online canadian pharmacy http://www.canadianpharmacy365.net/ pharmacy ratings phentermine no prescription

SIGNpost 00789

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00789 Ebola + Sharp Truth + Abstracts + News   18 February 2015

CONTENTS
0. SIGN Meeting 2015
1. Comment: Two articles estimating nosocomial Ebola transmission in West
Africa
2. Abstract: Spatiotemporal spread of the 2014 outbreak of Ebola virus
disease in Liberia and the effectiveness of non-pharmaceutical
interventions: a computational modelling analysis
4. Abstract: Sharp truth: health care workers remain at risk of bloodborne
infection
5. Abstract: An analysis of multimodal occupational exposure leading to
blood borne infections among health care workers
6. Abstract: Healthcare seeking and hospital admissions by people who
inject drugs in response to symptoms of injection site infections or
injuries in three urban areas of England
7. Abstract: Economic evaluation of needle and syringe exchange in two
provinces of Southwest China
8. Abstract: Time trend of injection drug errors before and after
implementation of bar-code verification system
9. Abstract: Safeguards to Prevent Neurologic Complications after Epidural
Steroid Injections: Consensus Opinions from a Multidisciplinary Working
Group and National Organizations
10. Abstract: Factors influencing the patient evaluation of injection
experience with the SmartJect autoinjector in rheumatoid arthritis
11. Abstract: Current molecular methods for the detection of hepatitis C
virus in high risk group population: A systematic review
12. Abstract: Outbreak of extrapulmonary tuberculosis infection associated
with acupuncture point injection
13. News
– Southern Africa: Drug users run the risk of harmful HIV transmissions
– Ireland: Over 12,000 used needles are being found on Dublin streets
every year

The web edition of SIGNpost is online at:
http://signpostonline.info/archives/1812

More information follows at the end of this SIGNpost!

Please send your requests, notes on progress and activities, articles,
news, and other items for posting to: sign.moderator@gmail.com

Normally, items received by Tuesday will be posted in the Wednesday
edition.

Subscribe or un-subscribe by email to: sign.moderator@gmail.com or to
sign@who.int

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

Visit the SIGNpostOnline archives at: http://signpostonline.info

Like SIGNpost on Facebook at: https://www.facebook.com/SIGN.Moderator
and get updates on your device!
__________________________________________________________________
________________________________*_________________________________

0. 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.
__________________________________________________________________
________________________________*_________________________________
1. Comment: Two articles estimating nosocomial Ebola transmission in West
Africa

David Gisselquist [and Simon Simon Collery] noted that the article
abstract from the Journal of Hospital Infection on nosocomial transmission
of Ebola in posted SIGNpost 00788 did not include patients risks.

See: Ebola virus disease in Africa: epidemiology and nosocomial
transmission. Shears P1, O’Dempsey TJ2, J Hosp Infect. 2015 Jan 20. pii:
S0195-6701(15)00046-8. http://www.ncbi.nlm.nih.gov/pubmed/25655197

Abstracts of the two article are posted below in items 2 and 3 with links
to the free full text.

Moderators thanks!
_________________________________________________________________
from: David Gisselquist <david_gisselquist@yahoo.com>
date: Thu, Feb 12, 2015
subject: two articles estimating nosocomial Ebola transmission in WA

Hi Allan,

Simon called my attention to the abstract of the article in Journal of
Hospital Infection on nosocomial transmission of Ebola in SIGNpost. I
don’t have access to the article. From the abstract it seems to focus —
like most international public health mention of Ebola risks in health
care — on risks to health care workers with little or no attention to
patients’ risks.

The two articles I sent deal with patients’ risks.

It has been frustrating to read about the $ millions of protective gear
provided but nothing about autoclaves or disposable equipment. Even worse,
West Africans who have the sense to resist sending their sick relatives
(malaria? diarrhea?) to an Ebola treatment unit where they might well get
Ebola are abused by the public health community, characterizing them as
ignorant savages.

Who’s ignorant? Let’s get some discussion of nosocomial risks to patients
into the public eye, so that people outside of Africa are not so ignorant
to think the health aid community can be trusted to do the right thing,
all they need is lots and lots of money. Money? A good dose of honesty in
line with the Declaration of Lisbon — publicly warning that patients can
get Ebola in hospitals — might be the key to avoiding other disasters
like what happened in West Africa. Can’t warn people? Sorry, it’s an
ethical obligation. Do it and deal with the public reaction. And as long
as Ebola is circulating in the community while public health poobahs are
arresting people with symptoms and fighting with communities, we’re not
out of the woods yet.

David
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Spatiotemporal spread of the 2014 outbreak of Ebola virus
disease in Liberia and the effectiveness of non-pharmaceutical
interventions: a computational modelling analysis
__________________________________________________________________
Free Full Text http://tinyurl.com/mcb9mcu

Lancet Infect Dis. 2015 Jan 6. pii: S1473-3099(14)71074-6.

