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SIGNpost 00813

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00813 Global Inject Safety Campaign + Abstracts + News 05 August 2015

CONTENTS
1. WHO Injection Safety Policy and Global Campaign
2. The Logistics Handbook: A Practical Guide for the Supply
Chain Management of Health Commodities Now Available in Hindi
3. Abstract: Urban-rural inequality regarding drug prescriptions in
primary care facilities – a pre-post comparison of the National
Essential Medicines Scheme of China
4. Abstract: Estimations of worldwide prevalence of chronic hepatitis B
virus infection: a systematic review of data published between 1965 and
2013
5. Abstract: Healthcare Waste Management Practice in the West Black Sea
Region, Turkey: A Comparative Analysis with the Developed and
Developing Countries
6. Abstract: Medication errors in anesthesia
7. Abstract: Using Pharmacies in a Structural Intervention to Distribute
Low Dead Space Syringes to Reduce HIV and HCV Transmission in People
Who Inject Drugs
8. Abstract: Innovative community-based educational face-to-face
intervention to reduce HIV, HCV and other blood-borne infectious risks
in difficult-to-reach people who inject drugs: results from the ANRS-
AERLI intervention study
9. Abstract: HIV prevalence, estimated incidence, and risk behaviors among
people who inject drugs in Kenya
10. Abstract: HIV, Hepatitis B and C among people who inject drugs: high
prevalence of HIV and Hepatitis C RNA positive infections observed in
Delhi, India
12. Abstract: Safety study of 38,503 intravitreal ranibizumab injections
performed mainly by physicians in training and nurses in a hospital
setting
13. Abstract: Effects and safety of magnesium sulfate on propofol-induced
injection pain, a meta-analysis of randomized controlled trials
14. Abstract: Micro-fractional epidermal powder delivery for improved skin
vaccination
15. Abstract: Postmarketing Safety Profile of Subcutaneous Interferon
Beta-1a Given 3 Times Weekly: A Retrospective Administrative Claims
Analysis
16. Abstract: Future prospect of insulin inhalation for diabetic patients:
The case of Afrezza versus Exubera
17. Abstract: Respiratory source control using a surgical mask: an in
vitro study
18. Abstract: The WHO 2014 global tuberculosis report–further to go
19. Special Purpose Needles Market: Global Industry Growth and Forecast,
2015-2025 by Future Market Insights
20. News
– Ireland: At least 260 deaths in 20 years since hepatitis C scandal
erupted
– Report reveals health consequences of contaminated blood products
supplied by State
– Global: Unsafe Injections Cause 2m Hepatitis Cases Annually – WHO

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1. WHO Injection Safety Policy and Global Campaign

http://www.who.int/injection_safety/global-campaign/en/
__________________________________________________________________
Injection safety policy and global campaign

All of us, at some point in our lives, will have an injection to retain or
restore good health. But sometimes injections that are intended to promote
health do the opposite. This happens when they are given in an unsafe way
– using the same needle or syringe to give injections to more than one
person. Practices like this can lead to the transmission of life-
threatening infections.

According to a new study, unsafe injections are responsible for as many as
33 800 HIV infections, 1.7 million hepatitis B infections and 315 000
hepatitis C infections annually. Both patients and health workers are at
risk through needle injury.

Towards safe injections for all

WHO and close partners – including the Safe Injection Global Network
(SIGN), UNICEF and GAVI, the Vaccine Alliance – have been working actively
together for more than a decade to promote safe injection practices.
Educating policy makers and health workers on the critical importance of
sterile equipment is key. The group’s initial push in 1999 focused
strongly on spurring countries to use only auto-disable syringes for
vaccinating children. Now the spotlight is on the risks associated with
injections into muscle (intramuscular) or skin (subcutaneous or
intradermal) to treat medical conditions; and how to make them safer
through education on safe procedures, elimination of unnecessary
injections and better design of equipment.

Making all injections safe brochure
www.who.int/injection_safety/global-campaign/injection-safety_brochure.pdf
pdf, 554kb

Breakthrough: The new smart syringes

The surest way to protect against unsafe injections is to use injection
devices that have been engineered so they cannot be re-used and don’t lead
to accidental needle stick injuries among health workers.

Re-use prevention features are essentially the same as the auto-disable
features designed for immunization of a single child. The main difference
is that syringes designed for delivering medicines allow the health worker
to adjust the dose as needed and to move the plunger twice when it is
necessary to mix two different medicines in one syringe or for the
reconstitution of vaccines and medicines where appropriate. Some models
include a weak spot in the plunger that causes it to break if the user
attempts to pull back on the plunger after the injection. Others have a
metal clip that blocks the plunger so it cannot be moved back while in
others the needle retracts into the syringe barrel at the end of the
injection.

Syringes are also being engineered with features to protect health workers
from “needle stick” injuries and resulting infections. A sheath or hood
slides over the needle after the injection is completed to protect the
user from being injured accidentally by the needle. These syringes also
generally have a re-use prevention feature.

WHO guideline on the use of safety-engineered syringes for intramuscular,
intradermal and subcutaneous injections in health-care settings
www.who.int/injection_safety/global-campaign/injection-safety_brochure.pdf
pdf, 620kb

Stakeholder support: What needs to happen, who needs to do it

The injection safety policy and global campaign is a three to five year
initiative that engages many public and private sector stakeholders such
as Ministries of Health, international donor programmes, industry players
and umbrella organizations representing injection device manufacturers and
health care workers.

Some critical goals of the initiative include:

Governments

By 2020 transition to the exclusive use, where appropriate, of safety-
engineered injection devices with re-use prevention and sharps (needle)
injury prevention. These devices should meet WHO quality standards.

Set health-system-wide policies and standards for procurement, use and
safe disposal of disposable syringes in situations where they remain
necessary, including in syringe programmes for people who inject drugs.

Develop an implementation strategy for safety syringes’ procurement,
training and education of health workers and sound waste management.

Establish a targeted communications programme and a framework for
evaluating overall progress.

Donors and development partners

Only fund procurement of safety-engineered injection devices in all
projects that include administration of injectable medicines.

Provide funding for ancillary needs, including appropriate quantities of
single-dose diluents and safety boxes, sharps waste management and health
worker training.

Manufacturers

Begin or expand production as soon as possible of safety-engineered
injection devices while maintaining sufficient production of single-use
disposable syringes.

Seek WHO Performance, Quality and Safety prequalification for their
products.

WHO is beginning to pilot test elements of the injection safety policy and
global campaign throughout 2015 and will announce and integrate lessons
learned.

http://www.who.int/injection_safety/global-campaign/en/
__________________________________________________________________
________________________________*_________________________________

2. The Logistics Handbook: A Practical Guide for the Supply
Chain Management of Health Commodities Now Available in Hindi
__________________________________________________________________
Anne Marie Hvid <anne_marie_hvid@jsi.com>

Jul 28 2015

The Logistics Handbook: A Practical Guide for the Supply Chain
Management of Health Commodities has been translated into Hindi and is
now available on the USAID | DELIVER PROJECT website. Emphasizing
health commodities, the handbook offers practical advice on managing
the supply chain. It is intended to help program managers who design,
manage, and assess logistics systems for health programs. In addition,
policymakers, system stakeholders, and anyone working in logistics
will also find it helpful as a system overview and as an overall
approach to supply chain management.

