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SIGNpost 00785

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00785 Agenda + Cambodia + Water + Abstracts + News 21 January 2015

CONTENTS
1. SIGN Meeting 2015: Draft Agenda
2. Cambodia: Update on Cluster OF HIV Cases, Roka Commune, Sang Ker
District, Battambang Province
3. GGHH Webinar Series: WATER | Methods and Tools for Sustainable
Management and Conservation in the Health Sector
4. Abstract: Pharmacy practice and injection use in community pharmacies
in Pokhara city, Western Nepal
5. Abstract: Benchmarking of Percutaneous Injuries at the Ministry of
Health Hospitals of Saudi Arabia in Comparison with the United States
Hospitals Participating in Exposure Prevention Information Network
(EPINet™)
6. Abstract: Knowledge and awareness regarding biomedical waste management
in dental teaching institutions in India – A systematic review
7. Abstract: Workplace Safety and Health for the Veterinary Health Care
Team
8. Abstract: The incidence of coring with blunt versus sharp needles
9. Abstract: Hormonal contraceptive use and women’s risk of HIV
acquisition: a meta-analysis of observational studies
10. Abstract: Vaccination during concurrent subcutaneous immunotherapy:
safety of simultaneous application
11. Abstract: Study on risk factors of hepatitis C virus infection among
Han population in Henan province
12. Abstract: Disinfecting the iPad: evaluating effective methods
13. No Abstract: Study supports link between injectable hormonal
contraceptive and HIV risk
14. News
– New Ebola cases slump in all three worst-hit countries: WHO
– Africa: Tailor-made vaccine set to banish Africa’s meningitis epidemics
– Science Daily: Study supports link between injectable hormonal
contraceptive and HIV risk
– Press Release: The Lancet Infectious Diseases: Study supports link
between injectable hormonal contraceptive and HIV risk

The web edition of SIGNpost is online at:
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__________________________________________________________________
________________________________*_________________________________

1. SIGN Meeting 2015: Draft Agenda

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

This is the first draft of the meeting agenda for information and comment
__________________________________________________________________

Day 1: 23 February 2015

Morning: Plenary- EB Room

08:30- 09:00

Registration
9:00-10:30

Opening remarks and launch of IS Policy by DG:

* ADG opening remarks

* Expert panel chaired by DG and launch of the new policy

* General discussion

10:30-10:45 10:45- 11:30

Coffee Break

Side meeting DG with industry CEOs

11:30 -13:00

Session 1: Introduction of RUPs /SIPs for therapeutic injections in
healthcare settings: basis of the new WHO policy and strategy

* Presentation on key findings of the systematic review on introduction
of RUPs/SIPs

* Presentation on cost effectiveness analysis of the introduction of
RUPs/SIPs for therapeutic injections in healthcare settings

* Presentation on key components of the new policy and global campaign

* General discussion

13:00-14:00 Lunch

Afternoon: Plenary. Salle A

Session 2: Country reports on introduction of RUPs/SIPs ( success,
challenges, lessons learned)

*Presentation from US

*Presentation from Brazil

*Presentation from Nigeria or Uganda

*Presentation on EU directive on the use of sharps protection devices

*Presentation on joint ICAN/SIGN survey on availability and use of
RUPs/SIPs in 12 African countries

*General discussion

Coffee break

16:30-17:30

Session 3: Discussion of main recommendations from sessions 1&2

Welcome reception by WHO
__________________________________________________________________

Day 2: 24 February 2015

08:30- 09:00

Morning: Breakout sessions- Salle A

Session 4: Key components of the country implementation of the new IS
policy and global campaign :

Group work :

* Group 1: Country strategies and plans including procurement of safety
devices, training of HCWs and HCWM and financing of the national plan and
strategies

* Group 2: Strategies for patient and community involvement to ensure
rational and safe use of injections

*Group 3: Monitoring and evaluation of policy and global campaign
implementation at country and global levels (which indicators? Who should
collect? To who should be sent? Data analysis and dissemination?)

Coffee break

11:30 -13:00

Breakout sessions ( continued)

13:00-14:00 Lunch

Afternoon: Plenary. EB Room

*Reports on group work and discussion following each group presentation

*Main Recommendations to WHO from group work and discussion

Coffee break

16:30-17:30

Session 5 Next steps and closure of the meeting
__________________________________________________________________
________________________________*_________________________________

2. Cambodia: Update on Cluster OF HIV Cases, Roka Commune, Sang Ker
District, Battambang Province

“75 people who tested positive [HIV] also tested for Hepatitis C Virus
(HCV) and 36 (48%) were found positive for that virus as well.”

Joint Press Release: Ministry of Health of Kingdom of Cambodia, World
Health Organization (WHO) and the Joint United Nations Programme on
HIV/AIDS (UNAIDS)
__________________________________________________________________
http://tinyurl.com/mndwduy

Update On Cluster Of Hiv Cases, Roka Commune, Sang Ker District,
Battambang Province

Posted on January 12, 2015 By unaidsap

Joint Press Release: Ministry of Health of Kingdom of Cambodia, World
Health Organization (WHO) and the Joint United Nations Programme on
HIV/AIDS (UNAIDS)

The Ministry of Health (MOH) of the Kingdom of Cambodia and partners are
reporting the available information about the magnitude of the cluster of
new HIV diagnoses reported in Battambang province, initial results of the
on-going epidemiological investigation and response. These efforts are led
by the National Centre for HIV/AIDS, Dermatology and STD (NCHADS) in close
collaboration with a wide range of national and international partners
including: the University of Health Sciences (UHS), the Institute Pasteur
in Cambodia (IPC), Khmer-Soviet Friendship Hospital, Battambang Provincial
Health Department, the Joint United Nations Programme on HIV/AIDS
(UNAIDS), the World Health Organization (WHO), UNICEF, US Centers for
Disease Control and Prevention (US CDC), US Agency for International
Development (USAID), KHANA, FHI360, ARV User Association (AUA), AIDS
Health Care Foundation (AHF), Population Services Khmer (PSK), Sihanouk
Hospital Center of Hope (SHCH), and Buddhist for Development (BFD).

