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SIGNpost 00800

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00800 Supply + Injection Practices + Abstracts + News 06 May 2015

CONTENTS
0. Moderators Note http://signpostonline.info
1. New Performance Management Toolkit Provides Step-by-Step Guidance for
Supply Chain Workers
2. High Cure Rates Will Not Curb Hepatitis C, Expert Warns
3. Abstract: Injection practice in Kaski district, Western Nepal: a
community perspective
4. Abstract: Comparison of routes for achieving parenteral access with a
focus on the management of patients with Ebola virus disease
5. Abstract: Shifting Patterns of the HIV Epidemic in Southwest China: A
Case Study Based on Sentinel Surveillance, 1995-2012
6. Abstract: Outbreak of primary inoculation tuberculosis in an
acupuncture clinic in southeastern China
7. Abstract: Consequences of a restrictive syringe exchange policy on
utilisation patterns of a syringe exchange program in Baltimore,
Maryland: Implications for HIV risk
8. Abstract: Clinical study and stability assessment of a novel
transcutaneous influenza vaccination using a dissolving microneedle
patch
9. Abstract: Evaluation of safety and immunogenicity of a quadrivalent
human papillomavirus vaccine in healthy females between 9 and 26 years
of age in Sub-Saharan Africa
10. Abstract: Understanding non-compliance with hand hygiene practices
11. Abstract: Role of healthcare apparel and other healthcare textiles in
the transmission of pathogens: a review of the literature
12. News
– Indiana USA: Pence signs Indiana needle exchange law
– Australia: Needles selling for $200 each in Australia’s prisons
– Canada: Health warning issued for unlicensed Surrey dentist
– Australia: Needles used as jail ‘currency’ for drugs
– Canada: Snow melt reveals thousands of dirty needles in Prince Albert:
More than one million needles were handed out at PA’s needle exchange
program
– India: Safety devices cut injuries by sharps by 59 per cent: Study
– Mass USA: Montague sees sharp drop in discarded needles
– USA: Smallpox-Like Virus Infects Lab Worker After Mishap
– California USA: Patients infected with hepatitis C after visiting Santa
Barbara doctor
– Australia: Drug use and needle sharing by HIV prisoner sparks flurry of
– testing and security crackdown

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1. New Performance Management Toolkit Provides Step-by-Step Guidance for
Supply Chain Workers
__________________________________________________________________
Anne Marie Hvid <anne_marie_hvid@jsi.com>
Sign Moderator <sign.moderator@gmail.com>
Sat, May 2, 2015

New Performance Management Toolkit Provides Step-by-Step Guidance for
Supply Chain Workers

In a new Performance Management Toolkit, the USAID | DELIVER PROJECT
provides step-by-step guidance and resources for health supply chain
workers with performance management responsibilities. The toolkit
gives you practical advice and ready-to-use tools, including templates
for writing job descriptions, tips for goal setting, guidance on
supportive supervision, and sample forms for employee evaluation. A
strong performance management system promotes communication, teamwork,
and an enabling environment for all workers, which will help build
strong supply chains. Learn more at http://bit.ly/1GMkXDa


Anne Marie Hvid, PMP
Knowledge Management Advisor
USAID | DELIVER PROJECT
deliver.jsi.com
__________________________________________________________________
________________________________*_________________________________

2. High Cure Rates Will Not Curb Hepatitis C, Expert Warns
__________________________________________________________________
http://www.medscape.com/viewarticle/844106

High Cure Rates Will Not Curb Hepatitis C, Expert Warns

Marcia Frellick, Medscape Medical News, Conference News (01.05.15)

COPENHAGEN, Denmark — Even with new drug combinations that have cure rates
nearing 100%, the fight against the hepatitis C virus is not over,
according to one global expert.

“I believe that an infection present in 130 million to 170 million
individuals cannot be eradicated with antiviral therapies. It’s just not
possible,” said Jean-Michel Pawlotsky, MD, from Henri Mondor University
Hospital in Créteil, France.

The disease is responsible for about 350,000 deaths each year around the
world. But more than 80% of people with hepatitis C are unaware of their
infection, especially in low-income countries.

There has been progress, Dr Pawlotsky said here at the 25th European
Congress of Clinical Microbiology and Infectious Diseases. “When I started
my career, approximately 10% of patients” achieved a sustained virologic
response. With the interferon-free regimens now available, rates are “93%
to 100%.”

But rapid progress will not lead to eradication, he said. The exorbitant
price for the new drugs is a well-documented issue that will work against
widespread cure. There is no prophylactic hepatitis C vaccine available
and virtually no research on preventive vaccines. “We don’t know how to
generate protective immunity against hepatitis C,” he explained.

The goal, said Dr Pawlotsky, is to control the disease, at least in the
countries that can afford to.

An infection present in 130 million to 170 million individuals cannot be
eradicated with antiviral therapies.

Meanwhile, there are other issues to be dealt with, such as the problem
posed by treating hepatitis C in people on a liver transplant list. If you
cure the infection, the patient is taken off the list or moved down;
however, the patient still has the cirrhotic liver and might develop
decompensation.

“You think you did something good by curing the hepatitis C infection, but
you prevented that person from being transplanted, and that patient could
die because of a sick liver. The other option is to go for liver
transplantation, but that is not a low-risk procedure. It’s an open
debate,” Dr Pawlotsky said.

Another quandary involves the ethics of retreating people who reinfect
themselves.

Ethical Questions Surrounding Retreatment

Michael Ohl, MD, from the University of Iowa in Iowa City, said he is
beginning to see reinfections in high-risk patients, such as intravenous
drug users and men who have sex with men.

“How many times should a patient be treated?” Dr Ohl asked.

“For society, it’s a problem,” Dr Pawlotsky acknowledged. “We recommend
monitoring these patients every year.”

Before treating these patients, it is important that they understand the
reason they are being treated and the need to change their behavior, he
added.

That’s good in theory, but difficult in reality. “If we do cost-
effectiveness analysis, these drugs are cost-effective on a societal basis
if we treat once,” Dr Ohl told Medscape Medical News.

“But how many times do we treat a particular individual?” he asked. “Or do
we say the resources are better used to treat more people the first time.
It’s an ethical question as well as a resource question.”

Dr Pawlotsky reports receiving grant and research support from Gilead;
being on the advisory boards of AbbVie, Achillion, Bristol-Myers Squibb,
Gilead, Janssen, and Merck; and speaking and teaching for AbbVie, Bristol-
Myers Squibb, Gilead, Janssen, Merck, and Roche.

25th European Congress of Clinical Microbiology and Infectious Diseases
(ECCMID): Poster K05. Presented April 27, 2015.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Injection practice in Kaski district, Western Nepal: a
community perspective
__________________________________________________________________
Open Access: http://www.biomedcentral.com/1471-2458/15/435/abstract

BMC Public Health. 2015 Apr 29;15(1):435. [Epub ahead of print]

Injection practice in Kaski district, Western Nepal: a community
perspective.

Gyawali S1, Rathore DS2, Shankar PR3, Kc VK4, Maskey M5, Jha N6.

