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SIGNpost 00827

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00827 Abstracts + Hep-C/B/D + IDU + Vax + News 04 November 2015

CONTENTS
1. Abstract: Hepatitis C oubreaks in Poland in 2003-2013. Medical
procedures as a dominant route of HCV transmission
2. Abstract: Molecular epidemiology of hepatitis B and Delta virus strains
that spread in the Mediterranean North East Coast of Tunisia
3. Abstract: The prevalence of hepatitis C among healthcare workers: a
systematic review and meta-analysis
4. Abstract: The acceptable duration between occupational exposure to
hepatitis B virus and hepatitis B immunoglobulin injection: Results
from a Korean nationwide, multicenter study
5. Abstract: Occurrence And Knowledge About Needle Stick Injury In Nursing
Students
6. Abstract: Understanding the hospital sharps injury reporting pathway
7. Abstract: How do university education and clinical experience influence
pre-registration nursing students’ infection control practice? A
descriptive, cross sectional survey
8. Abstract: Blood Trials: Transfusions, Injections, and Experiments in
Africa, 1890-1920
9. Abstract: Historical epidemiology of hepatitis C virus (HCV) in select
countries – volume 3
10. Abstract: Strategies to manage hepatitis C virus infection disease
burden – volume 3
11. Abstract: Risk Factors Associated with Unsafe Injection Practices at
the First Injection Episode among Intravenous Drug Users in France:
Results from PrimInject, an Internet Survey
12. Abstract: Internalized stigma and sterile syringe use among people who
inject drugs in New York City, 2010-2012
13. Abstract: Seroprevalence of the Hepatitis B, Hepatitis C, and Human
Immunodeficiency Viruses and Treponema pallidum at the Beijing General
Hospital from 2010 to 2014: A Cross-Sectional Study
14. Abstract: High HIV burden among people who inject drugs in 15 Indian
cities
15. Abstract: Risk of Injection-Site Abscess among Infants Receiving a
Preservative-Free, Two-Dose Vial Formulation of Pneumococcal Conjugate
Vaccine in Kenya
16. Abstract: Syringe-type and needle gauge have no role in adverse events
following DTwP immunization: a randomized multicenter trial
17. Abstract: Dangers of vaccine refusal near the herd immunity threshold:
a modelling study
18. Abstract: Healthcare-Associated Transmission of Plasmodium falciparum
in New York City
19. Abstract: Contamination of multidose butorphanol vials in small animal
general practices
20. News
– Global: Health care workers more likely to get hepatitis C
– Global: Health Care Workers At Greater Risk Of Hepatitis C Infection
– USA: Discarded syringes put cleanup workers along Pennsylvania roads at
risk
– UK: New research traces hepatitis C infections in Scotland back to WWII

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________________________________*_________________________________

1. Abstract: Hepatitis C oubreaks in Poland in 2003-2013. Medical
procedures as a dominant route of HCV transmission
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26519841

Przegl Epidemiol. 2015;69(3):465-72.
Hepatitis C oubreaks in Poland in 2003-2013. Medical procedures as a
dominant route of HCV transmission.

[Article in English, Polish]

Stepien M1, Rosinska M1.

1Department of Epidemiology, National Institute of Public Health-National
Institute of Hygiene in Warsaw.

BACKGROUND: According to the data from routine epidemiological
surveillance in Poland, over 70% of patients diagnosed with HCV infection
report exclusively medical exposure which suggests that infection was
probably associated with procedures performed in health care settings. To
a large extent, neither the source nor the mechanism of transmission,
however, may be determined. Infections detected in an acute phase,
accounting for ca 2 -3% of registered hepatitis C cases per year, better
reflect the actual routes of HCV transmission. Epidemiological
investigations of acute hepatitis C outbreaks allow for identifying the
procedures in which the virus is transmitted.

OBJECTIVE: To identify mechanisms and breaches of safety procedures, which
are most frequently associated with HCV infection, based on a review of
recent hepatitis C outbreaks in health care settings in Poland.

METHODS: A systematic review of reports on acute hepatitis C cases
registered in routine surveillance in 2006-2013 and literature review in
PubMed and SCOPUS.

RESULTS: A total of six outbreaks were documented in which 116 cases were
detected. Of them, four outbreaks were identified based on surveillance
data, including one unconfirmed outbreak, and information on two outbreaks
was retrieved from publications. Five of the described outbreaks were
acquired in health care settings, including two outbreaks which occurred
in dialysis units and one outbreak was associated with alternative
medicine procedures. Probably, infections were most commonly transmitted
due to mistakes of medical personnel resulting from negligence or
ignorance of procedures, i.e. multiple use of disposable equipment and
improper use of personal protective equipment (failure to change
disposable gloves). In one case, neither breaches of procedure nor actions
which could lead to HCV infection were determined.

CONCLUSIONS: A detailed epidemiological investigation should be conducted
in each registered case of acute hepatitis C as detected symptomatic cases
allow for identifying the outbreaks. Epidemiological investigations of
outbreaks should be improved by inclusion of molecular tests.
Identification of breaches of binding procedures indicates a necessity of
continuing training of personnel and enhanced control of compliance with
binding recommendations, especially with regard to injection safety.

KEY WORDS: hepatitis C, acute hepatitis C, outbreak, route of
transmission, Poland.

Free full text [PDF 276 KB]
http://www.przeglepidemiol.pzh.gov.pl/pobierz-artykul?id=1957
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Molecular epidemiology of hepatitis B and Delta virus strains
that spread in the Mediterranean North East Coast of Tunisia
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26513762

J Clin Virol. 2015 Oct 8;72:126-132.
Molecular epidemiology of hepatitis B and Delta virus strains that spread
in the Mediterranean North East Coast of Tunisia.

Yacoubi L1, Brichler S2, Mansour W2, Le Gal F2, Hammami W3, Sadraoui A3,
Ben Mami N4, Msaddek A5, Cheikh I6, Triki H7, Gordien E8.

1Laboratoire de Virologie Clinique, Institut Pasteur de Tunis, Tunisia;
Carthage University, Tunis, Tunisia.
2Laboratoire de Bactériologie, Virologie, Hygiène, Hôpital Avicenne,
Assistance Publique-Hôpitaux de Paris, Laboratoire Associé au Centre
National de Référence des Hépatites B, C et Delta, UFR Santé Médecine
Biologie Humaine, Université Paris 13, Bobigny, France.
3Laboratoire de Virologie Clinique, Institut Pasteur de Tunis, Tunisia.
4Department of Gastroenterology B, La Rabta Hospital, Tunisia; Tunis El
Manar University, Tunis, Tunisia.
5Department of Gastroenterology, Tahar Maamouri Hospital, Nabeul, Tunisia;
Tunis El Manar University, Tunis, Tunisia.
6Department of Gastroenterology, Habib Bougatfa Hospital, Bizerte,
Tunisia; Tunis El Manar University, Tunis, Tunisia.
7Laboratoire de Virologie Clinique, Institut Pasteur de Tunis, Tunisia;
Tunis El Manar University, Tunis, Tunisia. Electronic address:
henda.triki@pasteur.rns.tn.
8Laboratoire de Bactériologie, Virologie, Hygiène, Hôpital Avicenne,
Assistance Publique-Hôpitaux de Paris, Laboratoire Associé au Centre
National de Référence des Hépatites B, C et Delta, UFR Santé Médecine
Biologie Humaine, Université Paris 13, Bobigny, France. Electronic
address: emmanuel.gordien@aphp.fr.

BACKGROUND: Tunisia is classified as an area of middle endemic for
hepatitis B virus (HBV) infection, however little is known about hepatitis
Delta virus (HDV) infection.

OBJECTIVES: This study aimed to address the prevalence of HDV infection,
to identify possible risks factors, and to analyze the genetic diversity
of HDV strains that are spreading in Tunisia.

STUDY DESIGN: A retrospective large-scale study including 1615 HBsAg
positive patients, native of the North East coast of Tunisia, recruited
from Gastroenterology departments, was conducted. Demographic,
epidemiological, ethnical, clinical and biological data were recorded. HBV
and HDV serological analyses and DNA and RNA viral load quantification
were performed. Genotyping of HBV and HDV strains was performed using
nucleotide sequencing followed by phylogenetic analyses.

