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SIGNpost 00817

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00817 Nepal Policy + Waste + Vax + Abstracts + News 2 September 2015

CONTENTS
0. Moderators Note: New Guidelines
1. Abstract: Injection practices in Nepal: health policymakers’
perceptions
2. Abstract: Medical waste management – A review
3. Abstract: Post-exposure prophylaxis against Ebola virus disease with
experimental antiviral agents: a case-series of health-care workers
4. Abstract: Prison term for nurse who exposed child to HIV risk
5. Extract: Reducing pain during vaccine injections: clinical practice
guideline
6. Abstract: Impact of conflict and displacement on risk behaviours
amongst people who inject drugs in Kabul, Afghanistan
7. Abstract: A study on the risk and its determinants of HIV transmission
by syringe sharing among HIV-positive drug users
8. Abstract: Effect of vaccine administration modality on immunogenicity
and efficacy
9. Abstract: Inactivated poliovirus vaccine given alone or in a sequential
schedule with bivalent oral poliovirus vaccine in Chilean infants: a
randomised, controlled, open-label, phase 4, non-inferiority study
10. Abstract: Comparison of different hand-drying methods: the potential
for airborne microbe dispersal and contamination
11. NEW IPV ADVOCACY TOOLS!from International Vaccine Access Center
12. News
– Now, an antiviral drug that could protect humans from Ebola virus

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__________________________________________________________________
________________________________*_________________________________

0. Moderators Note: New Guidelines
__________________________________________________________________

The WHO Guideline on the use of Safety-Engineered Syringes for
Intramuscular, Intradermal and Subcutaneous Injections in Health Care is
available for free download or viewing at this link:
www.who.int/injection_safety/global-campaign/injection-safety_guidline.pdf
__________________________________________________________________
________________________________*_________________________________

1. Abstract: Injection practices in Nepal: health policymakers’
perceptions
__________________________________________________________________
Open Access Full Article http://www.biomedcentral.com/1472-698X/14/21

BMC Int Health Hum Rights. 2014 Jun 24;14:21.

Injection practices in Nepal: health policymakers’ perceptions.

Gyawali S1, Rathore DS, Shankar PR, Maskey M, Vikash KK.

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

BACKGROUND: The unnecessary and unsafe use of injections is common in
developing countries like Nepal. Policymakers have an important role in
promoting rational and safe injection use. Hence, the present study was
carried out to explore the perception of health policymakers regarding
safe injection practice in Nepal.

METHODS: An exploratory qualitative study design was used in this study.
Key policymakers from both the central and regional level were selected
using purposive sampling. A semi-structured questionnaire advocated by the
World Health Organization (WHO) was used after modifying the context.
Interviews were conducted to clarify doubts and obtain additional
information. The data was analyzed manually using deductive content
analysis technique.

RESULTS: In total, eleven policymakers participated. All unanimously
agreed that injection safety is a problem and seven participants reported
that injections are overused.

They shared the opinion that injections are administered by various
providers, including formal and informal health providers, and also
quacks.

Almost half the respondents reported that the National Drug Policy
discourages injection overuse, while others reported that the policy
contains no provisions regarding injection overuse.

Most policymakers stated that only single-use disposable injection
equipment is used to provide injection, while others thought that
sterilizable glass syringe is also used.

More than half of the participants believed that the quality of injection
equipment available in the Nepalese market is not regulated by any
government institution.

Almost two-third of the policymakers stated that syringes and needles are
not reused, while the rest thought syringes might be reused without
sterilization in some parts of the country.

Almost half of the respondents stated that illegal commercialization of
used syringes exists in Nepal.

Almost all respondents thought that health care institutions have a waste
management plan, while more than half of them opined that such plans are
limited to tertiary care hospitals located in the capital.

CONCLUSIONS: The result of this study revealed a divergence of views among
policymakers, even among those in the same ministry. Though there has been
some effort from the government to increase the safety of injection
practices, greater efforts are required, especially with regard to
standardization of policies and procedures related to injection practice.

Open Access Article http://www.biomedcentral.com/1472-698X/14/21
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Medical waste management – A review
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26301686

J Environ Manage. 2015 Aug 21;163:98-108.

Medical waste management – A review.

Windfeld ES1, Brooks MS2.