Access the Hindi translation of The Logistics Handbook: A Practical
Guide for the Supply Chain Management of Health Commodities as well as
other resources at http://bit.ly/1LOq3Cn

ANNE MARIE HVID, PMP
Knowledge Management Advisor
USAID | DELIVER PROJECT
deliver.jsi.com

Phone: 703.310.5256
WWW.JSI.COM
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Urban-rural inequality regarding drug prescriptions in
primary care facilities – a pre-post comparison of the National
Essential Medicines Scheme of China

Excerpt: “The urban-rural disparity in the use of parenteral
administration (injections and infusions) increased, albeit at a high
level in both areas (44 %-52 %).”
__________________________________________________________________
Free Open Access Article http://www.equityhealthj.com/content/14/1/58

Int J Equity Health. 2015 Jul 30;14:58.

Urban-rural inequality regarding drug prescriptions in primary care
facilities – a pre-post comparison of the National Essential Medicines
Scheme of China.

Yao Q1, Liu C2, Ferrier JA3, Liu Z4, Sun J5.

1School of Political Science and Public Administration, Wuhan University,
Wuhan, Hubei, 430072, China. yaoqianghero@126.com.
2School of Psychology and Public Health, La Trobe University, Melbourne,
VIC, 3086, Australia. C.Liu@latrobe.edu.au.
3School of Psychology and Public Health, La Trobe University, Melbourne,
VIC, 3086, Australia. Adamm.Ferrier@latrobe.edu.au.
4School of Medicine and Health Management, Tongji Medical College of
Huazhong University of Science and Technology, Wuhan, Hubei, 430030,
China. zy_liu2014@126.com.
5School of Political Science and Public Administration, Wuhan University,
Wuhan, Hubei, 430072, China. sunphh@126.com.

OBJECTIVE: To assess the impact of the National Essential Medicines Scheme
(NEMS) with respect to urban-rural inequalities regarding drug
prescriptions in primary care facilities.

METHODS: A stratified two-stage random sampling strategy was used to
sample 23,040 prescriptions from 192 primary care facilities from 2009 to
2010. Difference-in-Difference (DID) analyses were performed to test the
association between NEMS and urban-rural gaps in prescription patterns.
Between-Group Variance and Theil Index were calculated to measure urban-
rural absolute and relative disparities in drug prescriptions.

RESULTS: The use of the Essential Medicines List (EML) achieved a
compliance rate of up to 90 % in both urban and rural facilities. An
overall reduction of average prescription cost improved economic access to
drugs for patients in both areas. However, we observed an increased urban-
rural disparity in average expenditure per prescription. The rate of
antibiotics and glucocorticoids prescription remained high, despite a
reduced disparity between urban and rural facilities. The average
incidence of antibiotic prescription increased slightly in urban
facilities (62 to 63 %) and reduced in rural facilities (67 % to 66 %).

*** The urban-rural disparity in the use of parenteral administration
(injections and infusions) increased, albeit at a high level in both areas
(44 %-52 %).

CONCLUSION: NEMS interventions are effective in reducing the overall
average prescription costs. Despite the increased use of the EML,
indicator performances with respect to rational drug prescribing and use
remain poor and exceed the WHO/INRUD recommended cutoff values and
worldwide benchmarks. There is an increased gap between urban and rural
areas in the use of parenteral administration and expenditure per
prescription.

Free Open Access Article http://www.equityhealthj.com/content/14/1/58
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Estimations of worldwide prevalence of chronic hepatitis B
virus infection: a systematic review of data published between 1965 and
2013
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26231459

Lancet. 2015 Jul 28. pii: S0140-6736(15)61412-X.

Estimations of worldwide prevalence of chronic hepatitis B virus
infection: a systematic review of data published between 1965 and 2013.

Schweitzer A1, Horn J2, Mikolajczyk RT3, Krause G4, Ott JJ5.

1Department of Epidemiology, Helmholtz Centre for Infection Research,
Braunschweig, Germany; PhD Programme ‘Epidemiology’ Braunschweig-Hannover,
Braunschweig, Germany.
2Department of Epidemiology, Helmholtz Centre for Infection Research,
Braunschweig, Germany; PhD Programme ‘Epidemiology’ Braunschweig-Hannover,
Braunschweig, Germany; Research Group Epidemiological and Statistical
Methods, Helmholtz Center for Infection Research, Braunschweig, Germany.
3Department of Epidemiology, Helmholtz Centre for Infection Research,
Braunschweig, Germany; Research Group Epidemiological and Statistical
Methods, Helmholtz Center for Infection Research, Braunschweig, Germany;
Hannover Medical School, Hannover, Germany.
4Department of Epidemiology, Helmholtz Centre for Infection Research,
Braunschweig, Germany; Hannover Medical School, Hannover, Germany.
5Department of Epidemiology, Helmholtz Centre for Infection Research,
Braunschweig, Germany; Hannover Medical School, Hannover, Germany.
Electronic address: Joerdis.Ott@helmholtz-hzi.de.

BACKGROUND: The quantification of the burden of disease attributable to
hepatitis B virus (HBV) infection and the adaptation of prevention and
control measures requires knowledge on its prevalence in the general
population. For most countries such data are not routinely available. We
estimated the national, regional, and global prevalence of chronic HBV
infection.

METHODS: For this systematic review and pooled analysis, we searched for
data on prevalence of chronic HBV infection published between Jan 1, 1965,
and Oct 23, 2013, in the databases Medline, Embase, CAB Abstracts (Global
health), Popline, and Web of Science. We included studies reporting the
hepatitis B surface antigen (HBsAg) serological marker of chronic HBV
infection in non-high-risk groups and extracted data into a customised
database. For each country, we calculated HBsAg prevalence estimates and
95% CIs weighted by study size. We extrapolated prevalence estimates to
population sizes in 2010 to obtain the number of individuals with chronic
HBV infection.

FINDINGS: Of the 17 029 records screened, 1800 report on the prevalence of
HBsAg covering 161 countries were included. HBsAg seroprevalence was 3·61%
(95% CI 3·61-3·61) worldwide with highest endemicity in countries of the
African region (total 8·83%, 8·82-8·83) and Western Pacific region (total
5·26%, 5·26-5·26). Within WHO regions, prevalence ranged from 0·20%
(0·19-0·21; Mexico) to 13·55% (9·00-19·89; Haiti) in the Americas, to
0·48% (0·12-1·90; the Seychelles) to 22·38% (20·10-24·83; South Sudan) in
the African region. We estimated that in 2010, globally, about 248 million
individuals were HBsAg positive.

INTERPRETATION: This first global assessment of country-level population
prevalence of chronic HBV infection found a wide variation between
countries and highlights the need for continued prevention and control
strategies and the collection of reliable epidemiologic data using
standardised methodology.

FUNDING: World Health Organization.

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

5. Abstract: Healthcare Waste Management Practice in the West Black Sea
Region, Turkey: A Comparative Analysis with the Developed and
Developing Countries
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26223409

J Air Waste Manag Assoc. 2015 Jul 29.

Healthcare Waste Management Practice in the West Black Sea Region, Turkey:
A Comparative Analysis with the Developed and Developing Countries.

Ciplak N1, Kaskun S.

1a Faculty of Engineering, Department of Environmental Engineering ,
University of Karabuk , Karabuk , Turkey.