Spatiotemporal spread of the 2014 outbreak of Ebola virus disease in
Liberia and the effectiveness of non-pharmaceutical interventions: a
computational modelling analysis.

Merler S1, Ajelli M1, Fumanelli L1, Gomes MF2, Piontti AP2, Rossi L3, Chao
DL4, Longini IM Jr5, Halloran ME6, Vespignani A7.

1Bruno Kessler Foundation, Trento, Italy.
2Laboratory for the Modeling of Biological and Socio-Technical Systems,
Northeastern University, Boston, MA, USA.
3Institute for Scientific Interchange, Torino, Italy.
4Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research
Center, Seattle, WA, USA.
5Department of Biostatistics, College of Public Health, Health
Professions, and Emerging Pathogens Institute, University of Florida,
Gainesville, FL, USA.
6Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research
Center, Seattle, WA, USA; Department of Biostatistics, University of
Washington, Seattle, WA, USA.
7Laboratory for the Modeling of Biological and Socio-Technical Systems,
Northeastern University, Boston, MA, USA; Institute for Quantitative
Social Sciences at Harvard University, Cambridge, MA, USA. Electronic
address: a.vespignani@neu.edu.

BACKGROUND: The 2014 epidemic of Ebola virus disease in parts of west
Africa defines an unprecedented health threat. We developed a model of
Ebola virus transmission that integrates detailed geographical and
demographic data from Liberia to overcome the limitations of non-spatial
approaches in projecting the disease dynamics and assessing non-
pharmaceutical control interventions.

METHODS: We modelled the movements of individuals, including patients not
infected with Ebola virus, seeking assistance in health-care facilities,
the movements of individuals taking care of patients infected with Ebola
virus not admitted to hospital, and the attendance of funerals.
Individuals were grouped into randomly assigned households (size based on
Demographic Health Survey data) that were geographically placed to match
population density estimates on a grid of 3157 cells covering the country.
The spatial agent-based model was calibrated with a Markov chain Monte
Carlo approach. The model was used to estimate Ebola virus transmission
parameters and investigate the effectiveness of interventions such as
availability of Ebola treatment units, safe burials procedures, and
household protection kits.

FINDINGS: Up to Aug 16, 2014, we estimated that 38·3% of infections (95%
CI 17·4-76·4) were acquired in hospitals, 30·7% (14·1-46·4) in households,
and 8·6% (3·2-11·8) while participating in funerals. We noted that the
movement and mixing, in hospitals at the early stage of the epidemic, of
patients infected with Ebola virus and those not infected was a sufficient
driver of the reported pattern of spatial spread. The subsequent decrease
of incidence at country and county level is attributable to the increasing
availability of Ebola treatment units (which in turn contributed to
drastically decreased hospital transmission), safe burials, and
distribution of household protection kits.

INTERPRETATION: The model allows assessment of intervention options and
the understanding of their role in the decrease in incidence reported
since Sept 7, 2014. High-quality data (eg, to estimate household secondary
attack rate, contact patterns within hospitals, and effects of ongoing
interventions) are needed to reduce uncertainty in model estimates.

FUNDING: US Defense Threat Reduction Agency, US National Institutes of
Health.

Copyright © 2015 Elsevier Ltd. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Chains of transmission and control of Ebola virus disease in
Conakry, Guinea, in 2014: an observational study
__________________________________________________________________

Free Full Text http://dx.doi.org/10.1016/S1473-3099(14)71075-8

Lancet Infect Dis. 2015 Jan 22. pii: S1473-3099(14)71075-8.

Chains of transmission and control of Ebola virus disease in Conakry,
Guinea, in 2014: an observational study.

Faye O1, Boëlle PY2, Heleze E3, Faye O1, Loucoubar C1, Magassouba N4,
Soropogui B4, Keita S5, Gakou T5, Bah EH6, Koivogui L7, Sall AA8,
Cauchemez S9.

1Arbovirus and Viral Hemorrhagic Fever Unit, Institut Pasteur de Dakar,
Dakar, Senegal.
2INSERM, U1136, Paris, France; Sorbonne Universités, UPMC Paris 06,
Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France.
3Ministry of Health, Abidjan, Côte d’Ivoire.
4Projet de fièvres hémorragiques de Guinée, Université Gamal Abdel Nasser,
Conakry, Guinea.
5Ministry of Health, Conakry, Guinea.
6Service des maladies infectieuses, Hopital Donka, Conakry, Guinea.
7Institut National de Santé Publique de Guinée, Conakry, Guinea.
8Arbovirus and Viral Hemorrhagic Fever Unit, Institut Pasteur de Dakar,
Dakar, Senegal. Electronic address: asall@pasteur.sn.
9Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur,
Paris, France. Electronic address: simon.cauchemez@pasteur.fr.