1Department of Process Engineering and Applied Science, Dalhousie
University, PO Box 15000, Halifax, NS B3H 4R2, Canada.
2Department of Process Engineering and Applied Science, Dalhousie
University, PO Box 15000, Halifax, NS B3H 4R2, Canada. Electronic address:
Su-Ling.Brooks@dal.ca.

This paper examines medical waste management, including the common
sources, governing legislation and handling and disposal methods.

Many developed nations have medical waste legislation, however there is
generally little guidance as to which objects can be defined as
infectious. This lack of clarity has made sorting medical waste
inefficient, thereby increasing the volume of waste treated for pathogens,
which is commonly done by incineration. This review highlights that the
unnecessary classification of waste as infectious results in higher
disposal costs and an increase in undesirable environmental impacts.

The review concludes that better education of healthcare workers and
standardized sorting of medical waste streams are key avenues for
efficient waste management at healthcare facilities, and that further
research is required given the trend in increased medical waste production
with increasing global GDP.

Copyright © 2015 Elsevier Ltd. All rights reserved.

KEYWORDS: Healthcare; Infectious waste; Medical waste; Separate
collection; Waste management
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Post-exposure prophylaxis against Ebola virus disease with
experimental antiviral agents: a case-series of health-care workers
__________________________________________________________________
http://dx.doi.org/10.1016/S1473-3099(15)00228-5 Free Full Text

Post-exposure prophylaxis against Ebola virus disease with experimental
antiviral agents: a case-series of health-care workers

Dr Michael Jacobs, FRCPcorrespondenceemail, Emma Aarons, FRCPath, Sanjay
Bhagani, FRCP, Ruaridh Buchanan, MRCP, Ian Cropley, FRCP, Susan Hopkins,
FRCP, Rebecca Lester, MRCP, Daniel Martin, FRCA, Neal Marshall, MRPharmS,
Stephen Mepham, FRCPath, Simon Warren, FRCPath, Alison Rodger, FRCP

Published Online: 25 August 2015

Background: Although a few international health-care workers who have
assisted in the current Ebola outbreak in west Africa have been medically
evacuated for treatment of Ebola virus disease, more commonly they were
evacuated after potential accidental exposure to Ebola virus. An urgent
need exists for a consensus about the risk assessment of Ebola virus
transmission after accidental exposure, and to investigate the use of
post-exposure prophylaxis (PEP). Experimental vaccines have occasionally
been used for Ebola PEP, but newly developed experimental antiviral agents
have potential advantages. Here, we describe a new method for risk
assessment and management of health-care workers potentially exposed to
Ebola virus and report the use of experimental antiviral therapies for
Ebola PEP in people.

Methods: We devised a risk assessment and management algorithm for health-
care workers potentially exposed to Ebola virus and applied this to eight
consecutive individuals who were medically evacuated to the UK from west
Africa between January, and March, 2015. PEP with antiviral agents was
given to health-care workers assessed to have had substantial risk
exposures to Ebola virus. Participants were followed up for 42 days after
potential exposure.

Findings: Four of eight health-care workers were classified as having had
low risk exposures and managed by watchful waiting in the community. None
of these health-care workers developed Ebola virus disease. The other four
health- care workers had intermediate or maximum risk exposures and were
given PEP with antiviral agents. PEP was well tolerated with no serious
adverse effects.

*** None of these four health-care workers, including two with maximum
risk exposures from penetrating injuries with freshly used hollow- bore
needles, developed Ebola virus disease.

Interpretation: Standardised risk assessment should be adopted and
consensus guidelines developed to systematically study the efficacy and
safety of PEP with experimental agents. New experimental antiviral
treatments are a viable option for PEP against Ebola.

Funding: Royal Free London NHS Foundation Trust.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Prison term for nurse who exposed child to HIV risk
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24894216

Nurs Stand. 2014 Jun 10;28(40):10.

Prison term for nurse who exposed child to HIV risk.

[No authors listed]

Nursing leaders have expressed dismay over the imprisonment of an HIV-
positive nurse found guilty in Uganda of criminal negligence for placing a
patient at risk of infection.
__________________________________________________________________
________________________________*_________________________________

5. Extract: Reducing pain during vaccine injections: clinical practice
guideline
__________________________________________________________________
Free Full Text
http://www.cmaj.ca/content/early/2015/08/24/cmaj.150391.long

CMAJ. 2015 Aug 24. pii: cmaj.150391.

