129. abstract/109/1/124

Vaccine Education Center, Children’s Hospital of Philadelphia. Too Many
Vaccines? What You Should Know. Available at articles/vaccine-education-center/too-
No links exist between autism and thimerosal.

A mercury-containing compound, thimerosal has been used since the 1930s as
a vaccine preservative in vials that contain several doses of vaccine
(called multi-dose vials). Before giving a vaccine, a healthcare
professional inserts the needle of the syringe that will be used to
administer the vaccine into the stopper of the multi-dose vial and draws
out a single dose of vaccine. When the needle pierces the stopper, it is
possible that contaminants from outside the vial might be introduced, even
when sterile technique is used. Thimerosal keeps bacteria or other
microorganisms that might have entered the vaccine vial from multiplying.

Studies to determine if a relationship exists between thimerosalcontaining
vaccines and autism have taken two different approaches: (1) some examined
groups of children who had received childhood vaccines that contained
varying amounts of thimerosal. Autism occurred at essentially the same
rate no matter how much or little thimerosal the children had received.
(2) Other studies took the opposite approach, comparing autistic and non-
autistic children to see if the autistic children had received more
thimerosal-containing vaccines. No significant differences were found in
the number of thimerosal-containing vaccines the two groups had received.


American Academy of Pediatrics. Vaccine Safety: Examine the Evidence.

Pichichero ME, Gentile A, Giglio N, et al., Mercury levels in newborns and
infants after receipt of thimerosal-containing vaccines. Pediatrics. 2008;
121(2): e208–214.
Nelson KB, Bauman ML. Thimerosal and autism? Pediatrics. 2003;111(3):

Why was thimerosal in childhood vaccines?

The mercury compound in thimerosal – ethylmercury – is chemically
different from methylmercury, which is widely recognized as an
environmental pollutant. A key difference is that, unlike methylmercury,
ethylmercury is excreted from the body quickly. The amount of ethylmercury
in a thimerosal-preserved vaccine is minuscule compared with the amount of
mercury that is required to cause symptoms of mercury poisoning. Also, the
signs and symptoms of mercury poison ing are very different from the
characteristics of autism. The chemical difference between ethylmercury
and methylmercury is similar to the difference between ethyl alcohol,
found in wine and beer, and methyl alcohol (wood alcohol), a poison found
in antifreeze.

As a precaution, by 2001, all routinely recommended childhood vaccines
were changed to single-dose packaging so they wouldn’t require thimerosal.
At the time, this was thought prudent, but all the evidence that has
emerged since then shows that there was never a danger of children being
harmed by thimerosal in vaccines. Some influenza vaccine formulations come
in multi-dose vials that are preserved with thimerosal. Today, influenza
vaccine is the only childhood vaccine licensed for use in the U.S. that
contains more than a trace of thimerosal, and we know that it is safe for


CDC. Notice to Readers: Thimerosal in Vaccines: A joint statement of the
American Academy of Pediatrics and the Public Health Service. MMWR. 1999;
48(26):563–565. mm4826a3.htm

U.S. Food and Drug Administration.

Studies have found no link between autism and MMR vaccine.

Some studies of MMR vaccine compared groups of children who
had received MMR vaccine against those who had not. These studies
found that neither group was more likely to develop autism. Other
studies looked at comparable groups of autistic and non-autistic
children. These studies found that autistic children were no more
likely to have received MMR vaccine.

Rumors about the safety of MMR vaccine first arose about a decade ago
after a British physician (a gastroenterologist, not a person trained in
either vaccinology or in neurological disorders) announced he had found
virus from measles vaccines lingering in the intestines of 12 autistic
children. He believed this accounted for their autism. Other researchers,
however, were never able to replicate these results, which implied the
gastroenterologist’s conclusions were erroneous. Later, a press
investigation revealed that the doctor had falsified patient data and
relied on laboratory reports that he had been warned were incorrect. The
journal that originally published his study took the unusual step of
retracting it from the scientific literature on the grounds that it was
the product of dishonest and irresponsible research, and British
authorities revoked the doctor’s license to practice medicine.

The fear that vaccines might cause autism is a dangerous myth. Much
scientific research has been devoted to this topic. The result has been an
ever-increasing and uniformly reassuring body of evidence that childhood
vaccination is, in fact, entirely unrelated to the development of autism.
The readings below may be of interest to parents who wish to learn more.


Immunization Action Coalition. MMR Vaccine Does Not Cause Autism.

Offit PA. Autism’s False Prophets: Bad Science, Risky Medicine, and the
Search for a Cure. New York: Columbia University Press; 2008.


Copyright (C) 2014 Immunization Action Coalition
All rights reserved.

2. Abstract: Healthcare waste generation and management practice in
government health centers of Addis Ababa, Ethiopia

BMC Public Health. 2014 Nov 25;14(1):1221.

Healthcare waste generation and management practice in government health
centers of Addis Ababa, Ethiopia.
Tadesse ML, Kumie A.

BACKGROUND: Healthcare wastes are hazardous organic and inorganic wastes.
The waste disposal management in Addis Ababa city is seen unscientific
manner. The waste management practice in the health facilities are poor
and need improvement. This study will help different organizations,
stakeholders and policy makers to correct and improve the existing
situation of healthcare waste legislation and enforcement and training of
staff in the healthcare facilities in Addis Ababa. The study aimed to
assess the existing generation and management practice of healthcare waste
in selected government health centers of Addis Ababa.

METHODS: The cross-sectional study was conducted to quantify waste
generation rate and evaluate its management system. The study area was
Addis Ababa. The sample size was determined by simple random sampling
technique, the sampling procedure involved 10 sub-cities of Addis Ababa.
Data were collected using both waste collecting and measuring equipment
and check list. The Data was entered by EPI INFO version 6.04d and
analyzed by and SPSS for WINDOW version15.

RESULTS: The mean (+/-SD) healthcare waste generation rate was 9.61 +/-
3.28 kg/day of which (38%) 3.64 +/- 1.45 kg/day was general or non-
hazardous waste and (62%) 5.97 +/- 2.31 kg/day was hazardous. The mean
healthcare waste generation rate between health centers was a significant
different with Kurskal-Wallis test (chi2 = 21.83, p-value = 0.009). All
health centers used safety boxes for collection of sharp wastes and all
health centers used plastic buckets without lid for collection and
transportation of healthcare waste. Pre treatment of infectious wastes was
not practiced by any of the health centers. All health centers used
incinerators and had placenta pit for disposal of pathological waste
however only seven out of ten pits had proper covering material.

