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

SIGNpost 00825

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00825 RFI: Waste? + Abstracts + News 21 October 2015

CONTENTS
1. RFI: Disposal of self injectables in rural areas: What are the
practices around the world
2. Abstract: Operation resistance: A snapshot of falsified antibiotics and
biopharmaceutical injectables in Europe
3. Abstract: Risk factors for and circumstances of needlestick and sharps
injuries of doctors in operating rooms: A study focusing on surgeries
using general anesthesia at Kurume University Hospital, Japan
4. Abstract: Needlestick Injuries in Agriculture Workers and Prevention
Programs
5. Abstract: Awareness and practices regarding bio-medical waste
management among health care workers in a tertiary care hospital in
Delhi
6. Abstract: Drug-related HIV epidemic in Pakistan: a review of current
situation and response and the way forward beyond 2015
7. Abstract: High HCV prevalence among drug users in Iran: Systematic
review and meta-analysis of epidemiological evidence (2001-2012)
8. Abstract: Reviewing harm reduction for people who inject drugs in Asia:
the necessity for growth
9. Abstract: Hepatitis C and HIV incidence and harm reduction program use
in a conflict setting: an observational cohort of injecting drug users
in Kabul, Afghanistan
10. Abstract: Hepatitis C virus (HCV) infection & risk factors for HCV
positivity in injecting & non-injecting drug users attending a de-
addiction centre in northern India
11. Abstract: Epidemiology of HIV/AIDS in the East Azerbaijan Province,
Northwest of Iran
12. Abstract: The efficacy assessment of a self-administered immunotherapy
protocol
13. Abstract: Epidemiology of Ebola virus disease transmission among
health care workers in Sierra Leone, May to December 2014: a
retrospective descriptive study
14. Abstract: Use of a daily disinfectant cleaner instead of a daily
cleaner reduced hospital-acquired infection rates
15. Abstract: Lower infection rates after introduction of a photocatalytic
surface coating
16. No Abstract: Editorial: Harm reduction in Asia and the Pacific: an
evolving public health response [Link to Free Full Text]
17. No Abstract: Salvaging a prison needle and syringe program trial in
Australia requires leadership and respect for evidence
18. No Abstract: First Documented Transmission of Trypanosoma cruzi
Infection through Blood Transfusion in a Child with Sickle-Cell
Disease in Belgium
19. News
– USA: ManorCare blames contractor for hepatitis outbreak in new filing
– USA: Nursing Home Blamed for Hep C Outbreak
– Singapore: SGH Hep C cases: MOH to invite international experts to
advise review committee
– Singapore: SGH files police report over Hepatitis C cluster
– Cambodia: Cambodian doctor on trial for infecting patients with HIV:
Yem Chroeum is accused of infecting locals in a remote village by
reusing dirty needles

The web edition of SIGNpost is online at:
http://signpostonline.info/archives/1920

More information follows at the end of this SIGNpost!

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

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

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

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

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

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

__________________________________________________________________
________________________________*_________________________________

1. RFI: Disposal of self injectables in rural areas: What are the
practices around the world

Edward Krisiunas posts an interesting Request For Information.
__________________________________________________________________
From Edward Krisiunas <ekrisiunas@gmail.com>
Sign Moderator <sign.moderator@gmail.com>
Wed, Oct 21, 2015

Subject: Disposal of self injectables in rural areas..what are the
practices around the world?

Good evening all…

Spent some time in Viet Nam this summer and Swaziland…question came up
on best management practices on disposal of sharps of self injectors in
rural/remote areas? Any suggestion? Any simple messages to provide?

Thanks in advance for replying to the question..

Ed

Ed Krisiunas, MT(ASCP), MPH
President
WNWN International
PO Box 1164
Burlington, Connecticut
06013
1-860-675-1217 (O)
1-860-675-1311 (F)
1-860-839-3993 (M)
SKYPE – Boutiquewaste
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Operation resistance: A snapshot of falsified antibiotics and
biopharmaceutical injectables in Europe
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26456392
Drug Test Anal. 2015 Oct 12.

Operation resistance: A snapshot of falsified antibiotics and
biopharmaceutical injectables in Europe.

Venhuis BJ1, Keizers PH1, Klausmann R2, Hegger I1.

1National Institute for Public Health and the Environment RIVM, A. van
Leeuwenhoeklaan 9, 3721MA, Bilthoven, the Netherlands.
2Zoll Kriminalamt, Regional Intelligence Office Western-Europe (RILO-WE),
Bergisch Gladbacher Str. 837, D-51069, Cologne, Germany.

Operation Pangea is an annual international week of action combating
pharmaceutical crime. In this study, called Operation Resistance, we asked
the national agencies in Europe to search for falsified antibiotics and
biopharmaceutical injectables (peptides and proteins) amongst the
medicines seized in Pangea 7 (2014).

Reports were received from Belgium, Cyprus, Czech Republic, Denmark,
France, the Netherlands, Portugal, Sweden, Spain, the United Kingdom,
Norway, and Switzerland. The countries reported seizing about 21,000 dose
units (e.g. tablets, capsules) of falsified antibiotics in total. Most of
the antibiotics were unlicensed medicines with common antibiotic drugs.

In this study week, very few falsified biopharmaceutical injectables were
reported. Laboratories reported human growth hormone, sermorelin,
melanotan II, and no active ingredients.

The average shipment size seemed too large for personal use indicating
that a substantial part was intended for resale. This study provides a
snapshot of the falsified antibiotics and biopharmaceuticals that enter
European countries. How much is actually reaching users during Pangea week
– in on other weeks – remains unknown. The shipment sizes indicate
falsified antibiotics and biopharmaceuticals are imported for both
personal use and resale.

The use of antibiotics from unreliable sources is a health risk,
contributes to antimicrobial resistance, and may obscure a source of
infection from health agencies.

The falsified biopharmaceuticals are a health risk because they lack all
labelling and may contain unlicensed drugs for injection.

It seems important to raise awareness among health-care professionals that
falsified medicines in Europe are not restricted to erectile dysfunction
drugs.

Copyright © 2015 John Wiley & Sons, Ltd.

KEYWORDS: Pangea; antibiotics; antimicrobal resistance; biopharmaceutical;
counterfeit medicines; falsified medicines; peptide injectables
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Risk factors for and circumstances of needlestick and sharps
injuries of doctors in operating rooms: A study focusing on surgeries
using general anesthesia at Kurume University Hospital, Japan
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26462957

J Infect Chemother. 2015 Oct 10. pii: S1341-321X(15)00195-6.

Risk factors for and circumstances of needlestick and sharps injuries of
doctors in operating rooms: A study focusing on surgeries using general
anesthesia at Kurume University Hospital, Japan.

Yonezawa Y1, Yahara K2, Miura M3, Hieda F3, Yamakawa R4, Masunaga K5,
Mishima Y6, Watanabe H5.