BACKGROUND: An epidemic of Ebola virus disease of unprecedented size
continues in parts of west Africa. For the first time, large urban centres
such as Conakry, the capital of Guinea, are affected. We did an
observational study of patients with Ebola virus disease in three regions
of Guinea, including Conakry, aiming to map the routes of transmission and
assess the effect of interventions.

METHODS: Between Feb 10, 2014, and Aug 25, 2014, we obtained data from the
linelist of all confirmed and probable cases in Guinea (as of Sept 16,
2014), a laboratory database of information about patients, and interviews
with patients and their families and neighbours. With this information, we
mapped chains of transmission, identified which setting infections most
probably originated from (community, hospitals, or funerals), and computed
the context-specific and overall reproduction numbers.

FINDINGS: Of 193 confirmed and probable cases of Ebola virus disease
reported in Conakry, Boffa, and Télimélé, 152 (79%) were positioned in
chains of transmission. Health-care workers contributed little to
transmission. In March, 2014, individuals with Ebola virus disease who
were not health-care workers infected a mean of 2·3 people (95% CI
1·6-3·2): 1·4 (0·9-2·2) in the community, 0·4 (0·1-0·9) in hospitals, and
0·5 (0·2-1·0) at funerals.

After the implementation of infection control in April, the reproduction
number in hospitals and at funerals reduced to lower than 0·1. In the
community, the reproduction number dropped by 50% for patients that were
admitted to hospital, but remained unchanged for those that were not. In
March, hospital transmissions constituted 35% (seven of 20) of all
transmissions and funeral transmissions constituted 15% (three); but from
April to the end of the study period, they constituted only 9% (11 of 128)
and 4% (five), respectively. 82% (119 of 145) of transmission occurred in
the community and 72% (105) between family members. Our simulations show
that a 10% increase in hospital admissions could have reduced the length
of chains by 26% (95% CI 4-45).

INTERPRETATION: In Conakry, interventions had the potential to stop the
epidemic, but reintroductions of the disease and poor cooperation of a few
families led to prolonged low-level spread, showing the challenges of
Ebola virus disease control in large urban centres. Monitoring of chains
of transmission is crucial to assess and optimise local control strategies
for Ebola virus disease.

FUNDING: Labex IBEID, Reacting, PREDEMICS, NIGMS MIDAS initiative,
Institut Pasteur de Dakar.

Copyright © 2015 Elsevier Ltd. All rights reserved
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Sharp truth: health care workers remain at risk of bloodborne
infection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25663385

Occup Med (Lond). 2015 Feb 6. pii: kqu206.

Sharp truth: health care workers remain at risk of bloodborne infection.

Rice BD1, Tomkins SE2, Ncube FM2.

1Department of HIV and STI, Centre for Infectious Disease Surveillance and
Control, Public Health England, 61 Colindale Avenue, Colindale, London NW9
5EQ, UK. brian.rice@phe.gov.uk.
2Department of HIV and STI, Centre for Infectious Disease Surveillance and
Control, Public Health England, 61 Colindale Avenue, Colindale, London NW9
5EQ, UK.

BACKGROUND: In 2013, new regulations for the prevention of sharps injuries
were introduced in the UK. All health care employers are required to
provide the safest possible working environment by preventing or
controlling the risk of sharps injuries.

AIMS: To analyse data on significant occupational sharps injuries among
health care workers in England, Wales and Northern Ireland before the
introduction of the 2013 regulations and to assess bloodborne virus
seroconversions among health care workers sustaining a blood or body fluid
exposure.

METHODS: Analysis of 10 years of information on percutaneous and
mucocutaneous exposures to blood or other body fluids from source patients
infected with a bloodborne virus, collected in England, Wales and Northern
Ireland through routine surveillance of health care workers reported for
the period 2002-11.

RESULTS: A total of 2947 sharps injuries involving a source patient
infected with a bloodborne virus were reported by health care workers.
Significant sharps injuries were 67% higher in 2011 compared with 2002.
Sharps injuries involving an HIV-, hepatitis B virus- or hepatitis C virus
(HCV)-infected source patient increased by 107, 69 and 60%, respectively,
between 2002 and 2011. During the study period, 14 health care workers
acquired HCV following a sharps injury.

CONCLUSIONS: Our data show that during a 10-year period prior to the
introduction of new regulations in 2013, health care workers were at risk
of occupationally acquired bloodborne virus infection. To prevent sharps
injuries, health care service employers should adopt safety-engineered
devices, institute safe systems of work and promote adherence to standard
infection control procedures.