CONCLUSION: Segregation of wastes at point of generation with appropriate
collection materials and pre- treatment of infectious waste before
disposal should be practiced. Training should be given to healthcare
workers and waste handlers. Incinerators must be constructed in a manner
that facilitates complete combustion and the lining of placenta pit should
be constructed in water tight material.

Free full Open Access text

3. Abstract: Analysis of the healthcare waste management status in Tehran

J Environ Health Sci Eng. 2014 Aug 27;12(1):116. eCollection 2014.

Analysis of the healthcare waste management status in Tehran hospitals.

Malekahmadi F1, Yunesian M2, Yaghmaeian K2, Nadafi K2.

1Environmental and occupational Health centre, Ministry of Health and
Medical Education, 11th floor, Simaye Iran St, Tehran, 1467664961 Iran.
2Department of Environmental Health Engineering, School of Public Health
and Institute for Environmental Health Engineering Tehran University Of
Medical Sciences, Tehran, Iran.

BACKGROUND: Considering the importance of healthcare waste management,
following the ratification of the Waste Management law in 2005 and the
subsequent approval of its executive bylaw in 2006 and finally the
healthcare waste management criteria passing by the parliament in 2008, a
review on the status of healthcare waste management is needed to implement
the mentioned law properly.

FINDINGS: In this retrospective study during six months period all public
hospitals in Iran’s capital city, Tehran, were selected to conduct the
survey. Data collected through an expert-standardized questionnaire was
analyzed by using SPSS software. The results of the current status of
healthcare waste management in Tehran hospitals showed 5.6% of hospitals
were ranked excellent, 50.7% good, 26.4% medium, and the 13.9% of
hospitals were ranked weak and 3.5% ranked very poor.

CONCLUSIONS: The findings showed that appropriate technologies should be
used to have better disposal stage. As the ratified criteria were not
fully observed by all the selected hospitals, training courses and
comprehensive program conducting by each hospital could be enjoyed as
practical tools to implement the all stages of healthcare waste management

KEYWORDS: Collection; Disposal; Healthcare waste; Healthcare waste
management; Segregation; Temporary storage; Transportation; Treatment

Free Open Access Article

4. Abstract: The hospitalized patient as a partner in the survey on safe
care in the Czech Republic

Neuro Endocrinol Lett. 2014 Nov 30;35(Suppl):5-10.

The hospitalized patient as a partner in the survey on safe care in the
Czech Republic.

Bártlová S, Tóthová V, Brabcová I, Prokešová R, Kimmer D.

University of South Bohemia in Ceské Budejovice, Faculty of Health and
Social Studies, Department of Nursing and Midwifery, Ceské Budejovice,
Czech Republic.

OBJECTIVES: The study examined the extent to which patients in the Czech
Republic are involved in decisions regarding their treatment and whether
they are interested in ensuring safety during hospitalization.

METHODS: Patients were interviewed to determine their perspectives
regarding the previously stated objectives. The sample consisted of 514
patients who had been admitted to hospital for a minimum of three days.

RESULTS: It is clear that patients in the Czech Republic are unaware of
safety issues associated with provided care, but 52.2% of respondents
expressed a desire to be more involved in decisions pertaining to their
treatment. Widowed patients, as well as those hospitalized for more than
six days, expressed less of a desire for such involvement. Half of the
patients enrolled in the study stated that health care professionals had
encouraged them to ask questions about their treatment. With regard to
errors associated with surgical reversals, 58.3% of respondents stated
that nursing staff had performed checkups to avoid confusion in surgery.
Another patient safety issue is nosocomial infection acquired through
improper hand-washing techniques of medical personnel. 73.5% of patients
said they would not have the courage to ask medical staff (doctors or
nurses) whether they had washed their hands prior to examination.

CONCLUSION: Patients in the Czech Republic are unaware of the safety
issues associated with provided care, but more than half expressed a
desire to be more involved in decisions that pertain their treatment.

5. Abstract: Prevalence of hepatitis B surface antigen (HBsAg) and its
risk factors among individuals visiting Goba General Hospital, South
East Ethiopia, 2012

BMC Res Notes. 2014 Nov 24;7(1):833.

Prevalence of hepatitis B surface antigen (HBsAg) and its risk factors
among individuals visiting Goba General Hospital, South East Ethiopia,

Erena AN, Tefera TB.

BACKGROUND: Hepatitis B virus infection is a significant health problem.
Approximately two billion people worldwide have chronic Hepatitis B virus
infection and over one million die annually. Hepatitis B virus infection
and Human Immunodeficiency Virus co-infection is an emerging concern in
the clinical management of patients because of shared routes of

METHODS: Hospital based cross-sectional study was performed from January
to June, 2012 at Goba General Hospital. Socio-demographic and possible
risk factors data from study subjects were collected using pre-test and
structured questionnaire. Venous blood was collected and the serums were
tested for Hepatitis B surface antigen and Human Immune Deficiency Virus
using commercially available rapid test kits. Data were entered and
analyzed using the SPSS software package (version15). Binary and
multivariable logistic regressions were used to identify factors
associated factors. A p-value of <0.05 was considered statistical

Result: The prevalence of Hepatitis B surface Antigen in this study group
was 26 (7.4%). Prevalence of Hepatitis B Human Immune Deficiency Virus Co-
infection was about 9 (42.3%) and about 17 (5.1%) of Human Immuno
Deficiency Virus negative subjects were positive for Hepatitis B surface

Risk factors like, hospital admission, multiple sexual partners, HIV
status, and unsafe drug injection were found to have significant
association with Hepatitis B surface Antigen on binary logistic

However, multiple sexual partners and being positive for Human Immuno
Deficiency Virus infection were the only significantly associated with
Hepatitis B Virus on multivariable logistic regression.

CONCLUSION: Even though Hepatitis B surface Antigen prevalence is higher
among subjects who are Human Immuno Deficiency Virus positive, screening
program has to be started in the hospital for all clients regardless of
their disease status to prevent the potential spread of the infection.

Free full text

7. Abstract: Coverage of overdose prevention programs for opiate users and
injectors: a cross-sectional study

Harm Reduct J. 2014 Nov 22;11(1):33.

Coverage of overdose prevention programs for opiate users and injectors: a
cross-sectional study.

Arribas-Ibar E, Sánchez-Niubò A, Majó X, Domingo-Salvany A1, Brugal MT.

1Research group of drug abuse epidemiology, IMIM-Institut Hospital del Mar
d’Investigacions Mèdiques, Doctor Aiguader 88, E-08003 Barcelona, Spain.

BACKGROUND: The use of opiates, particularly heroin, remains an important
cause of morbidity and mortality. Half of the deaths among heroin
consumers are attributed to overdose. In response to this problem,
overdose prevention programs (OPPs) were designed. The objective of our
study was to assess coverage of OPPs among the target population in a
specific Spanish region (Catalonia) and to identify characteristics
related to attendance.