RESULTS: The study population included 819 (50.7%) men and 796 (49.3%)
women; aged 12-90 years (mean age 41±13 years). A very low prevalence of
HDV infection, 2% was observed. No risk factor, except a history of
hospitalization for surgery was found. All HDV strains belonged to
genotype 1, with a wide distribution within the HDV-1 group. They all
share the African amino acid marker, a serine at position 202 of the large
Delta protein. HBV genotypes were distributed as follows: HBV/D1 (56.8%),
HBV/D7 (40.9%), and HBV/A2 (2.3%).

CONCLUSION: Tunisia is a low endemic region for HDV infection, due to an
efficient policy of HBV infection control. HDV-1 is the sole genotype
found, with a high diversity within this group. Further studies are
ongoing in order to better characterize and manage the HBV/HDV-infected
patients according to the genetic variability of the viral strains.

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

KEYWORDS: Genotypes; HBV; HDV; Seroprevalence
__________________________________________________________________
________________________________*_________________________________

3. Abstract: The prevalence of hepatitis C among healthcare workers: a
systematic review and meta-analysis
__________________________________________________________________

http://oem.bmj.com/content/early/2015/10/05/oemed-2015-102879.long

Occup Environ Med. 2015 Oct 5. pii: oemed-2015-102879. Open Access
The prevalence of hepatitis C among healthcare workers: a systematic
review and meta-analysis.

Westermann C1, Peters C1, Lisiak B2, Lamberti M3, Nienhaus A4.

1University Medical Center Hamburg-Eppendorf, Institute for Health
Services Research in Dermatology and Nursing, Hamburg, Germany.
2Institution for Statutory Accident Insurance and Prevention in Health and
Welfare Services, Hamburg, Germany.
3Department of Biochemistry, Biophysics and General Pathology, Second
University of Naples, Naples, Italy.
4University Medical Center Hamburg-Eppendorf, Institute for Health
Services Research in Dermatology and Nursing, Hamburg, Germany Institution
for Statutory Accident Insurance and Prevention in Health and Welfare
Services, Hamburg, Germany.

The aim of this study was to estimate the prevalence of viral hepatitis C
(HCV) infection among healthcare workers (HCWs) compared to the general
population.

A systematic search for the years 1989-2014 was conducted in the Medline,
Embase and Cochrane databases. Studies on hepatitis C in HCWs were
included if they incorporated either a control group or reference data for
the general population. The study quality was classified as high, moderate
or low. Pooled effect estimates were calculated to determine the odds of
occupational infection. Heterogeneity between studies was analysed using
the X2 test (p<0.10) and quantified using the I2 test. 57 studies met our
criteria for inclusion and 44 were included in the meta-analysis.

Analysis of high and moderate quality studies showed a significantly
increased OR for HCV infection in HCWs relative to control populations,
with a value of 1.6 (95% CI 1.03 to 2.42). Stratification by study region
gave an OR of 2.1 in low prevalence countries; while stratification by
occupational groups gave an increased prevalence for medical (OR 2.2) and
for laboratory staff (OR 2.2).

The OR for professionals at high risk of blood contact was 2.7. The pooled
analysis indicates that the prevalence of infection is significantly
higher in HCWs than in the general population.

The highest prevalence was observed among medical and laboratory staff.

Prospective studies that focus on HCW-specific activity and personal risk
factors for HCV infection are needed.

Published by the BMJ Publishing Group Limited. For permission to use
(where not already granted under a licence) please go to
http://group.bmj.com/group/rights-licensing/permissions.

KEYWORDS: Healthcare workers < Materials; exposures and occupational
groups

Free full text
http://oem.bmj.com/content/early/2015/10/05/oemed-2015-102879.long
__________________________________________________________________
________________________________*_________________________________

4. Abstract: The acceptable duration between occupational exposure to
hepatitis B virus and hepatitis B immunoglobulin injection: Results
from a Korean nationwide, multicenter study
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26518500

Am J Infect Control. 2015 Oct 27. pii: S0196-6553(15)00941-4.
The acceptable duration between occupational exposure to hepatitis B virus
and hepatitis B immunoglobulin injection: Results from a Korean
nationwide, multicenter study.

Chang HH1, Lee WK1, Moon C2, Choi WS3, Yoon HJ4, Kim J5, Ryu SY6, Kim HA6,
Jo YM7, Kwon KT8, Kim HI8, Sohn JW9, Yoon YK9, Jung SI10, Park KH10, Kwon
HH11, Lee MS12, Kim YK13, Kim YS14, Hur J15, Kim SW16.

1Kyungpook National University Hospital School of Medicine, Daegu, Korea.
2Inje University Busan Paik Hospital, Busan, Korea.
3Korea University Ansan Hospital College of Medicine, Seoul, Korea.
4Eulji University Hospital, Daejeon, Korea.
5Hanyang University Guri Hospital, Guri, Korea.
6Keimyung University Dongsan Medical Center, Daegu, Korea.
7Konyang University College of Medicine, Daejeon, Korea.
8Daegu Fatima Hospital, Daegu, Korea.
9Korea University College of Medicine, Seoul, Korea.
10Chonnam National University Hospital Medical School, Gwangju, Korea.
11Catholic University of Daegu School of Medicine, Daegu, Korea.
12Kyung Hee University School of Medicine, Seoul, Korea.
13Wonju Severance Christian Hospital, Wonju, Korea.
14Chungnam National University School of Medicine, Daejeon, Korea.
15Yeungnam University Medical Center, Daegu, Korea.
16Kyungpook National University Hospital School of Medicine, Daegu, Korea.
Electronic address: ksw2kms@knu.ac.kr.

BACKGROUND: Postexposure prophylaxis for occupational exposure to
hepatitis B virus (HBV) plays an important role in the prevention of HBV
infections in health care workers (HCWs). We examined data concerning the
acceptable duration between occupational exposure and administration of a
hepatitis B immunoglobulin (HBIG) injection in an occupational clinical
setting.

METHODS: A retrospective analysis was conducted with data from 143 cases
of HCWs exposed to HBV in 15 secondary and tertiary teaching hospitals
between January 2005 and June 2013. Data were taken from the infection
control records of each hospital.

RESULTS: Active vaccination after HBV exposure was started in 119 cases
(83.2%) and postvaccination testing for hepatitis B antibody showed
positive seroconversion in 93% of cases. In 98 cases (68.5%), HBIG was
administered within 24 hours after HBV exposure; however, 45 HCWs (31.5%)
received an HBIG injection more than 24 hours postexposure and 2 among the
45 received an injection after 7 days. Although 31.5% received an HBIG
injection more than 24 hours postexposure, no cases of seroconversion to
hepatitis b antibody positivity occurred.

CONCLUSIONS: For susceptible HCWs, HBIG administered between 24 hours and
7 days postexposure may be as effective as administration within 24 hours
in preventing occupational HBV infection. Copyright © 2015 Association for
Professionals in Infection Control and Epidemiology, Inc. Published by
Elsevier Inc. All rights reserved.

KEYWORDS: Health care workers; Hepatitis B virus; Occupational exposure;
Postexposure prophylaxis; Treatment outcomes
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Occurrence And Knowledge About Needle Stick Injury In Nursing
Students
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26411134

J Ayub Med Coll Abbottabad. 2015 Apr-Jun;27(2):430-3.
Occurrence And Knowledge About Needle Stick Injury In Nursing Students.

Prasuna J, Sharma R, Bhatt A, Arazoo, Painuly D, Butola H, Yadav A.

BACKGROUND: Needle stick injury (NSI) became a major issue and most of the
research focuses on Nurses, Doctors and other health care workers, but at
the same time nursing students in clinical duties are at high risk.
Studies are available which examined NSI only in Medical students and
health care workers. The present study is aimed to measure the occurrence
of needle stick injury along with post exposure measures and evaluation of
the knowledge regarding needle stick injury among nursing student.

METHODS: A cross-sectional study was conducted in North-East India in
2013. The study participants comprised of 83 nursing students studying in
4th year B.Sc. (N) and 3rd year General Nursing and Midwifery (GNM).
Students were questioned regarding their occurrence to Needle Stick Injury
throughout their clinical training and measures taken following the
exposure. They were also asked to complete the Knowledge questionnaire on
NSI.

RESULTS: The study among 83 nursing students included 43 (51.81%) GNM 3rd
year and 40 (48.19%) B.Sc. Nursing Students. Out of a total 83 students,
75 (90.36%) were females. The occurrence of NSI during their course was
reported by 33 (39.76%) participants. The maximum NSI occurred during
first year of course (57.57%). It was found that 18 (54.54%) of NSIs were
not reported. Among those exposed, only 5 (15.15%) students had undergone
blood investigation and very few students took post exposure measures. It
was found that, only 23 (69.69%) students were immunized against Hepatitis
B before NSI.