1Department of Pharmacology, Manipal College of Medical Sciences, Pokhara,
Nepal. sudeshgy@hotmail.com.
2Department of Pharmacy, L.R. Institute of Pharmacy, Jabli-kyar, Solan,
India. rathoredsp66@gmail.com.
3Department of Pharmacology, Xavier University School of Medicine,
Oranjestad, Aruba, Kingdom of the Netherlands. ravi.dr.shankar@gmail.com.
4Department of Statistics, PN Multiple Campus, Pokhara, Nepal.
vkkc2001@gmail.com.
5Department of Community Medicine, Manipal College of Medical Sciences,
Pokhara, Nepal. manzasharma@gmail.com.
6Department of Clinical Pharmacology & Therapeutics, KIST Medical College,
Imadol, Nepal. nishajha32@gmail.com.

BACKGROUND: Previous studies have shown that unsafe injection practice is
a major public health problem in Nepal but did not quantify the problem.
The present community-based study was planned to: 1) quantify injection
usage, 2) identify injection providers, 3) explore differences, if any, in
injection usage and injection providers, and 4) study and compare people’s
knowledge and perception about injections between the urban and rural
areas of Kaski district.

METHODS: A descriptive, cross-sectional mixed-methods study was conducted
from July to November 2012, using a questionnaire based survey and focus
group discussions (FGDs). A semi-structured questionnaire advocated by the
World Health Organization was modified and administered to household heads
and injection receivers in selected households and the FGDs were conducted
using a topic guide. The district was divided into urban and rural areas
and 300 households from each area were selected. Twenty FGDs were held.

RESULTS: In 218 households (36.33%) [99 in urban and 119 in rural] one or
more members received at least one injection. During the three month
recall period, 258 subjects (10.44%) reported receiving injection(s) with
a median of two injections. The average number of injections per person
per year was calculated to be 2.37. Health care workers (34.8%), staff of
medical dispensaries (37.7%), physicians (25.2%), and traditional healers
(2.3%) were consulted by the respondents for their basic health care needs
and for injections. Compared to urban respondents, more rural respondents
preferred injections for fever (p?<?0.001). People preferred injections
due to injections being perceived by them as being powerful, fast-acting,
and longer lasting than oral pills. More than 82% of respondents were
aware of, and named, at least one disease transmitted by using unsterile
syringes during injection administration or when syringes are shared
between people.

CONCLUSIONS: Less preference for injections and high awareness about the
association between injections and injection-borne infections among the
general population is encouraging for safe injection practice. However,
respondents were not aware of the importance of having qualified injection
providers for safe injections and were receiving injections from
unqualified personnel.

Free full text
http://www.biomedcentral.com/1471-2458/15/435/abstract
http://www.biomedcentral.com/content/pdf/s12889-015-1775-5.pdf
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Comparison of routes for achieving parenteral access with a
focus on the management of patients with Ebola virus disease
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25914907

Cochrane Database Syst Rev. 2015 Feb 26;2:CD011386.

Comparison of routes for achieving parenteral access with a focus on the
management of patients with Ebola virus disease.

Ker K1, Tansley G, Beecher D, Perner A, Shakur H, Harris T, Roberts I.

1Cochrane Injuries Group, London School of Hygiene & TropicalMedicine,
Room 186, Keppel Street, London, WC1E 7HT, UK. katharine.ker@lshtm.ac.uk.

BACKGROUND: Dehydration is an important cause of death in patients with
Ebola virus disease (EVD). Parenteral fluids are often required in
patients with fluid requirements in excess of their oral intake. The
peripheral intravenous route is the most commonly used method of
parenteral access, but inserting and maintaining an intravenous line can
be challenging in the context of EVD. Therefore it is important to
consider the advantages and disadvantages of different routes for
achieving parenteral access (e.g. intravenous, intraosseous, subcutaneous
and intraperitoneal).

OBJECTIVES: To compare the reliability, ease of use and speed of insertion
of different parenteral access methods.

SEARCH METHODS: We ran the search on 17 November 2014. We searched the
Cochrane Injuries Group’s Specialised Register, Cochrane Central Register
of Controlled Trials (CENTRAL, The Cochrane Library), Ovid MEDLINE(R) In-
Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily, Ovid
MEDLINE(R) and Ovid OLDMEDLINE(R), Embase Classic + Embase (OvidSP),
CINAHL (EBSCOhost), clinicaltrials.gov and screened reference lists.

SELECTION CRITERIA: Randomised controlled trials comparing different
parenteral routes for the infusion of fluids or medication.

DATA COLLECTION AND ANALYSIS: Two review authors examined the titles and
abstracts of records obtained by searching the electronic databases to
determine eligibility. Two review authors extracted data from the included
trials and assessed the risk of bias. Outcome measures of interest were
success of insertion; time required for insertion; number of insertion
attempts; number of dislodgements; time period with functional access;
local site reactions; clinicians’ perception of ease of administration;
needlestick injury to healthcare workers; patients’ discomfort; and
mortality. For trials involving the administration of fluids we also
collected data on the volume of fluid infused, changes in serum
electrolytes and markers of renal function. We rated the quality of the
evidence as ‘high’, ‘moderate’, ‘low’ or ‘very low’ according to the GRADE
approach for the following outcomes: success of insertion, time required
for insertion, number of dislodgements, volume of fluid infused and
needlestick injuries.

MAIN RESULTS: We included 17 trials involving 885 participants. Parenteral
access was used to infuse fluids in 11 trials and medications in six
trials. None of the trials involved patients with EVD. Intravenous and
intraosseous access was compared in four trials; intravenous and
subcutaneous access in 11; peripheral intravenous and intraperitoneal
access in one; saphenous vein cutdown and intraosseous access in one; and
intraperitoneal with subcutaneous access in one. All of the trials
assessing the intravenous method involved peripheral intravenous access.We
judged few trials to be at low risk of bias for any of the assessed
domains.Compared to the intraosseous group, patients in the intravenous
group were more likely to experience an insertion failure (risk ratio (RR)
3.89, 95% confidence interval (CI) 2.39 to 6.33; n = 242; GRADE rating:
low). We did not pool data for time to insertion but estimates from the
trials suggest that inserting intravenous access takes longer (GRADE
rating: moderate). Clinicians judged the intravenous route to be easier to
insert (RR 0.15, 95% CI 0.04 to 0.61; n = 182). A larger volume of fluids
was infused via the intravenous route (GRADE rating: moderate). There was
no evidence of a difference between the two routes for any other outcomes,
including adverse events.

Compared to the subcutaneous group, patients in the intravenous group were
more likely to experience an insertion failure (RR 14.79, 95% CI 2.87 to
76.08; n = 238; GRADE rating: moderate) and dislodgement of the device (RR
3.78, 95% CI 1.16 to 12.34; n = 67; GRADE rating: low). Clinicians also
judged the intravenous route as being more difficult to insert and
patients were more likely to be agitated in the intravenous group.
Patients in the intravenous group were more likely to develop a local
infection and phlebitis, but were less likely to develop erythema, oedema
or swelling than those in the subcutaneous group. A larger volume of
fluids was infused into patients via the intravenous route. There was no
evidence of a difference between the two routes for any other
outcome.There were insufficient data to reliably determine if the risk of
insertion failure differed between the saphenous vein cutdown (SVC) and
intraosseous method (RR 4.00, 95% CI 0.51 to 31.13; GRADE rating: low).
Insertion using SVC took longer than the intraosseous method (MD 219.60
seconds, 95% CI 135.44 to 303.76; GRADE rating: moderate). There were no
data and therefore there was no evidence of a difference between the two
routes for any other outcome.There were insufficient data to reliably
determine the relative effects of intraperitoneal or central intravenous
access relative to any other parenteral access method.