METHODS: A cross-sectional survey recruited individuals from outpatient
treatment centers (OTCs), therapeutic communities (ThCs), and harm
reduction facilities (HRFs) in Catalonia. From 513 participants, 306
opiate users and/or injectors were selected for this study. Coverage was
calculated as the proportion of subjects who declared having participated
in an OPP. A Poisson regression with robust variance was used to assess
factors (socio- demographic aspects and psychoactive substance use
patterns) associated to OPP participation, taking into account recruitment

RESULTS: Average age of the 306 subjects was 39.7 years (s.d.: 7.7); 79%
were male; 79.2% lived in urban areas and 56.3% were unemployed or had
never worked. Overall OPP coverage was 43.5% (95% CI: 37%-49%). Training
was received mostly in HRF (60%), followed by OTC (24.4%), prison (19%),
and ThC (16%). OPP sessions were attended by 41% of Spanish-born study
participants and by 63.3% of foreigners; 92.2% of the participants lived
in urban areas. The Poisson regression analysis adjusted by age, sex, and
type of recruitment center showed that OPP participation rates were higher
for individuals with foreign nationality (PR = 1.3; 95% CI: 1.04-1.72),
for those living in municipalities with more than 100,000 inhabitants (PR
= 2.0; 95% CI: 1.37-2.81) or the Barcelona conurbation (PR = 2.5; 95% CI:
1.68-3.77), and for those having ever been in prison (PR = 1.6; 95% CI:
1.41-1.81) and had first consumption when they were less than 12 years old
(PR = 1.2; 95% CI: 1.06-1.45).

CONCLUSION: Coverage as a whole can be considered high. However, in
Catalonia, new strategies ought to be developed in order to attract opiate
users and injectors not currently participating, by expanding OPP offer to
services and regions where coverage is poor.

Free Open Access Article

8. Abstract: Injection Drug Users’ Perceived Barriers to Using Self-
Initiated Harm Reduction Strategies

Addict Res Theory. 2014 Aug 1;22(4):271-278.

Injection Drug Users’ Perceived Barriers to Using Self-Initiated Harm
Reduction Strategies.

Bonar EE1, Rosenberg H2.

1University of Michigan, Addiction Research Center, 4250 Plymouth Road,
Ann Arbor, MI 48109-0720.
2Bowling Green State University, Department of Psychology, Bowling Green,
OH 43403.

INTRODUCTION AND AIMS: Increasing the frequency with which injecting drug
users (IDUs) engage in self-initiated harm reduction strategies could
improve their health, but few investigations have examined IDUs’ perceived
barriers to engaging in these behaviors.

METHOD: We interviewed 90 IDUs recruited from needle exchanges to assess:
a) perceived obstacles to their use of two specific harm reduction
strategies (i.e., test shots and pre-injection skin cleaning) designed to
reduce two unhealthy outcomes (i.e., overdose and bacterial infections,
respectively) and b) their use of other risk-reduction practices.

RESULTS: The most frequently cited barrier for both test shots and skin
cleaning was being in a rush to inject one’s drugs. Other, less commonly
cited barriers were strategy-specific (e.g., buying drugs from a known
dealer as a reason not to do a test shot; not having access to cleaning
supplies as a reason not to clean skin). Regarding other risk reduction
practices, participants’ most frequently reported using new or clean
injecting supplies and avoiding sharing needles and injecting supplies.

DISCUSSION AND CONCLUSIONS: Some, but not all, of the barriers generated
by participants in our study were similar to those frequently reported in
other investigations, perhaps due to differences in the type of sample
recruited or in the harm reduction behaviors investigated.

KEYWORDS: harm reduction; infections; injecting drug use; test shots

9. Abstract: Risk behaviour of prison inmates in relation to HIV/STI

Psychiatr Danub. 2014 Dec;26 Suppl 2:395-401.

Risk behaviour of prison inmates in relation to HIV/STI.

Ravlija J1, Vasilj I, Marijanovic I, Vasilj M.

1Department of Epidemiology of Public Health Institute of Federation of
Bosnia and Herzegovina, Vukovarska 46, 88 000 Mostar, Bosnia and

INTRODUCTION: Persons serving a prison sentence are identified as a
population exposed to a higher risk of HIV/STIs due to a high incidence of
risk behaviour, especially intravenous drug misuse. To show results of
research on prevalence of HIV/STIs in relation to spread of risk behaviour
and other risk factors.

SUBJECTS AND METHODS: Cross-sectional study on a sample of 620 respondents
in 10 prisons. A specially structured questionnaire was applied as a
research instrument, together with blood sample taking for laboratory
analysis of HIV, HBV, HCV and syphilis.

RESULTS: Majority of respondents show insufficient knowledge about
HIV/AIDS, ways of transmission prevention, especially knowledge on ways of
HIV transmission. Every sixth respondent has experience of intravenous
drug use, of which 58% exchanged drug injection equipment. Every fifth
respondent with a tattoo had their tattoo done in prison. Below 2% of
respondents quote being victims of sexual abuse, and having wilful anal
sexual intercourse in prison. Test results in this research: HIV (0), HBV
(1.5%), HCV (14.3%) syphilis (0.5%).

CONCLUSION: Intravenous drug use presents the strongest risk factor for
HCV, and therefore for HIV/ STIs. Other risk factors – tattooing with kit
exchange, sexual risk intercourse, abuse, insufficient knowledge and
information about HIV/AIDS, ways of transmission and way of protection,
and lack of access to measures of prevention and “Harm reduction”

10. Foreward: Research On Risk Behavior Of Prison Inmates In Relation To
HIV/SPI Bosnia And Herzegovina, 2011

Institute for Public Health Federation B&H, Global Fund to Fight AIDS,
tuberculosis and malaria, and UNDP

Institute for Public Health Federation B&H

Research On Risk Behavior Of Prison Inmates In Relation To Hiv/Spi
Bosnia And Herzegovina, 2011

Vesna Vidic, Željko Ler, Jelena Ravlija

Study on prevalence of HIV and other sexually or blood-borne infections is
a first comprehensive, coordinated research among persons serving a prison
sentence in Bosnia and Herzegovina (B&H) and represents an important
contribution to the significance of conducting supervision over
marginalised groups exposed to an increased risk of HIV, hepatitis B and C
viral infection and syphilis, At the same time, it represents a
contribution to complementary programmes of „damage reduction“ – condom
programme, syringe exchange programme, methadone substitution programme,
etc, all contributing to monitoring blood-borne diseases among populations
exposed to an increased risk.