© The Author 2015. Published by Oxford University Press on behalf of the
Society of Occupational Medicine. All rights reserved. For Permissions,
please email: journals.permissions@oup.com.

KEYWORDS: HIV; Hepatitis; occupational injury; sharp injury; surveillance.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: An analysis of multimodal occupational exposure leading to
blood borne infections among health care workers
__________________________________________________________________
http://www.ijpmonline.org/text.asp?2015/58/1/66/151191

Indian J Pathol Microbiol. 2015 Jan-Mar;58(1):66-8.

An analysis of multimodal occupational exposure leading to blood borne
infections among health care workers.

Priya NL1, Krishnan KU, Jayalakshmi G, Vasanthi S.

1Institute of Microbiology, Madras Medical College, Chennai, Tamil Nadu,
India.

Occupational exposure poses a significant risk of transmission of blood-
borne pathogens to healthcare workers (HCWs). Adherence to standard
precautions, awareness about post exposure prophylaxis is poor in
developing countries.

This retrospective study analyzes the self-reported cases of occupational
exposure in a tertiary care hospital. During the study period, 105 HCWs
sustained occupational exposure to blood and body fluids.

Majority of the victims 36 (34.2%) were interns and the clinical practice
that led to the occupational exposure was withdrawal of blood (45.7%).

Good infection control practices and emphasis on appropriate disposal are
needed to increase the occupational safety for HCWs.

Free full text http://www.ijpmonline.org/text.asp?2015/58/1/66/151191
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Healthcare seeking and hospital admissions by people who
inject drugs in response to symptoms of injection site infections or
injuries in three urban areas of England
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24568684

Epidemiol Infect. 2015 Jan;143(1):120-31.

Healthcare seeking and hospital admissions by people who inject drugs in
response to symptoms of injection site infections or injuries in three
urban areas of England.

Hope VD1, Ncube F1, Parry JV2, Hickman M3.

1Centre for Infectious Disease Surveillance and Control,Public Health
England,London,UK.
2Centre for Research on Drugs & Health Behaviour,London School of Hygiene
& Tropical Medicine,London,UK.
3School of Social and Community Medicine,University of Bristol,Bristol,UK.

People who inject drugs (PWID) are vulnerable to infections and injuries
at injection sites.

The factors associated with reporting symptoms of these, seeking related
advice, and hospital admission are examined. PWID were recruited in
Birmingham, Bristol and Leeds using respondent-driven sampling (N = 855).

During the preceding year, 48% reported having redness, swelling and
tenderness (RST), 19% an abscess, and 10% an open wound at an injection
site. Overall, 54% reported 1 symptoms, with 45% of these seeking medical
advice (main sources emergency departments and General Practitioners).

Advice was often sought 5 days after the symptom first appeared (44% of
those seeking advice about an abscess, 45% about an open wound, and 35%
for RST); the majority received antibiotics.

Overall, 9·5% reported hospital admission during the preceding year. Ever
being diagnosed with septicaemia and endocarditis were reported by 8·8%
and 2·9%, respectively.

Interventions are needed to reduce morbidity, healthcare burden and delays
in accessing treatment.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Economic evaluation of needle and syringe exchange in two
provinces of Southwest China
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24969453

Zhonghua Yu Fang Yi Xue Za Zhi. 2014 Apr;48(4):291-5.

[Economic evaluation of needle and syringe exchange in two provinces of
Southwest China].

[Article in Chinese]

Xue H1, Hu Y, Sun J2.

1National Center for AIDS/STD Control and Prevention, Chinese Center for
Disease Control and Prevention, Beijing 102206, China.
2Email:jpsun@chinaaids.cn.

OBJECTIVE: To measure related cost, effectiveness and benefit of needle
and syringe exchange (NSP) in two provinces of Southwest China.

METHODS: Between September 2012 and February 2013, program files and
questionnaires were used to collect the information about cost,
effectiveness and benefit of NSP during three program years (July 2009 to
June 2010, July 2010 to June 2011, July 2011 to June 2012 ) in 31 counties
of two provinces of Southwest China. Unit cost indicators including cost
of providing per syringe and cost of covering per IDU, number of new HIV
infections avoided by providing needle and syringe exchange were used to
evaluate the effectiveness of NSP, and the benefit indicators included the
fees for ART, hospitalization cost and follow up of new HIV infection
avoided by NSP. NEAR model was used to calculate the cases averted by NSP.
Chi-square test was used to analyze the different percentage of allocation
areas between two provinces.

RESULTS: Between July 2009 and June 2012, 25 374 041 yuan were totally
used for NSP. In province A, the top investment area was management (1 848
485 yuan) while it was comprehensive intervention (5 452 355 yuan) in
province B.