AUTHORS’ CONCLUSIONS: There are several different ways of achieving
parenteral access in patients who are unable meet their fluid requirements
with oral intake alone. The quality of the evidence, as assessed using the
GRADE criteria, is somewhat limited because of the lack of adequately
powered trials at low risk of bias.

However, we believe that there is sufficient evidence to draw the
following conclusions: if peripheral intravenous access can be achieved
easily, this allows infusion of larger volumes of fluid than other routes;
but if this is not possible, the intraosseous and subcutaneous routes are
viable alternatives.

The subcutaneous route may be suitable for patients who are not severely
dehydrated but in whom ongoing fluid losses cannot be met by oral intake.

A film to accompany this review can be viewed here

__________________________________________________________________
________________________________*_________________________________

5. Abstract: Shifting Patterns of the HIV Epidemic in Southwest China: A
Case Study Based on Sentinel Surveillance, 1995-2012
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25928866

AIDS Patient Care STDS. 2015 Apr 30.

Shifting Patterns of the HIV Epidemic in Southwest China: A Case Study
Based on Sentinel Surveillance, 1995-2012.

Chow EP1, Gao L, Chen L, Jing J, Zhang L.

11 Research Center for Public Health, School of Medicine, Tsinghua
University , Beijing, China .

The HIV epidemic is experiencing a rapid shift in transmission profile in
China. This study aims to examine the changes in magnitude, transmission
pattern, and trend of the HIV epidemic in a typical Southwest Chinese
prefecture over the period of 1995-2012. HIV surveillance data from the
web-based reporting system were analyzed during this period. We
investigated the temporal trends in the changing characteristics of HIV
transmission, the HIV disease burden in key affected populations, and
assessed the impacts on HIV disease progression due to scale-up of
antiretroviral treatment.

A total of 3556 HIV/AIDS cases were reported in Yuxi prefecture, Yunnan,
over the study period. The number of HIV tests conducted has dramatically
increased from 1041 in 1995 to 247,859 in 2012, resulting in a substantial
increase in HIV diagnoses from 11 cases to 327 cases over the same period.
Since 2005, cumulatively 1250 eligible people living with HIV (PLHIV) have
received combination antiretroviral therapy which reduced AIDS disease
progression from 9.0% (95% CI: 6.7-11.4%) in 1995 to 0.1% (0-0.3%) in 2012
(ptrend=0.0002).

The primary mode of HIV transmission has been shifted from injection
sharing (71.9% diagnoses in 1995-2004) to unsafe sexual contacts (82.6%
diagnoses in 2012).

Yuxi prefecture is experiencing a concentrated but shifting HIV epidemic.
Scale-up of HIV testing is essential to effective sentinel surveillance
and enhancing early diagnosis and treatment in PLHIV.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Outbreak of primary inoculation tuberculosis in an
acupuncture clinic in southeastern China
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25148461

Epidemiol Infect. 2015 Apr;143(5):943-8.

Outbreak of primary inoculation tuberculosis in an acupuncture clinic in
southeastern China.

Wang J1, Zhu MY1, Li C1, Zhang HB1, Zuo GB1, Wang MH2, Teng HL1.

1Department of Spine Surgery,First Affiliated Hospital of Wenzhou Medical
University,Wenzhou,Zhejiang,China.
2Department of Radiology,First Affiliated Hospital of Wenzhou Medical
University,Wenzhou,Zhejiang,China.

Outbreak of Mycobacterium tuberculosis infections associated with
acupuncture has not been reported. Thirteen patients with a painful
swollen lump were referred to our hospital. The index patient received
acupuncture and paraspinal muscular injection at a local acupuncture
clinic in April 2011 and was diagnosed with M. tuberculosis 1 month later.
From May 2011 to August 2011, 12 more patients with a swollen lump on the
nuchal region or in the lower back or the buttocks region were referred to
our hospital. Tuberculin skin test (TST), T-SPOT.TB, acid-fast stain, M.
tuberculosis culture, chest radiograph, and lump magnetic resonance
imaging (MRI) were performed and the patients were diagnosed with
tuberculous abscess of the lump.

All 13 patients received intramuscular injection at the paraspinal muscle
by two acupuncturists at a local clinic and reported a swollen lump at the
injection site. The needles and syringes were reused after autoclave
sterilization.

The TST was positive in all patients. Twelve patients had positive acid-
fast stains. Mycobacterial cultures of abscess specimens were positive in
all 13 patients. T-SPOT.TB tests were positive in all patients who
underwent the test. The lesions and biopsies were subjected to polymerase
chain reaction (PCR) and gene sequencing by the Disease Control Center of
Zhejiang Province, China and the causative agent was identified as M.
tuberculosis, Beijing type.

In conclusion, physicians should consider the possibility of mycobacterial
infections, apart from other bacterial agents, in patients with a swollen
paraspinal lump following intramuscular injection.

KEYWORDS: paraspinal abscess
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Consequences of a restrictive syringe exchange policy on
utilisation patterns of a syringe exchange program in Baltimore,
Maryland: Implications for HIV risk
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25919590

Drug Alcohol Rev. 2015 Apr 28.

Consequences of a restrictive syringe exchange policy on utilisation
patterns of a syringe exchange program in Baltimore, Maryland:
Implications for HIV risk.

Sherman SG1, Patel SA, Ramachandran DV, Galai N, Chaulk P, Serio-Chapman
C, Gindi RM.

1Department of Epidemiology, Johns Hopkins Bloomberg School of Public
Health, Baltimore, USA.

INTRODUCTION AND AIMS: Syringe distribution policies continue to be
debated in many jurisdictions throughout the USA. The Baltimore Needle and
Syringe Exchange Program (NSP) operated under a 1-for-1 syringe exchange
policy from its inception in 1994 through 1999, when it implemented a
restrictive policy (2000-2004) that dictated less than 1-for-1 exchange
for non-program syringes.

DESIGN AND METHODS: Data were derived from the Baltimore NSP, which
prospectively collected data on all client visits. We examined the impact
of this restrictive policy on program-level output measures (i.e.
distributed?:?returned syringe ratio, client volume) before, during and
after the restrictive exchange policy. Through multiple logistic
regression, we examined correlates of less than 1-for-1 exchange ratios at
the client level before and during the restrictive exchange policy
periods.

RESULTS: During the restrictive policy period, the average annual program-
level ratio of total syringes distributed?:?returned dropped from 0.99 to
0.88, with a low point of 0.85 in 2000. There were substantial decreases
in the average number of syringes distributed, syringes returned, the
total number of clients and new clients enrolling during the restrictive
compared to the preceding period. During the restrictive period, 33?508
more syringes were returned to the needle exchange than were distributed.
In the presence of other variables, correlates of less than 1-for-1
exchange ratio were being white, female and less than 30 years old.