CONCLUSION: The present study indicated a high incidence of needle stick
injuries among nursing students with more under-reported cases and
subjects were not aware of post exposure measures. It is essential to deal
above problems by regular training on real-life procedure at the entry
level and reporting system should be more user-friendly platform.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Understanding the hospital sharps injury reporting pathway
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/25308763

Am J Ind Med. 2015 Mar;58(3):282-9.
Understanding the hospital sharps injury reporting pathway.

Boden LI1, Petrofsky YV, Hopcia K, Wagner GR, Hashimoto D.

1Boston University School of Public Health, Boston, Massachusetts.

BACKGROUND: Patient-care workers are frequently exposed to sharps
injuries, which can involve the risk of serious illness. Underreporting of
these injuries can compromise prevention efforts.

METHODS: We linked survey responses of 1,572 non-physician patient-care
workers with the Occupational Health Services (OHS) database at two
academic hospitals. We determined whether survey respondents who said they
had sharps injuries indicated that they had reported them and whether
reported injuries were recorded in the OHS database.

RESULTS: Respondents said that they reported 62 of 78 sharps injuries
occurring over a 12-month period. Only 28 appeared in the OHS data. Safety
practices were positively associated with respondents’ saying they
reported sharps injuries but not with whether reported injuries appeared
in the OHS data.

CONCLUSIONS: Administrators should consider creating reporting mechanisms
that are simpler and more direct. Administrators and researchers should
attempt to understand how incidents might be lost before they are
recorded.

© 2014 Wiley Periodicals, Inc.

KEYWORDS: hospital incident reporting; occupational injuries; sharps
injuries; surveillance; underreporting
__________________________________________________________________
________________________________*_________________________________

7. Abstract: How do university education and clinical experience influence
pre-registration nursing students’ infection control practice? A
descriptive, cross sectional survey
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24090618

Nurse Educ Today. 2014 Feb;34(2):196-201.

How do university education and clinical experience influence pre-
registration nursing students’ infection control practice? A descriptive,
cross sectional survey.

Hinkin J1, Cutter J2.

1College of Human and Health Sciences, Swansea University, St David’s
Park, Carmarthen SA31 3HB, United Kingdom. Electronic address:
j.hinkin@swansea.ac.uk.
2College of Human and Health Sciences, Swansea University, Swansea SA2
8PP, United Kingdom. Electronic address: j.cutter@swansea.ac.uk.

AIMS: This study aims to explore nursing students’ knowledge of infection
control and investigate how university education and clinical experience
influence their infection control practice.

BACKGROUND: In order to prevent and control healthcare associated
infections all healthcare staff must be knowledgeable about infection
control. However, knowledge and practice of infection control are often
sub-optimal. Education has had variable results in improving the infection
control knowledge of healthcare professionals yet, there have been few
studies examining this issue in relation to pre-registration nursing
students in the United Kingdom.

METHODS: This descriptive cross-sectional survey employed a questionnaire
composed of predominantly closed questions for data collection. A non-
probability, purposive sample of 354/444 (79.7%) nursing students from one
university participated in the study.

FINDINGS: Knowledge was generally adequate in questions related to
pathogen transmission, hand hygiene principles, glove use, immediate
action following sharps’ injuries, and risk reduction in relation to
sharps and waste management.

Topics that received less positive results related to the chain of
infection, the use of alcohol gel and Clostridium difficile and the
definition of inoculation injury. University education was the main
influence on knowledge and practice (340/353, 96.3%), but mentors
(322/354, 91.2%), nurses (316/353, 89.3%), doctors (175/353, 49.4%) and
other members of the multi-disciplinary team (213/352, 60.2%) were also
deemed influential.

Workload, time, and availability of facilities and equipment also
contributed to the adoption of infection control precautions. The findings
illustrated the importance of both theoretical and practical knowledge,
supported by competent role models.

CONCLUSION: The study identified the complexities of knowledge acquisition
and application in a practice based discipline. The support of a competent
role model to assist in applying theory to practice is vital. The study
has identified that there are many variables that affect IPC practice,
both positively and negatively.

© 2013.

KEYWORDS: Clinical practice; Education; Infection prevention and control;
Knowledge; Nursing students; Survey
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Blood Trials: Transfusions, Injections, and Experiments in
Africa, 1890-1920
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26514397

J Hist Med Allied Sci. 2015 Oct 29. pii: jrv048.
Blood Trials: Transfusions, Injections, and Experiments in Africa,
1890-1920.

Sunseri T1.

1B-346 Clark, 1776, Fort Collins, Colorado.

From about 1880 to 1920, a culture of medical experimentation promoted
blood transfusion as a therapy for severe anemia in Europe, which was
applied in German East Africa in 1892 for a case of blackwater fever, a
complication of malaria afflicting mainly Europeans. This first case of
blood transfusion in Africa, in which an African’s blood was transfused
into a German official, complicates the dominant narrative that blood
transfusions in Africa came only after World War I.

Medical researchers moreover experimented with blood serum therapies on
human and animal subjects in Europe and Africa, injecting blood of
different species, “races” and ethnicities into others to demonstrate
parasite transmissibility and to discover vaccines for diseases such as
malaria, sleeping sickness, and yellow fever.

While research in German colonies is highlighted here, this was a
transnational medical culture that crossed borders and oceans. This
research is of interest as a possible early pathway for the epidemic
spread of HIV and other zoonoses in Africa and the world, which biomedical
researchers have identified as emerging in West-Central Africa sometime
around the turn of the twentieth century.

© The Author 2015. Published by Oxford University Press. All rights
reserved. For permissions, please e-mail: journals.permissions@oup.com.

KEYWORDS: Africa; German colonialism; HIV; animal research; blackwater
fever; blood serum; blood transfusion; malaria; sleeping sickness
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Historical epidemiology of hepatitis C virus (HCV) in select
countries – volume 3
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26513445

J Viral Hepat. 2015 Dec;22 Suppl 4:4-20.
Historical epidemiology of hepatitis C virus (HCV) in select countries –
volume 3.

Liakina V, Hamid S, Tanaka J, Olafsson S, Sharara AI, Alavian SM, Gheorghe
L, El Hassan ES, Abaalkhail F, Abbas Z, Abdou A, Abourached A, Al Braiki
F, Al Hosani F, Al Jaberi K, Al Khatry M, Al Mulla MA, Al Quraishi H, Al
Rifai A, Al Serkal Y, Alam A, Alashgar HI, Alawadhi S, Al-Dabal L, Aldins
P, Alfaleh FZ, Alghamdi AS, Al-Hakeem R, Aljumah AA, Almessabi A, Alqutub
AN, Alswat KA, Altraif I, Alzaabi M, Andrea N, Assiri AM, Babatin MA,
Baqir A, Barakat MT, Bergmann OM, Bizri AR, Blach S, Chaudhry A, Choi MS,
Diab T, Djauzi S, El Khoury S, Estes C, Fakhry S, Farooqi JI,
Fridjonsdottir H, Gani RA, Ghafoor Khan A, Goldis A, Gottfredsson M,
Gregorcic S, Hajarizadeh B, Han KH, Hasan I, Hashim A, Horvath G, Hunyady
B, Husni R, Jafri W, Jeruma A, Jonasson JG, Karlsdottir B, Kim DY, Kim YS,
Koutoubi Z, Lesmana LA, Lim YS, Löve A, Maimets M, Makara M, Malekzadeh R,
Maticic M, Memon MS, Merat S, Mokhbat JE, Mourad FH, Muljono DH, Nawaz A,
Nugrahini N, Priohutomo S, Qureshi H, Rassam P, Razavi H, Razavi-Shearer
D, Razavi-Shearer K, Rozentale B, Sadik M, Saeed K, Salamat A, Salupere R,
Sanai FM, Sanityoso Sulaiman A, Sayegh RA, Schmelzer JD, Sibley A, Siddiq
M, Siddiqui AM, Sigmundsdottir G, Sigurdardottir B, Speiciene D, Sulaiman
A, Sultan MA, Taha M, Tarifi H, Tayyab G, Tolmane I, Ud Din M, Umar M,
Valantinas J, Videcnik-Zorman J, Yaghi C, Yunihastuti E, Yusuf MA, Zuberi
BF, Gunter J.