1Division of Biostatistics, Kurume University School of Medicine, Kurume,
Fukuoka 830-0011, Japan.
2Biostatistics Center, Kurume University School of Medicine, Kurume,
Fukuoka 830-0011, Japan. Electronic address: koji_yahara@med.kurume-
u.ac.jp.
3Division of Infection Control and Prevention, Kurume University Hospital,
Kurume, Fukuoka 830-0011, Japan.
4Central Division of Surgeries, Kurume University Hospital, Kurume,
Fukuoka 830-0011, Japan; Department of Ophthalmology, Kurume University
School of Medicine, Kurume, Fukuoka 830-0011, Japan.
5Division of Infection Control and Prevention, Kurume University Hospital,
Kurume, Fukuoka 830-0011, Japan; Department of Infection Control and
Prevention, Kurume University School of Medicine, Kurume, Fukuoka
830-0011, Japan.
6Central Division of Surgeries, Kurume University Hospital, Kurume,
Fukuoka 830-0011, Japan; Department of Anesthesiology, Kurume University,
Kurume, Fukuoka 830-0011, Japan.

Healthcare workers are exposed to serious infectious diseases via
needlestick and sharps injuries. The operating room is a particularly
important environment in which the risk for needlestick injuries is
increased for surgical doctors.

According to national surveillance studies, the proportion of needlestick
and sharps injuries in operating rooms has been increasing for unknown
reasons.

In this study, we examined risk factors for and circumstances of injuries
in operating rooms by combining and analyzing incidence reports and
electronic records of every surgery in Kurume University Hospital (Kurume,
Japan).

The annual injury rate (reflecting the reporting rate) rose continuously
from fiscal years 2007-2012. We conducted analyses focusing on surgeries
that used general anesthesia, which accounted for 88.1% of the injuries.
An analysis of the time of injury found that the number of injuries
increased toward the end of the surgical procedure.

A comparative analysis of surgeries by doctors who had experienced injury
revealed risk for the injury increased when a procedure ended after 20:00.
In addition, a comparative analysis of doctors with and without injury
experience who had similar level of operating time per year revealed that
the number of working years was not lower in the injured doctors.

Although the data analyzed in this study were confined to one university
hospital, our approach and these results will form a basis on which to
consider more effective measures to prevent injury in operating rooms.

Copyright © 2015 Japanese Society of Chemotherapy and The Japanese
Association for Infectious Diseases. Published by Elsevier Ltd. All rights
reserved.

KEYWORDS: Epidemiology; General anesthesia; Infection control; Needlestick
and sharps injury; Operating rooms; Surgery
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Needlestick Injuries in Agriculture Workers and Prevention
Programs
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26478987

J Agromedicine. 2015 Oct 19.
Needlestick Injuries in Agriculture Workers and Prevention Programs.

Buswell ML1, Hourigan M1, Nault AJ2, Bender JB1.

1a Center for Animal Health and Food Safety , University of Minnesota.
2b College of Veterinary Medicine – Veterinary Medical Library, University
of Minnesota.

There are a variety of biologics, vaccines, antibiotics, and hormones used
in animal agriculture. Depending upon the procedure or pharmaceutical
used, accidental injections or product exposures can result in mild to
severe injuries.

Needlestick injury (NSI) prevention, research, and education for
veterinarians and agriculture workers is limited.

Our objective was to collect and review published case reports and case
series/surveys on human needlestick exposure to veterinary biologics and
to summarize needlestick prevention strategies for agricultural
workers/veterinarians. A search was conducted of PubMed© and CABI©
databases. References were reviewed to identify additional articles. NSI
among agricultural workers were primarily included in this review. Thirty
articles were applicable to exposures in agricultural settings. Relevant
literature consisted of case reports, survey/case series articles,
prevention documents, and background articles. Fifty-nine case patients
were identified.

Most of these cases were associated with exposures to specific vaccines or
veterinary products.

Injury location was identified from 36 individuals: 24 (67%) NSI to the
hands, 10 (28%) injuries to the legs and two to other body locations. Of
the 59 cases, 20 (34%) involved oil-adjuvant vaccines.

Evidence of hospitalization was recorded for 30 case patients. The length
of hospitalization was available from 11 case patients. Median length of
hospitalization was 3 days (range 1 to 4). Surgical intervention was
reported in 25 case patients. Outcome information was available on 30 case
patients. Fifteen made a complete recovery within 2 weeks of treatment, 14
had residual sequellae attributed to the injury and there was 1 reported
death. Of the 13 survey/case series articles: two focused on oil-adjuvant
products, one on Brucellosis RB-51 vaccine, three on tilmicosin, one on
Salmonella enteritidis vaccine, one on high pressure injection, and five
were non-specific.

NSI in agriculture workers and veterinarians can result in significant
bodily injury and loss of work. There is a need for varied and
comprehensive educational programs for agricultural workers and
veterinarians to prevent NSI on livestock operations.

KEYWORDS: National Institute for Occupational Safety and Health (NIOSH);
Needlestick injuries; accident prevention; agricultural workers;
occupational exposures; occupational hazards; occupational injuries;
veterinarians
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Awareness and practices regarding bio-medical waste
management among health care workers in a tertiary care hospital in
Delhi
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26470969

Indian J Med Microbiol. 2015 Oct-Dec;33(4):580-2.

Awareness and practices regarding bio-medical waste management among
health care workers in a tertiary care hospital in Delhi.

Bhagawati G1, Nandwani S, Singhal S.

1Department of Microbiology, Employees State Insurance Corporation Post
Graduate Institute of Medical Science and Research, Basaidarapur – 110
015, Delhi, India.

Health care institutions are generating large amount of Bio-Medical Waste
(BMW), which needs to be properly segregated and treated.

With this concern, a questionnaire based cross-sectional study was done to
determine the current status of awareness and practices regarding BMW
Management (BMWM) and areas of deficit amongst the HCWs in a tertiary care
teaching hospital in New Delhi, India. The correct responses were graded
as satisfactory (more than 80%), intermediate (50-80%) and unsatisfactory
(less than 50%).

Some major areas of deficit found were about knowledge regarding number of
BMW categories (17%), mercury waste disposal (37.56%) and definition of
BMW (47%).
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Drug-related HIV epidemic in Pakistan: a review of current
situation and response and the way forward beyond 2015
__________________________________________________________________
http://www.harmreductionjournal.com/content/12/1/43 Open Access
Harm Reduct J. 2015 Oct 16;12(1):43.

Drug-related HIV epidemic in Pakistan: a review of current situation and
response and the way forward beyond 2015.

Bergenstrom A1, Achakzai B2, Furqan S3, Ul Haq M4, Khan R5, Saba M6.

1United Nations Office of Drugs and Crime (UNODC), Plot 5-11, Diplomatic
Enclave-II, G-4, Islamabad, 44000, Pakistan. anne.bergenstrom@unodc.org.
2National AIDS Control Programme, National Institute of Health, Chak
Shahzad, Park Road, Islamabad, 44000, Pakistan. achakzaibk@gmail.com.
3National AIDS Control Programme, National Institute of Health, Chak
Shahzad, Park Road, Islamabad, 44000, Pakistan. sofiafurqan@hotmail.com.
4United Nations Office of Drugs and Crime (UNODC), Plot 5-11, Diplomatic
Enclave-II, G-4, Islamabad, 44000, Pakistan. manzoor.ul.haq@unodc.org.
5UNAIDS Country Office for Pakistan & Afghanistan, Level-5, Serena
Business Complex, Khyaban-e-Suhrwardy, Islamabad, Pakistan.
KhanR@unaids.org.
6UNAIDS Country Office for Pakistan & Afghanistan, Level-5, Serena
Business Complex, Khyaban-e-Suhrwardy, Islamabad, Pakistan.
sabam@unaids.org.