Reducing pain during vaccine injections: clinical practice guideline.

Taddio A1, McMurtry CM1, Shah V1, Riddell RP1, Chambers CT1, Noel M1,
MacDonald NE1, Rogers J1, Bucci LM1, Mousmanis P1, Lang E1, Halperin SA1,
Bowles S1, Halpert C1, Ipp M1, Asmundson GJ1, Rieder MJ1, Robson K1,
Uleryk E1, Antony MM1, Dubey V1, Hanrahan A1, Lockett D1, Scott J1, Votta
Bleeker E1; HELPinKids&Adults.

Free Full Text
http://www.cmaj.ca/content/early/2015/08/24/cmaj.150391.long
__________________________________________________________________

Extract Extract Extract Extract Extract Extract

Reducing pain during vaccine injections: clinical practice guideline.

Pain from vaccine injections is common, and concerns about pain contribute
to vaccine hesitancy across the lifespan.1,2 Noncompliance with
vaccination compromises the individual and community benefits of
immunization by contributing to outbreaks of vaccinepreventable diseases.
Individuals may also engage in broader noncompliant behaviours if they
acquire a fear of needles as a result of negative vaccination experiences.
3

There are many evidence-based treatments to mitigate pain at the time of
vaccination; however, most are not routinely used.4,5 An independent,
cross-Canada multidisciplinary team, Help Eliminate Pain in Kids
(HELPinKIDS), assembled in 2008 to tackle this gap in clinical care. In
2010, the HELPinKIDS team published the first clinical practice guideline
on reducing pain during childhood vaccination.6

There are currently no guidelines on reducing pain during vaccination in
adults.

Scope The current guideline expands on and updates the 2010 guideline with
recommendations across the lifespan. This enhanced scope led to a revised
team name of HELPinKids&Adults.

The intended audience is all health care providers who administer vaccine
injections. Recommendations for the management of fear in individuals with
high levels of needle fear (i.e., individuals with persistent, intense
apprehension of or fear in response to a needle procedure, who may endure
needles with intense distress or avoidance) are reported separately, as
they require knowledge and skills beyond those of practitioners who
usually give vaccinations (C.M.M., unpublished data, 2015).

Delayed pain (hours to days after injection) was not considered in this
guideline.

Methods

Team composition

The HELPinKids&Adults team included 25 individuals from across Canada with
expertise in pain, fear, medicine, nursing, pharmacy, psychology,
vaccinology, infectious diseases, epidemiology, guideline development,
knowledge translation (KT), library sciences, public health, family
advisory/advocacy and health policy. Eighteen members of the
HELPinKids&Adults team formed the guideline panel group.

The project was funded by the Canadian Institutes of Health Research,
which had no input into the guideline. Financial and intellectual
conflicts of interest were disclosed by all members. Individuals with
self-identified conflicts were allowed to participate in all discussions,
but were excluded from voting on guideline recommendations in areas of
conflict. One government agency representative was an observer and did not
participate in voting on recommendations. Individuals from industries
manufacturing or distributing vaccines or pain treatments were excluded
from participating.

Guideline development

We used the AGREE II (Appraisal of Guidelines for Research and Evaluation
II) tool (www.agree trust.org) as the overarching methodology for
guideline development. GRADE (Grading of Recom….

Anna Taddio MSc PhD, C. Meghan McMurtry PhD, Vibhuti Shah MD MSc, Rebecca
Pillai Riddell PhD, Christine T. Chambers PhD, Melanie Noel PhD, Noni E.
MacDonald MD, Jess Rogers BA, Lucie M. Bucci MA, Patricia Mousmanis MD,
Eddy Lang MD, Scott A. Halperin MD, Susan Bowles PharmD, Christine Halpert
RN MA, Moshe Ipp MD, Gordon J.G. Asmundson PhD, Michael J. Rieder MD PhD,
Kate Robson, Elizabeth Uleryk MLS, Martin M. Antony PhD, Vinita Dubey MD,
Anita Hanrahan RN, Donna Lockett PhD, Jeffrey Scott MD, Elizabeth Votta
Bleeker PhD; HELPinKids&Adults

Competing interests: See end of article.

This article has been peer reviewed.