Detailed, country-specific epidemiological data are needed to characterize
the burden of chronic hepatitis C virus (HCV) infection around the world.
With new treatment options available, policy makers and public health
officials must reconsider national strategies for infection control. In
this study of 15 countries, published and unpublished data on HCV
prevalence, viraemia, genotype, age and gender distribution, liver
transplants and diagnosis and treatment rates were gathered from the
literature and validated by expert consensus in each country.

Viraemic prevalence in this study ranged from 0.2% in Iran and Lebanon to
4.2% in Pakistan. The largest viraemic populations were in Pakistan (7 001
000 cases) and Indonesia (3 187 000 cases).

Injection drug use (IDU) and a historically unsafe blood supply were major
risk factors in most countries.

Diagnosis, treatment and liver transplant rates varied widely between
countries. However, comparison across countries was difficult as the
number of cases changes over time. Access to reliable data on measures
such as these is critical for the development of future strategies to
manage the disease burden.

© 2015 John Wiley & Sons Ltd.

KEYWORDS:diagnosis; disease burden; epidemiology; hepatitis C; hepatitis C
virus; historical; incidence; mortality; prevalence; treatment
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Strategies to manage hepatitis C virus infection disease
burden – volume 3
__________________________________________________________________
http://onlinelibrary.wiley.com/doi/10.1111/jvh.12474/full

J Viral Hepat. 2015 Dec;22 Suppl 4:42-65. Free Full Article
Strategies to manage hepatitis C virus infection disease burden – volume 3

Alfaleh FZ, Nugrahini N, Maticic M, Tolmane I, Alzaabi M, Hajarizadeh B,
Valantinas J, Kim DY, Hunyady B, Abaalkhail F, Abbas Z, Abdou A,
Abourached A, Al Braiki F, Al Hosani F, Al Jaberi K, Al Khatry M, Al Mulla
MA, Al Quraishi H, Al Rifai A, Al Serkal Y, Alam A, Alashgar HI, Alavian
SM, Alawadhi S, Al-Dabal L, Aldins P, Alghamdi AS, Al-Hakeem R, Aljumah
AA, Almessabi A, Alqutub AN, Alswat KA, Altraif I, Andrea N, Assiri AM,
Babatin MA, Baqir A, Barakat MT, Bergmann OM, Bizri AR, Chaudhry A, Choi
MS, Diab T, Djauzi S, El Hassan ES, El Khoury S, Estes C, Fakhry S,
Farooqi JI, Fridjonsdottir H, Gani RA, Ghafoor Khan A, Gheorghe L, Goldis
A, Gottfredsson M, Gregorcic S, Gunter J, Hamid S, Han KH, Hasan I, Hashim
A, Horvath G, Husni R, Jafri W, Jeruma A, Jonasson JG, Karlsdottir B, Kim
YS, Koutoubi Z, Lesmana LA, Liakina V, Lim YS, Löve A, Maimets M, Makara
M, Malekzadeh R, Memon MS, Merat S, Mokhbat JE, Mourad FH, Muljono DH,
Nawaz A, Olafsson S, Priohutomo S, Qureshi H, Rassam P, Razavi H, Razavi-
Shearer D, Razavi-Shearer K, Rozentale B, Sadik M, Saeed K, Salamat A,
Salupere R, Sanai FM, Sanityoso Sulaiman A, Sayegh RA, Schmelzer JD,
Sharara AI, Sibley A, Siddiq M, Siddiqui AM, Sigmundsdottir G,
Sigurdardottir B, Speiciene D, Sulaiman A, Sultan MA, Taha M, Tanaka J,
Tarifi H, Tayyab G, Ud Din M, Umar M, Videcnik-Zorman J, Yaghi C,
Yunihastuti E, Yusuf MA, Zuberi BF, Blach S.

The hepatitis C virus (HCV) epidemic was forecasted through 2030 for 15
countries in Europe, the Middle East and Asia, and the relative impact of
two scenarios was considered: increased treatment efficacy while holding
the annual number of treated patients constant and increased treatment
efficacy and an increased annual number of treated patients.

Increasing levels of diagnosis and treatment, in combination with improved
treatment efficacy, were critical for achieving substantial reductions in
disease burden.

[>>>] A 90% reduction in total HCV infections within 15 years is feasible
in most countries studied, but it required a coordinated effort to
introduce harm reduction programmes to reduce new infections, screening to
identify those already infected and treatment with high cure rate
therapies.

This suggests that increased capacity for screening and treatment will be
critical in many countries. Birth cohort screening is a helpful tool for
maximizing resources. Among European countries, the majority of patients
were born between 1940 and 1985. A wider range of birth cohorts was seen
in the Middle East and Asia (between 1925 and 1995).

© 2015 John Wiley & Sons Ltd.

KEYWORDS: diagnosis; disease burden; elimination; epidemiology; hepatitis
C; hepatitis C virus; incidence; mortality; prevalence; scenarios;
strategy; treatment
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Risk Factors Associated with Unsafe Injection Practices at
the First Injection Episode among Intravenous Drug Users in France:
Results from PrimInject, an Internet Survey
__________________________________________________________________

http://www.hindawi.com/journals/jad/2015/507214/ Free Full Article

J Addict. 2015;2015:507214.
Risk Factors Associated with Unsafe Injection Practices at the First
Injection Episode among Intravenous Drug Users in France: Results from
PrimInject, an Internet Survey.

Guichard A1, Guignard R2, Lert F3, Roy E4.

1French National Institute of Prevention and Health Education, Scientific
Affairs Department, 42 boulevard de la Libération, 93203 Saint-Denis
Cedex, France ; Faculty of Nursing, Université Laval, Pavillon Ferdinand-
Vandry, Bureau 3465, 1050 avenue de la Médecine, Québec City, QC, Canada
G1V 0A6.
2French National Institute of Prevention and Health Education, Scientific
Affairs Department, 42 boulevard de la Libération, 93203 Saint-Denis
Cedex, France.
3French National Institute of Health and Medical Research (INSERM), U1018,
Hôpital Paul Brousse, 16 avenue Paul Vaillant Couturier, 94807 Villejuif
Cedex, France.
4Faculty of Medicine and Health Sciences, University of Sherbrooke, Campus
de Longueuil, 150 Place Charles-LeMoyne, Bureau 200, Longueuil, QC, Canada
J4K 0A8.

Background. New drug use patterns may increase the risk of human
immunodeficiency virus and hepatitis infections. In France, new injection
patterns among youths with diverse social backgrounds have emerged, which
may explain the persistently high rates of hepatitis C virus infection.

This study explores factors associated with injection risk behaviours at
first injection among users who began injecting in the post-2000 era.

Methods. A cross-sectional study was conducted on the Internet from
October 2010 to March 2011, through an online questionnaire. Multivariate
logistic regression identified the independent correlates of needle
sharing and equipment (cooker/cotton filter) sharing.

Results. Among the 262 respondents (mean age 25 years), 65% were male.
Both risk behaviours were positively associated with initiation before 18
years of age (aOR 3.7 CI 95% 1.3-10.6 and aOR 3.0 CI 95% 1.3-7.0) and
being injected by another person (aOR 3.1 CI 95% 1.0-9.9 and aOR 3.0 CI
95% 1.3-7.1). Initiation at a party was an independent correlate of
equipment sharing (aOR 2.6 95% CI 1.0-6.8).

CONCLUSIONS: Results suggest a need for innovative harm reduction
programmes targeting a variety of settings and populations, including
youths and diverse party scenes. Education of current injectors to protect
both themselves and those they might initiate into injection is critically
important.

Free Full Article http://www.hindawi.com/journals/jad/2015/507214/
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Internalized stigma and sterile syringe use among people who
inject drugs in New York City, 2010-2012
__________________________________________________________________

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4254372/

Drug Alcohol Depend. 2014 Nov 1;144:259-64.
Internalized stigma and sterile syringe use among people who inject drugs
in New York City, 2010-2012.

Rivera AV1, DeCuir J2, Crawford ND3, Amesty S4, Lewis CF5.

