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SIGNpost 00802

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00802 ID-AD + Abstracts + News 20 May 2015
CONTENTS
0. New WHO Injection Safety Guidelines
1. Clinical performance and safety of adapters for intradermal delivery
with conventional and autodisable syringes
2. Abstract: A prospective look at the burden of sharps injuries and
splashes among trauma health care workers in developing countries: true
picture or tip of iceberg
3. Abstract: No transmission of blood-borne viruses among hospital staff
despite frequent blood exposure
4. Abstract: Percutaneous and mucocutaneous exposure among Orthopaedic
surgeons: Immediate management and compliance with CDC protocol
5. Article: Identification of multidrug-resistant bacteria and Bacillus
cereus from healthcare workers and environmental surfaces in a hospital
6. Abstract: HIV, HCV, and Health-Related Harms Among Women Who Inject
Drugs: Implications for Prevention and Treatment
7. Abstract: HIV and STI prevalence and injection behaviors among people
who inject drugs in Nairobi: results from a 2011 bio-behavioral study
using respondent-driven sampling
8. Abstract: HIV prevalence and risk behaviors among people who inject
drugs in two serial cross-sectional respondent-driven sampling surveys,
Zanzibar 2007 and 2012
9. Abstract: Septic internal jugular vein thrombosis caused by
Fusobacterium necrophorum and mediated by a broken needle
10. Abstract: Using a multidimensional approach to improve quality related
to students’ hand hygiene practice
11. Abstract: Application of a three-microneedle device for the delivery
of local anesthetics
12. Abstract: Progestin-only contraception: injectables and implants
13. Abstract: Tattoo and vaccination sites: Possible nest for
opportunistic infections, tumors, and dysimmune reactions
14. Abstract: A 4-month-old baby presenting with dermal necrotizing
granulomatous giant cell reaction at the injection site of 13-valent
pneumococcal conjugate vaccine: a case report
15. Abstract: Prevalence of antibacterial resistant bacterial contaminants
from mobile phones of hospital inpatients
16. Abstract: Clinical presentation of hepatitis D in Pakistani children
17. Abstract: Ebola preparedness in the Western Pacific Region, 2014
18. News
– Connecticut USA: Malloy wants Congress to fund needle-exchange programs
– USA/Mexico: Binational Police Program in Tijuana Targets HIV Reduction:
Effort also aims to improve safety of officers
– USA: Hepatitis C and Injection Drug Use Top Targets of CDC Prevention
Efforts
– Canada: Illegal dentist’s patients warned of infection risk

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__________________________________________________________________
________________________________*_________________________________

0. New WHO Injection Safety Guidelines
__________________________________________________________________

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]
__________________________________________________________________
________________________________*_________________________________

1. Clinical performance and safety of adapters for intradermal delivery
with conventional and autodisable syringes
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25964169

Vaccine. 2015 May 8. pii: S0264-410X(15)00592-7.

Clinical performance and safety of adapters for intradermal delivery with
conventional and autodisable syringes.

Tsals I1, Jarrahian C2, Snyder FE3, Saganic L2, Saxon E2, Zehrung D2,
Zimmerman G4, Papania M5, Klaff L6.
Author information
1SID Technologies, 51 Rittenhouse Cir., Newtown, PA 18940, USA. Electronic
address: izzy.tsals@gmail.com.
2PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA.
3SID Technologies, 51 Rittenhouse Cir., Newtown, PA 18940, USA.
4West Pharmaceutical Services, Inc., 530 Herman O. West Drive, Exton, PA
19341, USA.
5Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta,
GA 30333, USA.
6Rainier Clinical Research Center, 723 SW 10th Street, Suite 100, Renton,
WA 98057, USA.

Although the number of vaccines and diagnostic tests currently delivered
intradermally is limited, this route of administration offers potential
advantages due to the high concentration of antigen-presenting cells in
the skin.

One factor which may in part be limiting development and use of
intradermal (ID) administration is concern about the ease and reliability
of the needle and syringe-based Mantoux technique.

A phase I clinical study was conducted to evaluate two ID adapters that
have been developed as injection-delivery aids to increase the safety,
simplicity, and reliability of ID injection: a prototype autodisable,
intradermal (ADID) adapter for autodisable (AD) syringes, and a marketed
side-merge adapter (SMA).

Thirty healthy adult volunteers each received six injections of 0.1mL of
sterile saline solution. Each adapter was used to give injections into the
upper deltoid, forearm, and suprascapular regions of each volunteer. The
needle-bevel orientation during injection was random. Injection
performance was determined by measuring wheal size and fluid leakage.

Wheals were similar in size for the ADID adapter (mean 9.9±0.17mm) and SMA
(mean 9.8±0.15mm). In all of the injections completed with the SMA, and
98% of those completed with the ADID, fluid leakage was less than 10% of
the intended injection volume. Minor skin abrasions were the only adverse
events.

Based on self-reporting of pain, injections were well tolerated (mean pain
score of 2 on a 0-10 scale). ID delivery using the SMA and ADID adapters
appears safe and effective.

Copyright © 2015. Published by Elsevier Ltd.

KEYWORDS: Delivery technology; Intradermal; Mantoux; Vaccination
__________________________________________________________________
________________________________*_________________________________

2. Abstract: A prospective look at the burden of sharps injuries and
splashes among trauma health care workers in developing countries: true
picture or tip of iceberg
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24680470

Injury. 2014 Sep;45(9):1470-8. doi: 10.1016/j.injury.2014.03.001.

A prospective look at the burden of sharps injuries and splashes among
trauma health care workers in developing countries: true picture or tip of
iceberg.

Rajkumari N1, Thanbuana BT2, John NV3, Gunjiyal J4, Mathur P5, Misra MC6.

1Department of Laboratory Medicine (Microbiology Division), Jai Prakash
Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New
Delhi 110029, India. Electronic address: nonika.raj@gmail.com.
2Hospital Infection Control, Jai Prakash Narayan Apex Trauma Centre, All
India Institute of Medical Sciences, New Delhi 110029, India. Electronic
address: SWEETBT123@gmail.com.
3Hospital Infection Control, Jai Prakash Narayan Apex Trauma Centre, All
India Institute of Medical Sciences, New Delhi 110029, India. Electronic
address: johnnibu@yahoo.com.
4Hospital Infection Control, Jai Prakash Narayan Apex Trauma Centre, All
India Institute of Medical Sciences, New Delhi 110029, India. Electronic
address: jacintagunjiyal@yahoo.co.in.
5Department of Laboratory Medicine (Microbiology Division), Jai Prakash
Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New
Delhi 110029, India. Electronic address: purvamathur@yahoo.co.in.
6Department of Surgery, Jai Prakash Narayan Apex Trauma Centre, All India
Institute of Medical Sciences, New Delhi 110029, India. Electronic
address: mcmisra@gmail.com.