Prison inmate population shows a high incidence of risky behaviour,
especially in terms of injected drugs misuse, and are therefore more
exposed to a higher risk of blood- borne infections. For example, fact
that HCV infection is especially present among younger prison inmates
anticipates health issues even in the next 10 to 20 years.

This is a first study about prevalence of risk and protective behaviours,
i.e. levels of sensitivity to HIV and other sexually transmitted
infections among the population serving a prison sentence, and considering
it includes more than one prison, it gives the possibility of estimating
the effect on out-ofprison environment, i.e. general population.

Experiences from a high number of countries show that it is possible to
prevent transmission of HIV, HCV, HBV and other blood-borne diseases among
prison inmates by creating specific prevention, education and information
programmes in prison structures, based on similar studies.

We hope this publication will successfully present the profile of risk and
protective behaviours of persons serving a prison sentence and demonstrate
that conditions for improvement of care for population exposed to a higher
risk of HIV/AIDS and other blood-borne and sexually transmitted diseases
can be achieved even in a prison surrounding, aiding a better control and
prevention of a ‘bridge” towards general population.

We hereby thank all associates, institutions and non-governmental
organisations who supported and participated in this study.

We especially thank those serving a prison sentence who willingly accepted
to participate in this study, the staff at corrective institutions where
this research was carried out, and also to members of research teams.

We express our thanks in particular to the Global Fund to Fight AIDS,
tuberculosis and malaria, and UNDP, who financed this research.

Research Team

11. Abstract: Postpartum Hemorrhage in Uganda: A Double-Blind Randomized
Non-Inferiority Trial

DOI: 10.1371/journal.pmed.1001752

Postpartum Hemorrhage in Uganda: A Double-Blind Randomized Non-Inferiority

Esther C. Atukunda, Mark J. Siedner, Celestino Obua, Godfrey R. Mugyenyi,
Marc Twagirumukiza, Amon G. Agaba

Published: November 04, 2014


Postpartum hemorrhage (PPH) is a leading cause of maternal death in sub-
Saharan Africa. Although the World Health Organization recommends use of
oxytocin for prevention of PPH, misoprostol use is increasingly common
owing to advantages in shelf life and potential for sublingual
administration. There is a lack of data about the comparative efficacy of
oxytocin and sublingual misoprostol, particularly at the recommended dose
of 600 µg, for prevention of PPH during active management of labor.

Methods and Findings

We performed a double-blind, double-dummy randomized controlled non-
inferiority trial between 23 September 2012 and 9 September 2013 at
Mbarara Regional Referral Hospital in Uganda. We randomized 1,140 women to
receive 600 µg of misoprostol sublingually or 10 IU of oxytocin
intramuscularly, along with matching placebos for the treatment they did
not receive. Our primary outcome of interest was PPH, defined as measured
blood loss =500 ml within 24 h of delivery. Secondary outcomes included
measured blood loss =1,000 ml; mean measured blood loss at 1, 2, and 24 h
after delivery; death; requirement for blood transfusion; hemoglobin
changes; and use of additional uterotonics.

At 24 h postpartum, primary PPH occurred in 163 (28.6%) participants in
the misoprostol group and 99 (17.4%) participants in the oxytocin group
(relative risk [RR] 1.64, 95% CI 1.32 to 2.05, p<0.001; absolute risk
difference 11.2%, 95% CI 6.44 to 16.1). Severe PPH occurred in 20 (3.6%)
and 15 (2.7%) participants in the misoprostol and oxytocin groups,
respectively (RR 1.33, 95% CI 0.69 to 2.58, p = 0.391; absolute risk
difference 0.9%, 95% CI -1.12 to 2.88). Mean measured blood loss was 341.5
ml (standard deviation [SD] 206.2) and 304.2 ml (SD 190.8, p = 0.002) at 2
h and 484.7 ml (SD 213.3) and 432.8 ml (SD 203.5, p<0.001) at 24 h in the
misoprostol and oxytocin groups, respectively. There were no significant
differences between the two groups in any other secondary outcomes. Women
in the misoprostol group more commonly experienced shivering (RR 1.91, 95%
CI 1.65 to 2.21, p<0.001) and fevers (RR 5.20, 95% CI 3.15 to 7.21, p =

This study was conducted at a regional referral hospital with capacity for
emergency surgery and blood transfusion. High-risk women were excluded
from participation.


Misoprostol 600 µg is inferior to oxytocin 10 IU for prevention of primary
PPH in active management of labor. These data support use of oxytocin in
settings where it is available. While not powered to do so, the study
found no significant differences in rate of severe PPH, need for blood
transfusion, postpartum hemoglobin, change in hemoglobin, or use of
additional uterotonics between study groups. Further research should focus
on clarifying whether and in which sub-populations use of oxytocin would
be preferred over sublingual misoprostol.

Trial registration NCT01866241

Free Full Text

12. Abstract: Patients’ assessment of adalimumab self-injection for
Crohn’s disease: a multicenter questionnaire survey (The PEARL Survey)

Hepatogastroenterology. 2014 Sep;61(134):1654-60.

Patients’ assessment of adalimumab self-injection for Crohn’s disease: a
multicenter questionnaire survey (The PEARL Survey).

Hirai F, Watanabe K, Matsumoto T, Iimuro M, Kamata N, Kubokura N, Esaki M,
Yamagami H, Yano Y, Hida N, Nakamura S, Matsui T.

BACKGROUND/AIMS: Adalimumab (ADA) is a self-injectable anti-tumor necrosis
factor-a antibody used for treating Crohn’s disease (CD). Although self-
injecting ADA may be convenient for patients, few reports have assessed
patients receiving ADA self-injection therapy.

METHODOLOGY: We conducted a questionnaire survey involving outpatients on
ADA self- injection therapy at four university hospitals. We analyzed the
degree of satisfaction with and adherence to the self-injection therapy
and performed sub-analyses.

RESULTS: Responses were obtained from 124 patients. Before treatment
initiation, 38% patients replied that they were unwilling to accept the
self-injection therapy. However, after treatment initiation, 75% patients
were satisfied with the treatment. 66 patients previously treated with
infliximab (IFX), the degree of treatment satisfaction was significantly
higher in patients who felt burdened to the time required for IFX infusion
than in those who had not felt burdened (P < 0.05). Patient adherence to
ADA was high (85%). Multivariate analysis regarding adherence revealed
that duration of disease (OR, 0.99), degree of treatment efficacy
satisfaction (OR, 13.42), and schedule registration (OR, 7.95) were
significant. Safety assessment results were within the range of those
already reported.

CONCLUSIONS: ADA self-injection was thought to have good adherence and a
safe administration method according to patients’ assessments.