Pakistan is among four countries in Asia where the estimated number of new
HIV infections has been increasing year by year ever since 1990. The Asian
Epidemic Modelling (AEM), conducted in 2015, reconfirmed that the use of
contaminated injection equipment among people who inject drugs (PWID)
remains the main mode of HIV transmission in the country. The estimated
number of PWID ranges from 104,804 to 420,000 PWID. HIV prevalence in this
population is above 40 % in several cities, including Faisalabad (52.5 %),
D.G. Khan (49.6 %), Gujrat (46.2 %), Karachi (42.2 %) and Sargodha (40.6
%), respectively. Harm reduction service delivery is being implemented
through a public-private partnership led by the National and Provincial
AIDS Control Programmes and Nai Zindagi with funding support from the
Global Fund. Current programmatic coverage of the needle and syringe
programme, HIV testing and counselling and antiretroviral treatment among
PWID remain insufficient to control ongoing transmission of HIV in the
country. While opioid substitution therapy (OST) is yet to be introduced,
significant progress and coordination among various ministries have taken
place recently to register buprenorphine in the dosage required for
treatment of opioid dependence, and possible introduction of OST will
greatly facilitate adherence to antiretroviral treatment among PWID living
with HIV.

Free full text http://www.harmreductionjournal.com/content/12/1/43
__________________________________________________________________
________________________________*_________________________________

7. Abstract: High HCV prevalence among drug users in Iran: Systematic
review and meta-analysis of epidemiological evidence (2001-2012)
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26460088
Int J Infect Dis. 2015 Oct 9. pii: S1201-9712(15)00232-5.

High HCV prevalence among drug users in Iran: Systematic review and meta-
analysis of epidemiological evidence (2001-2012).

Malekinejad M1, Navadeh S2, Lotfizadeh A3, Rahimi-Movaghar A4, Amin-
Esmaeili M5, Noroozi A6.

1Phillip R. Lee Institute for Health Policy Studies, University of
California, San Francisco; Global Health Sciences, University of
California, San Francisco. Electronic address: MMalekinejad@ucsf.edu.
2Global Health Sciences, University of California, San Francisco;
Department of Epidemiology and Biostatistics, School of Public Health,
Tehran University of Medical Sciences, Tehran, Iran. Electronic address:
soodabeh.navadeh@ucsf.edu.
3Phillip R. Lee Institute for Health Policy Studies, University of
California, San Francisco. Electronic address: alot@ucla.edu.
4Iranian National Center for Addiction Studies (INCAS), Iranian Institute
for Reduction of High-Risk Behaviors, Tehran University of Medical
Sciences. Electronic address: rahimia@tums.ac.ir.
5Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for
Reduction of High-Risk Behaviors, Tehran University of Medical Sciences.
Electronic address: dr.m.a.esmaeeli@gmail.com.
6Iranian National Center for Addiction Studies (INCAS), Iranian Institute
for Reduction of High-Risk Behaviors, School of Advanced Technologies in
Medicine, Tehran University of Medical Sciences. Electronic address:
a_r_noroozi@yahoo.com.

OBJECTIVE: Drug users, particularly drug injectors, are at elevated risk
of blood-borne diseases. This study systematically reviewed the prevalence
of hepatitis C virus (HCV) mono-infection and its co-infections with human
immunodeficiency virus (HIV) and hepatitis B virus (HBV) in drug users in
Iran.

METHODS: We conducted searches in international, regional, and Iranian
databases, screened documents, extracted data, generated pooled point
prevalence and 95% confidence intervals (CI).

RESULTS: Overall, 13,821 subjects (87.4% male) with an average age of 32.4
(95% CI: 31 – 33) from 24 original studies were included in the analysis.
Pooled HCV prevalence (95% CI) among drug users with and without an
injection history was 45% (37-54) and 8% (4-13), respectively. Pooled HCV
prevalence (95% CI) among individuals with versus without a history of
imprisonment and needle sharing were: 58% (39 – 77) vs. 44% (20 – 68) and
56% (41 – 71) vs. 49% (26 – 71), respectively. Prevalence (95% CI) of
HCV/HIV co-infection among injectors was 11% (5-16).

CONCLUSIONS: HCV prevalence is high in drug users in Iran especially among
those with a history of injection drug use, needle sharing, and
imprisonment. Drug user-focused HCV prevention and treatment programs are
imminently needed. Copyright © 2015. Published by Elsevier Ltd.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Reviewing harm reduction for people who inject drugs in Asia:
the necessity for growth
__________________________________________________________________
http://www.harmreductionjournal.com/content/12/1/32 Open Access
Harm Reduct J. 2015 Oct 16;12(1):32.

Reviewing harm reduction for people who inject drugs in Asia: the
necessity for growth.

Stone KA1.

1Harm Reduction International, Unit 2C09, South Bank Technopark, 90 London
Road, London, SE1 6LN, UK. katie.stone@ihra.net.

BACKGROUND: There is an estimate of three to five million people who
inject drugs living in Asia. Unsafe injecting drug use is a major driver
of both the HIV and hepatitis C (HCV) epidemic in this region, and an
increase in incidence among people who inject drugs continues. Although
harm reduction is becoming increasingly accepted, a largely punitive
policy remains firmly in place, undermining access to life-saving
programmes. The aim of this study is to present an overview of key
findings on harm reduction in Asia based on data collected for the Global
State of Harm Reduction 2014.

METHODS: A review of international scientific and grey literature was
undertaken between May and September 2014, including reports from
multilateral agencies and international non-governmental organisations. A
qualitative survey comprising open-ended questions was also administered
to civil society, harm reduction networks, and organisations of people who
use drugs to obtain national and regional information on key developments
in harm reduction. Expert consultation from academics and key thinkers on
HIV, drug use, and harm reduction was used to verify findings.

RESULTS: In 2014, 17 countries in Asia provide needle and syringe
programmes (NSP) provision and 15 opioid substitution therapy (OST). It is
estimated that between 60 and 90 % of people who use drugs in Asia have
HCV; however, treatment still remains out of reach due to cost barriers.
TB testing and treatment services are yet to be established for key
populations, yet nearly 15 % of the global burden of new cases of HIV-TB
co-infection are attributed to southeast Asia. Eighteen percent of the
total number of people living with HIV eligible for antiretroviral
treatment (ART) accessed treatment. Only Malaysia and Indonesia provide
OST in prison, with no NSP provision in prisons in the region.

CONCLUSION: To reduce HIV and viral hepatitis risk among people who inject
drugs, there is a necessity to significantly increase harm reduction
service provision in Asia. Although there has been progress, work still
needs to be done to ensure an appropriate and enabling environment. At
present, people who inject drugs are extremely difficult to reach;
structural and legal barriers to services must be reduced, integrated
holistic services introduced, and further research undertaken.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Hepatitis C and HIV incidence and harm reduction program use
in a conflict setting: an observational cohort of injecting drug users
in Kabul, Afghanistan
__________________________________________________________________
http://www.harmreductionjournal.com/content/12/1/22 Open Access

Harm Reduct J. 2015 Oct 16;12(1):22.