OBJECTIVES: Health care workers (HCWs) face constant risk of exposure to
cuts and splashes as occupational hazard. Hence, a prospective
observational study was conducted to observe the exposure of HCWs to
various sharp injuries and splashes during health care and to work up a
baseline injury rate among HCWs for future comparison in trauma care set
ups.

METHODS: A 2 year and 5 month study was conducted among the voluntarily
reported exposed HCWs of the APEX trauma centre. Such reported cases were
actively followed for 6 months after testing for viral markers and
counselled. The outcomes of such exposed HCWs and rate of seroconversion
was noted. To form a future reference point, the injury rate in trauma
care HCWs based on certain defined parameters along with the rate of under
reporting were also analysed in this study.

RESULTS: In our study, doctors were found to have the highest exposure
(129, 36.2%), followed by nurses (52, 14.6%) and hospital waste disposal
staff (27, 7.6%). Of the source patients, a high number of them were HBV
positive (11, 3.1%), followed by HIV positive patients (8, 2.2%). No
seroconversion was seen in any of the exposed HCWs. Injuries by sharps
(303, 85.1%) outnumber those due to splashes (53, 14.9%) which were much
higher in those working in pressing situations. Underreporting was common,
being maximally prevalent in hospital waste disposal staff (182, 51.1%).

CONCLUSIONS: High rates of exposure to sharp injuries and splashes among
HCWs call for proper safety protocols. Proper methods to prevent it,
encouraging voluntary reporting and an active surveillance team are the
need of the hour.

Copyright © 2014 Elsevier Ltd. All rights reserved.

KEYWORDS: Blood borne viral infections; Health care workers; Injury rate;
Needlestick injury; Post-exposure prophylaxis; Splashes; Underreporting
__________________________________________________________________
________________________________*_________________________________

3. Abstract: No transmission of blood-borne viruses among hospital staff
despite frequent blood exposure
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25186545

Dan Med J. 2014 Sep;61(9):A4907.

No transmission of blood-borne viruses among hospital staff despite
frequent blood exposure.

Eskandarani HA1, Kehrer M, Christensen PB.

1Department of Infectious Diseases Q, Odense University Hospital, Sdr.
Boulevard 29, 5000 Odense C, Denmark. peer.christensen@dadlnet.dk.

INTRODUCTION: Exposure to blood and body fluids (BBF) is a major concern
for health-care workers (HCWs) and implies a risk of infection with blood-
borne pathogens. However, in Denmark, no exposure incidence studies among
HCWs have been reported for the past ten years. The aims of this study
were to provide an updated evaluation of the annual frequency of
registered exposures during the 2003-2012 period, the prevalence and
incidence of transmission of HIV, HBV and HCV among HCWs, the prevalence
of HIV, HBV and HCV among source patients, the follow-up by HBV
vaccination and blood sampling in exposed HCWs and, finally, reporting
habits.

MATERIAL AND METHODS: All registered first-time cases of BBF exposure at
Odense University Hospital during the 2003-2012 period were included. The
exposed HCW and source patient were linked to a laboratory database to
obtain the test results for HIV, HBV, HCV and the anti-HBs level at
baseline and after exposure. For 2012, a detailed analysis of BBF exposure
was performed.

RESULTS: A total of 2,274 first-time BBF exposures were analysed. We
observed a 35% increase in the reported incidence of exposures in the
period. The prevalence and incidence of HIV, HBV and HCV among HCWs was
zero. The prevalence of anti-HIV among source patients was 0.9%, HBsAg
1.2% and anti-HCV/HCV-RNA 3.8%. In 2003-2012, 31.3% of the tested HCWs had
an anti- HBs = 10 IU/l at baseline and this increased to 76.1% after
vaccination. In 2012, 95% of the HCWs had blood samples at the time of
exposure, 35% had a three-month blood test and 17% had a six-month test.

CONCLUSION: Despite a high rate of exposure to BBF among HCWs, the risk of
infection was low.

FUNDING: no external funding received.

TRIAL REGISTRATION: not relevant.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Percutaneous and mucocutaneous exposure among Orthopaedic
surgeons: Immediate management and compliance with CDC protocol
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/25967855

J Orthop Trauma. 2015 May 9.

Percutaneous and mucocutaneous exposure among Orthopaedic surgeons:
Immediate management and compliance with CDC protocol.

Maniar HH1, Tawari AA, Suk M, Bowen TR, Horwitz DS.

11Department of Orthopaedic Surgery, Geisinger Medical Center, 100 N.
Academy Ave, Danville, PA 17822-2130, USA.

BACKGROUND: Orthopedic surgeons are at a high risk of sustaining a
percutaneous or mucocutaneous exposure to blood and body fluids. The CDC
recommends a wash with soap and water and notification of the concerned
hospital authorities following any percutaneous/ mucocutaneous exposure,
but a systematic amenability with these guidelines is not always seen.
This cross sectional study was undertaken to determine current knowledge
and practices of orthopedic surgeons in case of a percutaneous sharp
injury exposure, emphasize the immediate first aid steps taken after an
exposure, the degree of reporting and to explore the reasons for
noncompliance. Finally we sought to create awareness about the prevailing
CDC guidelines after any exposure to blood or body fluids.

MATERIALS AND METHODS: We conducted a cross sectional survey utilizing an
anonymous prepared questionnaire. The study population included
exclusively orthopedic surgeons, including residents, fellows and
attending physicians at four USA institutions. The questionnaire was also
available online on the OTA website as a part of survey monkey. The
questionnaire was comprised of 9 multiple choice questions and more than
one response could be given for some questions. The questions addressed
previous needle stick/sharp injury exposure, number of times that had
happened, whether reported to the hospital administration, reason for non-
reporting and risk perception for transmission of blood borne pathogens
(HIV, HBsAg, and HCV). The questions were also asked based on what should
be done in four different clinical settings based on respondents risk
perception.

RESULTS: 58 attendings, 7 fellows, 45 residents and 7 respondents who did
not indicate their position participated in the survey, for a total of 117
respondents. Out of 99, 24 had sustained it once, 18 twice, 11 three
times, and 35 at least four times. When questioned about informing the
incident to the hospital administration, 38 % had always reported the
incident, 33 % had never reported the incident and the remaining 29 % had
not reported it every time. 87 % gave the correct response about the risk
of transmission of HIV following an exposure. On questioning about the
risk of Hepatitis B transmission, from an HBsAg and HBeAg positive source,
13 % gave the correct response, while from HBsAg positive and HBeAg
negative source, 30 % gave the correct response. With regards to
transmission of HCV from a positive source, 36 % responded correctly. The
surgeons seemingly attempted to risk stratify their exposure and they were
more likely to report their exposure in the higher risk scenarios.