Between 8 to 31 December 2014, a total of 1940 people from Roka Commune
voluntarily undertook HIV testing and counselling and 212 people tested
positive for HIV. Among the people who tested HIV positive, 174 (82%) are
from Roka Village. Among the total of 212 diagnoses, 39 people (18%) are
14 years old or younger, 127 (60%) are between 15 and 59 years old and 46
(22%) are 60 years old or older. 75 people who tested positive also tested
for Hepatitis C Virus (HCV) and 36 (48%) were found positive for that
virus as well.

The investigation into the origins of the HIV cluster includes a case and
control study. The study showed that the percentage of people that
reported receiving an injection or intravenous infusion as part of their
health treatment was significantly higher among the people who tested
positive for HIV than the people who were HIV negative. This difference is
statistically significant. The study also looked at other risk factors
for HIV, such as unprotected sex and injecting drug use, and found no
significant differences between the two groups. Mother-to-child
transmission was also found unlikely as most of the children and young
people who tested HIV positive had an HIV negative mother.

Given the initial study findings, the Minister of Health, HE Dr. Mam
Bunheng, has reminded health authorities of the need to strictly follow
the MOH protocols. “The Ministry of Health is ensuring health facilities
follow universal precautions and use clean and sterile equipment, as well
as working on raising awareness of safe injection practices and overall
HIV prevention among the general public. We have reinforced implementation
of the MOH policy to stop unlicensed informal medical practices.”

Dr. Dongil Ahn, the World Health Organization representative in Cambodia
highlighted the importance of the rapid action by the Ministry of Health
which helped prevent HIV infections from continuing to spread, while
providing critical services to the affected community. “There is a
pressing need to strengthen the regulatory framework for the private and
informal health sector in order to ensure that health care is responsive,
safe and of high quality,” he said.

Authorities are making all efforts to respond effectively to the needs of
people who have recently found out that they are HIV positive. HIV
treatment and care services are available to residents of Roka Commune at
the Roka Health Center, in addition to the existing antiretroviral therapy
(ART) services available at Battambang Referral Hospital. A total of 161
people were registered for HIV care services and 78 started ART between 22
and 31 December 2014.

“Cambodia has a strong HIV community care and support system, which has
now been mobilized to provide dedicated community outreach services for
every household in the communities affected,” said Marie-Odile Emond,
UNAIDS Country Director for Cambodia. She added, “We will continue working
closely with all partners to expand HIV prevention, treatment and care
services and strengthen the surveillance systems to ensure that this
incident does not happen again.”

The Ministry of Health reconfirms that voluntary, confidential and quality
HIV testing and counselling services are available free of charge at most
public health facilities in the country. In line with the global WHO
guidelines, the national HIV testing protocol includes a sequence of HIV
tests. Any person living with HIV in Cambodia is offered free access to
the most effective and safe HIV treatment at referral hospitals across the
country, including in Battambang.

HE Dr. Mam Bunheng, Minister of Health indicated, “Cambodia has achieved a
significant reduction in HIV prevalence and a high level of ART coverage
for people living with HIV, which has been internationally recognized and
led to the United Nations Millennium Development Goal Award in 2010.”
“More than ever, the government commits to provide essential HIV
prevention, treatment, care and support services to all people in need in
an environment free of stigma and discrimination, moving towards the
elimination of new HIV infections by 2020.”

The Ministry asks that the media and the public respect the rights of all
people living with or affected by HIV and recognizes their right to
confidentiality and a life of dignity free of stigma and discrimination.
__________________________________________________________________
________________________________*_________________________________

3. GGHH Webinar Series: WATER | Methods and Tools for Sustainable
Management and Conservation in the Health Sector

Crossposted from Health Care Without Harm with thanks
__________________________________________________________________
Global Green and Healthy Hospitals – A project of HCWH
www.greenhospital.net

GGHH Webinar Series | Register Now!

WATER | Methods and Tools for Sustainable Management and Conservation in
the Health Sector

Global Green and Healthy Hospitals (GGHH) is proud to announce the launch
of its Global Webinar Series. Following the 10 sustainability goals set
out in the GGHH Agenda, each webinar will focus on a specific Agenda Goal
throughout 2015 and 2016.

Informational, educational, and interactive: these one hour webinars will
provide opportunities for members from around the globe to come together
to learn and share experiences. Each webinar will include background and
technical informational about the GGHH Agenda Goal, actions hospitals can
take to achieve their goals as well as case examples, success stories and
lessons learned from individual GGHH members. The webinars will include
time for questions and answers and discussion amongst the group.

Next Webinar: Water | Methods and Tools for Sustainable Management and
Conservation in the Health Sector http://tinyurl.com/mztqozt

Objectives:

Conservation, recycling and treatment measures to reduce hospital water
consumption and wastewater pollution.

The relationship between potable water availability and healthcare
resilience to withstand physical, natural, economic and social disruption.

When?

Wednesday 28th January or Thursday 29th January (depending on your time
zone). Stay tuned to further notice: An additional live session of this
webinar may be added to include more time zones.

Starting Time

Pacific Standard Time (for example, San Francisco): 28th January, 6 pm
South America Eastern Time (for example, Buenos Aires): 28th January, 11
pm

Central European Time: 29th January, 3 am

Philippine Time and China Standard Time (for example, Manila and Beijing):
29th January, 10 am

Korean Standard Time (for example, Seoul): 29th January, 11 am
Australian Eastern Daylight Time (for example, Melbourne): 29th January, 1
pm

Duration: 1 hour. Session will be recorded and made available after the
event.

Language: English

Cost: Free of charge. To register, click here. Space is limited.

Presenters:
Susan Wilburn, Sustainability Director, Global Green and Healthy
Hospitals, will present on Global Green and Healthy Hospitals.

Scott Slotterback, Policy Director, Global Green and Healthy Hospitals,
will present the GGHH Water Guidance Document for Members.
http://tinyurl.com/l9ecb7s

Dr. Jaelim Cho, Research Fellow, Department of Preventive Medicine at the
Yonsei University College of Medicine and member of Green Hospitals Task
Force at Yonsei University Health System and the Korea Society for Green
Hospital, will present their experience on sustainable management and
conversation of water at their institution.