Hepatitis C and HIV incidence and harm reduction program use in a conflict
setting: an observational cohort of injecting drug users in Kabul,
Afghanistan.

Todd CS1,2, Nasir A3, Stanekzai MR4, Fiekert K5, Sipsma HL6, Vlahov D7,
Strathdee SA8.

1Department of Obstetrics & Gynecology, College of Physicians and
Surgeons, and Heilbrunn Department of Population & Family Health, Columbia
University, Mailman School of Public Health, PH 16-69, 622 West 168th
Street, New York, NY, 10032, USA. CTodd@fhi360.org.
2Asia Pacific Business Unit and Clinical Sciences Division, FHI 360,
Sindhorn Building, 130-132 Wittayu Road, Bangkok, 10330, Thailand.
CTodd@fhi360.org.
3Health Protection and Research Organisation, Street 4, Taimani, Kabul,
Afghanistan. abdulnasir39@yahoo.com.
4Health Protection and Research Organisation, Street 4, Taimani, Kabul,
Afghanistan. mohammad-raza.stanikzai@unodc.org.
5Health Protection and Research Organisation, Street 4, Taimani, Kabul,
Afghanistan. k.fiekert@gmail.com.
6Department of Epidemiology, Yale School of Public Health, 60 College
Street, P.O. Box 208034, New Haven, CT, 06520-8034, USA. sipsmah@uic.edu.
7Department 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. dvlahov@nyam.org.
8Division of Global Public Health, University of California San Diego
School of Medicine, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507,
USA. sstrathdee@ucsd.edu.

BACKGROUND: Armed conflict may increase the risk of HIV and other
pathogens among injecting drug users (IDUs); however, there are few
prospective studies. This study aimed to measure incidence and potential
predictors, including environmental events and needle and syringe
distribution and collection program (NSP) use, of hepatitis C virus (HCV)
and HIV among IDUs in Kabul, Afghanistan.

METHODS: Consenting adult IDUs completed interviews quarterly in year 1
and semi- annually in year 2 and HCV and HIV antibody testing semi-
annually through the cohort period (November 2007-December 2009).
Interviews detailed injecting and sexual risk behaviors, NSP service use,
and conflict- associated displacement. Quarters with peak conflict or
local displacement were identified based on literature review, and key
events, including insurgent attacks and deaths, were reported with simple
counts. Incidence and predictors of HCV and HIV were measured with Cox
proportional hazards models.

RESULTS: Of 483 IDUs enrolled, 385 completed one or more follow-up visits
(483.8 person-years (p-y)). All participants were male with a median age
of 28 years and a median duration of injecting of 2 years. Reported NSP
use among the participants ranged from 59.9 to 70.5 % in the first year
and was 48.4 and 55.4 % at 18 and 24 months, respectively. There were 41
confirmed deaths, with a crude death rate of 93.4/1000 p-y (95 %
confidence interval (CI) 67.9-125) and overdose as the most common cause.
HCV and HIV incidence were 35.6/100 p-y (95 % CI 28.3-44.6) and 1.5/100 p-
y (95 % CI 0.6-3.3), respectively. Changing from injecting to smoking was
protective for HCV acquisition (adjusted hazard ratio (AHR)?=?0.53, 95 %
CI 0.31-0.92), while duration of injecting (AHR?=?1.09, 95 % CI
1.01-1.18/year) and sharing syringes (AHR?=?10.09, 95 % CI 1.01-100.3)
independently predicted HIV infection.

CONCLUSION: There is high HCV incidence and high numbers of reported
deaths among male Kabul IDUs despite relatively consistent levels of harm
reduction program use; peak violence periods did not independently predict
HCV and HIV risk. Programming should increase awareness of HCV
transmission and overdose risks, prepare clients for harm reduction needs
during conflict or other causes of displacement, and continue efforts to
engage community and police force support.

Free full text http://www.harmreductionjournal.com/content/12/1/22
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Hepatitis C virus (HCV) infection & risk factors for HCV
positivity in injecting & non-injecting drug users attending a de-
addiction centre in northern India
__________________________________________________________________
http://www.ijmr.org.in/text.asp?2015/142/3/311/166596 CC Open Access

Indian J Med Res. 2015 Sep;142(3):311-6.

Hepatitis C virus (HCV) infection & risk factors for HCV positivity in
injecting & non-injecting drug users attending a de-addiction centre in
northern India.

Basu D1, Sharma AK, Gupta S, Nebhinani N, Kumar V.

1Department of Psychiatry, Postgraduate Institute of Medical Education &
Research, Chandigarh, India.

BACKGROUND & OBJECTIVES: Injecting drug use is a major route of hepatitis
C virus (HCV) infection in India, but there may be other risk factors
also. This study was carried out to determine the seroprevalence of anti-
HCV antibody in injecting drug users (IDUs) vs. non-IDUs (NIDUs), and to
study the risk estimates for HCV seropositivity in the total sample of
substance users with regard to various demographic, clinical, behavioural
and personality factors.

METHODS: The IDUs (n = 201) and NIDUs (n = 219) were assessed for
demographic, clinical and behavioural information, and were rated on
instruments for severity of dependence, risk behaviour and personality
profiles. Anti-HCV antibody was tested by ELISA and confirmed by
recombinant immunoblot assay (RIBA) test.

RESULTS: Almost one-third of the IDUs (64 of 201; 31.8%) were positive for
anti-HCV antibody, as opposed to only seven (3.2%) of the NIDUs. The four
risk factors strongly associated with HCV positivity in multivariate
analysis were sharing syringe [Exp(B) 75.04; 95%CI 18.28-307.96; P<0.001],
reuse of injection accessories (16.39; 3.51-76.92; P<0.001), blood
transfusion (5.88; 1.63-21.23; P=0.007) and IDU status (3.60; 1.26-10.31;
P=0.017). Other variables less strongly but significantly associated with
HCV positivity were multiple sex partners, opioid dependence, risk
behaviour scores, impulsivity, and lower age of onset of drug use.

INTERPRETATION & CONCLUSIONS: Our study showed a high seroprevalence of
anti-HCV antibody in IDUs. In the substance users, HCV positivity was
significantly and independently associated with several clinical,
behavioural, and personality risk factors.

Free full text http://www.ijmr.org.in/text.asp?2015/142/3/311/166596
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Epidemiology of HIV/AIDS in the East Azerbaijan Province,
Northwest of Iran
__________________________________________________________________
Free Full Text http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4601292/
Jundishapur J Microbiol. 2015 Aug 1;8(8):e19766.

Epidemiology of HIV/AIDS in the East Azerbaijan Province, Northwest of
Iran.

Haghgoo SM1, Joula H1, Mohammadzadeh R1, Sabour S2, Yousefi R3, Ghahramani
G3, Rahimi AA4.

1Student Research Center, Tabriz University of Medical Sciences, Tabriz,
IR Iran.
2Department of Clinical Epidemiology (COH), Shahid Beheshti University of
Medical Sciences, Tehran, IR Iran.
3Health Center of East Azerbaijan Province, Tabriz University of Medical
Sciences, Tabriz, IR Iran.
4Department of Medical Microbiology, Tabriz University of Medical
Sciences, Tabriz, IR Iran.