1Department of Epidemiology, Mailman School of Public Health, Columbia
University, 722 West 168th Street, New York, NY 10032, USA. Electronic
address: avr2107@columbia.edu.
2Department of Epidemiology, Mailman School of Public Health, Columbia
University, 722 West 168th Street, New York, NY 10032, USA; College of
Physicians and Surgeons, Columbia University, 630 West 168th Street, New
York, NY 10032, USA.
3Division of Epidemiology and Biostatistics, Georgia State University
School of Public Health, 1 Park Place, Atlanta, GA 30302, USA.
4Center for Family and Community Medicine, College of Physicians and
Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032,
USA; Heilbrunn Department of Population and Family Health, Mailman School
of Public Health, Columbia University, 60 Haven Ave #B2, New York, NY
10032, USA.
5Department of Epidemiology, Mailman School of Public Health, Columbia
University, 722 West 168th Street, New York, NY 10032, USA.

BACKGROUND: Little is known on the effect of stigma on the health and
behavior of people who inject drugs (PWID). PWID may internalize these
negative attitudes and experiences and stigmatize themselves (internalized
stigma). With previous research suggesting a harmful effect of
internalized stigma on health behaviors, we aimed to determine socio-
demographic characteristics and injection risk behaviors associated with
internalized PWID-related stigma in New York City (NYC).

METHODS: Three NYC pharmacies assisted in recruiting PWID. Pharmacy-
recruited PWID syringe customers received training in recruiting up to
three of their peers. Participants completed a survey on injection
behaviors and PWID-related stigma. Among HIV-negative PWID (n=132),
multiple linear regression with GEE (to account for peer network
clustering) was used to examine associations with internalized PWID-
related stigma.

RESULTS: Latinos were more likely to have higher internalized stigma, as
were those with lower educational attainment. Those with higher
internalized stigma were more likely to not use a syringe exchange program
(SEP) recently, although no association was found with the recent use of
pharmacies for syringes. Lastly, higher internalized stigma was related to
less than 100% use of pharmacies or SEPs for syringe needs.

CONCLUSIONS: These data suggest that PWID with higher internalized stigma
are less likely to consistently use sterile syringe sources in urban
settings with multiple sterile syringe access points. These results
support the need for individual- and structural-level interventions that
address PWID-related stigma. Future research is needed to examine why PWID
with higher internalized stigma have less consistent use of public syringe
access venues.

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

KEYWORDS: HIV risk behaviors; Injection drug use; Stigma; Syringe sources

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4254372/
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Seroprevalence of the Hepatitis B, Hepatitis C, and Human
Immunodeficiency Viruses and Treponema pallidum at the Beijing General
Hospital from 2010 to 2014: A Cross-Sectional Study
__________________________________________________________________
http://dx.plos.org/10.1371/journal.pone.0140854 Open Access

PLoS One. 2015 Oct 26;10(10):e0140854.
Seroprevalence of the Hepatitis B, Hepatitis C, and Human Immunodeficiency
Viruses and Treponema pallidum at the Beijing General Hospital from 2010
to 2014: A Cross-Sectional Study.

Xu S1, Wang Q1, Zhang W1, Qiu Z2, Cui J1, Yan W1, Ni A1.

1Department of Clinical Laboratories, Peking Union Medical College
Hospital, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China.
2Department of Infectious Diseases, Peking Union Medical College Hospital,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing, China.

BACKGROUND: The hepatitis B, hepatitis C, human immunodeficiency viruses
and Treponema pallidum are important causes of infectious diseases concern
to public health.

METHODS: Between 2010 and 2014, we used an automated chemiluminescence
microparticle immunoassay to detect the hepatitis B, hepatitis C, and
human immunodeficiency viruses as well as Treponema pallidum (the rapid
plasma regain test was used in 2010-2011). Positive human immunodeficiency
virus tests were confirmed via western blotting.

RESULTS: Among 416,130 subjects, the seroprevalences for hepatitis B
virus, hepatitis C virus, human immunodeficiency virus, and Treponema
pallidum were 5.72%, 1.23%, 0.196%, and 0.76%, respectively.

Among 671 patients with positive human immunodeficiency virus results, 392
cases were confirmed via western blotting. Hepatitis B and human
immunodeficiency virus infections were more frequent in men (7.78% and
0.26%, respectively) than in women (4.45% and 0.021%, respectively).

The hepatitis B and C virus seroprevalences decreased from 6.21% and
1.58%, respectively, in 2010, to 5.37% and 0.988%, respectively, in 2014.
The human immunodeficiency virus seroprevalence increased from 0.04% in
2010 to 0.17% in 2014, and was elevated in the Infectious Disease (2.65%),
Emergency (1.71%), and Dermatology and Sexually Transmitted Diseases
(1.12%) departments. The specificity of the human immunodeficiency virus
screening was 71.4%. The false positive rates for the Treponema pallidum
screening tests increased in patients who were 60-70 years old. The co-
infection rates for the hepatitis C and human immunodeficiency viruses
were 0.47% in hepatitis C virus-positive patients and 7.33% in human
immunodeficiency virus-positive patients.

CONCLUSIONS: During 2010-2014, hepatitis B virus and human
immunodeficiency virus infections were more frequent among men at our
institution. Although the seroprevalences of hepatitis B and C viruses
decreased, the seroprevalence of human immunodeficiency virus infection
increased (with higher seroprevalences in high-risk departments).

Older patients were more likely to exhibit false positive findings for
syphilis.

Free Article http://dx.plos.org/10.1371/journal.pone.0140854
________________________________*_________________________________

14. Abstract: High HIV burden among people who inject drugs in 15 Indian
cities
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/25715105

AIDS. 2015 Mar 13;29(5):619-28.
High HIV burden among people who inject drugs in 15 Indian cities.

Lucas GM1, Solomon SS, Srikrishnan AK, Agrawal A, Iqbal S, Laeyendecker O,
McFall AM, Kumar MS, Ogburn EL, Celentano DD, Solomon S, Mehta SH.

1aJohns Hopkins University School of Medicine, Department of Medicine,
Baltimore, Maryland, USA bY.R. Gaitonde Centre for AIDS Research and
Education, Chennai, Tamil Nadu cAll India Institute of Medical Sciences,
Department of Psychiatry, New Delhi, India dLaboratory of
Immunoregulation, National Institute of Allergy and Infectious Diseases,
National Institutes of Health eJohns Hopkins University Bloomberg School
of Public Health, Baltimore, Maryland, USA.

BACKGROUND: Injecting drug use has historically been the principal driver
of the HIV epidemic in the northeast states of India. However, recent data
indicate growing numbers of people who inject drugs (PWIDs) in north and
central Indian cities.

METHODS: We conducted face-to-face surveys among PWIDs in seven northeast
and eight north/central Indian cities using respondent-driven sampling. We
used a rapid HIV-testing protocol to identify seropositive individuals and
multiassay algorithm to identify those with recent infection. We used
multilevel regression models that incorporated sampling weights and had
random intercepts for site to assess risk factors for prevalent and
incident (recent) HIV infection.

RESULTS: We surveyed 14,481 PWIDs from 15 Indian cities between January
and December 2013. Participants reported high rates of needle/syringe
sharing. The median (site range) estimated HIV prevalence and incidence
were 18.1% (5.9, 44.9) and 2.9 per 100 person-years (0, 12.4),
respectively. HIV prevalence was higher in northeast sites, whereas HIV
incidence was higher in north/central sites. The odds of prevalent HIV
were over three-fold higher in women than in men.

Other factors associated with HIV prevalence or incidence included
duration since first injection, injection of pharmaceutical drugs, and
needle/syringe sharing.

CONCLUSIONS: The burden of HIV infection is high among PWIDs in India, and
may be increasing in cities where injecting drug use is emerging. Women
who inject drugs were at substantially higher risk for HIV than men – a
situation that may be mediated by dual injection-related and sexual risks.

Comment in The evolving HIV epidemic among people who inject drugs in
India and the need for a heightened response. [AIDS. 2015]
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Risk of Injection-Site Abscess among Infants Receiving a
Preservative-Free, Two-Dose Vial Formulation of Pneumococcal Conjugate
Vaccine in Kenya
__________________________________________________________________
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0141896
PLoS One. 2015 Oct 28;10(10):e0141896. Open Access

Risk of Injection-Site Abscess among Infants Receiving a Preservative-
Free, Two-Dose Vial Formulation of Pneumococcal Conjugate Vaccine in
Kenya.