The need for proper healthcare waste management has been a crucial issue
in many developing countries as it is in Turkey.

The regulation regarding healthcare wastes in Turkey was updated in 2005
in accordance with the European Union waste directives, but it still falls
behind meeting the requirements of current waste treatment technologies.

Therefore this study aims to reveal deficiencies, inconsistencies and
improper applications of healthcare waste management in the western part
of the Turkish Black Sea region.

In this study, it was revealed that nearly 1 million people live in the
region, resulting in 5 million hospital admissions annually. All the
healthcare waste produced (1 000 tons year-1) is treated in an autoclave
plant. However treating some categories of healthcare wastes in autoclave
units mismatches with the EU waste regulations as alternative treatment
technologies are not technically capable to treat all types of healthcare
wastes.

A proper waste management system, therefore, requires an internal
segregation scheme to divert these wastes from the main healthcare waste
stream.

The existing malpractice in the region could cause serious health problems
if no measure is taken urgently. It is expected that healthcare waste
management in the region and then in all across Turkey will be improved
with significant deficiencies and inconsistencies pointed out in this
research.

Implications

In developed countries, specific rules and regulations have already been
implemented along with the recommendations for handling of healthcare
waste.

However in Turkey, these wastes are treated in autoclave units, which
mismatches with the European Union waste regulations as alternative
treatment technologies are not technically capable to treat all types of
healthcare wastes. The existing malpractice could cause serious health
problems if no measure is taken urgently.

The authors demonstrated the existing status of Turkish waste management
and revealed deficiencies, inconsistencies and improper applications in
comparison with developed and developing nations to align Turkish practice
to European Union requirements.

KEYWORDS: Health problems; Healthcare waste management; Segregation
scheme; Waste regulations; Waste treatment technologies
__________________________________________________________________
__________________________________________________________________

6. Abstract: Medication errors in anesthesia
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26062316

Med Pract Manage. 2015 Mar-Apr;30(6 Spec No):41-3.

Medication errors in anesthesia.

Prabhakar A, Malapero RJ, Gabriel RA, Kaye AD, Elhassan AO, Nelson ER,
Bates DW, Urman RD.

Medication errors represent one of the most common causes of morbidity and
mortality in hospitalized patients. Anesthesia has specific medication-
related risks; providers must administer many potent intravenous
medications quickly, often with minimal to no supervision.

Well-described reasons for medication administration errors in anesthesia
include medication ampoules with similar appearance and packaging,
clinician inattention, ineffective communication, fatigue, and haste.

Technologies that are used widely in other parts of the hospital, such as
barcoding, are a challenge to implement in anesthesia, and systemic
approaches, including color-coding of syringe labels and barcoding
technology of syringes, have been evaluated with mixed results.

Emphasis should be placed on implementing forcing functions when possible,
utilizing technology, standardization, and education about the need for
awareness in specific situations.

More studies need to be done to define the epidemiology of medication
errors in anesthesia, and more importantly, to assess interventions for
preventing them.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Using Pharmacies in a Structural Intervention to Distribute
Low Dead Space Syringes to Reduce HIV and HCV Transmission in People
Who Inject Drugs
__________________________________________________________________

Free Full Text
http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2015.302581

Am J Public Health. 2015 Jun;105(6):1066-71.

Using Pharmacies in a Structural Intervention to Distribute Low Dead Space
Syringes to Reduce HIV and HCV Transmission in People Who Inject Drugs.

Oramasionwu CU1, Johnson TL, Zule WA, Carda-Auten J, Golin CE.

1Christine U. Oramasionwu and Terence L. Johnson are with the UNC Eshelman
School of Pharmacy, University of North Carolina, Chapel Hill. William A.
Zule is with the Substance Abuse Treatment Evaluations and Interventions
Program, RTI International, Research Triangle Park, NC. Jessica Carda-
Auten is with the UNC Center for AIDS Research and the UNC Institute for
Global Health and Infectious Diseases, University of North Carolina,
Chapel Hill. Carol E. Golin is with the Gillings School of Global Public
Health and the School of Medicine, University of North Carolina, Chapel
Hill.

Ongoing injection drug use contributes to the HIV and HCV epidemics in
people who inject drugs. In many places, pharmacies are the primary source
of sterile syringes for people who inject drugs; thus, pharmacies provide
a viable public health service that reduces blood-borne disease
transmission.

Replacing the supply of high dead space syringes with low dead space
syringes could have far-reaching benefits that include further prevention
of disease transmission in people who inject drugs and reductions in
dosing inaccuracies, medication errors, and medication waste in patients
who use syringes.

We explored using pharmacies in a structural intervention to increase the
uptake of low dead space syringes as part of a comprehensive strategy to
reverse these epidemics.

Free Full Text
http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2015.302581
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Innovative community-based educational face-to-face
intervention to reduce HIV, HCV and other blood-borne infectious risks
in difficult-to-reach people who inject drugs: results from the ANRS-
AERLI intervention study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26234629

Addiction. 2015 Aug 1.

Innovative community-based educational face-to-face intervention to reduce
HIV, HCV and other blood-borne infectious risks in difficult-to-reach
people who inject drugs: results from the ANRS-AERLI intervention study.

Roux P1,2,3, Le Gall JM4, Debrus M5, Protopopescu C1,2,3, Demoulin B1,2,3,
Lions C1,2,3, Haas A4, Mora M1,2,3, Spire B1,2,3,4, Suzan-Monti M1,2,3,4,
Carrieri MP1,2,3.

1INSERM U912 (SESSTIM), Marseille, France.
2Aix Marseille Université, IRD, UMR-S912, Marseille, France.
3ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d’Azur,
Marseille, France.
4AIDES, France.
5Médecins du Monde, Paris, France.

AIMS: To study the effectiveness of an educational intervention on risks
associated with drug injection, comparing primary (unsafe HIV-HCV
practices) and secondary (local complications at injecting site) endpoints
in Harm Reduction (HR) programs offering this intervention versus HR
programs not offering it.

STUDY DESIGN: This non-random clustered intervention study was conducted
in 9 intervention groups (programs offering the intervention) and 8
control groups (programs not offering it). Each participant was followed
up through a phone interview at enrolment, at 6?months and 12?months.

SETTING: The study took place in 17 cities throughout France.

PARTICIPANTS: Of the 271 participants, 144 were enrolled in the
intervention group and 127 in the control group. Of the latter, 113
received at least one educational session.

INTERVENTION: A series of participant-centred face-to-face educational
sessions. Each session included direct observation by trained NGO staff or
volunteers of participants’ self-injecting the psychoactive product they
habitually used; analysis by the trained NGO staff or volunteers of the
participant’s injecting practices, identification of injection-related
risks and explanation of safer injecting practices; and an educational
exchange on the individual participant’s injection practices and the
questions he or she asked.

MEASURES: Primary and secondary outcomes were ” at least one unsafe HIV-
HCV practice” and at least one injection-related complication (derived
from a checklist).

FINDINGS: The proportion of participants with at least one unsafe HIV-HCV
practice in the intervention group decreased significantly, from 44% at M0
to 25% at M6, as well as complications at the injection site (from 66% to
39% at M12) while in the control group it remained mostly stable.
Multivariate probit analyses showed that the intervention group
experienced a significant reduction in unsafe HIV-HCV practices at M6
(coefficient (95%CI)?=?-0.73 (-1.47 to 0.01)) and in injection-related
complications at M12 (coefficient (95%CI)?=?-1.01 (-1.77 to -0.24)),
compared with the control group.