BACKGROUND: This study was performed in response to the rapid propagation
of HIV/AIDS across Iran and its status in this region. Accordingly, an
evidence-based program is required to combat this disease.

OBJECTIVES: The present study estimated the prevalence of HIV/AIDS in East
Azerbaijan (population: 3,724,000).

MATERIALS AND METHODS: We created a database of all positive cases from
1987 to 2012. We also analyzed and described the epidemiological status of
HIV/AIDS during a 25-year period by using SPSS.

RESULTS: In East Azerbaijan, 371 HIV/AIDS cases have been reported, i.e. 1
case per 10,000 population. The vast majority of reported cases (91%, n =
338) were men, whereas only 9% (n = 33) were women. The mean age of
patients was 30.8 ± 12.3 years. Unsafe drug injection (59%, n = 219) and
sexual interaction (13%, n = 48) were the two major modes of HIV
transmission. In addition, 7% (n = 25) of patients have been diagnosed
with HIV, hepatitis B Virus, and hepatitis C virus simultaneously.
Moreover, 60% (n = 205) of men were infected via drug injection, while 82%
(n = 27) of women were infected via unprotected sexual interaction (P <
0.001).

CONCLUSIONS: The results indicate a rapid increase in the number of
HIV/AIDS cases in East Azerbaijan, necessitating immediate attention and
strategies to combat the rapid spread of the disease. Development of
provincial and national HIV/AIDS strategies demands more accurate and
comprehensive HIV/AIDS surveillance.

KEYWORDS: Acquired Immunodeficiency Syndrome; Epidemiology; HIV

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4601292/
__________________________________________________________________
________________________________*_________________________________

12. Abstract: The efficacy assessment of a self-administered immunotherapy
protocol
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26467843
Int Forum Allergy Rhinol. 2015 Oct 14.

The efficacy assessment of a self-administered immunotherapy protocol.

Schaffer FM1,2, Garner LM1, Ebeling M3, Adelglass JM4, Hulsey TC3, Naples
AR1.

1United Allergy Services (UAS), San Antonio, TX.
2Division of Pediatric Pulmonary, Allergy and Immunology, Medical
University of South Carolina, Charleston, SC.
3Division of Pediatric Epidemiology, Medical University of South Carolina,
Charleston, SC.
4Allergy Testing and Treatment Center, Plano, TX.

BACKGROUND: We previously reported the safety of a self-administered
subcutaneous immunotherapy (SCIT) protocol. Here we report the results of
the retrospective efficacy trial of the United Allergy Service (UAS) self-
administered SCIT protocol. We hypothesized that by utilizing a slow SCIT
buildup phase, designed to attain recommended allergen concentrations on a
cumulative basis, efficacious outcomes and clinical relevance would be
achieved.

METHODS: We enrolled 60 SCIT patients and 56 control patients. The study
contrasted baseline and treatment period combined symptom plus medication
scores (CSMS) as the primary outcome measure and rhinoconjunctivitis
quality of life questionnaire (RQLQ) scores as the secondary study outcome
measure. Changes in pollen counts were also examined with regard to
effects on these efficacy parameters.

RESULTS: The treatment group showed significantly improved CSMS
(standardized mean difference [SMD]: -1.57; 95% confidence interval [CI],
-1.97 to -1.18; p < 0.001) and RQLQ (SMD: -0.91; 95% CI, -1.23 to -0.59; p
< 0.001). These treatment group outcome measures were respectively
improved by 33% and 29% compared to baseline and greater than 40% in
comparison to the control group (p < 0.0001). Significant results were
also shown when examining these outcome measures with regards to either
monotherapy or poly-allergen SCIT. Furthermore, a comparison to recent
meta-analyses of SCIT studies showed equivalent efficacy and clinical
relevance. Assessment of pollen counts during the baseline and treatment
periods further corroborated the efficacy of the UAS SCIT protocol.

CONCLUSION: These efficacy results, and our previous safety results, show
that a carefully designed and implemented self-administered SCIT protocol
is efficacious and safe.

© 2015 The Authors International Forum of Allergy & Rhinology published by
Wiley Periodicals, Inc., on behalf of ARS-AAOA, LLC.

KEYWORDS: aeroallergens; allergic rhinitis; allergy immunotherapy; allergy
injections; subcutaneous immunotherapy
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Epidemiology of Ebola virus disease transmission among
health care workers in Sierra Leone, May to December 2014: a
retrospective descriptive study
__________________________________________________________________
http://www.biomedcentral.com/1471-2334/15/416 Open Access

BMC Infect Dis. 2015 Oct 13;15(1):416.

Epidemiology of Ebola virus disease transmission among health care workers
in Sierra Leone, May to December 2014: a retrospective descriptive study.

Olu O1, Kargbo B2, Kamara S3, Wurie AH4, Amone J5, Ganda L6, Ntsama B7,
Poy A8, Kuti-George F9, Engedashet E10, Worku N11, Cormican M12, Okot C13,
Yoti Z14, Kamara KB15, Chitala K16, Chimbaru A17, Kasolo F18.

1World Health Organization (WHO) Intercountry Support Team for Eastern and
Southern Africa, Harare, Zimbabwe. oluo@who.int.
2Ministry of Health and Sanitation, Freetown, Sierra Leone.
brimakargbo@hotmail.com.
3Ministry of Health and Sanitation, Freetown, Sierra Leone.
sarian2007@yahoo.co.uk.
4Ministry of Health and Sanitation, Freetown, Sierra Leone.
aliehwuriedr@gmail.com.
5Ministry of Health, Kampala, Uganda. amonekaka@yahoo.co.uk.
6WHO, Freetown, Sierra Leone. gandal@who.int.
7WHO Intercountry Support Team West Africa, Ouagadougou, Burkina Faso.
ntsamab@who.int.
8WHO African Regional Office (AFRO), Brazzaville, Congo. poya@who.int.
9WHO, Freetown, Sierra Leone. kutigeorgef@who.int.
10WHO, Freetown, Sierra Leone. etsub2010@gmail.com.
11WHO, Freetown, Sierra Leone. negusuworku@gmail.com.
12School of Medicine, National University of Ireland Galway, Galway,
Ireland. martin.cormican@hse.ie.
13WHO, Kampala, Uganda. okotc@who.int.
14WHO, Freetown, Sierra Leone. yotiza@who.int.
15WHO, Geneva, Switzerland. kandebure@who.int.
16WHO, Nairobi, Kenya. chitalak@who.int.
17WHO, Freetown, Sierra Leone. achimbaru@yahoo.com.
18WHO African Regional Office (AFRO), Brazzaville, Congo. kasolof@who.int.

BACKGROUND: Anecdotal evidence suggests that much of the continuing
infection of health care workers (HCWs) with Ebola virus during the
current outbreak in Sierra Leone has occurred in settings other than Ebola
isolation units, and it is likely that some proportion of acquisition by
HCWs occurs outside the workplace. There is a critical need to define more
precisely the pathways of Ebola infection among HCWs, to optimise measures
for reducing risk during current and future outbreaks.