Correspondence to: Anna Taddio, anna.taddio@utoronto.ca

CMAJ 2015. DOI:10.1503 /cmaj.150391

• Pain at the time of vaccine injection is a common concern and
contributes to vaccine hesitancy across the lifespan.

• Evidence-based and feasible interventions are available to mitigate
pain and are part of good vaccination clinical practice.

• This guideline includes recommendations for pain mitigation based on
five domains of pain management interventions (procedural, physical,
pharmacologic, psychological and process): the “5P” approach.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Impact of conflict and displacement on risk behaviours
amongst people who inject drugs in Kabul, Afghanistan
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26303577

Int J Drug Policy. 2015 Jul 29. pii: S0955-3959(15)00215-7.

Impact of conflict and displacement on risk behaviours amongst people who
inject drugs in Kabul, Afghanistan.

Todd CS1, Nasir A2, Stanekzai MR2, Fiekert K2, Sipsma HL3, Strathdee SA4,
Vlahov D5.

1Department of Obstetrics & Gynecology, Columbia University & Heilbrunn
Department of Population & Family Health, Mailman School of Public Health,
PH 16-69, 622 West 168th Street, New York, NY 10032, USA. Electronic
address: CTodd@fhi360.org.
2Health Protection and Research Organisation, Street 4, Taimani, Kabul,
Afghanistan.
3Department of Epidemiology, Yale School of Public Health, 60 College
Street, P.O. Box 208034, New Haven, CT 06520-8034, USA.
4Division of Global Public Health, University of California San Diego
School of Medicine, 9500 Gilman Drive, MC 0507, La Jolla, CA 92093-0507,
USA.
5Department of Community Health Systems, University of California, San
Francisco School of Nursing, 2 Koret Way, #N-319X UCSF Box 0602, San
Francisco, CA 94143-0602, USA.

BACKGROUND: Theoretical work posits that drug-related risk behaviour
increases during armed conflict; however, few studies have been conducted
in conflict settings. The objective of this analysis is to determine
whether conflict or local displacement impact risk behaviours among people
who inject drugs (PWID) in Kabul, Afghanistan.

METHODS: Consenting PWID aged =18 years completed interviews at 3, 6, 9,
12, 18, and 24 months of follow-up. Quarters with peak conflict or local
displacement exposure were defined and associations with injecting drug
use and sexual risk behaviours analysed with generalized estimating
equations.

RESULTS: Of 483 PWID enrolled, 385 completed =1 follow-up visit (483.8
person-years) between 2007 and 2009. All participants were male, with 35%
initiating injecting as a refugee. Sharing syringes (Odds Ratio (OR))=
8.53, 95% Confidence Interval (CI): 2.58-28.2) and sexually transmitted
infection (STI) symptoms (OR=1.72, 95% CI: 1.00-2.96) increased
significantly during peak conflict quarters, while odds of STI symptoms
(OR=0.06, 95% CI: 0.02-0.20) and arrest (OR=0.61, 95% CI: 0.40-0.93) were
significantly lower during periods of displacement.

CONCLUSION: Syringe sharing significantly increased during peak conflict
periods amongst PWID in Kabul. Programming should include instruction for
coping with conflict and prepare clients for harm reduction needs during
conflict.

Copyright © 2015 Elsevier B.V. All rights reserved.

KEYWORDS: Afghanistan; Armed conflict; Harm reduction; Injecting drug use;
Syringe sharing
__________________________________________________________________
________________________________*_________________________________

7. Abstract: A study on the risk and its determinants of HIV transmission
by syringe sharing among HIV-positive drug users
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26310336

Zhonghua Yu Fang Yi Xue Za Zhi. 2015 Jun;49(6):513-7.

[A study on the risk and its determinants of HIV transmission by syringe
sharing among HIV-positive drug users].

[Article in Chinese]

Bao Y1, Zhang Y, Liang Y, Chen M, Sun J, Tan H2.

1Department of Epidemiology and Biostatistics, School of Public Health,
Central South University, Changsha 410008, China.
2Email: tanhz99@qq.com.

OBJECTIVE: To understand the risks and associated factors of HIV
transmission by sharing syringes among HIV-positive drug users.