Burton DC1, Bigogo GM1, Audi AO1, Williamson J2, Munge K3, Wafula J3, Ouma
D1, Khagayi S4, Mugoya I5, Mburu J3, Muema S1, Bauni E3, Bwanaali T3,
Feikin DR1, Ochieng PM1, Mogeni OD1, Otieno GA1, Olack B1, Kamau T5, Van
Dyke MK6, Chen R7, Farrington P8, Montgomery JM1, Breiman RF9, Scott JA10,
Laserson KF2.

1Kenya Medical Research Institute (KEMRI)/Centers for Disease Control and
Prevention (CDC) Research and Public Health Collaboration, Kisumu and
Nairobi, Kenya; International Emerging Infections Program, Global Disease
Detection Response Center, CDC, Kisumu and Nairobi, Kenya.
2Kenya Medical Research Institute (KEMRI)/Centers for Disease Control and
Prevention (CDC) Research and Public Health Collaboration, Kisumu and
Nairobi, Kenya; Center for Global Health, CDC, Atlanta, Georgia, United
States of America.
3KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
4Kenya Medical Research Institute (KEMRI)/Centers for Disease Control and
Prevention (CDC) Research and Public Health Collaboration, Kisumu and
Nairobi, Kenya.
5Division of Vaccines and Immunization, Ministry of Public Health and
Sanitation, Nairobi, Kenya.
6GlaxoSmithKline Vaccines, Wavre, Belgium.
7National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention,
CDC, Atlanta, Georgia, United States of America.
8Open University, Buckinghamshire, United Kingdom.
9International Emerging Infections Program, Global Disease Detection
Response Center, CDC, Kisumu and Nairobi, Kenya; Center for Global Health,
CDC, Atlanta, Georgia, United States of America.
10KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; London School of
Hygiene & Tropical Medicine, London, United Kingdom.

There is a theoretical risk of adverse events following immunization with
a preservative-free, 2-dose vial formulation of 10-valent-pneumococcal
conjugate vaccine (PCV10).

We set out to measure this risk. Four population-based surveillance sites
in Kenya (total annual birth cohort of 11,500 infants) were used to
conduct a 2-year post-introduction vaccine safety study of PCV10.
Injection-site abscesses occurring within 7 days following vaccine
administration were clinically diagnosed in all study sites (passive
facility-based surveillance) and, also, detected by caregiver-reported
symptoms of swelling plus discharge in two sites (active household-based
surveillance).

Abscess risk was expressed as the number of abscesses per 100,000
injections and was compared for the second vs first vial dose of PCV10 and
for PCV10 vs pentavalent vaccine (comparator). A total of 58,288 PCV10
injections were recorded, including 24,054 and 19,702 identified as first
and second vial doses, respectively (14,532 unknown vial dose).

The risk ratio for abscess following injection with the second (41 per
100,000) vs first (33 per 100,000) vial dose of PCV10 was 1.22 (95%
confidence interval [CI] 0.37-4.06). The comparator vaccine was changed
from a 2-dose to 10-dose presentation midway through the study. The
matched odds ratios for abscess following PCV10 were 1.00 (95% CI
0.12-8.56) and 0.27 (95% CI 0.14-0.54) when compared to the 2-dose and 10-
dose pentavalent vaccine presentations, respectively.

In Kenya immunization with PCV10 was not associated with an increased risk
of injection site abscess, providing confidence that the vaccine may be
safely used in Africa.

The relatively higher risk of abscess following the 10-dose presentation
of pentavalent vaccine merits further study.

Free full text
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0141896
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Syringe-type and needle gauge have no role in adverse events
following DTwP immunization: a randomized multicenter trial
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/24906043
Pediatr Infect Dis J. 2014 Sep;33(9):e239-46.

Syringe-type and needle gauge have no role in adverse events following
DTwP immunization: a randomized multicenter trial.

Fateh M1, Emamian MH, Zahraei SM, Fotouhi A.
Author information
1From the *Center for Health Related Social and Behavioral Sciences
Research, Shahroud University of Medical Sciences, Shahroud, Iran;
†Department of Epidemiology, School of Public Health, Shahroud University
of Medical Sciences, Shahroud, Iran; ‡Center for Communicable Disease
Control, Ministry of Health and Medical Education, Tehran, Iran; and
§Department of Epidemiology and Biostatistics, School of Public Health,
Tehran University of Medical Sciences, Tehran, Iran.

BACKGROUND: Auto-Disable syringes are recommended for immunization because
of their greater safety and preventing reuse. In this study, the role of
the syringe and needle gauge on the adverse events following Diphtheria,
Tetanus toxoids and whole-cell Pertussis immunization was studied.

METHODS: In this study, 1000 children from 2 months to 6 years of age,
eligible for Diphtheria, Tetanus toxoids and whole-cell Pertussis
immunization and who referred to 4 health centers, were randomized into 2
groups of regular syringe users (the Auto-Disable syringe with a 23 gauge
and 25 mm needle) and new syringe users (the disposable syringe with a 24
gauge and 25 mm needle). Adverse events following immunization were
evaluated on days 2, 4 and 6 after immunization by visiting the children
at their home and examining them.

RESULTS: The occurrence of the primary endpoint (severe local reaction)
was found to be 2.1% in all the children, 2.0% in the children vaccinated
with the Auto-Disable syringe and 2.2% in the children vaccinated with the
new syringe. This difference is not significant (P = 0.818). The
evaluation of other milder adverse events (secondary endpoints) showed
that the syringe type has no effect on the occurrence of these adverse
events.

CONCLUSIONS: Syringe types and needle diameter played no role in
precipitating the adverse events following immunization of the Diphtheria,
Tetanus toxoids and whole-cell Pertussis vaccine.
__________________________________________________________________
________________________________*_________________________________

17. Abstract: Dangers of vaccine refusal near the herd immunity threshold:
a modelling study
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/25981883

Lancet Infect Dis. 2015 Aug;15(8):922-6.
Dangers of vaccine refusal near the herd immunity threshold: a modelling
study.

Fefferman NH1, Naumova EN2.

1Department of Ecology, Evolution, and Natural Resources, Rutgers
University, New Brunswick, NJ, USA; Center for Discrete Mathematics and
Theoretical Computer Science (DIMACS), Rutgers University, Piscataway, NJ,
USA; Tufts University Initiative for the Forecasting and Modeling of
Infectious Diseases, Tufts University, Medford, MA, USA. Electronic
address: fefferman@aesop.rutgers.edu.
2Center for Discrete Mathematics and Theoretical Computer Science
(DIMACS), Rutgers University, Piscataway, NJ, USA; Tufts University
Initiative for the Forecasting and Modeling of Infectious Diseases, Tufts
University, Medford, MA, USA; Department of Civil and Environmental
Engineering, Tufts University, Medford, MA, USA.

BACKGROUND: Childhood vaccination remains the focus of heated public
debate. Parents struggle to understand the potential risks associated with
vaccination but both parents and physicians assume that they understand
the risks associated with infection. This study was done to characterise
how modern vaccination practices have altered patient risks from
infection.

METHODS: In this modelling study, we use mathematical analysis to explore
how modern-era vaccination practices have changed the risks of severe
outcomes for some infections by changing the landscape for disease
transmission. We show these effects using published data from outbreaks in
the USA for measles, chickenpox, and rubella. Calculation of risk
estimation was the main outcome of this study.

FINDINGS: Our calculations show that negative outcomes are 4·5 times worse
for measles, 2·2 times worse for chickenpox, and 5·8 times worse for
rubella than would be expected in a pre-vaccine era in which the average
age at infection would have been lower.

INTERPRETATION: As vaccination makes preventable illness rarer, for some
diseases, it also increases the expected severity of each case. Because
estimates of case risks rely on data for severity generated during a pre-
vaccine era they underestimate negative outcomes in the modern post-
vaccine epidemiological landscape. Physicians and parents should
understand when making decisions about their children’s health and safety
that remaining unvaccinated in a predominantly vaccine-protected community
exposes their children to the most severe possible outcomes for many
preventable diseases.

FUNDING: None.

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

18. Abstract: Healthcare-Associated Transmission of Plasmodium falciparum
in New York City
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26498730

Infect Control Hosp Epidemiol. 2015 Oct 26:1-3.
Healthcare-Associated Transmission of Plasmodium falciparum in New York
City.

Lee EH1, Adams EH2, Madison-Antenucci S3, Lee L4, Barnwell JW5, Whitehouse
J2, Clement E6, Bajwa W7, Jones LE1, Lutterloh E6, Weiss D1, Ackelsberg
J1.