Learn more about the presenters here. http://tinyurl.com/k9g8pl3

Moderator: Susan Wilburn, Sustainability Director, Global Green and
Healthy Hospitals

Those who participate in the entire webinar will receive a Certificate of
Attendance by email.

(Note: when you complete the registration form, please provide your name
as you would like it to appear on the Certificate of Attendance.)

We look forward to your participation. Please feel free to share this
information and invitation with your colleagues.

For more information, please visit www.greenhospitals.net and/or contact
us at globalnetwork@hcwh.org

Global Green and Healthy Hospitals – A project of HCWH |
www.greenhospital.net
Follow us on Facebook | Twitter | YouTube
January
28/29
Save the date!

Wednesday 28th January or Thursday 29th January (depending on your time
zone).
To register, click here. Space is limited http://tinyurl.com/m8a3pld

GGHH is a Project of Health Care Without Harm

HomepageHealth Care Without Harm (HCWH) is an international coalition that
works to transform the health care sector worldwide, without compromising
patient safety or care, so that it becomes ecologically sustainable and a
leading advocate for environmental health and justice.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Pharmacy practice and injection use in community pharmacies
in Pokhara city, Western Nepal
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4101856/

BMC Health Serv Res. 2014 Apr 28;14:190.

Pharmacy practice and injection use in community pharmacies in Pokhara
city, Western Nepal.

Gyawali S1, Rathore DS, Adhikari K, Shankar PR, K C VK, Basnet S.

1Department of Pharmacology, Manipal College of Medical Sciences, Pokhara,
Nepal. sudeshgy@hotmail.com.

BACKGROUND: Community pharmacies in Nepal serve as the first point of
contact for the public with the health care system and provide many
services, including administering injections. However, there is a general
lack of documented information on pharmacy practice and injection use in
these pharmacies. This study aims to provide information about pharmacy
practice in terms of service and drug information sources, and injection
use, including the disposal of used injection equipment.

METHODS: A mixed method, cross-sectional study was conducted in 54
community pharmacies in Pokhara city. Data was collected using a pre-
tested, semi- structured questionnaire, and also by the direct observation
of pharmacy premises. Interviews with pharmacy supervisors (proprietors)
were also conducted to obtain additional information about certain points.

RESULTS: Interviews were carried out with 54 pharmacy
supervisors/proprietors (47 males and 7 females) with a mean age and
experience of 35.54 and 11.73 years, respectively. Approximately a half of
the studied premises were operated by legally recognized pharmaceutical
personnel, while the remainder was run by people who did not have the
legal authority to operate pharmacies independently. About a quarter of
pharmacies were providing services such as the administration of
injections, wound dressing, and laboratory and consultation services in
addition to medicine dispensing and counseling services. The ‘Current
Index of Medical Specialties’ was the most commonly used source for drug
information. Almost two-thirds of patients visiting the pharmacies were
dispensed medicines without a prescription. Tetanus Toxoid, Depot-Medroxy
Progesterone Acetate, and Diclofenac were the most commonly-
used/administered injections. Most of the generated waste (including
sharps) was disposed of in a municipal dump without adhering to the proper
procedures for the disposal of hazardous waste.

CONCLUSIONS: Community pharmacies in Pokhara offer a wide range of
services including, but not limited to, drug dispensing, counseling,
dressing of wounds, and administering injections. However, the lack of
qualified staff and adequate infrastructure may be compromising the
quality of the services offered. Therefore, the health authorities should
take the necessary measures to upgrade the qualifications of the personnel
and to improve the infrastructure for the sake of good pharmacy practice
and the safer use of injections.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4101856/
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Benchmarking of Percutaneous Injuries at the Ministry of
Health Hospitals of Saudi Arabia in Comparison with the United States
Hospitals Participating in Exposure Prevention Information Network
(EPINet™)
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25588223

Int J Occup Environ Med. 2015 Jan;6(1):26-33.

Benchmarking of Percutaneous Injuries at the Ministry of Health Hospitals
of Saudi Arabia in Comparison with the United States Hospitals
Participating in Exposure Prevention Information Network (EPINet™).

Memish ZA, Assiri AM, Eldalatony MM1, Hathout HM.

1Industrial Medicine and Occupational Health, Public Health and Community
Medicine Department, Menoufiya University, Egypt.
mervat.moh.abd@gmail.com.

BACKGROUND: Exposure to blood-borne pathogens from needle-stick and sharp
injuries continues to pose a significant risk to health care workers.
These events are of concern because of the risk to transmit blood-borne
diseases such as hepatitis B virus, hepatitis C virus, and the human
immunodeficiency virus.

OBJECTIVE: To benchmark different risk factors associated with needle-
stick incidents among health care workers in the Ministry of Health
hospitals in the Kingdom of Saudi Arabia compared to the US hospitals
participating in Exposure Prevention Information Network (EPINet™).

METHODS: Prospective surveillance of needle-stick and sharp incidents
carried out during the year 2012 using EPINet™ ver 1.5 that provides
uniform needle stick and sharp injury report form.

RESULTS: The annual percutaneous incidents (PIs) rate per 100 occupied
beds was 3.2 at the studied MOH hospitals. Nurses were the most affected
job category by PIs (59.4%). Most PIs happened in patients’ wards in the
Ministry of Health hospitals (34.6%). Disposable syringes were the most
common cause of PIs (47.20%). Most PIs occurred during use of the syringes
(36.4%).

CONCLUSION: Among health care workers, nurses and physicians appear
especially at risk of exposure to PIs. Important risk factors of injuries
include working in patient room, using disposable syringes, devices
without safety features. Preventive strategies such as continuous training
of health care workers with special emphasis on nurses and physicians,
encouragement of reporting of such incidents, observation of sharp
handling, their use and implementation of safety devices are warranted.

Free full text
http://www.theijoem.com/ijoem/index.php/ijoem/article/view/467
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Knowledge and awareness regarding biomedical waste management
in dental teaching institutions in India – A systematic review
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25593667

J Clin Exp Dent. 2014 Oct 1;6(4):e419-24.