METHODS: We conducted a retrospective descriptive study of Ebola
acquisition among health workers in Sierra Leone during May-December 2014.
The data used were obtained mainly from the national Ebola database, a
cross-sectional survey conducted through administration of a structured
questionnaire to infected HCWs, and key informant interviews of select
health stakeholders.

RESULTS: A total of 293 HCWs comprising 277 (95 %) confirmed, 6 (2 %)
probable, and 10 (3 %) suspected cases of infection with Ebola virus were
enrolled in the study from nine districts of the country. Over half of
infected HCWs (153) were nurses; others included laboratory staff (19, 6.5
%), doctors (9, 3.1 %), cleaners and porters (9, 3.1 %), Community Health
Officers (8, 2.7 %), and pharmacists (2, 0.7 %). HCW infections were
mainly reported from the Western Area (24.9 %), Kailahun (18.4 %), Kenema
(17.7 %), and Bombali (13.3 %) districts.

Almost half of the infected HCWs (120, 47.4 %) believed that their
exposure occurred in a hospital setting. Others believed that they were
exposed in the home (48, 19 %), at health centres (45, 17.8 %), or at
other types of health facilities (13, 5.1 %). Only 27 (10.7 %) of all HCW
infections were associated with Ebola virus disease (EVD) isolation units.

Over half (60 %, 150) of infected HCWs said they had been trained in
infection prevention and control prior to their infection, whereas 34 %
(85) reported that they had not been so trained.

CONCLUSIONS: This study demonstrated the perception that most HCW
infections are associated with general health care and home settings and
not with dedicated EVD settings, which should provide substantial
reassurance to HCWs that measures in place at dedicated EVD facilities
generally provide substantial protection when fully adhered to.

Free Article http://www.biomedcentral.com/1471-2334/15/416
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Use of a daily disinfectant cleaner instead of a daily
cleaner reduced hospital-acquired infection rates
__________________________________________________________________
http://www.ajicjournal.org/article/S0196-6553(14)01284-X/fulltext
Am J Infect Control. 2015 Feb;43(2):141-6. OPen Access

Use of a daily disinfectant cleaner instead of a daily cleaner reduced
hospital-acquired infection rates.

Alfa MJ1, Lo E2, Olson N3, MacRae M4, Buelow-Smith L4.

1St Boniface Research Centre, Winnipeg, MB, Canada; Department of Medical
Microbiology, University of Manitoba, Winnipeg, MB, Canada. Electronic
address: malfa@sbrc.ca.
2Department of Medical Microbiology, University of Manitoba, Winnipeg, MB,
Canada; St Boniface Hospital, Winnipeg, MB, Canada.
3St Boniface Research Centre, Winnipeg, MB, Canada.
4St Boniface Hospital, Winnipeg, MB, Canada.

BACKGROUND: Documenting effective approaches to eliminate environmental
reservoirs and reduce the spread of hospital-acquired infections (HAIs)
has been difficult. This was a prospective study to determine if hospital-
wide implementation of a disinfectant cleaner in a disposable wipe system
to replace a cleaner alone could reduce HAIs over 1 year when housekeeping
compliance was =80%.

METHODS: In this interrupted time series study, a ready-to-use accelerated
hydrogen peroxide disinfectant cleaner in a disposable wipe container
system (DCW) was used once per day for all high-touch surfaces in patient
care rooms (including isolation rooms) to replace a cleaner only. The HAI
rates for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-
resistant enterococci (VRE), and Clostridium difficile were stratified by
housekeeping cleaning compliance (assessed using ultraviolet-visible
marker monitoring).

RESULTS: When cleaning compliance was =80%, there was a significant
reduction in cases/10,000 patient days for MRSA (P = .0071), VRE (P <
.0001), and C difficile (P = .0005). For any cleaning compliance level
there was still a significant reduction in the cases/10,000 patient days
for VRE (P = .0358).

CONCLUSION: Our study data showed that daily use of the DCW applied to
patient care high-touch environmental surfaces with a minimum of 80%
cleaning compliance was superior to a cleaner alone because it resulted in
significantly reduced rates of HAIs caused by C difficile, MRSA, and VRE.

Copyright © 2015 Association for Professionals in Infection Control and
Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

KEYWORDS: Clostridium difficile; Environmental cleaning; Housekeeping;
Methicillin-resistant Staphylococcus aureus; Vancomycin-resistant
enterococci

Free full text
http://www.ajicjournal.org/article/S0196-6553(14)01284-X/fulltext
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Lower infection rates after introduction of a photocatalytic
surface coating
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/25530557

Am J Infect Control. 2015 Feb;43(2):180-1.
Lower infection rates after introduction of a photocatalytic surface
coating.

Pulliam JR1.

1Budd Terrace at Wesley Woods, Emory Healthcare of Emory University,
Atlanta, GA. Electronic address: john.r.pulliam@emoryhealthcare.org.

Health care facilities contain potentially contaminated surfaces that are
either difficult to sanitize or prone to recontamination. Photocatalytic
materials exhibit antimicrobial activity when exposed to light and provide
a safe, durable coating on a wide range of surfaces.

We assessed infection rates before and after introduction of a
photocatalytic coating in our facility.

Infection rates decreased overall by 30%, a change that was statistically
significant (P = .02).

Similar changes to the built environment merit additional investigation.

Copyright © 2015 Association for Professionals in Infection Control and
Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

KEYWORDS:
Antimicrobial; Health care–acquired infection; Photocatalysis; Titanium
dioxide
__________________________________________________________________
________________________________*_________________________________

16. No Abstract: Editorial: Harm reduction in Asia and the Pacific: an
evolving public health response [Link to Free Full Text]
__________________________________________________________________
Harm Reduct J. 2015 Oct 16;12(1):47.

Harm reduction in Asia and the Pacific: an evolving public health
response.

Crofts N1, Azim T2.

1Centre for Law Enforcement and Public Health, 309 George St, Doncaster,
Vic, 3108, Australia. nick.crofts@unimelb.edu.au.
2icddr,b, GPO Box 128, Dhaka, 1000, Bangladesh.

Free full text http://www.harmreductionjournal.com/content/12/1/47
__________________________________________________________________
________________________________*_________________________________

17. No Abstract: Salvaging a prison needle and syringe program trial in
Australia requires leadership and respect for evidence
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26465687
Med J Aust. 2015 Oct 19;203(8):319-20.

Salvaging a prison needle and syringe program trial in Australia requires
leadership and respect for evidence.

Stoové M1, Treloar CJ2, Maher L2, Tyrrell H3, Wallace J4.

1Burnet Institute, Melbourne, VIC stoove@burnet.edu.au.
2University of New South Wales, Sydney, NSW.
3Hepatitis Australia, Canberra, ACT.
4LaTrobe University, Melbourne, VIC.
__________________________________________________________________
________________________________*_________________________________

18. No Abstract: First Documented Transmission of Trypanosoma cruzi
Infection through Blood Transfusion in a Child with Sickle-Cell
Disease in Belgium
__________________________________________________________________
http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003986

PLoS Negl Trop Dis. 2015 Oct 15;9(10):e0003986. Open Access

First Documented Transmission of Trypanosoma cruzi Infection through Blood
Transfusion in a Child with Sickle-Cell Disease in Belgium.