CONCLUSION: This study demonstrates that orthopedic surgeons of all levels
of training are at high risk of occupational exposure to blood borne
pathogens. Moreover, despite the level of training, the majority of
surgeons do not follow the recommended steps, though we do not know the
reasons for such behavior. Also, there is a low awareness of the
significant risk of hepatitis transmission among orthopedic surgeons
treating a population with a high prevalence of undiagnosed hepatitis.
__________________________________________________________________
________________________________*_________________________________

5. Article: Identification of multidrug-resistant bacteria and Bacillus
cereus from healthcare workers and environmental surfaces in a hospital
__________________________________________________________________
Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4185342/

Libyan J Med. 2014 Oct 3;9:25794.

Identification of multidrug-resistant bacteria and Bacillus cereus from
healthcare workers and environmental surfaces in a hospital.

Ali MM1, Aburowes AH1, Albakush AM2, Rzeg MM2, Alrtail A2, Ghenghesh KS3.
Author information
1Department of Biology, Faculty of Science El-Margeb University, Elkhomes,
Libya.
2Department of Laboratories, Microbiology Unit Central Hospital, Zliten,
Libya.
3El-Nakheel Compound, El-Sherouk City, Cairo, Egypt;
ghenghesh_micro@yahoo.com.

Nosocomial (hospital-acquired, healthcare-associated) infections are a
serious health problem worldwide. It is estimated that nosocomial
infections account for 10–15% and more than 40% of hospitalizations in
developed and developing countries, respectively (1). A wide spectrum of
organisms has been associated with nosocomial infections; however, the
most common nosocomial pathogens have been methicillin-resistant
Staphylococcus aureus (MRSA) and drug-resistant gram-negative bacteria
(2). Outbreaks of nosocomial infections initiated by colonized healthcare
workers (HCWs) have been reported previously (3). In addition, several
studies suggest that contaminated environment surfaces (e.g. medical
instruments) may play a role in the transmission of nosocomial pathogens
(4, 5).

In the summer of 2013, premoistened sterile cotton-tipped swabs were used
to collect specimens from the anterior nares and hands of 25 healthcare
workers (HCWs) and from 30 environment surfaces (ES) (medical equipment
[n=10], bed rails [n=10], and floors [n=10]) in the intensive care unit
(ICU) and operation theatre (OT) of Elkhomes hospital, Elkhomes, Libya.
Within 3 h of collection, swabs were plated on blood and MacConkey agars
and incubated at 37°C overnight. Suspected colonies were identified
phenotypically using standard bacteriological procedures (6) and the BD
Phoenix Automated Microbiology System (PAMS, MSBD Biosciences, Sparks, MD,
USA), according to the manufacturer instructions. Antimicrobial
susceptibility of the isolated staphylococci was determined by the disc-
diffusion methods according to the guidelines of the Clinical and
Laboratory Standards Institute (7). Susceptibility of staphylococci to
methicillin was determined by the cefoxitin disc-diffusion method.

We found Staphylococcus spp. (76.4% [42/55]) and Bacillus cereus (27.3%
[15/55]) were the most commonly isolated organisms from HCWs and ES in ICU
and OT of Elkhomes hospital. Three S. aureus were isolated from the
anterior nares of HCWs and one of them was MRSA. However, B. cereus was
isolated from the hands of three HCWs. Table 1 shows species of bacteria
isolated from HCWs and ES in Elkhomes hospital.

Table 1
Bacteria isolated from healthcare workers (HCWs) and environment surfaces
(ES) in Elkhomes hospital

B. cereus is a Gram-positive spore-forming facultative-anaerobic rod-
shaped organism that can be found in different types of soils and widely
distributed in the environment. Although the organism is mainly associated
with outbreaks of food poisoning, several nosocomial outbreaks in ICUs due
to B. cereus have been reported in the past (8–10). Poor disinfection
procedures and contaminated medical equipment were associated with such
outbreaks.

High resistance rates to commonly used antimicrobials in Libya was
observed among 42 staphylococci isolates from Elkhomes hospital; 97.6%
were resistant to ampicillin, 66.7% to amoxicillin–clavulanic acid,
cefotaxime, imipenem, and methicillin, 26.2% to gentamicin, 38.1% to
ciprofloxacin, 71.4% to erythromycin, and 31% to
trimethoprim–sulfamethoxazole. On the other hand, low-resistant rates were
observed to daptomycin (2.4%), linozolid (2.4%), and teicoplanin (9.5%).
Multidrug resistance (resistance to three drugs or more) was detected
among 59.5% (25/42) of staphylococci isolates examined. In addition, both
Acinetobacter spp. isolated in the present investigation were susceptible
only to ciprofloxacin and both were resistant to nearly all other
antimicrobials tested, including aztreonam, piperacillin–tazobactam, and
ertapenem.

In conclusion, we isolated MRSA, MDR bacteria, and B. cereus from HCWs and
ES in Elkhomes Hospital. Thorough environmental cleaning and adequate hand
hygiene of HCWs may help prevent the spread of such organisms to patients,
particularly to those with lowered immunity.

References

1. WHO. Prevention of hospital-acquired infections: a practical guide;
Malta: Department of Communicable Disease, Surveillance and Response;
2002.

2. Rosenthal VD, Maki DG, Salomao R, Moreno CA, Mehta Y, Higuera F, et al.
Device-associated nosocomial infections in 55 intensive care units of 8
developing countries. Ann Intern Med. 2006;145:582–91. [PubMed]

3. Danzmann L, Gastmeier P, Schwab F, Vonberg R-P. Health care workers
causing large nosocomial outbreaks: a systematic review. BMC Infect Dis.
2013;13:98. doi: 10.1186/1471-2334-13-98. [PMC free article] [PubMed]
[Cross Ref]

4. Boyce J. Environmental contamination makes an important contribution to
hospital infection. J Hosp Infect. 2007;65:50–54. [PubMed]

5. Hota B. Contamination, disinfection, and cross-colonization: are
hospital surfaces reservoirs for nosocomial infection? Clin Infect Dis.
2004;39:1182–89. [PubMed]

6. Collee JG, Duguid JP, Fraser AG, Marmion BP. Practical medical
microbiology. 13th ed. Edinburgh: Churchill Livingstone; 1989.

7. Clinical and Laboratory Standards Institute (CLSI) Performance
standards for antimicrobial susceptibility testing; Wayne, PA: Clinical
and Laboratory Standards Institute; 2008. Eighteenth Informational
Supplement. CLSI/NCCLS M100-S18.

8. Bryce EA, Smith JA, Tweeddale M, Andruschak BJ, Maxwell MR.
Dissemination of Bacillus cereus in an intensive care unit. Infect Control
Hosp Epidemiol. 1993;14:459–62. [PubMed]

9. Gray J, George RH, Durbin GM, Ewer AK, Hocking MD, Morgan ME. An
outbreak of Bacillus cereus respiratory tract infections on a neonatal
unit due to contaminated ventilator circuits. J Hosp Infect.
1999;41:19–22. [PubMed]

10. Van Der Zwet WC, Parlevliet GA, Savelkoul PH, Stoof J, Kaiser AM, Van
Furth AM, et al. Outbreak of Bacillus cereus infections in a neonatal
intensive care unit traced to balloons used in manual ventilation. J Clin
Microbiol. 2000;38:4131–36. [PMC free article] [PubMed]
Articles from The Libyan Journal of Medicine are provided here courtesy of
Co-Action Publishing

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4185342/
__________________________________________________________________
________________________________*_________________________________

6. Abstract: HIV, HCV, and Health-Related Harms Among Women Who Inject
Drugs: Implications for Prevention and Treatment
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25978485

J Acquir Immune Defic Syndr. 2015 Jun 1;69 Suppl 1:S176-81.