Knowledge and awareness regarding biomedical waste management in dental
teaching institutions in India- A systematic review.

Kapoor D1, Nirola A2, Kapoor V3, Gambhir RS4.

1Professor and Head. Dept. of Periodontics, Gian Sagar Dental College and
Hospital, Rajpura, Punjab.
2Professor and Head. Dept. of Periodontics, Laxmi Bai Institute of Dental
Sciences and Hospital, Patiala, Punjab.
3Professor and Head. Dept. of Oral and Maxillofacial Surgery, Gian Sagar
Dental College and Hospital, Rajpura.
4Sr. Reader. Dept. of Public Health Dentistry, Gian Sagar Dental College
and Hospital, Rajpura, Punjab.

OBJECTIVES: Proper handling, treatment and disposal of biomedical wastes
are important elements in any health care setting. Not much attention has
been paid to the management of Biomedical Waste (BMW) in recent years, in
dental colleges and hospitals in India. The present systematic review was
conducted to assess knowledge and awareness regarding BMW management among
staff and students of dental teaching institutions in India.

MATERIAL AND METHODS: A systematic review of relevant cross-sectional
studies was conducted regarding BMW management in India in dental teaching
institutions in India. Six studies were finally included in the present
review after conducting both electronic and manual search like Pubmed,
EMBASE etc. and after making necessary exclusions. Potential biases were
addressed and relevant data was extracted by the concerned investigators.

RESULTS: Six studies were finally included in the review. Colour coding of
wastes was not done by 67% of the subjects in one of the studies conducted
in Haryana. Almost all the subjects agreed to the fact that exposure to
hazardous health care waste can result in disease or infection in another
study. According to another study reports, none of the respondents was
able to list the legislative act regarding BMW when asked.

CONCLUSIONS: The results of the present review showed that knowledge and
awareness level of subjects was inadequate and there is considerable
variation in practice and management regarding BMW. There is a great need
for continuing education and training programmes to be conducted in dental
teaching institutions in India.

Key words:Biomedical waste, knowledge, awareness, dentists, institution.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4282912/
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Workplace Safety and Health for the Veterinary Health Care
Team
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25577561

Vet Clin North Am Small Anim Pract. 2015 Jan 8.
pii: S0195-5616(14) 00184-3.

Workplace Safety and Health for the Veterinary Health Care Team.

Gibbins JD1, MacMahon K2.

1Division of Surveillance, Hazard Evaluations, and Field Studies, National
Institute for Occupational Safety and Health, Centers for Disease Control
and Prevention, 1090 Tusculum Avenue, MS R-10, Cincinnati, OH 45226, USA.
Electronic address: jgibbins@cdc.gov.

2Education and Information Division, National Institute for Occupational
Safety and Health, Centers for Disease Control and Prevention, 1090
Tusculum Avenue, MS C-14, Cincinnati, OH 45226, USA.

Veterinary clinic employers have a legal and ethical responsibility to
provide a safe and healthy workplace. Clinic members are responsible for
consistently using safe practices and procedures set up by their employer.

Development and implementation of a customized comprehensive workplace
safety and health program is emphasized, including an infection control
plan.

Occupational safety and health regulations are reviewed.

The hazards of sharps, animal bites and scratches, and drugs are
discussed.

Strategies to prevent or minimize adverse health effects and resources for
training and education are provided.

Published by Elsevier Inc.

KEYWORDS: Animal bites; Hazardous drugs; Needlestick injuries;
Occupational health; Occupational safety; Regulations
__________________________________________________________________
________________________________*_________________________________

8. Abstract: The incidence of coring with blunt versus sharp needles
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24582180

J Clin Anesth. 2014 Mar;26(2):152-4.

The incidence of coring with blunt versus sharp needles.

Wani T1, Wadhwa A2, Tobias JD3.

1Department of Anesthesiology & Pain Medicine, Nationwide Children’s
Hospital, Columbus, OH 43205, USA.
2Department of Anesthesiology, University of Louisville, Louisville, KY
40202, USA.
3Department of Anesthesiology & Pain Medicine, Nationwide Children’s
Hospital, Columbus, OH 43205, USA; Department of Anesthesiology, The Ohio
State University, Columbus, OH 43210, USA. Electronic address:
Joseph.Tobias@Nationwidechildrens.org.

With the advent of safety needles to prevent inadvertent needle sticks in
the operating room (OR), a potentially new issue has arisen. These needles
may result in coring, or the shaving off of fragments of the rubber
stopper, when the needle is pierced through the rubber stopper of the
medication vial. These fragments may be left in the vial and then drawn up
with the medication and possibly injected into patients.

The current study prospectively evaluated the incidence of coring when
blunt and sharp needles were used to pierce rubber topped vials. We also
evaluated the incidence of coring in empty medication vials with rubber
tops.

The rubber caps were then pierced with either an18-gauge sharp hypodermic
needle or a blunt plastic (safety) needle. Coring occurred in 102 of 250
(40.8%) vials when a blunt needle was used versus 9 of 215 (4.2%) vials
with a sharp needle (P < 0.0001).

A significant incidence of coring was demonstrated when a blunt plastic
safety needle was used. This situation is potentially a patient safety
hazard and methods to eliminate this problem are needed.

Copyright © 2014 Elsevier Inc. All rights reserved.

KEYWORDS: Coring; Medication vials; Patient safety; Rubber vials
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Hormonal contraceptive use and women’s risk of HIV
acquisition: a meta-analysis of observational studies
__________________________________________________________________
Free Full Text: http://tinyurl.com/ltqpwyx Registration required

Hormonal contraceptive use and women’s risk of HIV acquisition: a meta-
analysis of observational studies

Lauren J Ralph, MPHcorrespondenceemail, Sandra I McCoy, PhD, Karen Shiu,
MPH, Nancy S Padian, PhD

Published Online: 08 January 2015

Article has an altmetric score of 105

DOI: http://dx.doi.org/10.1016/S1473-3099(14)71052-7

The evidence from epidemiological research into whether use of hormonal
contraception increases women’s risk of HIV acquisition is inconsistent.
We did a robust meta-analysis of existing data to provide summary
estimates by hormonal contraceptive method which can be used to inform
contraceptive guidelines, models, and future studies.