Blumental S1, Lambermont M2, Heijmans C3, Rodenbach MP2, El Kenz H2,
Sondag D2, Bottieau E4, Truyens C5.

1Pediatric Infectious Disease Unit, Hôpital Universitaire des Enfants
Reine Fabiola, Brussels, Belgium.
2Service du Sang, Belgian Red Cross, Brussels, Belgium.
3Hemato-oncology Department, Hôpital Universitaire des Enfants Reine
Fabiola, Brussels, Belgium.
4Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp,
Belgium.
5Laboratory of Parasitology, Faculty of Medicine, Université Libre de
Bruxelles, Brussels, Belgium.

Free full text
http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003986
__________________________________________________________________
________________________________*_________________________________

19. News

– USA: ManorCare blames contractor for hepatitis outbreak in new filing

– USA: Nursing Home Blamed for Hep C Outbreak

– Singapore: SGH Hep C cases: MOH to invite international experts to
advise review committee

– Singapore: SGH files police report over Hepatitis C cluster

– Cambodia: Cambodian doctor on trial for infecting patients with HIV:
Yem Chroeum is accused of infecting locals in a remote village by
reusing dirty needles

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/o95dywl
Cambodia: Cambodian doctor on trial for infecting patients with HIV:
Yem Chroeum is accused of infecting locals in a remote village by reusing
dirty needles.

Chanel News Asia (20.10.15)

PHNOM PENH: An unlicensed Cambodian doctor who allegedly infected more
than 200 people with HIV, including some who later died, went on trial for
murder Tuesday (Oct 20).

The case has shone a spotlight on the chronically underfunded health care
system in an impoverished nation where many have to rely on self-taught or
unlicensed medics to receive treatment.

Yem Chroeum, 55, is accused of infecting locals in the remote village of
Roka in western Battambang province by reusing dirty needles. Em Sovann,
his lawyer, said the court has set a five-day trial.

“In the courtroom my client still claims he is innocent,” Em Sovann told
AFP, adding that the doctor did not deliberately or knowingly infect his
patients.

Yem Chroeum faces charges of murder, deliberately infecting patients with
HIV and running an unlicensed clinic. He faces life in prison if
convicted, Em Sovann said.

For millions of Cambodians – especially the poor and those in remote
regions – unlicensed doctors are the only realistic healthcare option for
everyday ailments. World Bank figures say Cambodia, one of Asia’s poorest
nations, has just 0.2 doctors for every 100,000 people, on a par with
Afghanistan.

Similarly impoverished Myanmar has 0.4 per 100,000, while France boasts
3.2 per 100,000. Much of Cambodia’s shortfall is made up by unlicensed
practitioners. But the HIV infections in Roka shocked the country and saw
the government vow to crack down on unlicensed health providers. Some of
those who were infected are expected to testify at the trial.

Loeum Lorn, 52, said he and four of his family members had become HIV-
positive.

“We are his (the doctor’s) victims but it was only late on that we
discovered we were infected,” he told reporters outside the court.

He added that around ten villagers who were infected, mostly elderly, had
since died. At the trial Tuesday prosecutor Heng Luy accused the doctor of
hiding the facts and changing his story.

“We will have to collect all the information and evidence from all the
witnesses,” he told AFP. “But we can’t make any conclusion right now.”

– AFP/yt
__________________________________________________________________
__________________________________________________________________
https://tinyurl.com/orwmyuy
Singapore: SGH files police report over Hepatitis C cluster

Singapore General Hospital says the police report has been filed so that
the police may ascertain if there was any foul play.

Chanel News Asia (20.10.15)

SINGAPORE: The Singapore General Hospital (SGH) on Tuesday (Oct 20) filed
a police report over a Hepatitis C cluster found in its renal ward.

“After initial internal investigation, we are still unable to determine
the cause of the cluster of infection. Currently, an independent review
committee appointed by MOH is looking into this with the help of
international advisors. The police report has been filed so that the
police may ascertain if there was any foul play,” SGH said in a statement.

On Oct 6, SGH announced that 22 patients in its renal ward had contracted
Hepatitis C. It also said the infection could have been a contributing
factor in up to five deaths.

The hospital has since tightened measures at its wards and has screened
hundreds of patients and staff for the virus. Its staff are also being
interviewed by the independent review committee which includes two
international experts.

In a statement late Tuesday, Health Minister Gan Kim Yong said: “With the
help of the international advisors, the independent review committee (IRC)
will look into the cause of the cluster of Hepatitis C infection in the
Singapore General Hospital and identify gaps or weak points that need to
be improved.”

“Even as the IRC continues its work independently, we are not excluding
any probable cause. Hence SGH has made a police report of the incident.
This will allow the police to investigate and ascertain if there was any
foul play.”

Prime Minister Lee Hsien Loong has also said authorities need to establish
what happened, put things right if need be and learn from the experience.
“Because we must maintain public confidence, and trust in the healthcare
system,” Mr Lee said.

– CNA/ly
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/p6cx6bd
Singapore: SGH Hep C cases: MOH to invite international experts to advise
review committee

Chanel News Asia (17.10.15)

The Independent Review Committee is set to look into processes in both SGH
and MOH to identify whether there are any gaps and areas that can be
improved upon.

SINGAPORE: Minister for Health Gan Kim Yong will invite international
experts to help and advise the Independent Review Committee (IRC) looking
into the cause of the cases of Hepatitis C infections at the Singapore
General Hospital (SGH).

He announced this on the sidelines of a community event on Saturday (Oct
17), where he also gave updates on the work of the committee.

Mr Gan said: “The committee has been working for the last 2 weeks,
focusing on the cause of the Hepatitis C cases at the Singapore General
Hospital (SGH), looking at how it happened and to also try to determine
how we can prevent it from happening in future. The committee will also
look at the processes in both SGH and the Ministry of Health to identify
whether there are any gaps and areas that we can improve upon so that we
can strengthen our system. I have also assured the Committee that SGH and
MOH will extend our full support so as to facilitate the review and to
ensure that it is a very thorough review.”

He added: “The committee has requested that I invite some of the experts,
including international experts, to help and advise the committee, so as
to ensure that the review will be a very thorough one. I support the
proposal. The committee will be following up on this proposal and will
make further announcements when they are ready.”

In response to queries on whether any contingency plans will be put in
place to prevent similar incidents from happening again, Mr Gan said a key
objective of the committee is to identify areas for improvement.

“It is for this reason that we have told the committee that SGH and MOH
will adopt an open attitude because it is only by maintaining an open
attitude that we can extend the full support for their work so that the
review will then allow us to learn lessons from this incident to prevent
this from happening and to improve ourselves so that we can do better in
the future,” he added.

On Oct 6, SGH announced that it was investigating a cluster of Hepatitis C
infections in its renal ward. In total, 22 patients who were hospitalised
between April and June this year were infected, and SGH said it cannot
rule out that Hepatitis C could be a factor in the deaths of four of these
patients. Another recent death is under review.

The IRC was then established to probe the Hepatitis C cluster at SGH. The
IRC is made up of seven medical professionals from the Health Ministry,
Tan Tock Seng Hospital, the National University Hospital and Changi
General Hospital. They include renal and liver specialists, as well as a
chief nurse – all of whom are experts in their own fields.