DISCUSSION AND CONCLUSIONS: With fewer clean syringes in circulation,
restrictive policies could increase the risk of exposure to HIV among
Injection Drug Users (IDUs) and the broader community. The study provides
evidence to the potentially harmful effects of such policies.

© 2015 Australasian Professional Society on Alcohol and other Drugs.

KEYWORDS: Baltimore; HIV; drug user; needle-exchange program; public
policy
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Clinical study and stability assessment of a novel
transcutaneous influenza vaccination using a dissolving microneedle
patch
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25913250

Biomaterials. 2015 Apr 23;57:50-58.

Clinical study and stability assessment of a novel transcutaneous
influenza vaccination using a dissolving microneedle patch.

Hirobe S1, Azukizawa H2, Hanafusa T2, Matsuo K1, Quan YS3, Kamiyama F3,
Katayama I2, Okada N4, Nakagawa S5.

1Laboratory of Biotechnology and Therapeutics, Graduate School of
Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka
565-0871, Japan.
2Department of Dermatology, Course of Integrated Medicine, Graduate School
of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871,
Japan.
3CosMED Pharmaceutical Co. Ltd., 32 Higashikujokawanishi-cho, Minami-ku,
Kyoto 601-8014, Japan.
4Laboratory of Biotechnology and Therapeutics, Graduate School of
Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka
565-0871, Japan. Electronic address: okada@phs.osaka-u.ac.jp.
5Laboratory of Biotechnology and Therapeutics, Graduate School of
Pharmaceutical Sciences, Osaka University, 1-6 Yamadaoka, Suita, Osaka
565-0871, Japan. Electronic address: nakagawa@phs.osaka-u.ac.jp.

Transcutaneous immunization (TCI) is an attractive vaccination method
compared with conventional injectable vaccines because it is easier to
administer without pain.

We developed a dissolving microneedle patch (MicroHyala, MH) made of
hyaluronic acid and showed that transcutaneous vaccination using MH
induced a strong immune response against various antigens in mice.

In the present study, we investigated the clinical safety and efficacy of
a novel transcutaneous influenza vaccine using MH (flu-MH), which contains
trivalent influenza hemagglutinins (15 µg each). Subjects of the TCI group
were treated transcutaneously with flu-MH, and were compared with subjects
who received subcutaneous injections of a solution containing 15 µg of
each influenza antigen (SCI group).

No severe local or systemic adverse events were detected in either group
and immune responses against A/H1N1 and A/H3N2 strains were induced
equally in the TCI and SCI groups. Moreover, the efficacy of the vaccine
against the B strain in the TCI group was stronger than that in the SCI
group.

Influenza vaccination using MH is promising for practical use as an easy
and effective method to replace conventional injections systems.

Copyright © 2015 Elsevier Ltd. All rights reserved.

KEYWORDS: Drug delivery; ELISA; Hyaluronic acid; Immune response
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Evaluation of safety and immunogenicity of a quadrivalent
human papillomavirus vaccine in healthy females between 9 and 26 years
of age in Sub-Saharan Africa
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25912475

Hum Vaccin Immunother. 2015 Apr 27:0.

Evaluation of safety and immunogenicity of a quadrivalent human
papillomavirus vaccine in healthy females between 9 and 26 years of age in
Sub-Saharan Africa.

Mugo N1, Ansah NA, Marino D, Saah A, Garner EI.

1a Kenyatta National Hospital , Nairobi , Kenya.

Due to sporadic and not easily accessible cervical cancer screening, human
papillomavirus (HPV)-related cervical cancer is a leading cause of cancer
death in Sub-Saharan African women. This study was designed to assess the
safety and immunogenicity of a quadrivalent human papillomavirus (qHPV)
vaccine in sub-Saharan African women.

This seven month, double-blind study enrolled 250 healthy, human
immunodeficiency virus (HIV)-uninfected females ages 9-26 residing in
Ghana, Kenya and Senegal. Thirty females ages 13-15 and 120 females ages
16-26 received qHPV vaccine. In addition, 100 females ages 9-12 years were
randomized in a 4:1 ratio to receive either qHPV vaccine (n=80) or placebo
(n=20). The primary immunogenicity hypothesis was that an acceptable
percentage of subjects who received the qHPV vaccine seroconvert to
HPV6/11/16/18 at 4 weeks post-dose 3, defined as the lower bound of the
corresponding 95% confidence interval (CI) exceeding 90%.

The primary safety objective was to demonstrate that qHPV vaccine was
generally well tolerated when administered in a 3-dose regimen. The pre-
specified statistical criterion for the primary immunogenicity hypothesis
was met: the lower bound of the 95% exact binomial CI on the
seroconversion rate was at least 98% for each vaccine HPV type and all
subjects seroconverted by four weeks post-dose 3. Across vaccination
groups, the most common adverse events (AE) were at the injection site,
including pain, swelling, and erythema.

No subject discontinued study medication due to an AE and no serious AEs
were reported. There were no deaths. This study demonstrated that qHPV
vaccination of sub-Saharan African women was highly immunogenic and
generally well tolerated. Clinical trials.gov # NCT01245764.

KEYWORDS: AE – adverse event; CDC – Centers for Disease Control and
Prevention; CI – confidence interval; FDA – Food and Drug Administration;
GMT – geometric mean titers; HIV – human immunodeficiency virus; HPV –
human papillomavirus; ICC – invasive cervical cancer; LSIL – low-grade
squamous intraepithelial lesions; PCR – polymerase chain reaction; Pap –
papanicolaou; US – United States; VRC – vaccination report card; cLIA –
competitive Luminex immunoassay; immunogenicity; mMU/mL – milli Merck
Units/mL; qHPV – quadrivalent human papillomavirus; quadrivalent HPV
vaccine; safety; sub-Saharan Africa
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Understanding non-compliance with hand hygiene practices
__________________________________________________________________
Free Full Text http://journals.rcni.com/doi/full/10.7748/ns.29.35.40.e9929

Nurs Stand. 2015 Apr 29;29(35):40-6.

Understanding non-compliance with hand hygiene practices.

Gluyas H1.

1School of Health Professions, Murdoch University, Mandurah, Western
Australia, Australia.

Healthcare-associated infections (HCAIs) continue to be a challenge in
developed and developing countries. Hand hygiene practice is considered to
be the most effective strategy to prevent HCAIs, but healthcare workers’
compliance is poor.

Using a human factors perspective, this article explores elements that
affect healthcare workers’ hand hygiene compliance. Slips, lapses and
mistakes can occur depending on the worker’s skills and knowledge levels.
Violations of protocols may also occur, and these may be associated with
the intention to provide care efficiently.

Strong leadership and an understanding of why non-compliance with hand
hygiene occurs assists with developing strategies to improve compliance.