HIV, HCV, and Health-Related Harms Among Women Who Inject Drugs:
Implications for Prevention and Treatment.

Iversen J1, Page K, Madden A, Maher L.

1*Viral Hepatitis Epidemiology and Prevention Program, The Kirby
Institute, Faculty of Medicine, UNSW Australia, Sydney; †Department of
Epidemiology, Biostatistics and Preventive Medicine, University of New
Mexico Health Sciences Center, University of New Mexico, Albuquerque, NM;
and ‡Australian Injecting and Illicit Drug Users League (AIVL), Canberra.

BACKGROUND: Although an estimated 3.5 million women inject drugs globally,
women are outnumbered 4 to one by men who inject drugs and are often
ignored or overlooked in the development and delivery of prevention and
treatment services for this population. This study aimed to identify key
comorbidities prevalent among women who inject drugs (WWID), consider
factors that contribute to vulnerability of this population, and examine
implications for prevention and treatment.

METHODS: The literature was reviewed to examine the specific challenges
and needs of WWID. We searched health-related bibliographic databases and
grey literature to identify studies conducted among WWID and studies
conducted among people who inject drugs (PWID), where results were
disaggregated by gender and policies/guidelines/reports relevant to WWID.

RESULTS: WWID face a range of unique, gender-specific, and often
additional challenges and barriers. The lack of a targeted focus on WWID
by prevention and treatment services and harm-reduction programs increases
women’s vulnerability to a range of health-related harms, including blood-
borne viral and sexually transmitted infections, injection-related
injuries, mental health issues, physical and sexual violence, poor sexual
and reproductive health, issues in relation to childbearing and child
care, and pervasive stigma and discrimination.

CONCLUSIONS: There is a need to improve the collection and reporting of
gender- disaggregated data on prevalence of key infections and prevention
and treatment service access and program coverage. Women-focussed services
and integrating gender equity and human rights into the harm-reduction
programming will be a prerequisite if improvements in the health, safety,
and well-being of this often invisible and highly vulnerable population
are to be achieved.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: HIV and STI prevalence and injection behaviors among people
who inject drugs in Nairobi: results from a 2011 bio-behavioral study
using respondent-driven sampling
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25398417

AIDS Behav. 2015 Feb;19 Suppl 1:S24-35.

HIV and STI prevalence and injection behaviors among people who inject
drugs in Nairobi: results from a 2011 bio-behavioral study using
respondent-driven sampling.

Tun W1, Sheehy M, Broz D, Okal J, Muraguri N, Raymond HF, Musyoki H, Kim
AA, Muthui M, Geibel S.

1HIV and AIDS Program, Population Council, 4301 Connecticut Avenue, NW,
Suite 280, Washington, DC, 20008, USA, wtun@popcouncil.org.

There is a dearth of evidence on injection drug use and associated HIV
infections in Kenya.

To generate population-based estimates of characteristics and HIV/STI
prevalence among people who inject drugs (PWID) in Nairobi, a cross-
sectional study was conducted with 269 PWID using respondent-driven
sampling.

PWID were predominantly male (92.5 %). An estimated 67.3 % engaged in at
least one risky injection practice in a typical month. HIV prevalence was
18.7 % (95 % CI 12.3-26.7), while STI prevalence was lower [syphilis: 1.7
% (95 % CI 0.2-6.0); gonorrhea: 1.5 % (95 % CI 0.1-4.9); and Chlamydia:
4.2 % (95 % CI 1.2-7.8)].

HIV infection was associated with being female (aOR, 3.5; p = 0.048),
having first injected drugs 5 or more years ago (aOR, 4.3; p = 0.002), and
ever having practiced receptive syringe sharing (aOR, 6.2; p = 0.001).

Comprehensive harm reduction programs tailored toward PWID and their sex
partners must be fully implemented as part of Kenya’s national HIV
prevention strategy.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352193/
__________________________________________________________________
________________________________*_________________________________

8. Abstract: HIV prevalence and risk behaviors among people who inject
drugs in two serial cross-sectional respondent-driven sampling surveys,
Zanzibar 2007 and 2012
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25399032

AIDS Behav. 2015 Feb;19 Suppl 1:S36-45.

HIV prevalence and risk behaviors among people who inject drugs in two
serial cross-sectional respondent-driven sampling surveys, Zanzibar 2007
and 2012.

Matiko E1, Khatib A, Khalid F, Welty S, Said C, Ali A, Othman A, Haji S,
Kibona M, Kim E, Broz D, Dahoma M.

1Division of Global HIV/AIDS, US Centers for Disease Control and
Prevention, CDC Tanzania, c/o US Embassy, 686 Old Bagamoyo Road, PO Box
9123, Dar Es Salaam, Tanzania, iyt9@cdc.gov.

People who inject drugs (PWID) are at higher risk of acquiring HIV due to
risky injection and sexual practices.

We measured HIV prevalence and behaviors related to acquisition and
transmission risk at two time points (2007 and 2012) in Zanzibar,
Tanzania. We conducted two rounds of behavioral and biological
surveillance among PWID using respondent-driven sampling, recruiting 499
and 408 PWID, respectively. Through faceto- face interviews, we collected
information on demographics as well as sexual and injection practices. We
obtained blood samples for biological testing. We analyzed data using
RDSAT and exported weights into STATA for multivariate analysis.

HIV prevalence among sampled PWID in Zanzibar was 16.0 % in 2007 and 11.3
% in 2012; 73.2 % had injected drugs for 7 years or more in 2007, while in
the 2012 sample this proportion was 36.9 %. In 2007, 53.6 % reported
having shared a needle in the past month, while in the 2012 sample, 29.1 %
reported having done so. While 13.3 % of PWID in 2007 reported having been
tested for HIV infection and received results in the past year, this
proportion was 38.0 % in 2012.

Duration of injection drug use for 5 years or more was associated with
higher odds of HIV infection in both samples.

HIV prevalence and indicators of risk and preventive behaviors among PWID
in Zanzibar were generally more favorable in 2012 compared to 2007-a
period marked by the scale-up of prevention programs focusing on PWID.

While encouraging, causal interpretation needs to be cautious and consider
possible sample differences in these two cross- sectional surveys. HIV
prevalence and related risk behaviors persist at levels warranting
sustained and enhanced efforts of primary prevention and harm reduction.