CONCLUSIONS: An inexpensive and easily implemented educational
intervention on risks associated with drug injection significantly reduces
unsafe HIV-HCV transmission practices and injection-related complications.
This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.

KEYWORDS: Education; HCV; HIV; injecting drug user; intervention; local
complications
__________________________________________________________________
________________________________*_________________________________

9. Abstract: HIV prevalence, estimated incidence, and risk behaviors among
people who inject drugs in Kenya
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26226249

J Acquir Immune Defic Syndr. 2015 Jul 28.

“HIV prevalence, estimated incidence, and risk behaviors among people who
inject drugs in Kenya”.

Kurth AE1, Cleland CM, Des Jarlais DC, Musyoki H, Lizcano JA, Chhun N,
Cherutich P.

1*New York University College of Nursing, New York, NY, USA; §The Baron
Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth
Israel, New York, NY, USA; ¶National AIDS & STI Control Programme
(NASCOP), Nairobi, Kenya.

OBJECTIVE: HIV infection in sub-Saharan Africa increasingly occurs among
people who inject drugs (PWID). Kenya is one of the first to implement a
national needle and syringe program (NSP). Our study undertook a baseline
assessment as part of evaluating NSP in a seek, test, treat, and retain
approach.

METHODS: Participants enrolled May-December 2012 from 10 sites.
Respondent-driven sampling was used to reach n=1,785 PWID for HIV-1
prevalence and viral load determination and survey data.

RESULTS: Estimated HIV prevalence, adjusted for differential network size
and recruitment relationships, was 14.5% in Nairobi (95% CI 10.8-18.2) and
20.5% in the Coast region (95% CI 17.3-23.6). Viral load (log10
transformed) in Nairobi ranged from 1.71 to 6.12 (median 4.41; IQR
3.51-4.94) and in the Coast from 1.71 to 5.88 (median 4.01; IQR
3.44-4.72). Using log10 viral load 2.6 as a threshold for HIV viral
suppression, the percentage of HIV-infected participants with viral
suppression was 4.2% in Nairobi and 4.6% in the Coast. Heroin was the most
commonly injected drug in both regions, used by 93% of participants in the
past month typically injecting 2-3 times/day. Receptive needle/syringe
sharing at last injection was more common in Nairobi (23%) than the Coast
(4%). Estimated incidence among new injectors was 2.5/100 person-years in
Nairobi and 1.6/100 person-years in the Coast.

CONCLUSION: The HIV epidemic is well-established among PWID in both
Nairobi and Coast regions. Public health scale implementation of
combination HIV prevention has the potential to greatly limit the epidemic
in this vulnerable and bridging population.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: HIV, Hepatitis B and C among people who inject drugs: high
prevalence of HIV and Hepatitis C RNA positive infections observed in
Delhi, India
__________________________________________________________________
Free Open Access http://www.biomedcentral.com/1471-2458/15/726

BMC Public Health. 2015 Jul 30;15:726.

HIV, Hepatitis B and C among people who inject drugs: high prevalence of
HIV and Hepatitis C RNA positive infections observed in Delhi, India.

Ray Saraswati L1, Sarna A2, Sebastian MP3, Sharma V4, Madan I5, Thior I6,
Pulerwitz J7,8, Tun W9.

1Population Council, Zone 5A, India Habitat Centre, New Delhi, 110003,
India. lsaraswati@popcouncil.org.
2Population Council, Zone 5A, India Habitat Centre, New Delhi, 110003,
India. asarna@popcouncil.org.
3Population Council, Zone 5A, India Habitat Centre, New Delhi, 110003,
India. mphsebastian@gmail.com.
4Population Council, Zone 5A, India Habitat Centre, New Delhi, 110003,
India. vs.vartikas@gmail.com.
5Sahara Center for Residential Care and Rehabilitation, New Delhi, India.
iramadan@gmail.com.
6ARISE Project, PATH, Washington, DC, USA. ithior@path.org.
7ARISE Project, PATH, Washington, DC, USA. jpulerwitz@popcouncil.org.
8Population Council, Washington, DC, USA. jpulerwitz@popcouncil.org.
9Population Council, Washington, DC, USA. wtun@popcouncil.org.

BACKGROUND: India has large PWID (persons who inject drugs) population
estimated at 177,000. PWIDs are at high risk for HIV, Hepatitis B (HBV)
and Hepatitis C (HCV) infections. We report the prevalence of HIV, HBV and
HCV infections and correlates of HIV-HCV co-infection among male PWIDs in
Delhi.

METHODS: 3748 male PWIDs were recruited for a longitudinal HIV incidence
study. Participants were tested for HBV and HCV infections at their first
follow- up visit (FV1) using serum HBV-surface antigen, and HCV-antibody
tests followed by HCV RNA PCR, respectively. All PWIDs who were HIV-
negative at enrollment, were re-tested for HIV at FV1. Multinomial
logistic regression was employed to identify predictors of HIV, HCV and
HIV-HCV co-infection.

RESULTS: Overall prevalence of HIV, HBV and HCV among 2,292 participants
tested at FV1 was 25.9 %, 9.7 % and 53.7 %, respectively. 6.4 % of the
participants had HIV mono-infection, 34.1 % had HCV mono-infection, and
19.6 % had HIV- HCV co-infection. 26 % of HIV-positive participants
without HCV were HBsAg positive. In the regression model, having practiced
at least one risky injection in the past month (relative risk ratio (RRR):
1.38; 95 % CI: 1.01-1.89) and not knowing his own HIV status (RRR: 1.65,
95 % CI: 1.25-2.17) were independent predictors for HIV-HCV co-infection.
Longer duration of drug injections was associated with a higher likelihood
of HCV mono-infection (2-5 years RRR: 2.13; 6-10 years RRR: 2.74; =11
years RRR: 3.14) and HIV-HCV co-infection (2-5 years RRR: 5.14; 6-10 years
RRR: 8.53; >11 years RRR: 8.03). Higher frequency of injection days/month
was associated with a higher likelihood of HCV mono-infection (=10
days/month RRR: 1.61; 11-20 days/month RRR: 3.15; 21-30 days/month RRR:
3.47) and HIV-HCV co-infections (=10 days/month RRR: 2.26; 11-20
days/month RRR: 3.46; 21-30 days/month RRR: 4.83).

CONCLUSIONS: We report a high prevalence of HIV, HCV and HIV-HCV co-
infection among male PWIDs in Delhi. A tenth of the participants were
HBsAg positive. Targeted Intervention programs should make HBV/HCV
testing, prevention and care more accessible for PWIDs.

Free Open Access http://www.biomedcentral.com/1471-2458/15/726
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Injection and sexual HIV/HCV risk behaviors associated with
nonmedical use of prescription opioids among young adults in New York
City
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25124258

J Subst Abuse Treat. 2015 Jan;48(1):13-20.

Injection and sexual HIV/HCV risk behaviors associated with nonmedical use
of prescription opioids among young adults in New York City.