KEYWORDS: Cognitive performance; compliance; hand hygiene; handwashing;
healthcare associated infections; human factors; infection control;
patient safety; violations

Free Full Text http://journals.rcni.com/doi/full/10.7748/ns.29.35.40.e9929
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Role of healthcare apparel and other healthcare textiles in
the transmission of pathogens: a review of the literature
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25935701

J Hosp Infect. 2015 Mar 31. pii: S0195-6701(15)00142-5.

Role of healthcare apparel and other healthcare textiles in the
transmission of pathogens: a review of the literature.

Mitchell A1, Spencer M2, Edmiston C Jr3.

1International Safety Center, The Public’s Health, Apopka, FL, USA.
Electronic address: Amber.Mitchell@internationalsafetycenter.org.
2Infection Preventionist Consultants, Boston, MA, USA.
3Department of Surgery, Surgical Microbiology and Hospital Epidemiology
Research Laboratory, Medical College of Wisconsin, Milwaukee, WI, USA.

Healthcare workers (HCWs) wear uniforms, such as scrubs and lab coats, for
several reasons: (1) to identify themselves as hospital personnel to their
patients and employers; (2) to display professionalism; and (3) to provide
barrier protection for street clothes from unexpected exposures during the
work shift. A growing body of evidence suggests that HCWs’ apparel is
often contaminated with micro-organisms or pathogens that can cause
infections or illnesses.

While the majority of scrubs and lab coats are still made of the same
traditional textiles used to make street clothes, new evidence suggests
that current innovative textiles function as an engineering control,
minimizing the acquisition, retention and transmission of infectious
pathogens by reducing the levels of bioburden and microbial
sustainability.

This paper summarizes recent literature on the role of apparel worn in
healthcare settings in the acquisition and transmission of healthcare-
associated pathogens. It proposes solutions or technological interventions
that can reduce the risk of transmission of micro-organisms that are
associated with the healthcare environment.

Healthcare apparel is the emerging frontier in epidemiologically important
environmental surfaces.

Copyright © 2015 The Healthcare Infection Society. Published by Elsevier
Ltd. All rights reserved.

KEYWORDS: Active barrier apparel; Antimicrobial; Contaminated textiles;
Disinfection; Environmental pathogens; Healthcare apparel; Healthcare
laundering; Healthcare-associated infections; Occupational exposure;
Personal protective equipment
__________________________________________________________________
________________________________*_________________________________

12. News

– Indiana USA: Pence signs Indiana needle exchange law
– Australia: Needles selling for $200 each in Australia’s prisons
– Canada: Health warning issued for unlicensed Surrey dentist
– Australia: Needles used as jail ‘currency’ for drugs
– Canada: Snow melt reveals thousands of dirty needles in Prince Albert:
More than one million needles were handed out at PA’s needle exchange
program
– India: Safety devices cut injuries by sharps by 59 per cent: Study
– Mass USA: Montague sees sharp drop in discarded needles
– USA: Smallpox-Like Virus Infects Lab Worker After Mishap
– California USA: Patients infected with hepatitis C after visiting Santa
Barbara doctor
– Australia: Drug use and needle sharing by HIV prisoner sparks flurry of
– testing and security crackdown

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
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www.courierpress.com/news/state/needle-exchange-bill-now-law-in-indiana

Indiana USA: Pence signs Indiana needle exchange law

Lesley Weidenbener, Evansville Courier Press, Indiana USA (05.05.15)

Copyright 2015 Journal Media Group. All rights reserved. This material may
not be published, broadcast, rewritten, or redistributed.
INDIANAPOLIS – Gov. Mike Pence signed legislation Tuesday that will make
it easier for other counties to launch needle exchange programs to combat
diseases passed through intravenous drug use.

The law takes effect immediately.

It comes after Pence declared an emergency and created a temporary needle
exchange program in Scott County, where more than 140 people have been
diagnosed with HIV. The cases are all tied to intravenous drug use.

“Since that time, our public health community has worked tirelessly to
confront this outbreak,” Pence said in a statement. “Our administration
worked with members of the Indiana General Assembly to construct a legal
framework under which Scott County and other counties could respond to
public health emergencies in the future, and I am pleased to sign SEA 461
into law today.”

Originally, though, Pence said he opposed a statewide needle exchange
program. The resulting compromise requires local governments to prove to
the Indiana State Department of Health that a hepatitis C or HIV epidemic
is occurring. Hepatitis C is also spread through shared needles and
typically is an early indicator of a problem.

Last year, the House approved a bill to study needle exchange programs but
it died in the Senate. This year, lawmakers said they acted to try to
avoid the kinds of programs occurring in Scott County.

“I am grateful for the efforts of legislators in both political parties
for moving this important public health measure forward in a timely way,”
Pence said. “This measure will save lives and give public health officials
the broadest range of options to confront this and other public health
emergencies in the future.”

The law creates a process where Vanderburgh County or other counties with
high Hepatitis C or HIV rates could request the ability from the state to
operate a needle-exchange program.

However, the law signed Tuesday by Pence requires Vanderburgh County to
follow more steps to administer a program than initial proposals. An
earlier proposal gave Vanderburgh County and other high-risk counties the
option to begin needle-exchange programs right away. Now, to kick start
the approval process the law requires the local health department to find
an epidemic of Hepatitis C or HIV exists and infections are occurring
primarily through intravenous drug use, according to the law.

Local government officials then must hold a public hearing before
requesting the state declare a public health emergency. Only counties
receiving the declaration from the state can operate a needle-exchange
program, meaning the final decision lies with the Pence administration.

Vanderburgh County Health Officer Dr. Kenneth Spear told the Courier &
Press in April that needle exchanges can’t be run as standalone programs
and counties would need to tie in other services as well. Spear said he
would need to speak with the county’s communicable disease officials
before deciding whether to implement a program in Vanderburgh.

“It is not a panacea and it does not solve the problem, but in times of
significant outbreaks, it does help stem the tide and it allows us to
contact these people,” Spear said.

Copyright 2015 Journal Media Group.
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https://tinyurl.com/kugy7nd

Australia: Needles selling for $200 each in Australia’s prisons

5 May, 2015 Serkan Ozturk and AAP 2 comments

One single needle tip or syringe is trading for $200 among IV drug users
in prison, a parliamentary inquiry has heard.

Public health advocates are calling…
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http://www.surreyleader.com/news/302459471.html

Canada: Health warning issued for unlicensed Surrey dentist

by Alex Browne – Peace Arch News, Canada (04.05.15)

Fraser Health is warning that an unlicensed dentist in Surrey may have
exposed patients to a risk of hepatitis B and C, HIV and other blood-borne
infections.

The agency said an investigation by the College of Dental Surgeons of B.C.
has found that Valentyn Uvarov has been providing dental treatments at
14275 62 Ave. without a valid license to practise dentistry.

Anyone who has received dental treatments from Uvarov is being advised to
follow up with a health-care provider, or call 811 to address any health
concerns.

Fraser Health medical officer Dr. Michelle Murtie said the public health
warning of potential infectious-disease transmission was triggered by
CDSBC’s finding that infection prevention and control practices may not
have been in place, exposing patients to non-sterile materials.

“Part of the investigation found that containers for anesthetic, which
should be single-use only, were not being disposed of after one client,
increasing the risk of infection.”