The cost of providing per syringe was 3.67 yuan, and it decreased from
6.96 to 4.01 in province A and decreased from 3.38 to 2.17 in province B
with the increasing needles distributed. The cost of covering per IDU was
712.71 yuan and the unit cost decreased from 882.85 to 574.95 in province
A and decreased from 760.48 to 625.07 in province B with the growing
number of IDUs intervened. A total of 1 307 new HIV infection were avoided
by providing NSP, so 19 413.96 yuan would be used to avoid per IDU
infecting HIV.

A total of 367 507 488 yuan of HIV/AIDS related expenditure were avoided
by NSP and the cost benefit ratio was 14.48.

CONCLUSION: NSP has a good cost-benefit ratio and should be promoted.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Time trend of injection drug errors before and after
implementation of bar-code verification system
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25669212

Technol Health Care. 2015 Feb 6.

Time trend of injection drug errors before and after implementation of
bar-code verification system.

Sakushima K1, Umeki R2, Endoh A2, Ito YM3, Nasuhara Y4.

1Department of Regulatory Science, Hokkaido University Graduate School of
Medicine, Sapporo, Japan.
2Division of Medical information planning, Hokkaido University Hospital,
Sapporo, Japan.
3Department of Biostatistics, Hokkaido University Graduate School of
Medicine, Sapporo, Japan.
4Division of Hospital Safety Management, Hokkaido University Hospital,
Sapporo, Japan.

BACKGROUND: Bar-code technology, used for verification of patients and
their medication, could prevent medication errors in clinical practice.

OBJECTIVE: Retrospective analysis of electronically stored medical error
reports was conducted in a university hospital.

METHODS: The number of reported medication errors of injected drugs,
including wrong drug administration and to the wrong patient, was compared
before and after implementation of the bar-code verification system for
inpatient care.

RESULTS: A total of 2867 error reports associated with injection drugs
were extracted. Wrong patient errors decreased significantly after
implementation of the bar-code verification system (17.4/year vs.
4.5/year, p< 0.05), although wrong drug errors did not decrease
sufficiently (24.2/year vs. 20.3/year). The source of medication errors
due to wrong drugs was drug preparation in hospital wards.

CONCLUSION: Bar-code medication administration is effective for prevention
of wrong patient errors. However, ordinary bar-code verification systems
are limited in their ability to prevent incorrect drug preparation in
hospital wards.

KEYWORDS: Bar-code technology; error report; injection drug; medical
safety; wrong patient
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Safeguards to Prevent Neurologic Complications after Epidural
Steroid Injections: Consensus Opinions from a Multidisciplinary Working
Group and National Organizations
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25668411

Anesthesiology. 2015 Feb 9.

Safeguards to Prevent Neurologic Complications after Epidural Steroid
Injections: Consensus Opinions from a Multidisciplinary Working Group and
National Organizations.

Rathmell JP1, Benzon HT, Dreyfuss P, Huntoon M, Wallace M, Baker R, Riew
KD, Rosenquist RW, Aprill C, Rost NS, Buvanendran A, Kreiner DS, Bogduk N,
Fourney DR, Fraifeld E, Horn S, Stone J, Vorenkamp K, Lawler G, Summers J,
Kloth D, O’Brien D Jr, Tutton S.

1From the Massachusetts General Hospital and Harvard Medical School,
Boston, Massachusetts (J.P.R., N.S.R.); Northwestern University Feinberg
School of Medicine, Chicago, Illinois (H.T.B.); EvergreenHealth, Kirkland,
Washington (P.D., R.B.); Vanderbilt University School of Medicine,
Nashville, Tennessee (M.H.); University of California San Diego, San
Diego, California (M.W.); Washington University School of Medicine, St.
Louis, Missouri (K.D.R.); Cleveland Clinic Lerner College of Medicine,
Cleveland, Ohio (R.W.R.); Interventional Spine Specialists, Kenner,
Louisiana (C.A.); Rush Medical College, Chicago, Illinois (A.B.);
Ahwatukee Sports and Spine, Phoenix, Arizona (D.S.K.); University of
Newcastle, Newcastle, Australia (N.B.); University of Saskatchewan,
Saskatoon, Saskatchewan, Canada (D.R.F.); Southside Pain Solutions,
Danville, Virginia (E.F.); APM Spine and Sports Physicians, Virginia
Beach, Virginia (S.H.); Mayo Clinic Florida, Jacksonville, Florida (J.
Stone); Virginia Mason Medical Center, Seattle, Washington (K.V.);
Neuroimaging and Interventional Spine Services, LLC, Ridgefield,
Connecticut (G.L.); NewSouth NeuroSpine, Flowood, Mississippi (J.
Summers); Danbury Hospital, Danbury, Connecticut (D.K.); University of
North Carolina School of Medicine, Winston Salem, North Carolina (D.O.);
and Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wisconsin
(S.T.).