11Bureau of Communicable Diseases,Division of Disease Control,New York
City Department of Health and Mental Hygiene,Queens,New York.
22Healthcare Epidemiology and Infection Control Program,Metropolitan Area
Regional Office,New York State Department of Health,New Rochelle,New York.
33Division of Infectious Disease,Parasitology Laboratory,Wadsworth
Center,New York State Department of Health,Albany,New York.
44Public Health Laboratory,New York City Department of Health and Mental
Hygiene,New York,New York.
55Malaria Branch,Division of Parasitic Diseases and Malaria,Centers for
Disease Control and Prevention,Atlanta,Georgia.
66Bureau of Healthcare Associated Infections,New York State Department of
Health,Albany,New York.
77Office of Vector Surveillance and Control, Division of Environmental
Health,New York City Department of Health and Mental Hygiene,Queens,New
York.

A patient with no risk factors for malaria was hospitalized in New York
City with Plasmodium falciparum infection.

After investigating all potential sources of infection, we concluded the
patient had been exposed to malaria while hospitalized less than 3 weeks
earlier.

Molecular genotyping implicated patient-to-patient transmission in a
hospital setting.

Infect. Control Hosp. Epidemiol. 2015;00(0):1-3.
__________________________________________________________________
________________________________*_________________________________

19. Abstract: Contamination of multidose butorphanol vials in small animal
general practices
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26511104

J Small Anim Pract. 2015 Nov;56(11):637-40.
Contamination of multidose butorphanol vials in small animal general
practices.

Bell A1, Yamaoka TT1, Akil L2, Watson D2, Devine C3.

1School of Veterinary Medicine, University of Glasgow, Glasgow G61 1QH.
2Strathclyde Institute of Pharmacy and Biomedical Sciences, Glasgow G4
0RE.
3Borders Veterinary Cardiology Ltd, Biggar ML12 6HD.

OBJECTIVES: To assess and quantify medetomidine contamination of
butorphanol multidose vials in small animal general practices and
determine if practice policies and procedures regarding drug handling, as
determined by questionnaire, impact upon contamination level.

METHODS: Samples of butorphanol were withdrawn from in-use vials in
participating practices in June and July 2013. Samples were analysed using
high- performance liquid chromatography and mass spectrometry.

RESULTS: Forty-one samples were obtained from 31 practices. Contamination
was detected in 29 samples from 10 mL vials. The mean (asd) contamination
was 0 · 275 (a0 · 393) µg/mL; maximum contamination in any vial was 2 ·
034 µg/mL. There was no correlation between volume of the vial used and
the level of contamination. None of the survey factors predicted
contamination levels of the vials.

CLINICAL SIGNIFICANCE: Contamination of butorphanol multidose vials with
medetomidine was common but the level of contamination was insufficient to
cause detrimental effects in dogs if butorphanol were to be administered
alone. The potential for sporadic higher levels of contamination must be
taken into account, especially when using 50 mL vials when sedating
critically ill cases, because there is a risk of clinical side effects.

© 2015 British Small Animal Veterinary Association.
__________________________________________________________________
________________________________*_________________________________

20. News

– Global: Health care workers more likely to get hepatitis C
– Global: Health Care Workers At Greater Risk Of Hepatitis C Infection
– USA: Discarded syringes put cleanup workers along Pennsylvania roads at
risk
– UK: New research traces hepatitis C infections in Scotland back to WWII
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/pow8f98
Global: Health care workers more likely to get hepatitis C

Health24, USA (02.11.15)

Compared to the general population, health workers had 60 percent greater
odds of getting hepatitis C, and those who worked directly with blood had
almost triple the risk, according to the analysis in Occupational and
Environmental Medicine.

Hepatitis C is usually spread when blood from an infected person enters
the body of someone who isn’t infected.

Threat will remain

These days, most people infected with the virus get it from sharing
needles or equipment to inject drugs, but it can also be transmitted
during sex, and until a test for it was developed in the early 1990s,
people could acquire hepatitis C through blood transfusions.

“Contact with blood, for example, from needle stick injuries, is
associated with a risk of infection and continues to be the major threat
to the health of health care workers,” said lead study author Claudia
Westermann of the University Medical Centre Hamburg-Eppendorf in Germany
by email.

“Exposure to blood cannot completely be avoided when using `safe’
instruments, as they reduce the risk of needle stick injuries but do not
completely prevent them,” Westermann added. “Therefore blood borne virus
infections will remain a threat to health care workers for some time to
come.”

To assess the prevalence of hepatitis C among health care workers,
Westermann and colleagues analysed data from 44 previously published
studies.

In the U.S. and Europe, where hepatitis C prevalence is relatively low,
health care workers are more than twice as likely as other individuals to
get the virus, the data showed.

The risk for health workers was also doubled in North Africa, the Middle
East and South Asia, although infection rates in Japan were similar to the
rest of the population.

Lack of certain data

Male health workers had triple the odds of getting hepatitis C, compared
with a 50 percent greater risk for female workers.

Medical staff had 2.2 times the odds of getting hepatitis C, while odds
were 3.5 times greater for dentists and increased by just 70 percent for
nurses.

Professionals who came in regular contact with blood – surgeons, midwives,
microbiologists, pathologists, blood bank and dialysis staff – had 2.7
times the risk of infections with the virus.

Limitations of the analysis include a lack of data on personal risk
factors such as use of injected drugs or engagement in sexual practices
such as anal intercourse, the authors acknowledge.

It is unlikely, however, that health workers have unprotected sex or use
injected drugs more often than the general population, said Dr William
Buchta, medical director of the occupational medicine practice at the Mayo
Clinic in Rochester, Minnesota.

“Inadvertent exposure to patients’ blood and other infectious fluids is
common among health care workers and grossly under-reported, so exposure
to infected patients is a far more credible cause for this disparity,”
Buchta, who wasn’t involved in the study, said by email.

Transmitting the virus can be prevented in health care settings when
proper infection control practices are followed, including the use of
personal protective equipment, proper cleansing of infected tools, use of
blunt needles for certain surgical procedures, and many other practical
and relatively cheap and effective measures, Buchta added.

“We simply need to get the message out to health care workers that they
are at risk but can almost eliminate that risk without compromising the
care they deliver,” Buchta said
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https://tinyurl.com/p9n4bd4
Global: Health Care Workers At Greater Risk Of Hepatitis C Infection

By Winifred Ogbebo and Victor Okeke, :eadership, Nigeria (01.11.15)

Health care workers face higher than average risk of infection with the
hepatitis C virus, a research review suggests.

Compared to the general population, health workers had 60 per cent greater
odds of getting hepatitis C, and those who worked directly with blood had
almost triple the risk, according to the analysis in, “Occupational and
Environmental Medicine.”

Hepatitis C is usually spread when blood from an infected person enters
the body of someone who isn’t infected.

These days, most people infected with the virus get it from sharing
needles or equipment to inject drugs, but it can also be transmitted
during sex, and until a test for was developed in the early 1990s, people
could acquire hepatitis C through blood transfusions.

“Contact with blood, for example, from needle stick injuries, is
associated with a risk of infection and continues to be the major threat
to the health of health care workers,” said lead study author Claudia
Westermann of the University Medical Center Hamburg-Eppendorf.

“Exposure to blood cannot completely be avoided when using safp
instruments, as they reduce the risk of needle stick injuries but do not
completely prevent them,” Westermann added. “Therefore blood borne virus
infections will remain a threat to health care workers for some time to
come.”

To assess the prevalence of hepatitis C among health care workers,
Westermann and colleagues analyzed data from 44 previously published
studies.

In the U.S. and Europe, where hepatitis C prevalence is relatively low,
health care workers are more than twice as likely as other individuals to
get the virus, the data showed.

The risk for health workers doubled in North Africa, the Middle East and
South Asia, although infection rates in Japan were similar to the rest of
the population.
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https://tinyurl.com/qc93luk Video report at the link
USA: Discarded syringes put cleanup workers along Pennsylvania roads at
risk

By Craig Smith, TribLive, Trib Total Media, USA (31.10.15)

Vince Mastrorocco remembers when volunteers for Derry Township’s highway
cleanup program were unfazed by Saturday mornings spent hauling away old
tires and litter.

That was before the region’s deadly heroin epidemic took hold and roadside
garbage became peppered with contaminated hypodermic needles, he said.
“It’s getting progressively worse,” Mastrorocco said. “It’s one thing to
go out there and pick up cigarettes, but to go out there and pick up drug
paraphernalia … it angers me.”