Free Full text
http://link.springer.com/article/10.1007/s10461-014-0929-2/fulltext.html
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Septic internal jugular vein thrombosis caused by
Fusobacterium necrophorum and mediated by a broken needle
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25290582

Scand J Infect Dis. 2014 Dec;46(12):911-5. d

Septic internal jugular vein thrombosis caused by Fusobacterium
necrophorum and mediated by a broken needle.

Galyfos G1, Palogos K, Kavouras N.

1From the Department of Surgery, General Hospital of Chalkis , Chalkis ,
Greece.

The injection of drugs into the neck is unusual and thrombosis of the
internal jugular vein can be a rare clinical presentation with a high risk
for severe complications.

We report a case of a 31-year-old male intravenous drug user presenting
with fever, shortness of breath and right neck oedema.

Laboratory studies revealed elevated inflammation parameters. X-ray
imaging revealed a broken syringe needle inside the soft tissues of the
neck. Computed tomography (CT) scans of the thorax and brain were
unremarkable, while cervical CT showed a fully thrombosed, right internal
jugular vein.

Intravenous antibiotics were initiated, and modified after identification
of an anaerobic Gram-negative oropharynx-derived pathogen (Fusobacterium
necrophorum). The patient was discharged after resolution of symptoms
under treatment. Septic internal jugular vein thrombosis should always be
included in the differential diagnosis of local neck inflammation and
systemic sepsis in intravenous drug users.

Prompt and aggressive antibiotic treatment is vital, whereas the role of
anticoagulation therapy is not definitely known.

KEYWORDS: Fusobacterium necrophorum; Intravenous drug use; Lemierre
syndrome; anticoagulation; septic thrombophlebitis
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Using a multidimensional approach to improve quality related
to students’ hand hygiene practice
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25061953

Nurse Educ. 2014 Nov-Dec;39(6):269-73.

Using a multidimensional approach to improve quality related to students’
hand hygiene practice.

Whitcomb KS1.

1Author Affiliation: Simulation Center Coordinator, Texas Tech University
Health Sciences Center, Abilene.

When faced with a hand hygiene compliance rate of 44% of nursing students
in clinical courses, faculty took on the challenge of meeting the
hospital’s expectation of 90% compliance or greater.

A multidimensional approach to improve students’ hand hygiene compliance
was used to implement interventions in the school’s simulation center and
to create supports in the clinical area.

This approach showed positive, sustainable improvement.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Application of a three-microneedle device for the delivery
of local anesthetics
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25960640

Patient Prefer Adherence. 2015 Apr 21;9:585-8.

Application of a three-microneedle device for the delivery of local
anesthetics.

Ishikawa K1, Fukamizu H1, Takiguchi T1, Ohta Y1, Tokura Y2.

1Department of Plastic and Reconstructive Surgery, Hamamatsu University
School of Medicine, Hamamatsu, Japan.
2Department of Dermatology, Hamamatsu University School of Medicine,
Hamamatsu, Japan.

PURPOSE: We investigated the effectiveness of a newly developed device for
the delivery of local anesthetics in the treatment of axillary osmidrosis
and hyperhidrosis. We developed a device with three fine, stainless steel
needles fabricated with a bevel angle facing outside (“three-microneedle
device” [TMD]) to release a drug broadly and homogeneously into tissue in
the horizontal plane. Use of this device could reduce the risk of
complications when transcutaneous injections are undertaken.

PATIENTS AND METHODS: Sixteen Japanese patients were enrolled. The mean
volume of lidocaine hydrochloride per unit area needed to elicit
anesthesia when using a TMD was compared with that the volume required
when using a conventional 27- gauge needle. The visual analog scale (VAS)
score of needlestick pain and injection-associated pain was also compared.

RESULTS: The mean volume of lidocaine hydrochloride per unit area to
elicit anesthesia using the TMD was significantly lower than that the
volume required when using the conventional 27-gauge needle. The VAS score
of needlestick pain for the TMD was significantly lower than that the VAS
score for the 27-gauge needle.

CONCLUSION: These data suggest that the TMD could be useful for the
delivery of local anesthetics in terms of clinical efficacy and avoidance
of adverse effects.

KEYWORDS: lidocaine; local anesthesia; pain; three-microneedle device;
transcutaneous drug delivery

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410905/
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Progestin-only contraception: injectables and implants
__________________________________________________________________

Open Access:
http://www.bestpracticeobgyn.com/article/S1521-6934(14)00103-5/abstract

Best Pract Res Clin Obstet Gynaecol. 2014 Aug;28(6):795-806.

Progestin-only contraception: injectables and implants.

Jacobstein R1, Polis CB2.

1Engender Health, and Department of Maternal and Child Health, University
of North Carolina Gillings School of Public Health, 440 Ninth Avenue, New
York, NY 10001, USA. Electronic address: Rjacobstein@engenderhealth.org.
2United States Agency for International Health (USAID), and Department of
Epidemiology, Johns Hopkins Bloomberg School of Public Health 1201
Pennsylvania Ave NW, Suite 315, Washington, DC 20004, USA.

Progestin-only contraceptive injectables and implants are highly
effective, longer-acting contraceptive methods that can be used by most
women in most circumstances. Globally, 6% of women using modern
contraception use injectables and 1% use implants.

Injectables are the predominant contraceptive method used in sub-Saharan
Africa, and account for 43% of modern contraceptive methods used. A lower-
dose, subcutaneous formulation of the most widely used injectable, depot-
medroxyprogesterone acetate, has been developed.

Implants have the highest effectiveness of any contraceptive method.
Commodity cost, which historically limited implant availability in low-
resource countries, was markedly lowered between 2012 and 2013.

Changes in menstrual bleeding patterns are extremely common with both
methods, and a main cause of discontinuation.

Advice from normative bodies differs on progestin-only contraceptive use
by breastfeeding women 0-6 weeks postpartum.

Whether these methods are associated with HIV acquisition is a
controversial issue, with important implications for sub-Saharan Africa,
which has a disproportionate burden of both human immunodeficiency virus
(HIV) and maternal mortality.

Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights
reserved.

KEYWORDS: HIV; depot-medroxyprogesterone acetate (DMPA); hormonal
contraception; hormonal implants; injectable contraception; progestin-only
contraception

Open Access:
http://www.bestpracticeobgyn.com/article/S1521-6934(14)00103-5/abstract
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Tattoo and vaccination sites: Possible nest for
opportunistic infections, tumors, and dysimmune reactions
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25160110

Clin Dermatol. 2014 Sep-Oct;32(5):678-84.

Tattoo and vaccination sites: Possible nest for opportunistic infections,
tumors, and dysimmune reactions.

Huynh TN1, Jackson JD2, Brodell RT3.

1University of Alabama Birmingham Medical Center, 1802 6th Ave S,
Birmingham, AL 35233.
2Division of Dermatology, University of Mississippi School of Medicine,
2500 N State St, Jackson, MS 39216.
3Division of Dermatology, University of Mississippi School of Medicine,
2500 N State St, Jackson, MS 39216; Division of Pathology, University of
Mississippi School of Medicine, 2500 N State St, Jackson, MS 39216;
Department of Dermatology, University of Rochester School of Medicine and
Dentistry, 601 Elmwood Ave Rochester, NY 14642. Electronic address:
rbrodell@umc.edu.