BACKGROUND:: Epidural corticosteroid injections are a common treatment for
radicular pain caused by intervertebral disc herniations, spinal stenosis,
and other disorders. Although rare, catastrophic neurologic injuries,
including stroke and spinal cord injury, have occurred with these
injections.

METHODS:: A collaboration was undertaken between the U.S. Food and Drug
Administration Safe Use Initiative, an expert multidisciplinary working
group, and 13 specialty stakeholder societies. The goal of this
collaboration was to review the existing evidence regarding neurologic
complications associated with epidural corticosteroid injections and
produce consensus procedural clinical considerations aimed at enhancing
the safety of these injections. U.S. Food and Drug Administration Safe Use
Initiative representatives helped convene and facilitate meetings without
actively participating in the deliberations or decision-making process.

RESULTS:: Seventeen clinical considerations aimed at improving safety were
produced by the stakeholder societies. Specific clinical considerations
for performing transforaminal and interlaminar injections, including the
use of nonparticulate steroid, anatomic considerations, and use of
radiographic guidance are given along with the existing scientific
evidence for each clinical consideration.

CONCLUSION:: Adherence to specific recommended practices when performing
epidural corticosteroid injections should lead to a reduction in the
incidence of neurologic injuries.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Factors influencing the patient evaluation of injection
experience with the SmartJect autoinjector in rheumatoid arthritis
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25664404

Clin Exp Rheumatol. 2015 Jan 29.

Factors influencing the patient evaluation of injection experience with
the SmartJect autoinjector in rheumatoid arthritis.

Schulze-Koops H1, Giacomelli R, Samborski W, Rednic S, Herold M, Yao R,
Govoni M, Vastesaeger N, Weng HH.

1Division of Rheumatology, Department of Internal Medicine IV, University
of Munich, Germany. hendrik.schulze-koops@med.uni-muenchen.de.

OBJECTIVES: To evaluate factors influencing injection patterns and patient
evaluations of an autoinjector device in biologic-naïve patients beginning
golimumab (GLM) treatment.

METHODS: GO-MORE was an open-label, multinational, prospective study in
patients with active rheumatoid arthritis (RA) (28-joint disease activity
score based on erythrocyte sedimentation rate [DAS28-ESR] =3.2). Patients
injected 50 mg subcutaneous GLM once monthly for 6 months. Patients
reported use preferences and autoinjector evaluations by questionnaire.
Responses were analysed descriptively. Effects of patient variables were
evaluated with chi-square tests or t-tests.

RESULTS: Of 3,280 efficacy-evaluable patients, 67.7% self-injected with
the autoinjector. Compared with patients who self-injected, patients who
had someone else administer injections had greater baseline disease
activity (e.g., DAS28-ESR 5.84 vs. 6.23, respectively), but not more
tender/swollen joints in hands/wrists. Month 6 efficacy was greater for
patients who self-injected. In those who self-injected, injection site
(thigh [75.2%; 1,563/2,077], abdomen [17.4%; 363/2,077], upper arm [7.2%;
151/2,077]) was not associated with wrist swelling or tender/swollen
joints in the hand used for injection. Autoinjector ratings were similar
across injection sites, yet less pain/discomfort was associated with
abdomen injection. Patient autoinjector ratings were favourable overall
(e.g. ease of use, pain). Patients with baseline functional impairment had
slightly less favourable ratings.

CONCLUSIONS: Biologic-naïve patients who self-injected had less baseline
disease activity and higher response rates than patients who did not self-
inject. Although patients prefer to inject in the thigh, injection in the
belly may be less painful. Most patients who self-injected had favourable
autoinjector evaluations; patients with functional impairment had slightly
less favourable ratings.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Current molecular methods for the detection of hepatitis C
virus in high risk group population: A systematic review
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25674515

World J Virol. 2015 Feb 12;4(1):25-32.

Current molecular methods for the detection of hepatitis C virus in high
risk group population: A systematic review.

Firdaus R1, Saha K1, Biswas A1, Sadhukhan PC1.

1Rushna Firdaus, Kallol Saha, Aritra Biswas, Provash Chandra Sadhukhan,
ICMR Virus Unit, I.D and B.G Hospital Campus, GB-4 (East Wing),
Beliaghata, Kolkata 700010, India.

Hepatitis C virus (HCV) is an emerging infection worldwide and the numbers
of persons infected are increasing every year. Poor blood transfusion
methods along with unsafe injection practices are potential sources for
the rapid spread of infection.

Early detection of HCV is the need of the hour especially in high risk
group population as these individuals are severely immunocompromised.

Enzyme Immunoassays are the most common detection techniques but they
provide no evidence of active viremia or identification of infected
individuals in the antibody-negative phase and their efficacy is limited
in individuals within high risk group population.