The committee has been given two months to complete its task.

As of 1pm on Friday, a total of 485 out of 678 patients have been screened
for Hepatitis C, said SGH in a statement. Among them, 441 have received
their results and all have tested negative. The results of the remaining
44 are still pending, while an additional 144 patients have already made
appointments for screening.

The hospital added that it has screened 284 out of a total of 319 staff
members so far. 279 of them have had their results released, and all of
them have tested negative for Hepatitis C.

– CNA/av
__________________________________________________________________
__________________________________________________________________
https://tinyurl.com/nldfu9q
USA: Nursing Home Blamed for Hep C Outbreak

By Lacey Louwagie, Courthouse News Service (16.10.15)

MINOT, N.D. (CN) – An “unprecedented outbreak” of hepatitis C at a North
Dakota nursing home made at least 44 people sick, at least four of whom
died, 13 people, including representatives of the estates, claim in court.

Lead plaintiff Richard Kerzman claims he was one of the elderly patients
who contracted hepatitis C from 2003 through 2013 due to the negligence of
ManorCare Nursing Home and Trinity Health.

Kerzman et al. say at least 52 people in and around Minot contracted
hepatitis C during the outbreak. The lawsuit says that state investigators
traced 44 of the infections to the ManorCare Nursing Home.

Kerzman et al. claim the nursing home and the companies that provided
phlebotomy, podiatry and nail care services there “flagrantly violated
their fundamental duties to protect their patients and residents, and
infected them with a deadly and debilitating disease that could have been
prevented by even the most rudimentary care.”

Kerzman is one of nine surviving residents who sued Trinity Hospitals,
ManorCare of Minot and their affiliates, in Ward County Court. Four
plaintiffs sued as representatives of an estate.

They claim the negligence went on for a decade, until public health
officials noticed in the summer of 2013 that an “unusually large number of
elderly patients in the Minot area had recently tested positive for the
hepatitis C virus.”

A North Dakota Department of Health investigation revealed that the
viruses were genetically similar, indicating a common source for the
infection. The investigation found that “common factors between the vast
majority of the victims include residency at ManorCare, receipt of medical
services at ManorCare, and the contraction of a genetically similar
genotype and quasispecies of the virus” between 2011 and 2013.

Dr. Casmiar Nwaigwe, director of infectious disease at Trinity, said: “No
matter how you do the statistics, it is impossible for (this outbreak) to
be an accident,” according to the complaint. (Parentheses in complaint.)

Nwaigwe is not a party to the lawsuit.

The complaint also quotes North Dakota Health Department epidemiologist
Sarah Weninger, who investigated the outbreak along with the Centers for
Disease Control: “You know one or two is an accident but when you have 44,
and we did, when we did testing, and one facility has such a high
prevalence, that’s not … that’s not an accident.” (Ellipsis in
complaint.)

The plaintiffs range in age from 65 to 92. They quote Dr. Nwaigwe as
saying that “an elderly person who has taken no risks associated with
contracting hepatitis C should not have been infected with the disease.”

Risky behaviors for hepatitis C include injecting drugs through shared
needles, unsafe sex, and getting tattooed with a dirty needle.

Hepatitis C is a potentially fatal contagious liver disease that causes
nausea, abdominal pain, vomiting, and can progress to cancer.

Many of the plaintiffs were not good candidates for treatment, as they
are, or were, elderly and frail, and some of them could not afford
treatment.

Behdad Sadeghi, one of plaintiffs’ attorneys, told Courthouse News that at
least one of his clients had died of complications from the disease.

“What has been lost in the coverage about this escalating finger pointing
between ManorCare and Trinity is the fact that there are real people here
who have a potentially fatal and debilitating disease, and who still are
in need of compensation and treatment,” Sadeghi said.

He said that ManorCare and Trinity “have been very aggressive in blaming
each other. But our clients wish that they had been this aggressive in
implementing infection prevention practices that would have prevented this
outbreak in the first place. Instead of fighting one another and dragging
this out, ManorCare and Trinity should come together to do right by their
patients. We hope they do soon.”

ManorCare declined a request for comment, and Trinity did not respond. A
similar lawsuit is pending in Federal Court.

The Centers for Disease Control estimates that 29,781 people were infected
with hepatitis C in 2013, and that 2.7 million people are currently
infected.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/nlhmgw6
USA: ManorCare blames contractor for hepatitis outbreak in new filing

Elizabeth Leis Newman, McKnight’s Long Term Care News, USA (16.10.15)

ManorCare Health Services has filed a new motion in federal court stating
its contractor was responsible for one of the largest outbreaks of
Hepatitis C ever seen in the United States.

More than 40 people were infected with the liver disease at the 114-bed
facility in Minot, ND, in 2013. ManorCare Health Services has accused
Trinity Health Services of failing to train its phlebotomists and ignoring
suspicions that employees were re-using needles to draw blood, according
to court documents filed this month in federal court. ManorCare is seeking
punitive damages against Trinity in the case, which is pending in the U.S.
District Court for the District of North Dakota.

“Trinity tolerated and concealed behavior by its employees and contractors
that violated the most fundamental standards of infection control and
patient safety, and presented an obvious recipe for a hepatitis C
outbreak,” the document stated.

Plaintiffs originally filed a class action lawsuit against ManorCare but
withdrew it due to a new belief Trinity Health is solely responsible and
allowing drug diversion, a local television station reported.

Trinity Health said it would not respond to questions due to pending
litigation. However, “Trinity will be filing its opposition to ManorCare’s
recent motion in accordance with the rules of court,” Randy Schwan,
Trinity Health vice president, said in a statement.

ManorCare also declined further comment due to ongoing legal proceedings
but thanked its supporters in a statement.

“At ManorCare Health Services-Minot, we remain committed to supporting
those affected by the outbreak, and are thankful for the continued trust
that our patients and their families place in us,” a statement sent to
McKnight’s said.

The outbreak made up a quarter of all hepatitis C cases since 2008,
according to the Centers for Disease Control and Prevention. While
injection drug users are often at highest risk of contracting the disease,
it can be spread through any re-used needle or syringe.
__________________________________________________________________
________________________________*_________________________________

New WHO Injection Safety Guidelines

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

The new guideline is:

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

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

PDF Requires Adobe Acrobat Reader [620 KB]
__________________________________________________________________
________________________________*_________________________________
Making all injections safe brochure

This is an illustrated summary brochure for the general public.

pdf, 554kb [6 pages]

www.who.int/injection_safety/global-campaign/injection-safety_brochure.pdf
__________________________________________________________________
________________________________*_________________________________

SIGN Meeting 2015

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

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

A report of the meeting will be posted ASAP
__________________________________________________________________
________________________________*_________________________________
* 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
__________________________________________________________________
________________________________*_________________________________
All members of the SIGN Forum are invited to submit messages, comment on
any posting, or to use the forum to request technical information in
relation to injection safety.

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

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

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

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

The SIGNpost Website is http://SIGNpostOnline.info

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

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

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

The SIGN Internet Forum was established at the initiative of the World
Health Organization’s Department of Essential Health Technologies.

The SIGN Secretariat home is the 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
__________________________________________________________________

Comments are closed.