13. Abstract: Acupuncture Safety in Patients Receiving Anticoagulants: A
Systematic Review

Perm J. 2014 Nov 24. doi: 10.7812/TPP/14-057.

Acupuncture Safety in Patients Receiving Anticoagulants: A Systematic

Mcculloch M1, Nachat A2, Schwartz J3, Casella-Gordon V4, Cook J5.

1Research Lead for Integrative Medicine at the Walnut Creek Hospital in CA
and a Research Chief at the Pine Street Foundation in San Anselmo, CA.
2Director of Integrative Medicine at the Walnut Creek Hospital in CA.
3Research Intern in Integrative Medicine at the Walnut Creek Hospital in
4Clinical Nurse Specialist in Integrative Medicine at the Walnut Creek
Hospital in CA.
5Research Intern in Integrative Medicine at the Walnut Creek Hospital in

INTRODUCTION: Theoretically, acupuncture in anticoagulated patients could
increase bleeding risk. However, precise estimates of bleeding
complication rates from acupuncture in anticoagulated patients have not
been systematically examined.

OBJECTIVE: To critically evaluate evidence for safety of acupuncture in
anticoagulated patients.

METHODS: We searched PubMed, EMBASE, the Physiotherapy Evidence Database,
and Google Scholar.

RESULTS: Of 39 potentially relevant citations, 11 met inclusion criteria:
2 randomized trials, 4 case series, and 5 case reports. Seven provided
reporting quality sufficient to assess acupuncture safety in 384
anticoagulated patients (3974 treatments). Minor-moderate bleeding related
to acupuncture in an anticoagulated patient occurred in one case: a large
hip hematoma, managed with vitamin K reversal and warfarin discontinuation
following reevaluation of its medical justification. Blood-spot bleeding,
typical for any needling/injection and controlled with pressure/cotton,
occurred in 51 (14.6%) of 350 treatments among a case series of 229
patients. Bleeding deemed unrelated to acupuncture during anticoagulation,
and more likely resulting from inappropriately deep needling damaging
tissue or from complex anticoagulation regimens, occurred in 5 patients.
No bleeding was reported in 2 studies (74 anticoagulated patients): 1 case
report and 1 randomized trial prospectively monitoring acupuncture-
associated bleeding as an explicit end point. Altogether, 1 moderate
bleeding event occurred in 3974 treatments (0.003%).

CONCLUSION: Acupuncture appears to be safe in anticoagulated patients,
assuming appropriate needling location and depth. The observed 0.003%
complication rate is lower than the previously reported 12.3% following
hip/knee replacement in a randomized trial of 27,360 anticoagulated
patients, and 6% following acupuncture in a prospective study of 229,230
all-type patients. Prospective trials would help confirm our findings.

14. Abstract: Hepatitis C vaccine

Hum Vaccin Immunother. 2014 Jul;10(7):1927-9.

Hepatitis C vaccine.

Verma R1, Khanna P, Chawla S.

1a Department of Community Medicine; Pt. B.D. Sharma PGIMS; Rohtak,
Haryana India.

Hepatitis C virus (HCV) was first identified in 1989. HCV is a small,
enveloped RNA virus. Globally, 3-4 million persons are infected with HCV
each year, and are at risk of developing liver cirrhosis and/or liver

The common modalities of the spread of hepatitis C infection are blood
transfusions, injection drug use, unsafe therapeutic injections, and
healthcare-related procedures. The standard treatment for hepatitis C has
been combination antiviral therapy with interferon (IFN) and ribavirin,
which are effective against all the genotypes of hepatitis viruses (pan-
genotypic). A 12-month course of Peg-IFN/ribavirin treatment costs >
$20?000. New HCV-specific antiviral drugs, especially in combination, have
shown very high cure rates; however, the annual cost for a single subject
($82?000) make these unaffordable in most of the world.

There is no hepatitis C vaccine. However, several vaccines in development,
and some have shown promising preclinical results. Over the last few
years, numerous HCV vaccine approaches have been assessed in mice and
primates, but only a few vaccines have progressed to human trials.

The challenge to develop HCV vaccine is to move into larger at-risk or
infected populations to test efficacy.

KEYWORDS: Cirrhosis; Clinical trial; Genotype; HCV; Vaccine

15. Abstract: Thimerosal compromises human dendritic cell maturation,
IL-12 production, chemokine release, and T-helper polarization

Hum Vaccin Immunother. 2014 Aug;10(8):2328-35.

Thimerosal compromises human dendritic cell maturation, IL-12 production,
chemokine release, and T-helper polarization.

Loison E1, Gougeon ML.

1a Institut Pasteur; Antiviral Immunity Biotherapy and Vaccine Unit;
Infection and Epidemiology Department; Paris, France.

Thimerosal is a preservative used in multidose vials of vaccine
formulations to prevent bacterial and fungal contamination. We recently
reported that nanomolar concentrations of thimerosal induce cell cycle
arrest of human T cells activated via the TCR and inhibition of
proinflammatory cytokine production, thus interfering with T-cell
functions. Given the essential role of dendritic cells (DCs) in T-cell
polarization and vaccine immunity, we studied the influence of non-toxic
concentrations of thimerosal on DC maturation and functions.

Ex-vivo exposure of human monocyte-derived DCs to nanomolar concentrations
of thimerosal prevented LPS-induced DC maturation, as evidenced by the
inhibition of morphological changes and a decreased expression of the
maturation markers CD86 and HLA-DR. In addition thimerosal dampened their
proinflammatory response, in particular the production of the Th1
polarizing cytokine IL-12, as well as TNF-a and IL-6. DC-dependent T
helper polarization was altered, leading to a decreased production of IFN-
y IP10 and GM-CSF and increased levels of IL-8, IL-9, and MIP-1a.

Although multi-dose vials of vaccines containing thimerosal remain
important for vaccine delivery, our results alert about the ex-vivo
immunomodulatory effects of thimerosal on DCs, a key player for the
induction of an adaptive response.

KEYWORDS: Th polarization; chemokines; cytokines; dendritic cells;

16. News

– USA: Colorado company develops a flu shot — without a needle
– USA: Needle exchange reduces rate of infectious diseases
– UN: Ebola shows WHO needs revamp, says U.N. reformer Rudd
– Russia: Russia warns of HIV/AIDS epidemic
– Europe and Central Asia failing to curb spread of HIV: WHO
– USA: New report underlines success of City’s ‘Clean Needle Exchange
– Vaccines: Powdered measles vaccine found safe in early clinical trials
Selected news items reprinted under the fair use doctrine of international
copyright law:

USA: Colorado company develops a flu shot — without a needle

Andrea Dukakis, Colorado Public Radio (01.12.14)

LISTEN Audio: Heather Potters, co-founder and co-chairman of PharmaJet,
talks with Ryan Warner

The device shoots a narrow stream of medicine into a person’s skin.
(Photo: Courtesy of PharmaJet)

With flu season in full swing, there’s a new option for flu vaccinations.
Golden-based PharmaJet has developed an injection device that shoots a
narrow stream of fluid into a person’s skin without using a needle.
Heather Potters, co-founder and co-chairman of PharmaJet, says she and her
mother originally came up with the idea because of concern for patient
safety, particularly in developing countries.