Mateu-Gelabert P1, Guarino H2, Jessell L2, Teper A2.
Author information
1National Development and Research Institutes, Inc., New York, NY, USA.
Electronic address: mateu-gelabert@ndri.org.
2National Development and Research Institutes, Inc., New York, NY, USA.

Prevalence of nonmedical prescription opioid (PO) use has increased
markedly in the U.S. This qualitative study explores the drug-use and
sexual experiences of nonmedical PO users as they relate to risk for HIV
and HCV transmission.

Forty-six New York City young adult nonmedical PO users (ages 18-32)
completed in-depth, semi-structured interviews. Despite initial
perceptions of POs as less addictive and safer than illegal drugs, PO
misuse often led to long-term opioid dependence and transition to heroin
use and drug injection.

Injectors in the sample reported sporadic syringe-sharing, frequent
sharing of non-syringe injection paraphernalia and selective sharing with
fellow injectors who are presumed “clean” (uninfected).

Participants reported little knowledge of HCV injection- related risks and
safer injection practices. They also reported engaging in unprotected sex
with casual partners, exchange sex and group sex, and that PO misuse
increases the risk of sexual violence.

Prevention efforts addressing HIV/HCV risk should be targeted to young
nonmedical PO users.

Copyright © 2014 Elsevier Inc. All rights reserved.

KEYWORDS: HIV/HCV risk; Injection risk behavior; Prescription opioid
misuse; Sexual risk behavior
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Safety study of 38,503 intravitreal ranibizumab injections
performed mainly by physicians in training and nurses in a hospital
setting
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25403735

Acta Ophthalmol. 2015 Mar;93(2):122-5.

Safety study of 38,503 intravitreal ranibizumab injections performed
mainly by physicians in training and nurses in a hospital setting.

Hasler PW1, Bloch SB, Villumsen J, Fuchs J, Lund-Andersen H, Larsen M.

1Department of Ophthalmology, University Hospital Basel, Basel,
Switzerland.

PURPOSE: To evaluate and to compare the safety of intravitreal ranibizumab
injections performed by physicians and nurses at a single large hospital
clinic in Denmark during 5 years.

DESIGN: Retrospective, interventional, non-comparative study.

METHODS: SETTING: All eyes that underwent a protocolized ranibizumab
injection procedure performed in an operating room mainly by nurses and
physicians in their first year of ophthalmology training.

STUDY POPULATION: A total of 4623 eyes in 3679 patients with subretinal
neovascularization secondary to a variety of retinal diseases, mainly
neovascular AMD treated with intravitreal therapy (IVT) at the Glostrup
Hospital from January 1, 2007 to December 31, 2011 with a mean follow-up
of 12.2 months (95% confidence interval: 11.9-12.6).

MAIN OUTCOME MEASURES: Frequency of endophthalmitis, traumatic cataract,
intraocular haemorrhage and retinal detachment from 2007 to 2012.

RESULTS: Overall, 38,503 intravitreal ranibizumab injections were
performed in 4623 eyes. Injections were performed by nurses (32.5%),
ophthalmology residents (61.3%) and vitreoretinal surgeons (6.2%). Severe
complications to treatment were observed in 17 eyes: Endophthalmitis (14
eyes, 0.36 ‰ of injections whereof seven cases were culture-positive),
anterior uveitis (one eye, 0.026 ‰), traumatic cataract (one eye, 0.026 ‰)
and rhegmatogenous retinal detachment (one eye, 0.026 ‰). Retinal pigment
epithelial tears were registered in 14 eyes in 14 subjects within the
first year of treatment with ranibizumab. Of the 14 cases of
endophthalmitis, seven occurred within a period of 5 weeks in 2010 when
occasionally abnormal needle outflow resistance prompted the needle
replacement in the operating room. No drug-related adverse events were
recorded.

CONCLUSIONS: Intravitreal ranibizumab injection performed by nurses and
physicians without preinjection topical antibiotics was associated with a
rate of injection-related adverse events of 0.44 ‰.

© 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John
Wiley & Sons Ltd.

KEYWORDS: case series; non-comparative; observational; retrospective

Comment in

Translational public health care perspective: intravitreal treatment of
neovascular age-related macular degeneration has revolutionized clinical
ophthalmology. [Acta Ophthalmol. 2015]
http://www.ncbi.nlm.nih.gov/pubmed/25688486
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Effects and safety of magnesium sulfate on propofol-induced
injection pain, a meta-analysis of randomized controlled trials
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4509164/

Int J Clin Exp Med. 2015 May 15;8(5):6813-21. eCollection 2015.

Effects and safety of magnesium sulfate on propofol-induced injection
pain, a meta-analysis of randomized controlled trials.

Li M1, Zhao X2, Zhang L3, Niu X3, Guo T3, Yang B4, Liu Z5.
Author information
1Department of Anesthesiology, Shanghai First Maternity and Infant
Hospital, Tongji University School of Medicine Shanghai, China ;
Department of Anesthesiology, Shanghai Tenth People’s Hospital, Tongji
University School of Medicine Shanghai, China.
2Department of Anesthesiology, Shanghai East Hospital, Tongji University
School of Medicine Shanghai, China.
3Department of Anesthesiology, Shanghai Tenth People’s Hospital, Tongji
University School of Medicine Shanghai, China.
4Department of Orthopedics, The Huangdao Affiliated Hospital of Qingdao
University, Qingdao University School of Medicine Qingdao, China.
5Department of Anesthesiology, Shanghai First Maternity and Infant
Hospital, Tongji University School of Medicine Shanghai, China.

BACKGROUND: Propofol is the most widely used drug in the induction of
general anesthesia, however its disadvantages of injection pain has always
been a problem for clinical anesthetists. Many strategies have been
proposed and magnesium sulfate is one of them. This is the first meta-
analysis studies evaluating effects of magnesium sulfate pretreatment for
preventing propofol-induced injection pain.

METHODS: We searched MEDLINE, EMBASE, Google scholar and the Cochrane
Database of Systematic Review databases for randomized controlled trials
(RCTs) that evaluated the prophylactic effect of magnesium sulfate on
propofol injection pain. Meta-analyses were performed using RevMan 5.3
software.

RESULTS: Five RCTs involving 545 participants were included. Magnesium
sulfate allows more patients experiencing no pain or mild pain during
propofol injection ([RR] 2.70, 95% [CI] 1.10-6.64, P=0.03, 2.12,95% CI
1.46-3.08, P < 0.0001, respectively). And the number of patients with
severe pain (RR 0.12, 95% CI 0.06-0.25, P < 0.00001) on injecting propofol
were significantly decreased. However, no statistical significance was
found between magnesium sulfate group and placebo group in moderate pain
(RR 0.22, 95% CI 0.05-0.97, P=0.05).

CONCLUSION: Our meta-analysis suggested that pretreatment with magnesium
sulfate intravenously before injecting propofol allow more patients to
experiencing no pain during propofol injection and can reduce the
intensity of injection pain effectively without causing any adverse
effect.

KEYWORDS: Pain; injection; magnesium sulfate; propofol

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4509164/
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Micro-fractional epidermal powder delivery for improved skin
vaccination
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25135790

J Control Release. 2014 Oct 28;192:310-6.

Micro-fractional epidermal powder delivery for improved skin vaccination.

Chen X1, Kositratna G2, Zhou C3, Manstein D2, Wu MX4.