Methods: We updated a recent systematic review to identify and describe
studies that met inclusion criteria. To ensure inclusion of more recent
research, we searched PubMed for articles published after December, 2011,
using the terms “hormonal contraception”, “HIV/acquisition”,
“injectables”, “progestin”, and “oral contraceptive pills”. We assessed
statistical heterogeneity for these studies, and, when appropriate,
combined point estimates by hormonal contraception formulation using
random-effects models. We assessed publication bias and investigated
heterogeneity through subgroup and stratified analyses according to study
population and design features.

Findings: We identified 26 studies, 12 of which met inclusion criteria.
There was evidence of an increase in HIV risk in the ten studies of depot
medroxyprogesterone acetate (pooled hazard ratio [HR] 1·40, 95% CI
1·16–1·69). This risk was lower in the eight studies done in women in the
general population (pooled HR 1·31, 95% CI 1·10–1·57). There was
substantial between-study heterogeneity in secondary analyses of trials
(n=7, I2 51·1%, 95% CI 0–79·3). Although individual study estimates
suggested an increased risk, substantial heterogeneity between two studies
done in women at high risk of HIV infection (I2 54%, 0–88·7) precluded
pooling estimates. There was no evidence of an increased HIV risk in ten
studies of oral contraceptive pills (pooled HR 1·00, 0·86–1·16) or five
studies of norethisterone enanthate (pooled HR 1·10, 0·88–1·37).

Interpretation: Our findings show a moderate increased risk of HIV
acquisition for all women using depot medroxyprogesterone acetate, with a
smaller increase in risk for women in the general population. Whether the
risks of HIV observed in our study would merit complete withdrawal of
depot medroxyprogesterone acetate needs to be balanced against the known
benefits of a highly effective contraceptive.

Funding: None.

Free Full Text: http://tinyurl.com/ltqpwyx Registration required
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Vaccination during concurrent subcutaneous immunotherapy:
safety of simultaneous application
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25599553

Eur Ann Allergy Clin Immunol. 2015 Jan;47(1):10-4.

Vaccination during concurrent subcutaneous immunotherapy: safety of
simultaneous application.

Ullrich D1, Ullrich K2, Mussler S3, Thum-Oltmer S3.

1Otorhinolaryngological Medical Practice/Day Surgery Wedemarkstr. 83 30900
Wedemark, Germany. Phone: +49 5130 3737 87 Fax: +49 5130 3752 62 E-mail:
Ullrich-Dieter@t-online.de.
2Otorhinolaryngological Medical Practice/Day Surgery, Wedemark, Germany.
3Allergopharma GmbH & Co. KG, Reinbek, Germany.

BACKGROUND: During subcutaneous immunotherapy (SCIT), injections should be
separated from vaccinations against infectious diseases by at least 1
week, because it is assumed that adverse reactions can result from the
additional activation of the immune system.

METARIAL AND METHODS: Data of a total of 875 individuals receiving SCIT
and/or vaccination in one ENT-practice were included and analyzed
retrospectively. 444 individuals had received vaccination against
infectious diseases, 336 allergic patients received only SCIT. Moreover,
79 allergic patients had received vaccination and SCIT injections
simultaneously on one day in different locations, while 16 patients
inadvertently received SCIT injections within up to 4 days after
vaccination. Some of the patients were observed for consecutive years
receiving several vaccinations parallel to SCIT. Systemic reactions (SRs)
during SCIT were classified according to the WAO (World Allergy
Organization) grading.

RESULTS: Patients exclusively receiving vaccinations did not report any
drug-related SR. One SR third grade and two SRs second grade occurred in 3
asthmatic patients exclusively receiving SCIT. The patients simultaneously
receiving vaccination and SCIT did not have any SR. This was also the case
for the subjects consecutively receiving parallel SCIT and vaccination for
up to 5 years.

CONCLUSION: The international guidelines for allergen-specific
immunotherapy (SIT) recommend an intermission of at least one week between
SCIT and the administration of vaccines. However, these findings
demonstrate the possibility to shorten or abolish this interval without
increasing the risk of SRs.

KEYWORDS: IgE-mediated allergy, simultaneous application; Vaccination
against infectious diseases; allergen-specific subcutaneous immunotherapy
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Study on risk factors of hepatitis C virus infection among
Han population in Henan province
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25582370

Zhonghua Yu Fang Yi Xue Za Zhi. 2014 Nov;48(11):985-9.

[Study on risk factors of hepatitis C virus infection among Han population
in Henan province].

[Article in Chinese]

Li J1, Ma Y2, Yang W2, Sun D2, Zhu Q2, Wang Z3.

1Institute for Prevention and Control of STD and AIDS , Henan Provincial
Center for Diseases Control and Prevention,Zhengzhou 450016, China.
2Institute for Prevention and Control of STD and AIDS , Henan Provincial
Center for Diseases Control and Prevention, Zhengzhou 450016, China.
3Institute for Prevention and Control of STD and AIDS , Henan Provincial
Center for Diseases Control and Prevention, Zhengzhou 450016, China.
Email: wangzhe@hncdc.com.cn.

OBJECTIVE: To study the risk factors of hepatitis C Virus Infection among
Han population in Henan Province, providing evidence for the development
of targeted prevention and control measures.

METHODS: In this 1: 1 matched case-control study, data of 134 cases and
134 controls were collected in seven hospitals from June 2013 to September
2013. Case group with the following conditions: Han nationality, first
diagnosed hepatitis C in 2013, Current address and investigation belong to
the same district (county), above 18 years old; with the following
conditions can’t into case group: not to cooperate with the investigation,
late-stage Hepatitis C patients. Control group with the following
conditions: Han nationality, with the matched case patients the same
gender, in the same hospital for treatment , from the same district
(county), the age difference = 5 years old and in the same age group. With
the following conditions can’t into control group:not to cooperate with
the investigation, diagnosed with hepatitis B, hepatitis C patients.
Collect 3 ml blood samples to test anti-HCV. Single factors were analyzed
with ?(2) between case and control, risk factors were analyzed with
logistic regression model.