In some countries, as many as 70 percent of needles are reused, leading to
the spread of disease. She says PharmaJet’s device also reduces the risk
of accidents where health workers accidentally prick themselves with
contaminated needles.

Potters says the product is also appealing to people who are squeamish
about needles. She says it’s not uncommon for people to go without a flu
vaccine because they are frightened of needles.

A study published earlier this year in the journal The Lancet found
PharmaJet’s device compared favorably to traditional needles. But, the
study also noted, the needle-free injector was “associated with a higher
frequency of local injection site reactions.”

Currently, patients can choose from a variety of options when getting flu
vaccines, including a nasal spray and traditional injections. PharmaJet
says its needle-free injections are just as effective, though doctors
recommend the nasal spray as the most effective vaccine for children ages
two to eight.

USA: Needle exchange reduces rate of infectious diseases

By Marissa Harshman, The Columbian, Washington USA (28.11.14)

In 12 months, Clark County Public Health’s needle exchange program has
collected 1.2 million dirty syringes and handed out nearly 1 million clean
needles to drug users.

The program, health officials said, is keeping drug users’ dirty needles
off the streets and out of parks and driving down infectious disease rates
in the community.

“We’ve made a difference, and we’ve got great outcomes,” said Sandi
Kendrick, a public health educator who runs the exchange program. “It
saves lives.”

Clients come into the discreet, cream-colored building on East Fourth
Plain Boulevard and hand over plastic jugs full of used needles. A 20-
pound cat litter jug can hold 500 syringes. A laundry detergent bottle
holds about 100 needles.

Each client has an exchange code — a combination of letters and numbers
from their name, mother’s name and birthdate — they use to anonymously
exchange their used needles for clean ones.

In addition to clean needles, clients can get clean alcohol wipes,
cookers, cottons, condoms and abscess care kits. Clients can also get a
free, confidential hepatitis C test with results in just 20 minutes and
hepatitis A and B vaccines.

While the program has been successful in reducing the HIV rate among the
population who injects drugs — the rate has plummeted statewide in the
last decade — the growing number of people using heroin, many of whom
previously abused prescription drugs, has caused the needle exchange
client numbers to soar, said Adiba Ali, an epidemiologist with Clark
County Public Health.

In 12 months, the exchange program had 1,500 clients who made 6,000 visits
— all in just eight hours per week. That’s roughly double the program’s
client load from five years earlier, Ali said.

With HIV rates declining, the Washington Department of Health, which funds
the local exchange programs, has shifted its emphasis to reducing
hepatitis C rates, Ali said. Those rates have been climbing, partly
because of increased testing, she said.

In addition to hepatitis C tests and drug supplies, staff also provide
education on how to prevent the spread of infectious diseases and
encourage clients to use needles only once and to not share their needles.

Staff also offer overdose prevention education, highlighting how to avoid
overdoses, signs of overdose and how to help someone who is overdosing. A
two-year, $20,000 grant from the Syringe Access Fund has enabled the
program to begin offering naloxone, an injectable drug used to reverse the
effects of opiate overdose.

The program gives naloxone kits to clients and family members of drug
users after they go through a 15-minute training on how to use the drug.
Naloxone is a prescription drug, and, unlike with the needle exchange, the
program requires clients to provide their names in order to get the drug.

Each naloxone kit contains supplies to administer two doses of naloxone:
two syringes, two vials of naloxone, two pairs of gloves, alcohol wipes, a
rescue breathing mask and instructions. When clients come back for
refills, staff gathers information about the situations in which the kits
were used.

Since the program began in late April, they’ve handed out 240 kits and
have recorded about 50 overdose reversals, Kendrick said.

“Some people have used it the next day,” Kendrick said. “It’s the ultimate
harm reduction.”

Staff use the experience as an opportunity to discuss treatment and
recovery. Clients who have used the naloxone to save an overdosing friend
are sometimes more open to getting clean themselves, Kendrick said.

“People are really empowered by saving people’s lives,” she said.

Research has also shown that people who access syringe exchange programs
are more likely to undergo treatment and more likely to be successful in
treatment, Kendrick said.

“It really makes our community healthier because we’re educating them and
empowering them to make healthier choices,” Kendrick said.

UN: Ebola shows WHO needs revamp, says U.N. reformer Rudd

By Tom Miles, Reuters (27.11.14)

GENEVA Thu Nov 27, 2014 (Reuters) – The World Health Organization (WHO)
needs reform to prevent a recurrence of crises such as West Africa’s Ebola
outbreak, former Australian prime minister Kevin Rudd said on Thursday.

Rudd is leading a two-year study to suggest ways to improve the
effectiveness of the United Nations system and other global bodies, which
are often deadlocked by disagreements between states or hamstrung by their
internal bureaucracy.

The WHO’s Africa office has been widely criticized for its slow response
to the Ebola epidemic, which has now killed at least 5,689 people. The WHO
has promised to investigate its handling of the outbreak once the epidemic
is over.

Rudd said he was seeking practical recommendations to improve the system’s
effectiveness, adding he thought the WHO suffered from a “systemic
problem” in the way power was shared between its central organization and
regional branches.

“If you do not want this sort of thing to repeat itself then a substantive
reform would lie in sufficiently empowering WHO globally to act globally
on threats to global public health,” Rudd told reporters in Geneva after
briefing diplomats.

That is the kind of “too-difficult-to-handle” issue that diplomats are now
avoiding, Rudd added.

His commission plans to publish its ideas as it goes along, winding up as
the United Nations names a replacement for Secretary-General Ban Ki-moon,
whose term ends on Dec. 31, 2016.

Rudd, 57, said global institutions were coming under unprecedented
pressure due to rapid shifts in world power relations, demographics,
technology, the emergence of non-state actors and a shrinking funding

People are increasingly finding ways to work around international
organizations, threatening the U.N. system with “death by a thousand
cuts”, he said.

“None of us wants to see that happen.”

(Editing by Gareth Jones)
Russia: Russia warns of HIV/AIDS epidemic

Reported HIV/AIDS cases increased 80 percent in 2013.