Although neither state nor local officials can provide information about
whether anyone has been injured by needles dropped along roads,
Mastrorocco said, “It’s just a matter of time until someone gets stuck.”

Fear about HIV, hepatitis and other illnesses transmitted by contaminated
needles gives pause to volunteers who once freely donated time to public-
service projects. Mastrorocco said his program once had about 20
volunteers. Now, there are five.

The trouble facing cleanup crews is an unexpected sign that the heroin
epidemic can extend to people far removed from the drug culture.

With overdose deaths nearing 300 last year in Allegheny County and
quadrupling over the past three years in Washington and Westmoreland
counties, U.S. Attorney David Hickton in Pittsburgh has declared it “a
public health crisis.”

WARNINGS SOUNDED

Some groups warn volunteers to wear proper clothing to guard against
exposure to needles.

When used needles started showing up along Greene County roads, highway
volunteers were told to switch from tennis shoes to hard-sole shoes. “You
don’t want to take a chance,” said Lisa Snider, district manager of the
Greene County Conservation District.

Litter crew members are told never to touch a discarded needle. “Leave it
alone. Report it to law enforcement,” said Colleen Martin, PennDOT’s
Adopt-A-Highway coordinator in Greene County.

About two years ago, Martin said, “We found about 36 (needles) in a
quarter of a mile. I was dumbfounded. … I never thought that people
could be that stupid.”

As heroin use escalates, the problem shows no signs of abating and
roadside litter once consisting of candy wrappers, cigarette butts and
beer cans has taken on a danger, officials said.

“It puts the volunteers in a difficult spot,” said Ellen Keefe, executive
director of Westmoreland Cleanways and Recycling. “You’re picking up a pop
bottle and not expecting to see a needle in there.”

Most protective measures that cleanup groups traditionally used, such as
gloves, provide little protection against needles, according to state
officials.

People who come across needles or syringes anywhere should report the
finding to the local fire department or police, said state Department of
Environmental Protection spokesman John Poister.

“They have the proper gloves to dispose of it,” he said. “The latex gloves
most people use aren’t going to help you. In the strongest terms, we
advise people to avoid handling syringes at all cost. We consider it
medical waste.”

Needles can’t be included in regular trash; they must be separated and
disposed of properly, preferably in a plastic container, he said.

NO QUICK FIX

Health officials say there is no easy solution to the problem of needles
tossed by drug users.

Though some states limit the sale of hypodermic needles to those with
medical prescriptions, Pennsylvania has no such law, said Jason Snyder,
spokesman for the state Department of Drug and Alcohol Prevention.

Some states loosened laws in the past decade to slow the spread of HIV and
hepatitis.

Officials with the Food and Drug Administration estimate more than 9
million syringe users administer in excess of 3 billion injections yearly
outside traditional health care facilities, many for legitimate medical
purposes such as diabetics injecting insulin or women undergoing fertility
treatments.

In most cases, those patients are trained to safely dispose of their
needles, officials said.

“People just throw the needles out the door. … It’s a big problem,” said
Dr. Richard Sagal, president of the Gloucester, Mass.-based Safe Needle
Disposal group that fields about 1,000 calls a month from people with
questions about how to handle used needles.

Time does not decrease the risk associated with a dirty needle.

“Some viruses can survive on the needle for some time,” he said.
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https://tinyurl.com/owrrmj2
UK: New research traces hepatitis C infections in Scotland back to WWII

University of Glasgow via MedicalXpress.com (28.10.15)

[Photo: hepatitis C Electron micrographs of hepatitis C virus purified
from cell culture. Scale bar is 50 nanometers. Credit: Center for the
Study of Hepatitis C, The Rockefeller University.]

The roots of hepatitis C infection in Scotland date back to the Second
World War, according to new research from the University of Glasgow.
In a study published in the Journal of Virology, scientists from the MRC-
University of Glasgow Centre for Virus Research and NHS virus diagnostics
labs describe how they examined the spread of hepatitis C virus (HCV)
across Scotland by comparing the sequence of virus strains in infected
individuals across various geographical areas.

The researchers showed that HCV entered Scotland during the 1930s and
1940s while also spreading to other countries throughout the world,
probably through the mass treatment of soldiers in field hospitals.
Transmission of the virus within Scotland started to increase in the 1970s
with different strains originating in Glasgow and Edinburgh. The Glasgow
strains subsequently spread to other regions of Scotland. It was not until
several decades later, in the 1990s, that extensive HCV transmission was
observed in Aberdeen and the predominant strain was one that was rarely
identified outside of Aberdeenshire.

Looking in more detail at the Glasgow strains, they were able to identify
the key areas of the city involved in the spread of the virus up to the
present day. Focusing treatment and preventative measures in these regions
could help to reduce the prevalence of HCV in Scotland.

It is estimated that 36,700 people in Scotland are currently infected with
HCV. The virus infects the liver and causes a chronic infection which may
remain undetected for decades before symptoms occur. HCV is a blood-borne
virus which was once spread through the use of unscreened blood and blood
products or through using unsterilized medical equipment such as syringes.

Nowadays, transmission of the virus in the UK is associated mainly, but
not exclusively, with the sharing of needles during injecting drug use.

Understanding how HCV spreads could support national initiatives such as
the Hepatitis C Action plan to prevent transmission of the virus, to treat
infected individuals and to monitor the appearance of drug-resistant
strains.

Lead scientist of the study Dr Carol McWilliam Leitch, of the Centre for
Virus Research, said: “HCV poses a significant public health challenge in
Scotland as well as globally. There is currently no vaccine against the
virus and the recently developed antiviral drugs are not only extremely
costly, but resistant strains have already emerged. Pinpointing regions of
Scotland driving HCV spread will allow us to more effectively target
treatments, monitor their effect and track resistant strains. These
measures are essential if we are to combat the virus. We now intend to
focus our attention on HCV spread in other Scottish regions and to extend
the study across the UK”.

Dr John McLauchlan, Associate Director of the Centre for Virus Research,
commented: “Scotland has an international reputation in studying the HCV
epidemic that is a global clinical problem, particularly in areas of
public health. This study gives us a historical record of the spread of
the virus in different communities. It will act as a platform for future
projects with Health Protection Scotland to follow any strains in the
community that may be resistant to these new drugs. In doing so, we can
support national initiatives that will eradicate HCV infection as a public
health concern”.

Professor David Goldberg of Health Protection Scotland, who led the team
which developed and implemented Scotland’s Hepatitis C Action Plan, said:
“This unique study provides invaluable information on the origins of a
country’s hepatitis C epidemic. Such information is vital in understanding
the spread of infection, so critical in shaping strategies to prevent
further infection and disease.”

Leon Wylie, Head of Hepatitis Scotland, added “This research is very
exciting, if we had known then what we know now about Hep C in Scotland we
could have identified, and intervened at, key transmission points. This
may have significantly altered the course of the epidemic.

“It is vital that we also use this new method to provide the most benefit
for those affected by the illness. As the new treatments are very
effective, but also very expensive, we need to ensure we monitor and
minimise any build up of resistance to the new drugs in people affected by
Hep C.

“Not only can this type of science help with Hep C, it can potentially be
used with preventing or identifying outbreaks of other types of blood
borne infections, such as HIV, amongst those at risk. It again shows
Scotland at the cutting edge of the international response to viral
hepatitis”.

The study, titled ‘Spatiotemporal Reconstruction of the Introduction of
Hepatitis C Virus into Scotland and Its Subsequent Regional Transmission’,
is published in the Journal of Virology. The study was funded by the
Medical Research Council.

Explore further: New vaccine for hepatitis C virus

More information: Anna L. McNaughton et al. Spatiotemporal Reconstruction
of the Introduction of Hepatitis C Virus into Scotland and Its Subsequent
Regional Transmission, Journal of Virology (2015). DOI:
10.1128/JVI.02106-15

Journal reference: Journal of Virology

Provided by: University of Glasgow
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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
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Use of trade names and commercial sources is for identification only and
does not imply endorsement.

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

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

The SIGNpost Website is http://SIGNpostOnline.info

The SIGNpost website provides an archive of all SIGNposts, meeting
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We would like your help in building this archive. Please send your old
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Email mailto:sign.moderator@gmail.com
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The SIGN Internet Forum was established at the initiative of the World
Health Organization’s Department of Essential Health Technologies.

The SIGN Secretariat home is the 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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