Molecular virological techniques have an important role in detecting
active infection with utmost specificity and sensitivity. Technologies for
assessment of HCV antibody and RNA levels have improved remarkably, as
well as our understanding of how to best use these tests in patient
management.

This review aims to give an overview of the different serological and
molecular methods employed in detecting HCV infection used nowadays.

Additionally, the review gives an insight in the new molecular techniques
that are being developed to improve the detection techniques particularly
in High Risk Group population who are severely immunocompromised.

KEYWORDS: Enzyme immunoassay; High risk group population; Molecular
detection; Nucleic acid amplification assays; Polymerase chain reaction

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4308525/
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Outbreak of extrapulmonary tuberculosis infection associated
with acupuncture point injection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25677256

Clin Microbiol Infect. 2014 Nov 14. pii: S1198-743X(14)00089-5.

Outbreak of extrapulmonary tuberculosis infection associated with
acupuncture point injection.

Jia Z1, Chen S2, Hao C3, Huang Y4, Liu Z2, Pan A2, Liao R5, Wang X6, Lu
Z7.

1National Institute of Drug Dependence, Peking University, Beijing 100191,
PR China; Takemi Program in International Health, Department of Global
Health and Population, Harvard School of Public Health, 665 Huntington
Avenue, Boston, MA 02115, USA.
2Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou,
Zhejiang 310006, PR China.
3School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong
510080, PR China; Takemi Program in International Health, Department of
Global Health and Population, Harvard School of Public Health, 665
Huntington Avenue, Boston, MA 02115, USA.
4Department of Epidemiology, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD 21205, USA.
5Office of Scientific Research, Peking University, Beijing 100871, PR
China. Electronic address: liaorikun@pku.edu.cn.
6Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou,
Zhejiang 310006, PR China. Electronic address: xmwang@cdc.zj.cn.
7Department of Biomedical Engineering, College of Engineering, Peking
University, Beijing 100871, PR China. Electronic address: zhlu@pku.edu.cn.

Mycobacterium tuberculosis infection is rarely reported to be associated
with acupuncture practices.

We performed a retrospective outbreak investigation of a unique outbreak
of 33 extrapulmonary M. tuberculosis infections related to acupuncture
point injection therapy (AIT) among clients who visited a private
traditional Chinese medicine clinical centre in China.

The lumps, abscesses and ulcers occurred mostly on the neck, shoulders,
waist, knees and hips, localized at acupuncture point meridian sites.
These symptoms appeared from January to November 2011, with a peak cluster
of infections in September 2011 (nine cases). M. tuberculosis Beijing
strain was isolated and confirmed by DNA sequencing. All diagnosed
patients were treated empirically with appropriate antibiotic treatment,
and their condition improved.

Our study indicated that this outbreak was most likely resulted from
contaminated AIT. Drafting standard guidelines for AIT is urgently needed,
and routine medical supervision should be provided, including obligating
health providers to perform routine physical examinations that include
testing for infectious diseases.

Copyright © 2014. Published by Elsevier Ltd.

KEYWORDS: Acupoint injection; China; extrapulmonary Mycobacterium
tuberculosis infection; outbreak; routine medical supervision
__________________________________________________________________
________________________________*_________________________________

13. News

– Southern Africa: Drug users run the risk of harmful HIV transmissions
– Ireland: Over 12,000 used needles are being found on Dublin streets
every year

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

Southern Africa: Drug users run the risk of harmful HIV transmissions

By Ina Skosana, Mail & Guardian Online South Africa (17.02.15)

More harm reduction policies and programmes will help reduce dangers of
practices such as sharing dirty needles and ‘flashblooding’.

An increase in the use of injected drugs, such as heroin, is putting drug
users at risk of contracting HIV and other communicable diseases in sub-
Saharan Africa.

New patterns of injected drug use in sub-Saharan Africa call for an
increase in preventative efforts among this population which is at risk of
HIV infection, according to a report by the United Kingdom-based
nongovernmental organisation, Harm Reduction International (HRI).

The Centres for Disease Control and Prevention in the United States states
that “substance use and abuse are important factors in the spread of HIV.
Alcohol and other drugs can lower a person’s inhibitions and create risk
factors for HIV transmission.”

HRI said in its Global State of Harm Reduction report, released on
Tuesday, that although injected drug use has been documented in more than
150 countries, it is difficult to establish an accurate number for people
who inject drugs. Globally, this form of drug consumption is estimated to
be between 8.9-million and 22.4-million people. The number of people in
this population group and living with HIV ranges from 900 000 to 4.8-
million.

Harm reduction policies

The organisation, which advocates for the “prevention of harm [from drug
use] rather than on the prevention of drug use itself”, estimates that HIV
prevalence among people who inject drugs in Tanzania is 33.9%, 16.7% in
Uganda, 9.1% in Senegal and 19% in South Africa.