Tattoos have gained worldwide popularity in recent years, and vaccinations
are universal preventive measures designed to minimize morbidity
associated with specific pathogens.

Both dermal tattoos and vaccine injections may alter local immune
responses, creating an immunocompromised district on or near the site of
placement. This can lead to the development of opportunistic infections,
benign and malignant tumors, and local dysimmune reactions.

With regard to tattoos, a predominance of warts among a variety of
opportunistic infections has been reported. These warts appear to result
from a local immune dysregulation rather than from direct inoculation or
coincidence. A variety of tumors including basal and squamous cell
carcinomas, keratoacanthomas, and malignant melanoma also have been
reported in association with tattoos. Granulomatous, lichenoid, and
pseudolymphomatous reactions represent the most common dysimmune
reactions.

Vaccination sites similarly provide a setting for both benign and
malignant tumors. Frequent reports of dermatofibrosarcoma protuberans
would be unlikely to result from coincidence. Granuloma annulare and
pseudolymphomatous reactions are relatively common dysimmune reactions.

Copyright © 2014 Elsevier Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

14. Abstract: A 4-month-old baby presenting with dermal necrotizing
granulomatous giant cell reaction at the injection site of 13-valent
pneumococcal conjugate vaccine: a case report
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25152179

J Med Case Rep. 2014 Aug 24;8:285.

A 4-month-old baby presenting with dermal necrotizing granulomatous giant
cell reaction at the injection site of 13-valent pneumococcal conjugate
vaccine: a case report.

Alsuwaidi AR1, Albawardi A, Khan NH, Souid AK.

1Department of Pediatrics, United Arab Emirates University, P,O, Box
17666, Al-Ain, UAE. alsuwaidia@uaeu.ac.ae.

INTRODUCTION: Adjuvants (for example, aluminum salts) are frequently
incorporated in licensed vaccines to enhance the host immune response.
Such vaccines include the pneumococcal conjugate, combinations of
diphtheria- tetanus/acellular pertussis, tetanus- diphtheria/acellular
pertussis, hepatitis B, some Haemophilus influenzae type b, hepatitis A,
and human papillomavirus. These preparations have been associated with
complicated local adverse events, especially if administered
subcutaneously or intradermally in comparison to deep intramuscular
injection. We describe a severe inflammatory reaction at the site of an
injection of 13-valent pneumococcal conjugate vaccine.

CASE PRESENTATION: A 4-month-old Arab baby boy developed dermal
necrotizing granulomatous giant cell reaction at the injection site (right
anterior thigh) of the second dose of 13-valent pneumococcal conjugate
vaccine. Ziehl-Neelsen and periodic-acid Schiff were negative. This
reaction probably resulted from improper intramuscular administration
because the first (at 2 months of age) and third (at 10 months of age)
doses were uneventful.

CONCLUSIONS: Dermal necrotizing granulomatous reactions are a serious
complication of the 13-valent pneumococcal conjugate vaccine. Health care
providers need to administer this preparation deeply into a muscle mass.
Completing the vaccine series is an acceptable option. Physicians are
encouraged to report their experience with completing vaccine series
following adverse events.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4150417/
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Prevalence of antibacterial resistant bacterial contaminants
from mobile phones of hospital inpatients
__________________________________________________________________
Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189012/

Libyan J Med. 2014 Oct 6;9:25451.

Prevalence of antibacterial resistant bacterial contaminants from mobile
phones of hospital inpatients.

Vinod Kumar B1, Hobani YH2, Abdulhaq A3, Jerah AA4, Hakami OM4, Eltigani
M4, Bidwai AK4.

1Department of Medical Lab Technology, College of Applied Medical
Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia;
bvinodkumar2006@yahoo.com.
2Department of Medical Lab Technology, College of Applied Medical
Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia; Medical
Research Center, Jazan University, Jazan, Kingdom of Saudi Arabia.
3Department of Medical Lab Technology, College of Applied Medical
Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia; Deanship of
Scientific Affairs and Research, Jazan University, Jazan, Kingdom of Saudi
Arabia.
4Department of Medical Lab Technology, College of Applied Medical
Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia.

Mobile phones contaminated with bacteria may act as fomites. Antibiotic
resistant bacterial contamination of mobile phones of inpatients was
studied.

One hundred and six samples were collected from mobile phones of patients
admitted in various hospitals in Jazan province of Saudi Arabia.

Eighty-nine (83.9%) out of 106 mobile phones were found to be contaminated
with bacteria. Fifty-two (49.0%) coagulase-negative Staphylococcus, 12
(11.3%) Staphylococcus aureus, 7 (6.6%) Enterobacter cloacae, 3 (2.83%)
Pseudomonas stutzeri, 3 (2.83%) Sphingomonas paucimobilis, 2 (1.8%)
Enterococcus faecalis and 10 (9.4%) aerobic spore bearers were isolated.

All the isolated bacteria were found to be resistant to various
antibiotics. Hence, regular disinfection of mobile phones of hospital
inpatients is advised.

KEYWORDS: Antibacterial resistant; bacterial contaminants; mobile phones

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189012/
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Clinical presentation of hepatitis D in Pakistani children
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25089545

Eur J Gastroenterol Hepatol. 2014 Oct;26(10):1098-103.

Clinical presentation of hepatitis D in Pakistani children.

Abbas Z1, Soomro GB, Hassan SM, Luck NH.

1Department of Hepatogastroenterology, Sindh Institute of Urology and
Transplantation, Karachi, Pakistan.

BACKGROUND: There are limited data on hepatitis D in children. The aim of
this study was to assess the clinical presentation of hepatitis D virus
(HDV) infection in Pakistani children.

MATERIALS AND METHODS: All pediatric patients (age=18 years) seen in the
clinic with chronic HDV infection and detectable HDV RNA (n=48) were
compared with consecutive hepatitis B virus (HBV) monoinfection patients
(n=48). A total of 50 patients underwent liver biopsy: 28 in the HDV group
and 22 in the HBV group.

RESULTS: There was a male preponderance (85.4%). Significant differences
were noted in age (P=0.012), presence of cirrhosis (P=0.004), splenomegaly
(P<0.001), esophageal varices (P=0.006), splenic varices (P=0.022),
alanine aminotransferase, aspartate aminotransferase and ?-glutamyl
transferase levels (P<0.001 each), platelet count (P=0.015), international
normalized ratio (P<0.001), severity of inflammation on liver biopsy (P=
0.007), and advanced fibrosis (P=0.016) in the two groups, indicating more
severe disease in the HDV group. In the HDV group, six patients had normal
ALT, of whom three were positive for hepatitis B e antigen (HBeAg) and HBV
DNA. HBV DNA was detectable in 50% and HBeAg in 52% of the HDV patients.
There were no differences in the severity of liver disease in HBeAg-
reactive and HBeAg-nonreactive patients. Six patients with hepatitis D had
decompensation at the time of presentation; five were HBV DNA positive and
three had reactive HBeAg. Only one patient with HBV monoinfection had
decompensation.