METHOD: The survey was conducted among HIV-positive injecting drug users
(IDUs- HIV+) who received HIV counseling, testing and treatment in
Changsha city Infectious Disease Hospital and Hengyang city No.3 People’s
Hospital from July 2012 to May 2013 to understand their socio-demographic
characteristics, HIV prevalence and syringe sharing. A total of 503 IDUs-
HIV+ were involved in and provided the contact list of 2 460 drug users
who had the syringe sharing experience over one month with IDUs-HIV+. 420
IDUs-HIV+ among 503 were defined as infection sources due to sharing
syringe with at least one drug user. Among them, 234 HIV-negative persons
were in control group, and 186 HIV-positive were in cased group. A total
of 1 220 drug users were followed up among 2 460 and defined as vulnerable
population. The HIV transmission rate was calculated based on the HIV
prevalence among vulnerable population. Based on the result of HIV
transmission to vulnerable population from 420 infection sources, case-
control study and the multivariate logistic regression analysis were
adopted to explore the associated factors of HIV transmission among IDUs-
HIV+.

RESULTS: As the sources of HIV transmission, 420 IDUs-HIV+ had an average
duration of (4.5 ± 1.2) years for drug use. As a susceptible population, 1
220 drug users sharing syringes with the 420 IDUs-HIV+ had an average
duration of (1.1 ± 0.5) years for drug use. There were 238 HIV-positive
persons among 1 220 vulnerable drug users, with a transmission rate of
0.57. In the case-control study, the proportion of male subjects was 87.1%
(162/186) in the case group, which was higher than that in the control
group (77.8%, 182/234). The proportion of subjects who received support
after knowing their HIV infection status was 51.1% (95/186) in the case
group, which was lower than that in the control group (79.5%, 186/234).

The proportion of subjects sharing syringes every time of using drugs was
47.8% (89/186) in the case group, which was higher than that in the
control group (36.8%, 86/234).

The proportion of subjects having AIDS awareness was 21.0% (39/186) in the
case group, which was lower than that in the control group (64.5%,
151/234); the proportion of subjects having close contact with HIV-
positive persons for more than 106 days was 60.2% (112/186) in the case
group, which was higher than that in the control group (31.6%, 74/234).
The proportion of subjects maintaining the original drug use method after
being infected with HIV was 50.5% (94/186) in the case group, which was
higher than that in the control group (16.7%, 39/234) (all P values <
0.05). The multivariate logistic regression analysis was carried out to
analyse high correlate factors of HIV transmission by sources of
transmission, and the AIDS awareness, duration of contact between sources
of transmission and vulnerable population, access to support following
confirmed HIV infection were protective factors, OR (95% CI) values were
0.155 (0.104-0.262), 0.170 (0.106-0.253), and 0.306 (0.189-0.450),
respectively; while the frequency of syringe sharing and continuous drug
use after being infected with HIV were risk factors, and the OR (95% CI)
values were 3.06 (1.77-5.29), and 3.54 (2.16-5.80), respectively.

CONCLUSION: HIV transmission by IDUs-HIV+ might be contained by raising
AIDS awareness, providing comprehensive psychological support, conducting
needle exchange and methadone maintenance treatment and reducing syringe
sharing.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Effect of vaccine administration modality on immunogenicity
and efficacy
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26313239

Expert Rev Vaccines. 2015 Aug 27:1-15.

Effect of vaccine administration modality on immunogenicity and efficacy.

Zhang L1, Wang W, Wang S.

1a 1 Department of Infectious Diseases, The First Affiliated Hospital with
Nanjing Medical University, Nanjing 210029, China.

The many factors impacting the efficacy of a vaccine can be broadly
divided into three categories: features of the vaccine itself, including
immunogen design, vaccine type, formulation, adjuvant and dosing;
individual variations among vaccine recipients and vaccine administration-
related parameters.

While much literature exists related to vaccines, and recently systems
biology has started to dissect the impact of individual subject variation
on vaccine efficacy, few studies have focused on the role of vaccine
administration-related parameters on vaccine efficacy.

Parenteral and mucosal vaccinations are traditional approaches for
licensed vaccines; novel vaccine delivery approaches, including needless
injection and adjuvant formulations, are being developed to further
improve vaccine safety and efficacy.

This review provides a brief summary of vaccine administration-related
factors, including vaccination approach, delivery route and method of
administration, to gain a better understanding of their potential impact
on the safety and immunogenicity of candidate vaccines.