Murtie said there have no reports of how long Uvarov had been practising
dentistry without a license, although it is believed to have been at least
a year.

“We do not have any records of clients – there is no client information
available, so it’s hard to reach them,” she said. “We believe it was a
limited community he was providing services to – it was predominantly
Russian-speaking people who were receiving treatment.

“If anyone knows of any friends or family who used these services, we
would urge them to follow up with a health-care provider to see if testing
might be needed.”

For more information, visit www.fraserhealth.ca
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https://tinyurl.com/ofyno2l

Australia: Needles used as jail ‘currency’ for drugs

9news.com.au, AAP, Australia (04.05.15)

Needle and syringe programs in prisons would arm inmates and give them a
currency with which to buy drugs, putting prison staff at risk, a
parliamentary inquiry has heard.

Public health advocates are calling for syringe programs to be implemented
in prisons to stem high rates of hepatitis C infection among Australian
prisoners.

It’s estimated one in two prisoners are living with the disease, which is
typically spread by sharing needles to inject illicit drugs.

Health advocates say it’s a breach of human rights that prisoners aren’t
being provided with clean needles.

But unions say the move would put prison staff at risk.

A House of Representatives inquiry into hepatitis C has heard one single
needle tip can fetch $150 to $200 in prison, with needles often rented out
in exchange for drugs.

Supplying clean needles to prisoners would therefore create a prison
currency, said Andrew Smith, assistant secretary of the WA Prison
Officers’ Union.

“It needs to be recognised that they are currently a currency within the
prison,” Mr Smith told the hearing in Canberra on Monday.

“It’s a very, very expensive commodity and by providing them into the
prison, you’re providing a currency.”

Troy Wright from the Community and Public Sector Union said a syringe
program would pose serious and tangible risks to prison guards, either
through accidental needle stick injuries or needles being used as weapons.

But Mark Stoove, associate professor at the Burnet Institute, said
evidence from countries that had already implemented prison syringe
programs suggested no reported incidents of needles being used as weapons
or an increase in trafficking or drug use.

Instead, it increased participation in drug treatment programs and reduced
blood-borne disease transmission, he said.

© AAP 2015
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https://tinyurl.com/mkr9bh4

Canada: Snow melt reveals thousands of dirty needles in Prince Albert:
More than one million needles were handed out at PA’s needle exchange
program

By Ryan Pilon, CBC News, Canada (04.05.15)

Usually the spring melt brings about beauty with grass turning green and
flowers beginning to bloom.

However, in some areas of Prince Albert the snow melt reveals something
ugly instead: thousands of dirty needles are found lying in the grass and
brush.

Between April 2013 and April 2014, the region handed out 1,203,382 needles
to drug users. With a 95 per cent exchange and recovery rate (which
includes those cleaned up by the community) that leaves 60,169 unaccounted
for.

“Finding needles in the community, such as this, isn’t a good thing,” said
Brett Enns, the Vice-President of Community and Primary Care for the
Prince Albert Parkland Health Region. “What we’d like to see is the folks
using the needles becoming more responsible in terms of safely and
appropriately disposing of those needles.”

‘When my kids are here I don’t allow them to go back here because it’s not
safe for them.’
– Norman Pfeil

The owner of The Welding Shop in PA, Norman Pfeil, said at times there are
thousands of needles on his property, and users have also broken into one
of the buildings he owns to shoot up.

“When my kids are here I don’t allow them to go back here because it’s not
safe for them,” said Pfeil.

Pfeils’ welding shop is located across the train tracks from the needle
exchange office.

Used Needles in PA
Thousands of dirty needles litter the ground in several areas of Prince
Albert. (Ryan Pilon/CBC)

“My point of view is they should — if they’re going to use a needle — they
should use it inside the [exchange] building and no needles should be
leaving the building,” said Pfeil.

The health region insists the benefits of preventing the spread of blood
borne diseases outweighs the negatives.

“Some have said that if we pull the needle exchange program that this will
all clean up,” said Enns. “And while there might be some lessening of the
sights you see, it will never go away.”

?Enns said the program needs to continue to educate users about the
importance of returning the needles they use.

Prince Albert accounts for almost 27 per cent of the needles provided by
prevention and risk reduction programs in the province.

Here are figures for some other regions for the same April 2013 to April
2014 time period:

Five Hills Health Region (which serves Moose Jaw and area, and has a
similar population to Prince Albert): 95,719 needles with a 79 per cent
exchange and recovery rate.
Regina Qu’Appelle Health Region: 2,468,306 needles.
Saskatoon Health Regina: 567,304 needles.
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https://tinyurl.com/p7z67lq

India: Safety devices cut injuries by sharps by 59 per cent: Study

Contact with contaminated needles, scalpels, broken glass and other sharp
objects may expose healthcare workers to blood that contains pathogens
which pose potentially lethal risk.

The needle-stick injuries are wounds caused by needles that accidentally
puncture the skin — a hazard for people who work with hypodermic syringes
and other needle equipment.

By: The Indian Express, Express News Service, Pune India (30.04.15)

A three-year study has shown that using safety devices has led to a 59 per
cent reduction in needle stick and injuries by other sharps that the
health workers face at hospitals. “Needle-stick and other sharps injuries
are a hazard in any health care setting,” said Dr Nita Munshi, head,
department of Pathology at Ruby Hall Clinic, which has launched a campaign
along with BD pharmaceutical firm on the need for maintaining the safety
of the health care workers.

Contact with contaminated needles, scalpels, broken glass and other sharp
objects may expose healthcare workers to blood that contains pathogens
which pose potentially lethal risk. The needle-stick injuries are wounds
caused by needles that accidentally puncture the skin — a hazard for
people who work with hypodermic syringes and other needle equipment.

“Health care workers’ safety has rarely been considered a priority,” said
Munshi. However, since a couple of years, a network of hospitals has been
implementing various initiatives to minimise needle-stick injuries. At
Ruby Hall Clinic, a week-long campaign is under way. It aims to reach out
to more than 1000 persons including doctors, nurses, Class III and IV
staff.

“Monitoring of the needle-stick injuries is done every month. At times,
there may be no cases, or in a month, there could be three cases. There is
no published data yet on the number of such injuries,” Munshi said.
He added that a study on infection control for the last three years has
shown that using safety devices has helped to reduce such injuries by 59
per cent. “We have instructed our staff that there is a need to avoid
recapping or bending needles that are contaminated. Several safety
measures like the lancet test and others have been used. These help ensure
nobody gets injured,” Munshi added.
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https://tinyurl.com/nkyh827

Mass USA: Montague sees sharp drop in discarded needles

By David Rainville, The Recorder, Massachusetts USA (30.04.15)

MONTAGUE — Earlier this month, Police Chief Charles “Chip” Dodge asked for
the community’s help dealing with discarded needles.

He got it, from private citizens, local businesses, other town departments
and the Franklin County Solid Waste District.

On April 6, Dodge bemoaned the littered syringes on Facebook, and asked
the public to help pick them up if they were able to do so safely.
Officers, he said, are often busy on other calls, and someone could easily
be pricked by a dirty needle before police could arrive to pick it up.