1Wellman Center for Photomedicine, Massachusetts General Hospital,
Department of Dermatology, Harvard Medical School, Boston, MA, USA.
Electronic address: xchen14@partners.org.
2Cutaneous Biology Research Center, Department of Dermatology,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
3Wellman Center for Photomedicine, Massachusetts General Hospital,
Department of Dermatology, Harvard Medical School, Boston, MA, USA.
4Wellman Center for Photomedicine, Massachusetts General Hospital,
Department of Dermatology, Harvard Medical School, Boston, MA, USA;
Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA,
USA. Electronic address: mwu2@partners.org.

Skin vaccination has gained increasing attention in the last two decades
due to its improved potency compared to intramuscular vaccination. Yet,
the technical difficulty and frequent local reactions hamper its broad
application in the clinic.

In the current study, micro-fractional epidermal powder delivery (EPD) is
developed to facilitate skin vaccination and minimize local adverse
effects. EPD is based on ablative fractional laser or microneedle
treatment of the skin to generate microchannel (MC) arrays in the
epidermis followed by topical application of powder drug/vaccine-coated
array patches to deliver drug/vaccine into the skin. The novel EPD
delivered more than 80% sulforhodamine b (SRB) and model antigen ovalbumin
(OVA) into murine, swine, and human skin within 1h.

EPD of OVA induced anti-OVA antibody titer at a level comparable to
intradermal (ID) injection and was much more efficient than tape stripping
in both delivery efficiency and immune responses. Strikingly, the micro-
fractional delivery significantly reduced local side effects of LPS/CpG
adjuvant and BCG vaccine, leading to complete skin recovery. In contrast,
ID injection induced severe local reactions that persisted for weeks.
While reducing local reactogenicity, EPD of OVA/LPS/CpG and BCG vaccine
generated a comparable humoral immune response to ID injection. EPD of
vaccinia virus encoding OVA induced significantly higher and long-lasting
interferon ?-secreting CD8+ T cells than ID injection.

In conclusion, EPD represents a promising technology for needle-free,
painless skin vaccination with reduced local reactogenicity and at least
sustained immunogenicity.

Copyright © 2014 Elsevier B.V. All rights reserved.

KEYWORDS: Laser; Local reactogenicity; Microneedle; Powder delivery; Skin
vaccination; Vaccine adjuvant
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Postmarketing Safety Profile of Subcutaneous Interferon
Beta-1a Given 3 Times Weekly: A Retrospective Administrative Claims
Analysis
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26233537

J Manag Care Spec Pharm. 2015 Aug;21(8):650-60.

Postmarketing Safety Profile of Subcutaneous Interferon Beta-1a Given 3
Times Weekly: A Retrospective Administrative Claims Analysis.

Smith MY1, Sabidó-Espin M, Trochanov A, Samuelson M, Guedes S, Corvino FA,
Richy FF.

1Merck KGaA, Frankfurter Straße 250, Darmstadt, Germany 64293. florent-
frederic.richy@merckgroup.com.

BACKGROUND: Health insurance administrative claims databases represent a
valuable source of information regarding the safety profile of marketed
products as used in actual clinical practice in a broader range of
patients than that assessed in clinical trials. Interferon beta-1a
administered subcutaneously 3 times weekly (IFN ß-1a SC tiw), which was
approved in 2002 by the FDA for the treatment of relapsing-remitting
multiple sclerosis (MS), has over a decade of postmarketing experience. To
date, however, its postmarketing safety profile has not been described
using a real-world evidence source such as administrative claims data.

OBJECTIVE: To describe the safety profile of IFN ß-1a SC tiw as presented
in its U.S. prescribing information (PI) for patients with MS initiating
IFN ß-1a SC tiw therapy using data from U.S. health care administrative
claims databases.

METHODS: This study featured an observational and retrospective “new
start” cohort design using data from the Truven MarketScan Commercial and
Medicare Supplemental health care administrative claims databases.
Patients were eligible for inclusion if they were aged =?18 years; had =?1
diagnosis for MS recorded between January 1, 2006, and December 31, 2012;
had =?2 prescriptions for IFN ß-1a SC tiw; and had =?90 days of continuous
eligibility pre-index date and =?180 days of continuous eligibility post-
index date. Patients with a prescription for IFN ß-1a SC tiw without a MS
diagnosis were excluded. Patients were followed from first prescription
for IFN ß-1a SC tiw (index date) until date of therapy switch or
discontinuation, end of insurance eligibility, or end of observation
period. Adverse events (AEs) examined were those listed in the Warnings
and Precautions, Adverse Reactions, and Postmarketing Experience sections
of the 2014 U.S. PI. Outcomes of interest were identified at the Medical
Dictionary for Regulatory Activities (version 17.1) Preferred Term level
and then coded to the corresponding ICD-9-CM criteria. Descriptive
analyses of patient demographic, health status, health care utilization,
and adherence status were performed, and incidence rates (IRs) per 100
person-years of labeled AEs with corresponding 95% CIs were calculated.
The IR calculation was based on events that presented after therapy
initiation and that were not present in the 90-day pre-index period.

RESULTS: The top 6 AEs included influenza-like symptoms (IR?=?15.65, 95%
CI?=?14.96-16.36); malaise (IR?=?15.33, 95% CI?=?14.65-16.04; fatigue
(IR?=?15.02, 95% CI?=?14.35-15.72); abdominal pain (IR?=?10.18, 95%
CI?=?9.67-10.70); chest pain (IR?=?8.48, 95% CI?=?8.03-8.95); and
depression (IR?=?7.75, 95% CI?=?7.32-8.20). In contrast, the 6 lowest IRs
were for maculo-papular rash (IR?=?0.01, 95% CI?=?0.00-0.04; injection-
site necrosis (IR?=?0.01, 95% CI?=?0.00-0.03); erythema multiforme
(IR?=?0.01, 95% CI?=?0.00-0.04); hypoesthesia (IR?=?0.00, 95%
CI?=?0.00-0.02); Stevens-Johnson Syndrome (IR?=?0.00, 95% CI?=?0.00-0.02);
and xerophthalmia (IR?=?0.00, 95% CI?=?0.00-0.02).

CONCLUSIONS: Study results show strong convergence between the real-world
safety profile of IFN ß-1a SC tiw and its U.S. label.

Our findings demonstrate the value of using real-world evidence obtained
from administrative claims to complement clinical trial and postmarketing
surveillance data in order to characterize the safety profile of
established products, such as IFN ß-1a SC tiw, in the postmarketing
context.
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Future prospect of insulin inhalation for diabetic patients:
The case of Afrezza versus Exubera
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26222134

J Control Release. 2015 Jul 26. pii: S0168-3659(15)30038-9.

Future prospect of insulin inhalation for diabetic patients: The case of
Afrezza versus Exubera.

Al-Tabakha MM1.

1Pharmaceutical Sciences Unit, College of Pharmacy, Al-Ain University of
Science and Technology, P.O. Box 64141, Al Ain, United Arab Emirates.
Electronic address: Moawia.Altabakha@aau.ac.ae.

The current review was designed to compare between the insulin inhalation
systems Exubera and Afrezza and to investigate the reasons why Exubera was
unsuccessful, when Afrezza maker is expecting their product to be
felicitous.