By Ed Adamczyk UPI, USA (27.11.14)

MOSCOW, Nov. 27 (UPI) — The World Health Organization warned Thursday
that reported HIV cases in Europe and Central Asia are increasing

The virus, which causes AIDS, infected 136,235 people in Eastern Europe
and Central Asia last year, an 80 percent increase over 2012, the WHO and
the European Center for Disease Prevention and Control reported, adding
80,000 of those cases were in Russia. Previously, Eastern Europe and
Central Asia reported annual declines in AIDS cases in the past decade.

“(The) HIV/AIDS epidemic in Russia is growing rapidly and becomes
irreversible in many ways. The number of newly diagnosed cases of HIV
infection has been growing, the number of HIV-infected patients with
manifestations of AIDS has been growing as well,” Russia’s Federal
Scientific and Methodological Center for Prevention and Control of AIDS
said Thursday.

The comments from the agencies came in anticipation of World AIDS Day,
Dec. 1.

The Russian news agency Tass said 0.5 percent of the Russian population,
or one in 200 people, is infected with the virus, with higher percentages
in cities and among younger adults.

“One percent of the population, for example in St. Petersburg, refers to
officially registered infected people, but if we take the age group where
they are the majority, then there are about five percent of young men
there. That is, every 20th person has HIV,” said Vadim Pokrovsky, a
Russian Academy of Sciences professor, told the Russian news service
Interfax. “Dear women, keep it in mind that the probability of marrying an
HIV-positive man is very high.”

Europe and Central Asia failing to curb spread of HIV: WHO

By Kate Kelland Reuters (27.11.14)

LONDON Thu Nov 27, 2014 (Reuters) – Despite major advances in treating and
preventing HIV, Europe and Central Asia have failed to tackle the
epidemic, with some 136,000 people becoming newly infected with the
incurable AIDS virus last year, health officials said on Thursday.

Figures from the World Health Organization (WHO) and the European Centre
for Disease Prevention and Control (ECDC) showed 80 percent more new HIV
cases in 2013 compared to 2004, meaning a crucial target to reverse the
tide of AIDS in the region will be missed.

“Europe has not managed to reach the 2015 Millennium Development Goal
target … and time is running out,” said Zsuzsanna Jakab, the WHO’s
regional director. “We cannot afford dropping our guard on HIV/AIDS.”

The human immunodeficiency virus (HIV) attacks the immune system and
causes a lifelong illness. The end-stage of the infection, acquired
immunodeficiency syndrome (AIDS), is a result of the immune system being

HIV is spread via blood, semen and breast milk. There is no cure, but AIDS
can be kept at bay for years in people with HIV who take cocktails of
antiretroviral drugs. The drugs also help prevent infected people from
passing HIV to others.

Of the new HIV infections in 2013 in the 53 countries of the WHO’s
European region, more than 105,000 were reported in Eastern Europe and
Central Asia.

Compared to 2004, Eastern Europe and Central Asian countries have seen a
two-fold surge in new HIV cases — largely driven by an HIV epidemic among
drug users — and European Union and European Economic Area (EU/EEA)
countries have seen no decline.

In Eastern Europe, where 77 percent of all new infections were reported in
2013, two thirds of cases among injecting drug users were detected late,
Jakab said.

“This means they are more likely to transmit HIV, their treatment is more
expensive, and they are more likely to die.”

Marc Sprenger, the ECDC’s director, said that in western Europe, groups at
highest HIV risk are not reached effectively by prevention services —
particularly gay and bisexual men.

In the EU/EEA, sex between men is still the main mode of HIV transmission,
accounting for 42 percent of new cases in 2013.

“The number of HIV diagnoses among this group … has been going up in all
but four EU/EEA countries,” Sprenger said. “Prevention and control of HIV
among men who have sex with men has to be a cornerstone of national HIV

USA: New report underlines success of City’s ‘Clean Needle Exchange

By Neal Putnam, LGBT Weekly, San Diego USA (26.11.14)

Graphic: Recieved VS Disbursed, Source: Safe Point San Diego Clean Syringe
Exchange Program Annual Report 2014

The city’s medical services director, Dr. James Dunford told a City
Council committee Nov. 13 that more than 2.5 million dirty needles were
properly disposed of since the start of the city’s Clean Syringe Exchange

Presenting the Safe Point San Diego Clean Syringe Exchange Program Annual
Report for fiscal year 2014 Dunford then asked Council members to imagine
the stack of 2.5 million dirty needles: “Put that at Petco Park and see
what kind of pile you’d be looking at.”

Dunford told members of the Public Safety & Livable Neighborhoods
Committee the program has taken in 405,416 dirty needles just in the last
fiscal year. He said the program has collected 276,958 more syringes than
clean ones distributed to drug addicts.

The program’s purposes since 2002 have always been the same: Reduce the
spread of HIV (AIDS) and Hepatitis C – not only to addicts and their
families, but to police officers, firefighters, paramedics, sanitation
workers and the public from accidental needle sticks.

“There were dirty syringes being found all over the place, at beaches, and
children’s playgrounds,” said Dunford.

The City’s mobile units collect the dirty needles during a three hour
nighttime period downtown and three hours in North Park. Dunford said the
drug addicts come discretely to the location and quickly leave afterwards.
“The clients know to come in and get out,” said Dunford.

He said the program operated with a “quid pro quo” in which addicts could
get clean needles in exchange for dirty ones but it would also come with
referrals to drug treatment programs, HIV counseling, healthcare and other

He cited the statistics of 686 new client visits, compared with 13,826
repeat client visits in the last year. There were 12,847 referrals, which
broke down to 742 to substance abuse treatment; 775 to detoxification
services; 717 to mental health treatment; 1,219 to primary medical care
and 9,394 to other referrals.

“I am very happy to report there are no major issues. No complaints of
note,” said Dunford. “No police issues that have been brought to our

San Diego has the third highest AIDS rate in the state, said Dunford.
There were more than 2,000 diagnoses last year of Hepatitis C in San

The program is operated by Family Health Centers of San Diego and Tim
Fraser, the director of community and government relations, told the
committee the organization is very committed to the program “and we want
to continue to see it thrive.”

“We thank the City Council for their continued support and funding effort.
We do continue to see the increased need and desire and our referrals are
coming through so we are very supportive of this program,” said Fraser.
The City doesn’t directly pay for the program, but it has received
$201,255 in community development block grants from the state that were
authorized by the City Council since 2012.

Private donors for the program include the Human Dignity Foundation; AIDS
United; Comer Foundation and MAC AIDS Foundation.

“Unfortunately, we still don’t have the County on board with it, and I
harp on this every year,” said Committee Chairwoman Marti Emerald.