At the time, officers were responding to littered needle calls on a near-
daily basis, as the melting snowbanks revealed syringes that had spent the
winter buried.

Police would respond as soon as they could, put on gloves, pick up the
needle and put it into an empty soda bottle or other hard, capped
container for disposal.

Lately, Dodge said, needle calls have dropped off sharply. Friday, he said
the department hadn’t received a single one for two weeks.

“The lack of calls for help may be a result of people picking them up and
disposing of them on their own or just because of the fact that we have
brought attention to this problem,” Dodge said.

Dodge’s Facebook posts about the needle problem generated a lot of
comments, and a few offers for help.

Shortly after Dodge went public with his plea, Jan Ameen, director of the
Franklin County Solid Waste Management District reached out to him.

The solid waste district offers disposable “sharps” biohazard boxes
intended for people with a medical need for hypodermic needles, but
provides them to anyone who requests them, without asking why they need
them. The agency has also provided some to Montague police as well. When
the quart- or gallon-sized boxes are full, they are returned to the
district, which hands them off to a medical hazard disposal company.

She said the district has distributed roughly 700 a year in the county in
the last two or three years.

Ameen is also working to secure a grant to buy more sharps boxes, but
funding is geared toward residential use. She said she may seek another
grant to buy 400 specialized sharps containers more suitable for police
departments and other professionals like landscapers who might come across
needles.

Dodge has provided a box to the F.L. Roberts convenience store on Third
Street, where it will be kept behind the counter in case any needles are
found nearby. Dodge is also working with other businesses to host sharps
containers.

People can also turn in sharps at the police station, the Turners Falls
Fire Department, the Unity Park fieldhouse, or on Wednesdays only at the
nurse’s office in Town Hall. Dodge said no questions will be asked of
anyone who wishes to get rid of a needle at any of those places.

The Board of Health can also accept needles. They currently need to be in
a sharps box, but the board is looking into changing the policy.

The town’s Health Agent Gina McNeely has also offered to respond to needle
calls when police are unavailable.

The general public is also stepping up to help.

Turners Falls resident and owner of Turn It Up music stores Patrick
Pezzati offered to take matters into his own hands, by going on foot
around downtown to pick up used needles.

“I saw the Facebook posts, and people seemed really upset (about
needles),” Pezzati said. “A lot of them were saying they’d feel bad if a
kid got stuck with one, but that there was no way they’d pick up a needle.
I thought, ‘It’s no big deal; I should do it.’”

So, he grabbed some latex gloves and a hard plastic bottle, and went
looking. He has yet to pick up a single needle, because he hasn’t come
across one.

“I walked all around Turners, from Unity Park to the Food City plaza,” he
said. “I checked the back alleys, behind Dumpsters, along the bike path,
near the train tracks — everywhere — and I didn’t find a single one.”

He said it might be because there are fewer needles being thrown out, or
other citizens are picking them up for safe disposal. He said he’s met
several people in his travels who said they’d be willing to pick up a
needle if they saw one.

Pezzati said he’ll head out again, this time taking his bike so he can
cover more ground.

Pezzati owns stores in Northampton and Brattleboro, Vt., in addition to
his Montague shop. He said the heroin and opioid problem is bad in all
three locales, but needles don’t seem to be as much of a problem in
Northampton.

“I think the needle exchange helps a bit in that regard,” Pezzati said.
“If people can exchange their used needles for new ones, chances are they
won’t discard them on the street.”

He was referring to a program run by Tapestry Health in Northampton.

Users can bring old needles to the center and exchange them for fresh
ones, in hopes of cutting down on needle sharing and associated disease
transmission. The center also provides information on treatment and offers
to help users get into programs to help them quit. While Tapestry operates
a Greenfield office, it does not offer a needle exchange program.
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https://tinyurl.com/pmxe4wd

USA: Smallpox-Like Virus Infects Lab Worker After Mishap

by Rachael Rettner, Live Science (30.04.15)

A lab worker in Boston became infected with a virus similar to smallpox
after he accidentally stuck himself with a needle that was contaminated
with the virus, according to a new report of the case.

But the case is noteworthy because the worker developed the infection
despite having recently been vaccinated against the virus, which was
intended to protect him in case of exactly such an accident.

In November 2013, the 27-year-old lab worker was preforming an experiment
that required him to inject mice with the vaccinia virus — which is the
virus in the smallpox vaccine. (The vaccinia virus is similar to smallpox,
but doesn’t actually cause the disease.) While putting a cap back on the
needle he was using, he accidentally stuck the needle into his left thumb.

The worker immediately sterilized his gloves and washed his hands for 10
minutes, and saw that there was a small amount of blood from his injury.
He filed an accident report at his work, and was told to go to the
emergency room if he had signs of infection.

About a week later, the man developed a rash on his left bicep, and went
to the ER. But the hospital doctors thought the man had a bacterial
infection, and gave him antibiotics.

A few days later, the man developed a lesion of dead tissue on his thumb,
and went to a health clinic at his work, where he was diagnosed with a
vaccinia virus infection.

But soon, the man began to recover and the rash on his arm started to go
away. About two weeks later, the man had the dead tissue removed from the
wound on his thumb, and a sample from the wound tested positive for
vaccinia virus. Over the next month, his skin lesion disappeared, and he
no longer had symptoms, according to the report, from the Centers for
Disease Control and Prevention. [7 Devastating Infectious Diseases]

About 10 months before his injury, the man had received the smallpox
vaccine because his job required him to work with the vaccinia virus. At
that time, the man appeared to have a proper reaction to the vaccine — he
developed a small white lesion at the vaccination site — which is thought
to indicate a successful immune response to the vaccine. (The general
public is no longer vaccinated against smallpox, since the disease has
been eradicated worldwide.)

The man appears to be the first person to develop a vaccinia virus
infection from a lab accident, even though he was recently vaccinated
against the disease, the researchers said. It’s not clear why the man
developed an infection despite being vaccinated, but the researchers noted
that the level of immune response needed to protect against the vaccinia
virus is not known.

It’s possible that the smallpox vaccine didn’t fully protect the man
against infection, but that it reduced the severity of his symptoms, the
researchers said.

“This underscores the importance of smallpox vaccination among laboratory
workers who use [vaccinia virus] in research settings,” the researchers
said.

In addition, “establishing and reinforcing safe laboratory practices such
as proper handling of contaminated needles and use of personal protective
equipment is important in reducing the risk of injury and infection,” the
researchers said.

The man had received proper safety training, and an investigation of the
lab showed that it was well maintained, the report said. But after the
incident the laboratory discouraged the practice of recapping needles.

The case was reported this week in the CDC journal Morbidity and Mortality
Weekly Report.
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https://tinyurl.com/kwkksou

California USA: Patients infected with hepatitis C after visiting Santa
Barbara doctor

By Veronica Rocha, Los Angeles Times, California USA (28.04.15)

Santa Barbara County health officials say patients were infected with
hepatitis C after an injection procedure

Patients of Allen Thomashefsky, a Santa Barbara doctor, are urged to get
tested for blood viruses

At least five patients tested positive for hepatitis C after receiving
injections at a Santa Barbara doctor’s medical office, public health
officials said.