RESULTS: The ratio about blood donation, blood transfusion, operation and
acupuncture of cases were 35.1% (47/134), 27.6% (37/134), 42.5% (57/134),
12.7% (17/134), with differences compared to those of controls (2.2%
(3/134), 5.2% (7/134), 21.6% (29/134), 5.2% (7/134))(?(2) values were
47.60, 24.47, 13.42 and 4.58, all P values <0.05). Compared with those
never received blood transfusion and those never donated blood, former
blood receptors and blood donors had higher risk of hepatitis C
infection(OR: 2.01, 95%CI:1.32-3.05; OR:2.68, 95%CI:1.85-3.88).

RESULTS: of multiple nonconditional logistic regression analysis showed
that Plasma donors and whole blood donors had higher risk of hepatitis C
infection than those never donated plasma and blood (OR:76.71, 95%CI:
10.25-574.25; OR:10.23, 95%CI: 2.15-48.70).

CONCLUSION: Blood transfusion and abnormal blood are independent risk
factors among Han population in Henan Province of hepatitis C infection.
The Plasma donors, blood donors and with the increase in the times of
blood transfusion, the risk of hepatitis C infection is increase.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Disinfecting the iPad: evaluating effective methods
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24746231

J Hosp Infect. 2014 Jun;87(2):77-83.

Disinfecting the iPad: evaluating effective methods.

Howell V1, Thoppil A1, Mariyaselvam M1, Jones R1, Young H1, Sharma S1,
Blunt M1, Young P2.

1The Queen Elizabeth Hospital, King’s Lynn, Norfolk, UK.
2The Queen Elizabeth Hospital, King’s Lynn, Norfolk, UK. Electronic
address: peteryoung101@gmail.com.

BACKGROUND: Tablet computers are increasingly used in healthcare, but they
may carry nosocomial pathogens. There are few data available on how to
clean an iPad effectively for use in the clinical setting.

AIM: We aimed to identify the most effective method of decontaminating the
Apple iPad, without causing damage, and establish the duration of any
residual effect.

METHODS: Following contamination with a microbial broth (meticillin-
resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus
(VRE) and Clostridium difficile), we examined efficacy of iPad
disinfection in the laboratory using six different disinfectant wipes:
Sani-Cloth CHG 2% (chlorhexidine 2%/alcohol 70%), Clorox, Tristel,
Trigene, soap and water, and plain cloth. Following cleaning, iPads were
recontaminated to examine residual activity. After 480 Sani-Cloth CHG 2%
disinfecting episodes, functional and visual analysis of iPads was
performed by blinded subjects.

FINDINGS: With the exception of Clostridium difficile, Sani-Cloth CHG 2%
and Clorox wipes were most effective against MRSA and VRE, and they were
significantly better than the Apple-recommended plain cloth (P = 0.001). A
substantial residual antimicrobial effect was seen for >6h after wiping
the iPad with Sani-Cloth CHG 2% despite repeated recontamination and
without further disinfection. The functionality or visual appearance of
the iPad was not damaged by repeated use of Sani-Cloth CHG 2% wipes.

CONCLUSIONS: Sani-Cloth CHG 2% wipes effectively disinfect the iPad
against MRSA and VRE, with a residual antibacterial effect and without
causing damage. Copyright © 2014 The Healthcare Infection Society.
Published by Elsevier Ltd. All rights reserved.

KEYWORDS: Chlorhexidine; Decontamination; Personal digital assistant
(PDA); Tablet computer; iPad
__________________________________________________________________
________________________________*_________________________________

13. No Abstract: Study supports link between injectable hormonal
contraceptive and HIV risk
__________________________________________________________________
BMJ. 2015 Jan 9;350:h112.

Study supports link between injectable hormonal contraceptive and HIV
risk.

Wise J1.

1London.
__________________________________________________________________
________________________________*_________________________________

14. News

– New Ebola cases slump in all three worst-hit countries: WHO
– Africa: Tailor-made vaccine set to banish Africa’s meningitis epidemics
– Science Daily: Study supports link between injectable hormonal
contraceptive and HIV risk
– Press Release: The Lancet Infectious Diseases: Study supports link
between injectable hormonal contraceptive and HIV risk

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
New Ebola cases slump in all three worst-hit countries: WHO

by Tom Miles, Reuters (14.01.15)

Geneva (Reuters) – All three countries hit hardest by the Ebola epidemic
have recorded their lowest weekly number of new cases for months, the
World Health Organization said on Wednesday, as the global death toll
reached 8,429 out of 21,296 cases reported so far.

Sierra Leone and Guinea both saw the lowest weekly total of confirmed
Ebola cases since August 2014. Liberia, which reported two days with zero
new cases last week, had its lowest weekly total since June, the WHO said.

(Reporting ; Editing by Alison Williams)
__________________________________________________________________
__________________________________________________________________
Africa: Tailor-made vaccine set to banish Africa’s meningitis epidemics

By Kate Kelland, Reuters, UK (09.01.15)

The website of a global partnership formed to wipe out deadly meningitis
epidemics in sub-Saharan Africa is closing down with a simple message:
“Thank you and goodbye!”.

Barely five years after the team began rolling out a tailor-made vaccine
in Africa’s “meningitis belt”, the disease has all but disappeared there
and the Meningitis Vaccine Project (MVP) is closing down after pioneering
what may be a model for tackling infectious diseases in developing
countries.

“We have not seen a single case among vaccinated populations …,” said
Marie Pierre-Preziosi, MVP’s director, “and transmission has stopped.”

The tale of MenAfriVac, made by Serum Institute of India and costing just
50 U.S. cents a shot, elicits hopeful comparisons with the current rush to
develop a vaccine against Ebola:

A deadly disease needed tackling quickly at a price affordable to some of
the world’s poorest people; a committed group of scientists, drugmakers
and philanthropists got together and developed a cheap, simple vaccine
specifically for Africans; it was tested, trialled and deployed in record
time; and in a matter of years, thousands of lives have been saved.

On Friday, the World Health Organization (WHO) authorised MenAfriVac for
use in routine child immunizations in Africa, establishing it as part of
everyday healthcare and bringing an end into sight for a disease that has
plagued Africa for more than a century.