In January 2006, Pfizer secured FDA and EC approval for the first of its
kind, regular insulin through Exubera inhaler device for the management of
type 1 and 2 diabetes mellitus (DM) in adults. The product was no longer
available to the market after less than two years from its approval
triggering a setback for competitive new inhalable insulins that were
already in various clinical development phases.

In contrary, Mannkind Corporation started developing its ultra-rapid-
acting insulin Afrezza in a bold bid, probably by managing the issues in
which Exubera were not successful. Afrezza has been marketed since
February, 2015 by Sanofi after getting FDA approval in June 2014.

The results from this systematic review indicate the effectiveness of
insulin inhalation products, particularly for patients initiating insulin
therapy.

Pharmaceutical companies should capitalize on the information available
from insulin inhalation to produce competitive products that are able to
match the bioavailability of subcutaneous (SC) insulin injection and to
deal with the single insulin unit increments and basal insulin
requirements in some diabetic patients or extending the horizon to
inhalable drug products with completely different drug entities for other
indications.

Copyright © 2015. Published by Elsevier B.V.

KEYWORDS: Diabetes Mellitus; Insulin Inhalation Pharmacodynamics; Insulin
Inhalation Pharmacokinetics; Insulin Inhalation Safety; Insulin Inhalers;
Insulin Types
__________________________________________________________________
________________________________*_________________________________

17. Abstract: Respiratory source control using a surgical mask: an in
vitro study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26225807

J Occup Environ Hyg. 2015 Jul 30:1-29.

Respiratory source control using a surgical mask: an in vitro study.

Patel RB1, Skaria SD, Mansour MM, Smaldone GC.

1a Stony Brook University Medical Center, Pulmonary, Critical Care & Sleep
Medicine , 101 Nicolls Rd, HSC T-17-040, Stony Brook , NY 11794-8172 ,
Phone: 631-444-3869, Fax: 631-444-7501.

BACKGROUND: Cough etiquette and respiratory hygiene are forms of source
control encouraged to prevent the spread of respiratory infection. The use
of surgical masks as a means of source control has not been quantified in
terms of reducing exposure to others.

AIM: We designed an in vitro model using various facepieces to assess
their contribution to exposure reduction when worn at the infectious
source (Source) relative to facepieces worn for primary (Receiver)
protection, and the factors that contribute to each.

METHODS: In a chamber with various airflows, radiolabeled aerosols were
exhaled via a ventilated soft-face manikin head using tidal breathing and
cough (Source). Another manikin, containing a filter, quantified recipient
exposure (Receiver). The natural fit surgical mask, fitted (SecureFit™)
surgical mask and an N95-class filtering facepiece respirator (commonly
known as an ‘N95 respirator’) with and without a Vaseline-seal were
tested.

RESULTS: With cough, source control (mask or respirator on Source) was
statistically superior to mask or unsealed respirator protection on the
Receiver (Receiver protection) in all environments. To equal source
control during coughing, the N95 respirator must be Vaseline-sealed.
During tidal breathing, source control was comparable or superior to mask
or respirator protection on the Receiver.

CONCLUSION: Source control via surgical masks may be an important adjunct
defense against the spread of respiratory infections. The fit of the mask
or respirator, in combination with the airflow patterns in a given
setting, are significant contributors to source control efficacy. Future
clinical trials should include a surgical mask source control arm to
assess the contribution of source control in overall protection against
airborne infection.

KEYWORDS: Surgical mask; aerosol; environmental controls; respirator
__________________________________________________________________
________________________________*_________________________________

18. Abstract: The WHO 2014 global tuberculosis report–further to go
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25539957

Lancet Glob Health. 2015 Jan;3(1):e10-2.

The WHO 2014 global tuberculosis report–further to go.

Zumla A1, George A2, Sharma V2, Herbert RH2; Baroness Masham of Ilton,
Oxley A3, Oliver M3.

1Division of Infection and Immunity, University College London, and NIHR,
BRC University College London Hospitals NHS Foundation Trust, London NW3
2PF, UK; All Party Parliamentary Group on Global Tuberculosis, London, UK.
Electronic address: a.zumla@ucl.ac.uk.
2All Party Parliamentary Group on Global Tuberculosis, London, UK.
3Results UK, London, UK.
__________________________________________________________________
________________________________*_________________________________

19. Special Purpose Needles Market: Global Industry Growth and Forecast,
2015-2025 by Future Market Insights
__________________________________________________________________
https://tinyurl.com/orl39lo

Special Purpose Needles Market: Global Industry Growth and Forecast,
2015-2025 by Future Market Insights

Future Market Insights, Press Release (29.07.15)

Needles and syringes are collectively known as a “sharps”. These are the
most widely used medical disposables around the globe. Needle or syringes
can be defined as the device consisting of a glass, metal, or rubber tube
with a nozzle and piston for sucking in and ejecting liquid in a thin
stream. The main purpose of this needles is to clean wounds by injecting
or sucking fluids into the body

Special purpose needles are the syringes or needle that are made for the
different disease or disability in the body like blood collection needles,
suture needles and etc.

The market of needles, syringes, and disposable needles or we can say for
disposable medical products has expanded considerably due to increase in
the number of outpatient procedures and due to the increasing awareness of
disease such as HIV/AIDS, simplex malaria, typhus and etc.

Special Purpose Needles Market: Drivers and Restraints

Presently, special purpose needles global market is driven by the aging
population, rise in demand of better healthcare infrastructure globally.

Special purpose needles global market drives by the aging population,
rising incidence of infectious disease. Demand for better healthcare
infrastructure around the globe, advancement in product designs, increased
emphasis on preventing hospital acquired infections are some of the other
factors that drives the special purpose needles market globally. However,
lack of knowledge and lack of skilled professional act as a barriers for
special purpose needle global market.

Special Purpose Needles Market: Segmentation

Special purpose needles market is segmented into following types:

Fine Aspirating Needles
Biopsy Needles
Blood Collection Needles
Bone Marrow Needles
Catheter Needles
Dental Needles
Epidural Needles
AV Fistula Needles
Pen Needles
Intravenous Needles
Ophthalmic Needles
Spinal Anesthesia Needles
Suture Needles.

Browse Full Report@ https://tinyurl.com/nsl3ecs

Special Purpose Needles Market: Overview

With rise in demand of better healthcare infrastructure around the globe
and rising incidence of infectious disease, the global special purpose
needles market is expected to grow at healthy CAGR in the forecast period
(2012-2025).

Special Purpose Needles Market: Region-wise Outlook

Depending on geographic region, the global special purpose needles market
is segmented into seven key regions: North America, South America, Eastern
Europe, Western Europe, Asia Pacific, Japan, and Middle East & Africa.

Asia pacific represents the largest regional market worldwide due to large
number of population and high development in healthcare sector. While the
North America ranks as the fastest growing market with a double digit
growth rate.

Special Purpose Needles Market: Key players

Some of the key participating market players in special purpose needles
global market are Becton, Dickinson and Company, Ethicon Inc., B. Braun
Medical Inc., Covidien Plc, Argon Medical Devices Inc., Smiths Medical.
Terumo Medical Corporation and others.

The research report presents a comprehensive assessment of the market and
contains thoughtful insights, facts, historical data, and statistically
supported and industry-validated market data. It also contains projections
using a suitable set of assumptions and methodologies. The research report
provides analysis and information according to categories such as market
segments, geographies, types, technology and applications.