Now, the Santa Barbara County Public Health Department is urging any
patients who visited the medical office of Allen Thomashefsky to get
tested for hepatitis B, hepatitis C and HIV.

Public health officials performed two inspections at Thomashefsky’s office
in November 2014 after they received information that a patient with no
known risk factors developed hepatitis C after a visit. The patient
underwent multiple injections at his office.

Inspectors examined the office and found unsafe practices that put
patients at risk for bloodborne viruses as well as joint infections,
according to the department. Public health officials say inspectors found
that standard infection control procedures were not practiced.

The multiple medical breaches led public health officials to order
Thomashefsky to close his office, which was done March 19.

Thomashefsky did not immediately return requests for comment.

Thomashefsky performed regenerative injection therapy, or prolotherapy, to
treat patients with chronic muscle or joint pain.

The Oregon Medical Board is also investigating the doctor and has limited
his medical practice in the state. Thomashefsky, who has an office in
Ashland, Ore., was ordered April 14 to stop performing injection
procedures.

Four of the five patients who tested positive for hepatitis C had
undergone injection procedures at his medical office on the same day they
became infected. Three patients had no known risk factors for hepatitis C,
an infection that attacks the liver and causes inflammation.

Public health officials have performed 240 tests and no patients have
tested positive for HIV.

The department has been contacting Thomashefsky’s patients who received
injections in the last seven years.

The Centers for Disease Control and Prevention is also performing
molecular genetic testing to determine if the hepatitis C virus found in
the infected patients originates from the same source.

The public health department and the CDC are investigating the cause of
the outbreak.
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https://tinyurl.com/qjfk7l2

Australia: Drug use and needle sharing by HIV prisoner sparks flurry of
testing and security crackdown

Natalie O’Brien, Sydney Morning Herald, Australia (22.03.15)

Six inmates at a Sydney jail have been tested for HIV and drug use, after
an HIV positive patient was found shooting up drugs and sharing needles
with the inmates, sparking concerns about a spread of the infection across
the prison.

Intelligence gathered by prison officials led to searches at the minimum
security prison last month and the discovery of two inmates in possession
of syringes and a third who confessed he had HIV and had been sharing
syringes with others.

Sources have told The Sun-Herald that he has also revealed how the drugs
were being trafficked into the jail, however no drugs were found during
the searches.

It is understood the six prisoners known to have shared the needles have
been tested for HIV. Inmates have also undergone urine tests for drugs.
The results of the tests are not yet known.

Inmates have expressed concerns that they “have been exposed unwittingly
to the virus” and said they discovered what was going on after being were
locked in their cells at the Dawn de Loas correction centre.

They have told families and friends that they had their privileges
including phone calls and visitors cancelled while officers from the
Security Operations Group (SOG) officers scoured cells and common grounds
for drugs and implements.

A spokeswoman for Corrective Services NSW said police had been called in
to investigate and a ” number of inmates have been regressed in
classification, moved to other centres, and have had privileges withdrawn
as a result.”

She said that the area involved was an isolated section of the prison.

Justice Health had also been called in to offer support, testing and
counselling for inmates, she added.

A 2009 NSW Inmate Health Survey of 996 prisoners in 30 correctional
centres, found 43 per cent had a history of injecting drug use before they
were jailed and many claimed they continued to inject while in prison.

Thirty two prisoners said they had started using heroin for the first time
while they were in an adult prison and 97 percent of those who injected in
prison had shared needles with other inmates.

Professor Basil Donovan from the University of NSW Kirby Institute for
Infection and Immunity in Society, said less than one percent of prisoners
have HIV compared to Hepatitis C, which is about 35 per cent. He said that
injecting in prisons is “typically unsafe” and people can be “remarkably
inventive” with many using the same device.

New statistics just released by NSW Health show that there has been one
new reported infection of HIV among prisoners almost every year since
2008.

Prisoner advocate Debbie Kilroy from Sisters Inside said that infections
like Hepatitis and HIV can spread very quickly because of the high numbers
of people doing drugs and sharing needles. “It is a major health concern,”
she said.

A coronial inquiry last year into the heroin overdose death in jail of
inmate Tracy Lee Brannigan, found that the “availability of illicit
substances in correctional facilities is an endemic problem”.

The spokeswoman for Corrective Services said they had introduced
recommendations made by the coroner and expanded its prison contraband
search strategy including at or after lock-in time and focussing on
inmates who are known or suspected drug users.

She said that Corrective Services conduct “regular, targeted and random
visitor and prison searches to detect and seize contraband. CSNSW uses
strong intelligence gathering, X-ray machines, metal detectors, CCTV
cameras and thermal detection technology to keep contraband out.”

In addition to individual prisons carrying out daily cell searches, the
SOG which uses sniffer dogs, last year conducted almost 103,000 visitor
searches and 86,000 inmate, cell and prison common area searches. These
resulted in the seizure of 214 syringes from prisons and 300 syringes from
visitors. Out of the cell and prison common area searches 164 inmates were
charged internally with correctional offences.

The chair of the Prison Officers Vocational Branch, Steven McMahon, said
prison officers are working hard to keep drugs out of jails but need more
resources including at least two drug dogs for every centre on every
visiting day to keep on top of the problem.

He said that prison officers are serious about finding and removing
needles. “We have very tight controls”. But he believes the main entry
point into the jails remains contact visits between inmates and their
families and friends.

The ACT government is considering a needle exchange program for its prison
to stop the spread of blood-borne diseases, but Mr McMahon is not in
favour of it, he said that needles can be used as weapons and they do not
want an increase in the number of weapons among the jail population in NSW
which is currently about 11,000.

In jail, the black market price for a syringe is about $200.

They remain the most prized contraband because they are so hard to get and
once “owned” can be “rented out” to others.

The most common drugs for injecting remain “the white lady” (heroin) and
ice according to Mr McMahon. But research from the NSW Bureau of Crime
Statistics and Research is showing a mix of other drugs are now finding
their way into prisons including cocaine, cannabis and amphetamines.

Brett Collins from Justice Action said that drugs in jail present very
significant health issues for prisoners especially because. “if someone
has some gear it is expected they will share”.
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New WHO Injection Safety Guidelines

WHO is urging countries to transition, by 2020, to the exclusive use of
the new “smart” syringes, except in a few circumstances in which a syringe
that blocks after a single use would interfere with the procedure.

The new guideline is:

WHO Guideline on the use of Safety-Engineered Syringes for Intramuscular,
Intradermal and Subcutaneous Injections in Health Care

It is available for free download or viewing at this link:
www.who.int/injection_safety/global-campaign/injection-safety_guidline.pdf

PDF Requires Adobe Acrobat Reader [620 KB]
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Making all injections safe brochure

This is an illustrated summary brochure for the general public.

pdf, 554kb [6 pages]

www.who.int/injection_safety/global-campaign/injection-safety_brochure.pdf

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SIGN Meeting 2015

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

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

A report of the meeting will be posted ASAP
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* 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
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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
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________________________________*_________________________________

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
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