KEYWORDS: administration; efficacy; immunogenicity; vaccination; vaccine;
vaccine delivery
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Inactivated poliovirus vaccine given alone or in a sequential
schedule with bivalent oral poliovirus vaccine in Chilean infants: a
randomised, controlled, open-label, phase 4, non-inferiority study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26318714

Lancet Infect Dis. 2015 Aug 26. pii: S1473-3099(15)00219-4.

Inactivated poliovirus vaccine given alone or in a sequential schedule
with bivalent oral poliovirus vaccine in Chilean infants: a randomised,
controlled, open-label, phase 4, non-inferiority study.

O’Ryan G M1, Bandyopadhyay AS2, Villena R3, Espinoza M3, Novoa J4, Weldon
WC5, Oberste MS5, Self S6, Borate BR6, Asturias EJ7, Clemens R8, Orenstein
W9, Jimeno J10, Rüttimann R11, Costa Clemens SA12; Chilean IPV/bOPV study
group.

1Faculty of Medicine, University of Chile, Santiago, Chile. Electronic
address: moryan@med.uchile.cl.
2Bill & Melinda Gates Foundation, Seattle, WA, USA.
3Faculty of Medicine, University of Chile, Santiago, Chile.
4Faculty of Medicine, University of Desarrollo, Santiago, Chile.
5Centers for Disease Control and Prevention, Atlanta, GA, USA.
6Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
7University of Colorado School of Medicine and Colorado School of Public
Health, Aurora, CO, USA.
8Global Research in Infectious Diseases, Rio de Janeiro, Brazil.
9Emory Vaccine Center, Atlanta, GA, USA.
10Vaxtrials, Panama City, Panama.
11Fighting Infectious Diseases in Emerging Countries, Miami, FL, USA.
12Instituto de Pós Graduação Carlos Chagas, Rio de Janeiro, Brazil.

BACKGROUND: Bivalent oral poliovirus vaccine (bOPV; types 1 and 3) is
expected to replace trivalent OPV (tOPV) globally by April, 2016, preceded
by the introduction of at least one dose of inactivated poliovirus vaccine
(IPV) in routine immunisation programmes to eliminate vaccine-associated
or vaccine-derived poliomyelitis from serotype 2 poliovirus. Because data
are needed on sequential IPV-bOPV schedules, we assessed the
immunogenicity of two different IPV-bOPV schedules compared with an all-
IPV schedule in infants.

METHODS: We did a randomised, controlled, open-label, non-inferiority
trial with healthy, full-term (>2·5 kg birthweight) infants aged 8 weeks
(± 7 days) at six well-child clinics in Santiago, Chile. We used supplied
lists to randomly assign infants (1:1:1) to receive three polio
vaccinations (IPV by injection or bOPV as oral drops) at age 8, 16, and 24
weeks in one of three sequential schedules: IPV-bOPV-bOPV, IPV-IPV-bOPV,
or IPV-IPV-IPV. We did the randomisation with blocks of 12 stratified by
study site. All analyses were done in a masked manner. Co-primary outcomes
were non-inferiority of the bOPV-containing schedules compared with the
all-IPV schedule for seroconversion (within a 10% margin) and antibody
titres (within two-thirds log2 titres) to poliovirus serotypes 1 and 3 at
age 28 weeks, analysed in the per-protocol population. Secondary outcomes
were seroconversion and titres to serotype 2 and faecal shedding for 4
weeks after a monovalent OPV type 2 challenge at age 28 weeks. Safety
analyses were done in the intention-to-treat population. This trial is
registered with ClinicalTrials.gov, number NCT01841671, and is closed to
new participants.

FINDINGS: Between April 25 and August 1, 2013, we assigned 570 infants to
treatment: 190 to IPV-bOPV-bOPV, 192 to IPV-IPV-bOPV, and 188 to IPV-IPV-
IPV. 564 (99%) were vaccinated and included in the intention-to-treat
cohort, and 537 (94%) in the per-protocol analyses. In the IPV-bOPV-bOPV,
IPV-IPV-bOPV, and IPV-IPV-IPV groups, respectively, the proportions of
children with seroconversion to type 1 poliovirus were 166 (98·8%) of 168,
95% CI 95·8-99·7; 178 (100%), 97·9-100·0; and 175 (100%), 97·9-100·0.
Proportions with seroconvsion to type 3 poliovirus were 163 (98·2%) of
166, 94·8-99·4; 177 (100%), 97·9-100·0, and 172 (98·9%) of 174, 95·9-99·7.
Non-inferiority was thus shown for the bOPV-containing schedules compared
with the all-IPV schedule, with no significant differences between groups.