Graphic: Client Visits, Source: Safe Point San Diego Clean Syringe
Exchange Program Annual Report 2014

“I don’t know what its going to take for the County supervisors to come on
board and help us to really expand our reach when it comes to getting
dirty needles off the streets and help drug addicts into care,” said

“The problem doesn’t end at the city limits,” said Dunford.
There were no speakers against the program, and Emerald played devil’s
advocate and asked Dunford if the program would increase drug use.
“Nothing could be further from the truth,” replied Dunford.

Dunford said he talks to inmates in jails, and he said he was “astounded
by the number of drug addicts I see.” He said he asked inmates if they
used dirty needles and most of them said they used the City’s clean needle
exchange program because they didn’t want to get AIDS or Hepatitis C.

Client demographics in 2014 have remained similar over the last six years,
such as:
• 73 percent male
• 75 percent white; 14 percent Hispanic; 9 percent other; 4 percent
African American
• 77 percent high school graduate
• 69 percent unemployed
• 42 percent owns, rents; 25 percent homeless; 22 percent stay at
friends; 11 percent other
• 35 is median age
• 68 percent never married; 21 percent divorced, widowed; 9 percent
married; 2 percent domestic partner

“I appreciate the report,” said 4th District Councilmember Myrtle Cole.
Also hearing the report was 2nd District Councilmember Ed Harris, at his
last meeting, who will be replaced by Republican Chris Cate in December.

To read the full report visit:

Vaccines: Powdered measles vaccine found safe in early clinical trials

Cooperative Institute for Research in Environmental Science (CIRES)
University of Colorado, Colorado USA (24.11.14)

A measles vaccine made of fine dry powder and delivered with a puff of air
triggered no adverse side effects in early human testing and it is likely
effective, according to a paper to be published November 28 in the journal
Vaccine. The paper is now available online.

In 2013, measles killed 145,700 people, most of them children, according
to the World Health Organization. That’s despite the fact that the
conventional injectable vaccine against the measles virus is effective.

“Delivering vaccines in the conventional way, with needle injections,
poses some serious challenges, especially in resource-poor parts of the
world,” said Robert Sievers, co-author of the new paper, a fellow of the
Cooperative Institute for Research in Environmental Sciences (CIRES) and
also a professor in the University of Colorado Boulder’s Department of
Chemistry and Biochemistry.

His team innovated a dry delivery technique for the measles vaccine to
eliminate the need for injections, liquid storage, and other challenges,
such as vaccine contamination. “You don’t need to worry about needles; you
don’t need to worry about reconstituting vaccines with clean water; you
don’t need to worry about disposal of sharps waste or other vaccine
wastage issues; and dry delivery is cheaper,” Sievers said.

The new paper represents the first successful Phase I clinical trial for a
dry powder vaccine, he said. Sievers and his co-authors identified no
adverse effects of the powdered and inhaled vaccine when tested in 60
healthy men who were already immune to measles. In this safety-focused
clinical trial, they tested delivery with two devices—the Aktiv-Dry
PuffHaler® and BD Technologies Solovent™—compared with the usual under-
the-skin liquid injection method.

“Out of an abundance of caution, we test first in people who have already
had the disease, or been injected earlier by needles with liquid
vaccines,” he explained. The men in all three groups responded similarly,
with no clinically relevant side effects and some evidence of a positive
immune response to vaccination. Because the men were already immune to the
disease, this experiment could not yet compare effectiveness of the
vaccines, measured by immune response. That will be the primary goal of
follow-on Phase II/III pivotal trials.

“It is very good news that we encountered no problems, and now we can move
on,” Sievers said. The next phase of tests could include work in people
who are not yet immune to measles, including women and children.

The authors of the new paper include researchers from the Serum Institute
of India, Ltd., in Pune, India, which is the largest manufacturer of
childhood vaccines used in developing countries; an Indian medical
college; a North Carolina medical technology company; and the Georgia-
based Centers for Disease Control and Prevention. Several of the authors
also are affiliated with the Boulder company Aktiv-Dry, LLC, where Sievers
is president and CEO.

In preclinical research, Sievers’ team has already demonstrated that the
vaccine protects rhesus macaques and cotton rats from infection by the
measles virus. The researchers also have shown that their dry vaccines can
be safely stored for 6 months to 4 years, at room temperature or in
refrigerators kept at 36 to 46 degrees Fahrenheit (2-8 degrees Celsius),

This work was funded in part by a $20 million grant from the Foundation
for the National Institutes of Health through the Grand Challenges in
Global Health Initiative, which was created by the Bill and Melinda Gates

CIRES is a partnership of CU-Boulder and the National Oceanic and
Atmospheric Administration.

SIGN Meeting 2015

The Safe Injection Global Network SIGN meeting is 23-24 February 2015 at
WHO Headquarters in Geneva Switzerland

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

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
* SAFETY OF INJECTIONS brief yourself at:

A fact sheet on injection safety is available at:

* Visit the WHO injection safety website and the SIGN Alliance Secretariat

* Download the WHO Best Practices for Injections and Related Procedures
Toolkit March 2010 [pdf 2.47Mb]:

Use the Toolbox at:

Get SIGN files on the web at:
get SIGNpost archives at:

Like on Facebook:

The SIGN Secretariat, the Department of Health Systems Policies and
Workforce, WHO, Avenue Appia 20, CH-1211 Geneva 27, Switzerland.
Facsimile: +41 22 791 4836 E- mail:

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:

The report is navigable using bookmarks and is searchable. Viewing
requires the free Adobe Acrobat Reader at:

Translation tools are available at:
All members of the SIGN Forum are invited to submit messages, comment on
any posting, or to use the forum to request technical information in
relation to injection safety.

The comments made in this forum are the sole responsibility of the writers
and does not in any way mean that they are endorsed by any of the
organizations and agencies to which the authors may belong.

Use of trade names and commercial sources is for identification only and
does not imply endorsement.

The SIGN Forum welcomes new subscribers who are involved in injection

* Subscribe or un-subscribe by email to:, or to

The SIGNpost Website is

The SIGNpost website provides an archive of all SIGNposts, meeting
reports, field reports, documents, images such as photographs, posters,
signs and symbols, and video.

We would like your help in building this archive. Please send your old
reports, studies, articles, photographs, tools, and resources for posting.


The SIGN Internet Forum was established at the initiative of the World
Health Organization’s Department of Essential Health Technologies.

The SIGN Secretariat home is the Department of Health Systems Policies and
Workforce, Geneva Switzerland.

The SIGN Forum is moderated by Allan Bass and is hosted on the University
of Queensland computer network.

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