A small number of sub-Saharan African countries have taken up harm
reduction policies. Kenya and Tanzania, for example, have increased the
number of places that provide drug users with clean needles and syringes.
The aim of these needle syringe programmes is to prevent HIV or hepatitis
C infection through the use of dirty needles.

Tanzania has also scaled up opioid substitution therapy services – the
medical procedure of replacing illegal opioid with a longer-acting opioid
[a group of substances that resemble morphine].

The World Health Organisation says both these methods are effective in
reducing HIV infection and HIV risk behaviour among drug users who inject
themselves.

Practice of flashblood

Although awareness programmes are planned in three South Africa cities –
Pretoria, Cape Town and Durban – there is only one needle-syringe
programme site in the country. The Cape Town initiative focuses on men who
have sex with men who inject drugs.

The HRI report states that more of these services are needed – especially
in light of the increase in high-risk practices such as flashblood, where
one user draws blood back into the syringe after injecting heroin and then
passes the syringe on to a peer, who injects the blood.

The report also highlights the surge in availability of illegal drugs in
countries such as Tanzania that are along “key transit points for the
trafficking of heroin, cocaine and other drugs”.

The HRI said the provision of harm reduction services in sub-Saharan
Africa has been marginal and “has not grown in proportion to the HIV
epidemic among people who inject drugs”.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/oq4u4r3

Ireland: Over 12,000 used needles are being found on Dublin streets every
year

By Shuki Byrne, Sunday World, Dublin Ireland (16.02.15)

Dozens of dirty needles largely used to inject dangerous drugs such as
heroin are being found on Dublin streets every single day.

According to a report in the Herald, over 12,000 used needles are being
taken off the streets of the capital every year.

There are three groups currently responsible for the collection and
disposal of the dirty needles – Dublin City Council (DCC), the Ana Liffey
Project and Dublin Town, the body that represents city businesses.

The Herald reports a total of 4,600 used needles were collected in the
north inner city and a further 7,000 were picked up from Parnell Street
across to St Stephen’s Green in 2014.

The Ana Liffey Drug Project picked up 2,000 used needles, DCC gathered
2,600 and Dublin Town collected 7,000. On average, more than 220 needles a
week or 32 a day – are being recovered.

Director of the Ana Liffey Drug Project Tony Duffin said the issue of
dirty needles and their collection and disposal is a serious issue in the
capital.

“At this point, all stakeholders are agreed that public injecting is a
serious issue in Dublin’s city centre, both north and south.
Unfortunately, unsafe disposal of injecting paraphernalia is one
consequence of this,” he said.

The CEO of Dublin Town said that needles used to be largely found on
Dublin’s north side but that trend was no longer the case.

“There’s no doubt that drugs are an issue in the city, everybody knows
that but what we need is a constructive solution that works for everyone,”
Mr Richard Guiney said.

Incidents where people have come into contact with used needles are
becoming more prevalent in the city.

Last year, two council workers were pricked by the needles while cleaning
the city’s alleyways and streets.

Last month a young boy was rushed to hospital after being pricked by a
used needle on a Dublin Bus.

The six-year-old boy was pricked by the dirty needle on the 66b bus, which
goes to Maynooth. He was taken off at Lucan Road and rushed to Tallaght
Hospital.

The other passengers were also removed and quickly transferred to a
different bus while emergency services dealt with the incident.

It is not the first time a passenger on the city’s public transport
network has been hurt by a syringe.

In 2012, an incident on a Luas tram was reported when a child picked up a
used needle and syringe. In February 2005, a 15-year-old schoolboy sat on
a bloody syringe hidden in the back seat of a bus.

He told a court in a compensation case that he felt a jab in his leg when
he sat down on the 78A at the Liffey Valley Shopping Centre terminus. He
told the driver who called an ambulance.

The boy underwent innoculation and blood tests, but it was three years
before he received the all-clear regarding potential Hep C and Hep B
infection.

Today’s figures come after Taoiseach Enda Kenny himself came across a pile
of used needles, while out with the homeless last December.

“We stopped the Taoiseach from walking on syringes in the Harcourt Street
area, and he was taken aback by that, to see syringes, sleeping bags,
bottles.

“When we explained they were needle spikes, he was taken aback,” said Lord
Mayor Christy Burke.
__________________________________________________________________
________________________________*_________________________________
* 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
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
safety.

* Subscribe or un-subscribe by email to: sign.moderator@gmail.com, or to
sign@who.int

The SIGNpost Website is http://SIGNpostOnline.info

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.

Email mailto:sign.moderator@gmail.com
__________________________________________________________________
________________________________*_________________________________

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. http://www.uq.edu.au
__________________________________________________________________

Comments are closed.