In the IPV-bOPV-bOPV, IPV-IPV-bOPV, and IPV-IPV-IPV groups, respectively,
the proportions of children with seroprotective antibody titres to type 1
poliovirus were 168 (98·8%) of 170, 95% CI 95·8-99·7; 181 (100%),
97·9-100·0; and 177 (100%), 97·9-100·0. Proportions to type 3 poliovirus
were 166 (98·2%) of 169, 94·9-99·4; 180 (100%), 97·9-100·0; and 174
(98·9%) of 176, 96·0-99·7. Non-inferiority comparisons could not be done
for this outcome because median titres for the groups receiving OPV were
greater than the assay’s upper limit of detection (log2 titres >10·5). The
proportions of children seroconverting to type 2 poliovirus in the IPV-
bOPV-bOPV, IPV-IPV-bOPV, and IPV-IPV-IPV groups, respectively, were 130
(77·4%) of 168, 95% CI 70·5-83·0; 169 (96·0%) of 176, 92·0-98·0; and 175
(100%), 97·8-100. IPV-bOPV schedules resulted in almost a 0·3 log
reduction of type 2 faecal shedding compared with the IPV-only schedule.

No participants died during the trial; 81 serious adverse events were
reported, of which one was thought to be possibly vaccine-related
(intestinal intussusception).

INTERPRETATION: Seroconversion rates against polioviruses types 1 and 3
were non-inferior in sequential schedules containing IPV and bOPV,
compared with an all-IPV schedule, and proportions of infants with
protective antibodies were high after all three schedules. One or two
doses of bOPV after IPV boosted intestinal immunity for poliovirus type 2,
suggesting possible cross protection. Additionally, there was evidence of
humoral priming for type 2 from one dose of IPV. Our findings could give
policy makers flexibility when choosing a vaccination schedule, especially
when trying to eliminate vaccine-associated and vaccine-derived
poliomyelitis.

FUNDING: Bill & Melinda Gates Foundation.

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

10. Abstract: Comparison of different hand-drying methods: the potential
for airborne microbe dispersal and contamination
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25586988

J Hosp Infect. 2015 Mar;89(3):215-7.

Comparison of different hand-drying methods: the potential for airborne
microbe dispersal and contamination.

Best EL1, Redway K2.

1Microbiology Department, Old Medical School, Leeds General Infirmary,
Leeds Teaching Hospitals NHS Trust, Leeds, UK. Electronic address:
emma.best@leedsth.nhs.uk.
2Department of Biomedical Sciences, Faculty of Science and Technology,
University of Westminster, London, UK.

Efficient washing and drying of hands is important in prevention of the
transfer of micro-organisms. However, knowledge surrounding the potential
for microbial contamination according to hand-drying methods is limited.

This study assessed the potential for airborne microbe dispersal during
hand drying by four methods (paper towels, roller towel, warm air and jet
air dryer) using three different models.

The jet air dryer dispersed liquid from users’ hands further and over a
greater range (up to 1.5m) than the other drying methods (up to 0.75 m),
demonstrating the differing potential risks for airborne microbe
dissemination, particularly if handwashing is suboptimal.

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

KEYWORDS: Environmental contamination; Hand hygiene; Hand washing; Hygiene
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11. NEW IPV ADVOCACY TOOLS!from International Vaccine Access Center
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International Vaccine Access Center

Thirty countries have now introduced IPV vaccine as part of objective 2 of
the Polio Eradication and Endgame Strategic Plan.

In August, the second of the polio endemic countries, Pakistan, introduced
IPV nationally. There are now 30 countries that have introduced the
vaccine. Nigeria, the other endemic country to introduce IPV has now also
successfully gone one year without a case of reported wild poliovirus.