BRAIN DAMAGE AND DEATH

Before MenAfriVac’s introduction in 2010, people in a belt stretching from
Senegal to Ethiopia were regularly afflicted by epidemics of the ‘A’
strain of meningitis.

Meningococcal meningitis infects the thin lining surrounding the brain and
spinal cord. It can cause severe brain damage, deafness, epilepsy or
necrosis and, if untreated, is fatal in 50 percent of cases.

One of Africa’s worst recorded outbreaks was in 1996-97, when some 250,000
were infected and more than 25,000 died in a few months.

An epidemic in Nigeria in 2008-09 saw 56,000 cases, almost three times the
current total of Ebola cases in West Africa.

Yet five years on, meningitis A is rare in Africa. Jean-Marie Okwo-Bele,
director of the WHO’s immunisation department, called the introduction of
MenAfriVac a “stunning success”.

In 2010, he told a briefing of the “fear in the population” during
seasonal outbreaks in the Democratic Republic of Congo, saying: “You can
see empty streets because people are so afraid to be in contact with each
other.”

CHEAPER AND BETTER

Back then, the available meningitis vaccines were broad-spectrum,
targeting four strains, A, C, Y and W-135. They were also expensive, so in
Africa were generally limited to emergency immunisation campaigns that
were often too little, too late.

So African leaders urged global health experts to make something better –
a vaccine costing no more than 50 U.S. cents that could specifically
protect against the meningitis A that was claiming so many lives.

“African health officials told us: ‘Don’t come with a vaccine we cannot
afford, because that would not be a solution’,” Pierre-Preziosi said.

In record time, with focused drug research, committed partnerships and
funding from the Bill & Melinda Gates Foundation, MVP bypassed big pharma
firms and approached a cheaper generic drugmaker, Serum Institute of
India, to develop a monovalent, or single-strain, meningitis A shot.

It is the first vaccine made specifically for Africa, and the first not to
need constant refrigeration, allowing it to be transported to remote areas
in hot regions.

Since being introduced in Burkina Faso in 2010, it has been given to 215
million people across Benin, Cameroon, Chad, Ivory Coast, Ethiopia, Ghana,
Mali, Niger, Mauritania, Nigeria, Senegal, Sudan, Togo and Gambia.

MVP’s website features a valedictory film clip.

“It’s quite short,” says Pierre-Preziosi. “But in it, you will see the
meningitis belt disappear.”

(Reporting by Kate Kelland, Editing by Kevin Liffey)
__________________________________________________________________
__________________________________________________________________
http://www.sciencedaily.com/releases/2015/01/150109045617.htm

Science Daily: Study supports link between injectable hormonal
contraceptive and HIV risk

January 9, 2015

Source: The Lancet

Summary:

Women using depot medroxyprogesterone acetate, commonly known as Depo-
Provera or the birth control shot, have a moderately increased risk of
becoming infected with HIV, a large meta-analysis of 12 studies involving
more than 39,500 women has found. Other forms of hormonal contraception,
including oral contraceptive pills, do not appear to increase this risk.

Women using depot medroxyprogesterone acetate (DMPA), commonly known as
Depo-Provera or the birth control shot, have a moderately increased risk
of becoming infected with HIV, a large meta-analysis of 12 studies
involving more than 39 500 women published in The Lancet Infectious
Diseases has found. Other forms of hormonal contraception, including oral
contraceptive pills, do not appear to increase this risk.

Worldwide about 144 million women use hormonal contraception–around 41
million use the injectable forms and 103 million take the oral
contraceptive pill. Whether or not use of hormonal contraceptives
increases women’s risk of HIV acquisition has been hotly debated for more
than two decades. But research so far has been inconclusive.

Researchers from the University of California at Berkeley in the USA
conducted a meta-analysis of all existing data examining the effect of
using the most commonly prescribed forms of hormonal contraception
(combined oral contraceptives, progestin-only pills, and the injectable
contraceptives DMPA and norethisterone enanthate) on HIV risk up to June,
2014.

Analysis of 12 observational studies from sub-Saharan Africa involving 39
560 women suggest that DMPA use increases a woman’s chance of becoming
infected with HIV by 40% compared with women using other contraceptive
methods or no method. Although statistically significant, this represents
only a moderate increase in relative risk. This risk appears to be lower
among women in the general population (increase 31%) than for women
already at high risk of acquiring HIV such as sex workers. However, the
limited number of studies on high risk women leaves uncertainty for this
important subgroup of women. No increased risk was noted for users of oral
contraceptive pills, combined oral contraceptives, or norethisterone
enanthate.

“The moderate elevation in risk observed in our study is not enough to
justify a complete withdrawal of DMPA for women in the general
population,” cautions Lauren Ralph, lead author and an epidemiologist at
the University of California at Berkeley. “Banning DMPA would leave many
women without immediate access to alternative, effective contraceptive
options. This is likely to lead to more unintended pregnancies, and
because childbirth remains life-threatening in many developing countries,
could increase overall deaths among women.”

She adds, “Further evidence regarding the magnitude and mechanisms of the
DMPA and HIV link among high risk women, such as commercial sex workers
and women in serodiscordant partnerships (where one partner is HIV-
positive and the other is not), is urgently needed.”

Writing in a linked Comment, Christopher Colvin from the University of
Cape Town in South Africa, and Abigail Harrison from Brown University
School of Public Health in the USA say, “Currently, the increasingly
narrow and fierce debates over the HIV and depot medroxyprogesterone
acetate link have focused on whether a large randomised controlled trial
should be done to better understand this link. Like many scientific
controversies, views have become hardened, personal, financial, or
political agendas have been suggested, and there has even been intrigue in
the form of leaked copies of articles under peer review. Both sides have
raised important, compelling arguments, but their partisan character can
weaken the quality of the debates and restrict the view of the complex
relation between evidence, policy, and practice.”

They add, “Ralph and colleagues’ signature contribution is their nuanced
discussion of what their research adds and what is possible with current
and future evidence…They describe an approach to evidence, policy, and
practice rooted in an “ecology of evidence” as the foundation for thinking
through the next steps. The current polarised environment around the
proposed trial makes this more holistic approach all the more difficult,
but necessary.”