CONCLUSION: Children with HDV infection have more aggressive liver disease
than HBV monoinfection irrespective of HBeAg status.
__________________________________________________________________
________________________________*_________________________________

17. Abstract: Ebola preparedness in the Western Pacific Region, 2014
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410100/

Western Pac Surveill Response J. 2015 Jan 26;6(1):66-72.

Ebola preparedness in the Western Pacific Region, 2014.

Zhen X1, Pavlin B2, Squires RC3, Chinnayah T3, Konings F3, Lee CK3, Ailan
L3; World Health Organization Regional Office for the Western Pacific
Ebola Emergency Support Team.

1Emerging Disease Surveillance and Response Unit, Division of Health
Security and Emergencies, World Health Organization Regional Office for
the Western Pacific, Manila, Philippines . ; Both authors contributed
equally in the writing of this paper.
2Office of the WHO Representative in Papua New Guinea, Port Moresby, Papua
New Guinea . ; Both authors contributed equally in the writing of this
paper.
3Emerging Disease Surveillance and Response Unit, Division of Health
Security and Emergencies, World Health Organization Regional Office for
the Western Pacific, Manila, Philippines .

West Africa is currently experiencing the largest outbreak of Ebola virus
disease (EVD) in history with intense transmission in several affected
countries. For non-affected countries, the best protective measures are
adequate levels of preparedness including vigilant surveillance to detect
cases early and well prepared health systems to ensure rapid containment
of the virus and to avoid further spread. The World Health Organization
Regional Office for the Western Pacific recently conducted two activities:
a web-based EVD preparedness survey and an EVD simulation exercise to
determine the overall level of EVD preparedness in the Region. The survey
and exercise together demonstrate there is a good overall level of
preparedness for a potential imported case of EVD in the Western Pacific
Region. However, several areas still require further strengthening before
the Region can efficiently and effectively respond to potential EVD
events, including laboratory testing arrangements; clinical management and
infection prevention and control; and public health intervention measures,
particularly at points of entry. Importantly, the survey and exercise also
highlight the unique situation in Pacific island countries and emphasize
that special considerations are needed to better support these countries
in EVD preparedness.
Free PMC Article

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410100/
__________________________________________________________________
________________________________*_________________________________

18. News

– Connecticut USA: Malloy wants Congress to fund needle-exchange programs
– USA/Mexico: Binational Police Program in Tijuana Targets HIV Reduction:
Effort also aims to improve safety of officers
– USA: Hepatitis C and Injection Drug Use Top Targets of CDC Prevention
Efforts
– Canada: Illegal dentist’s patients warned of infection risk

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
https://tinyurl.com/nxatkj9

Connecticut USA: Malloy wants Congress to fund needle-exchange programs

By Ken Dixon, CT News (blog), Connecticut USA (19.05.15)

On AIDS Awareness Day, Gov. Dannel P. Malloy today asked Congress to fund
needle-exchange programs to cut the spread of HIV.

Here’s the letter:

“The prescription opioid and heroin epidemic ravaging our country and the
recent outbreak of HIV and hepatitis in the Midwest underscore a federal
policy that is failing our public health system.

The time has come for Congress to reverse its ban on funding syringe
exchange programs.

Infected needles result in 3,000 to 5,000 transmissions of HIV each year
and an estimated 10,000 transmissions of the hepatitis C virus in the
United States.

People who inject drugs make up eight percent of new HIV infections in the
United States, and over 60 percent of new hepatitis C (HCV) infections, an
emerging epidemic in young people.

Syringe exchange programs are a proven and cost-effective approach for
preventing transmission of HIV and viral hepatitis among people who inject
drugs. Data supports that these programs promote public health and safety
by taking syringes off the streets. They also help protect law enforcement
personnel from needle stick injuries, which can result in the transmission
of diseases such as HIV/AIDS and hepatitis C.

Connecticut, a state with legal syringe since 1992, has seen a steep
decline in HIV cases among injection drug users. Injection drug use risk
represented almost 40 percent of newly diagnosed HIV cases in 2002, and
only 8.5 percent of newly diagnosed cases in 2013. The National Alliance
of State and Territorial AIDS Directors recently named a fellowship in
honor of Beth Weinstein, who served as the AIDS Director for the
Connecticut Department of Public Health from 1987-2002. She helped usher
in the law that led to one of the first syringe exchange programs in the
United States. Because of Ms. Weinstein’s leadership, Connecticut’s
syringe exchange program has saved thousands of lives. Still the need for
these services is great.

The current ban on use of federal funds for syringe exchange limits the
success of state funded public health initiatives like Connecticut’s
syringe exchange program. I urge you to work with your colleagues in
Congress to reverse this ban and support the use of federal funds for
syringe exchange.

Sincerely,

Dannel P. Malloy
Governor”
__________________________________________________________________
__________________________________________________________________
https://tinyurl.com/kmgvnzc

USA/Mexico: Binational Police Program in Tijuana Targets HIV Reduction:
Effort also aims to improve safety of officers

Heather Buschman, PhD, UC San Diego Health System, (18.05.15)

Research consistently shows that policing practices, such as confiscating
or breaking needles, are key factors in the HIV epidemic among persons who
inject drugs. Police officers themselves are also at risk of acquiring HIV
or viral hepatitis if they experience needle-stick injuries on the job — a
significant source of anxiety and staff turn-over.

HIV prevention training

A binational team from UC San Diego and the U.S.-Mexico Border Health
Commission, Mexico Section will train Tijuana law enforcement officers on
needle handling and HIV prevention.

A binational team from the University of California, San Diego School of
Medicine and the U.S.-Mexico Border Health Commission, Mexico Section has
launched a new research project aimed at promoting prevention of HIV and
other blood-borne infections. The effort is led by Steffanie Strathdee,
PhD, professor and director of the UC San Diego Global Health Initiative,
Leo Beletsky, JD, MPH, associate professor, and Gudelia Rangel, PhD,
deputy general director for migrant health and executive secretary of the
Mexico Section of the Mexico-United States Border Health Commission, in
partnership with the Tijuana Police Department and Police Academy. The
binational team will offer and evaluate Proyecto ESCUDO (Project SHIELD),
a police education program designed to align law enforcement and HIV
prevention in Tijuana.

“Our unprecedented partnership with the Tijuana police department enables
us to evaluate ESCUDO as a binational effort,” said Strathdee, who is also
associate dean of global health sciences and chief of the Division of
Global Public Health at UC San Diego’s Department of Medicine.

“Research by our team and others shows that police practices are fueling
HIV risks among drug users,” noted Rangel. “This project serves a dual
purpose by aiming to reduce the risk of blood-borne infections among the
police and people who inject drugs in the community.”