The report covers exhaustive analysis on:

Market Segments
Market Dynamics
Market Size
Supply & Demand
Current Trends/Issues/Challenges
Competition & Companies involved
Technology
Value Chain
Request Report TOC@ http://www.futuremarketinsights.com/toc/rep-gb-583

Regional analysis includes

North America (U.S., Canada)
Latin America (Mexico. Brazil)
Western Europe (Germany, Italy, France, U.K, Spain, Nordic countries,
Belgium, Netherlands, Luxembourg)
Eastern Europe (Poland, Russia)
Asia Pacific (China, India, Australia & New Zealand)
Japan
Middle East and Africa (S. Africa, N. Africa)

ABOUT US:

Future Market Insights (FMI) is a leading market intelligence and
consulting firm. We deliver syndicated research reports, custom research
reports and consulting services, which are personalized in nature. FMI
delivers a complete packaged solution, which combines current market
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trends.

Our research services cover global as well as regional emerging markets
such as GCC, ASEAN, and BRICS. Our offerings cover a broad spectrum of
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__________________________________________________________________
________________________________*_________________________________

20. News

– Ireland: At least 260 deaths in 20 years since hepatitis C scandal
erupted
– Report reveals health consequences of contaminated blood products
supplied by State
– Global: Unsafe Injections Cause 2m Hepatitis Cases Annually – WHO

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/ng3pamu

Ireland: At least 260 deaths in 20 years since hepatitis C scandal erupted
Report reveals health consequences of contaminated blood products supplied
by State

Paul Cullen, Irish Times, Ireland (300.07.15)

At least 260 people who were infected with hepatitis C from contaminated
blood products supplied by the State have died in the 20 years since the
scandal broke, according to a new report.

While the causes of death are not solely due to liver disease, the death
rate among those who developed a chronic infection is almost three times
that suffered by those who did not, the 2015 report of the National
Hepatitis C Database shows.

The report sets out the serious health consequences suffered by men and
women who were infected through anti-D immunoglobulin, blood transfusions,
blood clotting factors or treatment for kidney disease.

The first group of patients with advanced liver disease who have been
approved will be treated at one of 10 centres across the State in the
coming weeks.

But it also points to a more optimistic future for patients thanks to the
availability of powerful new drug treatments which make the complete
eradication of the virus a possibility.

The database was set up in 2004 to collect data on people infected with
hepatitis C and track the progression of the disease. Some 1,320 people
are participating in the study, or 77 per cent of those who were infected.

A total of 1,060 people were still alive at the end of 2013, and 390 of
these were chronically infected with hepatitis C. Of this group, two-
thirds were women infected through anti-D immunoglobin given during
pregnancy while the rest were men and women infected though blood
transfusion and blood clotting factors.

Liver disease

Among those who were chronically infected, 29 per cent showed signs of
liver disease, 22 per cent had cirrhosis and 5 per cent had liver cancer.
Severe liver disease was more common among men, older patients and those
who with a higher alcohol intake. Those who drank heavily were over five
times more likely to have serious liver disease compared to those who did
not.

The death rate among those who were chronically infected was 23 per cent,
compared to 8 per cent among those who were not.

The report notes a rapidly shifting therapeutic landscape, with the
arrival of new and highly effective drugs, given over a shorter duration
and with fewer side effects, offers a more optimistic future for patients
with chronic hepatitis C infection.

“There have been huge developments in the area of therapeutic drug
treatment for hepatitis C in the last number of years and we are now
entering into an era where complete eradication of the virus is a real
possibility,” said Michele Tait, chairwoman of the National Hepatitis C
Database Steering Committee.

Brian O’Mahony, chief executive of the Irish Haemophilia Society, said the
data showed a serious progression of the virus over the past four years.
Of 240 haemophiliacs who received contaminated blood products, 112 have
died.

Hepatitis is an inflammation of the liver which is most commonly caused by
a viral infection. Blood is now routinely screened for the virus and
hepatitis C currently occurs primarily through injecting drug use.

The HSE National Service Plan for 2015 provided €30 million to begin the
phased rollout of treatment programme for patients with hepatitis C.
Virtually all of the 400 people with the virus are expected to be “cured”
following a 12-week programme of treatment costing between €45,000 and
€55,000 per patient.
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https://tinyurl.com/pryjqdz

Global: Unsafe Injections Cause 2m Hepatitis Cases Annually – WHO

By Winifred Ogbeb & Victor Okeke,Leadership Newspapers, Nigeria (29.07.15)

The World Health Organisation (WHO) has said that about two million people
a year contract hepatitis from unsafe injections.

It added that there is an urgent need for countries to enhance action to
prevent viral hepatitis infection and to ensure that people who have been
infected are diagnosed and offered treatment.

The WHO director general, Dr Margaret Chan, disclosed this yesterday in a
statement to mark World Hepatitis Day 2015 with the theme “Prevent
Hepatitis. Act Now”.

She said, “These infections can be averted through the use of sterile
syringes that are specifically designed to prevent reuse.”

She noted that eliminating unnecessary injections is also an effective
strategy to protect against hepatitis transmission.

“There are 16 billion injections administered every year. Around 5 per
cent of these injections are for immunisation, a further 5 per cent for
procedures like blood transfusions and injectable contraceptives, and the
remaining 90 per cent to administer medicines. For many diseases,
injections are not the first recommended course of treatment and oral
medications could be used,” she said.

This year, the WHO is focusing particularly on Hepatitis B and C, which
together cause approximately 80 per cent of all liver cancer deaths and
kill close to 1.4 million people every year.

WHO is alerting people to the risks of contracting hepatitis from unsafe
blood, unsafe injections, and sharing drug-injection equipment as some 11
million people who inject drugs have Hepatitis B or C infection.

Children born to mothers with Hepatitis B or C and sex partners of people
with hepatitis are also at risk of becoming infected.

The organisation emphasised the need for all health service providers to
reduce risks by using only sterile equipment for injections and other
medical procedures, testing all donated blood and blood omponents for
Hepatitis B and C (as well as HIV and syphilis) and promoting the use of
the Hepatitis B vaccine.

Safer sex practices, including minimising the number of partners and using
barrier protective measures (condoms), also protect against transmission.

WHO recommended vaccinating all children against Hepatitis B infection,
from which approximately 780,000 people die each year.

“A safe and effective vaccine can protect from Hepatitis B infection for
life,” the WHO said.

Ideally, the vaccine should be given as soon as possible after birth,
preferably within 24 hours. The birth dose should be followed by 2 or 3
doses to complete the vaccine series.

WHO also recommended vaccinating adults who are at increased risk of
acquiring Hepatitis B. These nclude people who frequently require blood or
blood products (for example dialysis patients), healthcare workers, people
who inject drugs, household and sexual contacts of people with chronic
hepatitis, and people with multiple sexual partners.

Medicines are now available that can cure most people with Hepatitis C and
control Hepatitis B infection. People who receive these medicines are less
likely to die from liver cancer and cirrhosis and less likely to transmit
the virus to others.
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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
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The comments made in this forum are the sole responsibility of the writers
and does not in any way mean that they are endorsed by any of the
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Use of trade names and commercial sources is for identification only and
does not imply endorsement.

The SIGN Forum welcomes new subscribers who are involved in injection
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
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We would like your help in building this archive. Please send your old
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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
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