Story Source:
The above story is based on materials provided by The Lancet. Note:
Materials may be edited for content and length.

Journal Reference:
Lauren J Ralph, Sandra I McCoy, Karen Shiu, Nancy S Padian. Hormonal
contraceptive use and women’s risk of HIV acquisition: a meta-analysis of
observational studies. The Lancet Infectious Diseases, 2015; DOI:
10.1016/S1473-3099(14)71052-7

Cite This Page:

MLA APA Chicago

The Lancet. “Study supports link between injectable hormonal contraceptive
and HIV risk.” ScienceDaily. ScienceDaily, 9 January 2015. <
www.sciencedaily.com/releases/2015/01/150109045617.htm>.
__________________________________________________________________
__________________________________________________________________
http://www.eurekalert.org/pub_releases/2015-01/tl-tli010715.php

PUBLIC RELEASE: 8-JAN-2015

Press Release: The Lancet Infectious Diseases: Study supports link between
injectable hormonal contraceptive and HIV risk

Fom EurekaAlert.org

THE LANCET

Women using depot medroxyprogesterone acetate (DMPA), commonly known as
Depo-Provera or the birth control shot, have a moderately increased risk
of becoming infected with HIV, a large meta-analysis of 12 studies
involving more than 39 500 women published in The Lancet Infectious
Diseases has found. Other forms of hormonal contraception, including oral
contraceptive pills, do not appear to increase this risk.

Worldwide about 144 million women use hormonal contraception–around 41
million use the injectable forms and 103 million take the oral
contraceptive pill. Whether or not use of hormonal contraceptives
increases women’s risk of HIV acquisition has been hotly debated for more
than two decades. But research so far has been inconclusive.

Researchers from the University of California at Berkeley in the USA
conducted a meta-analysis of all existing data examining the effect of
using the most commonly prescribed forms of hormonal contraception
(combined oral contraceptives, progestin-only pills, and the injectable
contraceptives DMPA and norethisterone enanthate) on HIV risk up to June,
2014.

Analysis of 12 observational studies from sub-Saharan Africa involving 39
560 women suggest that DMPA use increases a woman’s chance of becoming
infected with HIV by 40% compared with women using other contraceptive
methods or no method. Although statistically significant, this represents
only a moderate increase in relative risk.* This risk appears to be lower
among women in the general population (increase 31%) than for women
already at high risk of acquiring HIV such as sex workers. However, the
limited number of studies on high risk women leaves uncertainty for this
important subgroup of women. No increased risk was noted for users of oral
contraceptive pills, combined oral contraceptives, or norethisterone
enanthate.

“The moderate elevation in risk observed in our study is not enough to
justify a complete withdrawal of DMPA for women in the general
population”, cautions Lauren Ralph, lead author and an epidemiologist at
the University of California at Berkeley. “Banning DMPA would leave many
women without immediate access to alternative, effective contraceptive
options. This is likely to lead to more unintended pregnancies, and
because childbirth remains life-threatening in many developing countries,
could increase overall deaths among women.”**

She adds, “Further evidence regarding the magnitude and mechanisms of the
DMPA and HIV link among high risk women, such as commercial sex workers
and women in serodiscordant partnerships (where one partner is HIV-
positive and the other is not), is urgently needed.”**

Writing in a linked Comment, Christopher Colvin from the University of
Cape Town in South Africa, and Abigail Harrison from Brown University
School of Public Health in the USA say, “Currently, the increasingly
narrow and fierce debates over the HIV and depot medroxyprogesterone
acetate link have focused on whether a large randomised controlled trial
should be done to better understand this link. Like many scientific
controversies, views have become hardened, personal, financial, or
political agendas have been suggested, and there has even been intrigue in
the form of leaked copies of articles under peer review. Both sides have
raised important, compelling arguments, but their partisan character can
weaken the quality of the debates and restrict the view of the complex
relation between evidence, policy, and practice.”

They add, “Ralph and colleagues’ signature contribution is their nuanced
discussion of what their research adds and what is possible with current
and future evidence…They describe an approach to evidence, policy, and
practice rooted in an “ecology of evidence” as the foundation for thinking
through the next steps. The current polarised environment around the
proposed trial makes this more holistic approach all the more difficult,
but necessary.”

###

Notes to Editors:

*This study does not give any absolute measures because none of the
individual studies did so, and meta-analyses pool previous study
estimates.

**Quotes direct from author and cannot be found in text of Article.
__________________________________________________________________
________________________________*_________________________________

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
protection.
__________________________________________________________________
________________________________*_________________________________
* SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org

A fact sheet on injection safety is available at:
http://www.who.int/mediacentre/factsheets/fs231/en/index.html

* Visit the WHO injection safety website and the SIGN Alliance Secretariat
at: http://www.who.int/injection_safety/en/

* Download the WHO Best Practices for Injections and Related Procedures
Toolkit March 2010 [pdf 2.47Mb]:
http://whqlibdoc.who.int/publications/2010/9789241599252_eng.pdf

Use the Toolbox at: http://www.who.int/injection_safety/toolbox/en/

Get SIGN files on the web at: http://signpostonline.info/signfiles-2
get SIGNpost archives at: http://signpostonline.info/archives-by-year

Like on Facebook: http://facebook.com/SIGN.Moderator

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: sign@who.int
__________________________________________________________________
________________________________*_________________________________

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

The SIGN 2010 meeting report pdf, 1.36Mb is available on line at:
http://www.who.int/injection_safety/toolbox/sign2010_meeting.pdf

The report is navigable using bookmarks and is searchable. Viewing
requires the free Adobe Acrobat Reader at: http://get.adobe.com/reader/

Translation tools are available at: http://www.google.com/language_tools
or http://www.freetranslation.com
__________________________________________________________________
________________________________*_________________________________
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
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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
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* Subscribe or un-subscribe by email to: sign.moderator@gmail.com, or to
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We would like your help in building this archive. Please send your old
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________________________________*_________________________________

The SIGN Internet Forum was established at the initiative of the World
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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
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