Proyecto ESCUDO will monitor trends in occupational needle-sticks and the
attitudes, behaviors and safety precautions taken by Tijuana police.
ESCUDO’s impact on people who inject drugs will be externally validated
through a parallel study of Tijuana drug injectors.

“We are very excited by this unique partnership,” said Secretario
Alejandro Lares, Tijuana’s chief of police. “Proyecto ESCUDO will be the
first study of its kind in the world.”

“These findings are expected to inform future international efforts to
bring police education programs to scale in the growing number of
countries where policing is a documented driver of HIV infection,” said
Beletsky, an associate professor of law and public health at UC San Diego
and at Northeastern University.

Funding support for this project comes from the UC San Diego Center for
AIDS Research, Open Society Foundations and National Institute on Drug
Abuse (grant R01DA039073).

UC San Diego | School of Medicine | Health Sciences
Copyright © 2015 Regents of the University of California.
__________________________________________________________________
__________________________________________________________________
https://tinyurl.com/mjdex46

USA: Hepatitis C and Injection Drug Use Top Targets of CDC Prevention
Efforts

Catherine Kolonko, MD Magazine, USA (13.05.15)

In a continuing effort to curb the spread of hepatitis C among the
riskiest populations, government health officials recently held a webinar
to discuss links between opioid injection drug use and increased cases of
the liver disease.

“We absolutely are having an epidemic of hepatitis C infections but it’s
concentrated among certain states, not ubiquitous among all the states in
the country,” said Jon Zibbell, a medical anthropologist with the US
Centers for Disease Control and Prevention’s Division of Viral Hepatitis.

Surveillance summary data released in recent weeks indicate that out of
the 41 reporting states in the country, there were 12 that together
accounted for roughly 70 percent of the acute hepatitis C cases in 2013.
Those states are California, Florida, Indiana, Kentucky, Massachusetts,
Michigan, New Jersey, New York, North Carolina, Ohio, Pennsylvania, and
Tennessee.

Researchers documented a 75% increase in reported cases of acute hepatitis
C from 2010 to 2012, according to the CDC. The number of new cases is
growing even faster among young people who inject drugs.

Still, many policy makers are unaware that the prescription opioid drug
epidemic is fueling new hepatitis C infections. Hepatitis C is a
bloodborne virus that can spread among people who inject drugs, not just
through sharing tainted needles but also through use of equipment to
prepare drugs for injection, according to Zibbell.

Government data shows that opioid sales have increased since the late
1990s, noted Zibbell, as well as accidental opioid related deaths. Over
the same time period there has been a rise in hepatitis C infections,
indicating that the prevalence of opioid use has been the driver in spread
of the disease, he said.

The climb in new cases of thevirus is disproportionately highest among
young adults ages 18 to 29. It is a demographic that can challenge
prevention efforts among health officials partly because of stigma
associated with the virus and drug use, Zibbell said.

As part of a prevention campaign, the CDC has released a fact sheet about
hepatitis C and injection drug use, which discusses how the virus is
transmitted and notes that the best way to prevent it is to stop using
drugs. It also addresses how to reduce risk of getting infection for
people who are unwilling or unable to stop injecting drugs.

Many people who inject drugs may be unaware that there are other risks
besides sharing a tainted needle. In one study 57% of drug injection users
reported sharing needles but 82% reported sharing equipment, Zibbell said.

“This harkens back to what I was talking about that people are still
sharing equipment,” he said. “I think this is one of the reasons why
needle exchange (programs) has not shown the same reduction in incidence
with hepatitis C as it has with HIV. There are numerous reasons for that
and I think this is one of them.”

It’s important to talk about “bloody fingers” when it comes to preventing
spread of hepatitis C among people who inject drugs, concluded Zibbell. As
mentioned in the CDC fact sheet, blood on fingers and hands can
contaminate the injection site, cotton, “cookers,” ties and swabs enabling
the virus tospread from one person to another.
__________________________________________________________________
__________________________________________________________________
http://www.surreyleader.com/news/302494221.html

Canada: Illegal dentist’s patients warned of infection risk

by Jeff Nagel, Surrey Leader, BBC Canada (04.05.15)

“The College of Dental Surgeons of B.C. says an unlicensed practitioner in
Surrey was apparently reusing single-use anesthetic containers,
potentially exposing patients to blood borne diseases. Image ”

Patients who were treated by an unlicensed dentist operating illegally in
Surrey are being warned they may have been exposed to blood borne
infectious diseases because of lax infection control safeguards.

The College of Dental Surgeons of B.C. said Valentyn Uvarov had been
operating without a dentistry license out of 14275 62 Avenue and its
investigators suspect he was reusing what are supposed to be single-use
containers of injectable anesthetic from one patient to the next.

“This would potentially pose a risk of blood and body fluids transferring
from one client to the rest and associated with that blood borne
infections such as hepatitis B and C and HIV,” said Fraser Health medical
health officer Dr. Michelle Murti.

Uvarov’s patients are advised by Fraser Health to follow up with health
care providers or call 811 to determine if testing is recommended.

Murti said Uvarov didn’t keep patient records, but it’s believed he
treated a relatively small number of mostly Russian-speaking patients,
many of them friends and family.

The College of Dental Surgeons of B.C. obtained a court order April 24
barring him from practising dentistry or claiming to be a dentist.

“We first got wind of him in September of 2013 when a member of the public
alerted us,” college registrar and CEO Jerome Marburg said.

The initial investigation didn’t yield enough evidence, Marburg said, but
by this March investigators had enough for a warrant to search the
premises, turning up more grounds to obtain the court injunction.

Other incidents of rogue dentists operating without a licence in Metro
Vancouver have spawned health warnings before.

Most notorious was Burnaby’s Tung Sheng (David) Wu, who was sentenced to
three months in jail in 2013 for violating a court order against
practising dentistry. He operated in unsanitary conditions at cut-rate
prices.

Four other illegal dental practitioners have been flagged by the dental
surgeons’ college in the past 18 months – Vladimir Shapoval in Coquitlam,
Hua Zheng Huang in Vancouver, Chao Ming Guan in Vancouver and Wei Ming
(Margaret) Du in Vancouver.

Marburg said others are actively under investigation but he wouldn’t guess
at how many illegal dentists operate in the region.

“Most of it’s underground so you just don’t know the scale of it.”

Marburg said new immigrants often don’t realize dentistry is a regulated
profession and can be preyed on by practitioners they find by word of
mouth through their community.

“These people are not good Samaritans. They are purveyors of harm. They
are not do-gooders.”

He said anyone can check a dentist’s status through the college’s website,
and added various low- or no-cost clinic options exist for patients who
can’t afford care.
__________________________________________________________________
________________________________*_________________________________

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]
__________________________________________________________________
________________________________*_________________________________

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
__________________________________________________________________
________________________________*_________________________________

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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