To document the experience of early adopters of IPV, Johns Hopkins
Bloomberg School of Public Health’s International Vaccine Access Center
(IVAC) worked with four countries, WHO, UNICEF, Gavi, the Task Force for
Global Health and the Bill and Melinda Gates Foundation to create a series
of written cases studies, a multi-country video, individual country videos
and guidance for countries to develop their own case studies and human
interest stories to support the monumental effort to introduce IPV into
126 countries previously using only OPV and help strengthen their routine
immunization programs.

These materials, now available on the IVAC and WHO websites as well as
YouTube include:

https://tinyurl.com/p2pn89l or
www.jhsph.edu/research/centers-and-institutes/ivac/projects/IPV-
Advocacy.html

• Short graphic movie about global IPV introduction;
• Film Series on IPV introduction: Albania, Nepal, Nigeria, and
Tunisia;
• Case Studies of IPV introduction in Albania, Nigeria, and Tunisia;
• Guidelines for documenting vaccine introductions and human
interest stories

We hope you will join us in marking this occasion. Please feel free to use
these materials to support your efforts. Please contact Katie Gorham at:
Kgorham3@jhu.edu if you need additional assistance.
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12. News

– Now, an antiviral drug that could protect humans from Ebola virus

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
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https://tinyurl.com/nnyy8fa

Now, an antiviral drug that could protect humans from Ebola virus

Financial Express. by ANI, India (26.08.15)

In a breakthrough discovery, scientists have developed anti-viral-based
therapies that have the potential to protect humans from the deadly Ebola
virus.

In the study, eight British health-care workers were evacuated to the
Royal Free Hospital in London, UK after possible accidental exposure to
Ebola virus in Sierra Leone between January and March 2015.

Four of the healthcare workers were considered to have been at significant
risk of exposure to Ebola from needlestick injuries and were given post-
exposure prophylaxis (PEP) with the antiviral drug favipiravir, with or
without monoclonal antibodies.

None of the health-care workers went on to develop Ebola. All eight
healthcare workers remained healthy throughout the 42 day follow-up, with
no signs of disease or detectable levels of virus in their blood.
Lead author Michael Jacobs of the Royal Free NHS Foundation Trust said
that it was possible that none of these health-care workers were infected
with Ebola virus, and added that they cannot know for sure whether or not
post-exposure prophylaxis prevented the onset of Ebola-virus disease.

*** However, Jacobs mentioned that two of the workers had needlestick
injuries contaminated with fresh blood from patients with Ebola virus
disease putting them at very high risk of transmission.

Jacobs concluded that a similar approach to treat household contacts of
Ebola cases might work to prevent a major route of spread during an
epidemic.

The study is published in the Journal Lancet Infectious Diseases.

The Lancet Infectious Diseases.
<http://dx.doi.org/10.1016/S1473-3099(15)00228-5>.

https://tinyurl.com/q7ba4z5
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New WHO Injection Safety Guidelines

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

The new guideline is:

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

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

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

This is an illustrated summary brochure for the general public.

pdf, 554kb [6 pages]

www.who.int/injection_safety/global-campaign/injection-safety_brochure.pdf
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SIGN Meeting 2015

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

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

A report of the meeting will be posted ASAP
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* SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org

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

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

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

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

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

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

The SIGN Secretariat, the Department of Health Systems Policies and
Workforce, WHO, Avenue Appia 20, CH-1211 Geneva 27, Switzerland.
Facsimile: +41 22 791 4836 E- mail: sign@who.int
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All members of the SIGN Forum are invited to submit messages, comment on
any posting, or to use the forum to request technical information in
relation to injection safety.

The comments made in this forum are the sole responsibility of the writers
and does not in any way mean that they are endorsed by any of the
organizations and agencies to which the authors may belong.

Use of trade names and commercial sources is for identification only and
does not imply endorsement.

The SIGN Forum welcomes new subscribers who are involved in injection
safety.

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

The SIGNpost Website is http://SIGNpostOnline.info

The SIGNpost website provides an archive of all SIGNposts, meeting
reports, field reports, documents, images such as photographs, posters,
signs and symbols, and video.

We would like your help in building this archive. Please send your old
reports, studies, articles, photographs, tools, and resources for posting.

Email mailto:sign.moderator@gmail.com
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The SIGN Internet Forum was established at the initiative of the World
Health Organization’s Department of Essential Health Technologies.

The SIGN Secretariat home is the Service Delivery and Safety (SDS)
Health Systems and Innovation (HIS) at WHO HQ, 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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