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SIGNpost 00843

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00843    Behaviour Change + Abstracts + News   09 March 2016

CONTENTS
1. Abstract: Towards changing healthcare workers’ behaviour: a qualitative
study exploring non-compliance through appraisals of infection
prevention and control practices
2. Abstract: Adherence to Healthcare Waste Management Guidelines among
Nurses and Waste Handlers in Thika Sub-county- Kenya
3. Abstract: An unfortunate injection
4. Abstract: Awareness of hepatitis B infection among healthcare students
in a private medical college in Odisha
5. Abstract: Seroprevalence Of HAV, HBV, HCV, And HEV Among Acute
Hepatitis Patients At Kenyatta National Hospital In Nairobi, Kenya
6. Abstract: Prevalence of human immunodeficiency virus, hepatitis C
virus, and hepatitis B virus infection among heroin injectors in the
central region of Saudi Arabia
7. Abstract: Hepatitis C in Australian prisons: a national needs
assessment
8. Abstract: Syringe exchange in the United States: a national level
economic evaluation of hypothetical increases in investment
9. Abstract: Efficacy of the jet injector in local anaesthesia for small
wound sutures: a randomised clinical trial compared with the needle
infiltration technique
10. Abstract: Using a Vibration Device to Ease Pain During Facial Needling
and Injection
11. Abstract: Post-injection endophthalmitis rates and characteristics
following intravitreal bevacizumab, ranibizumab and aflibercept
12. Abstract: Global analysis of a mathematical model for Hepatitis C
virus transmissions
13. Abstract: Comparison of Immunogenicity and Safety of Pentavalent
Vaccine Quinvaxem® in Compact Prefilled Auto-disabled (cPAD) Injection
System versus Single-dose Vials in Healthy Infants: A Phase-3, Open-
Label, Randomized, Parallel-Group, Noninferiority Study
14. Abstract: Knowledge and practices of barbers regarding HIV
transmission in Karachi: a cross-sectional study
15. News
– Angola: Country free from fake yellow fever vaccine

CONTENTS

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__________________________________________________________________
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1. Abstract: Towards changing healthcare workers’ behaviour: a qualitative
study exploring non-compliance through appraisals of infection
prevention and control practices
__________________________________________________________________

www.journalofhospitalinfection.com/article/S0195-6701(15)00079-1/abstract

J Hosp Infect. 2015 Jun;90(2):126-34. Open Access Article
Towards changing healthcare workers’ behaviour: a qualitative study
exploring non-compliance through appraisals of infection prevention and
control practices.

Shah N1, Castro-Sánchez E2, Charani E1, Drumright LN3, Holmes AH1.

1NIHR Health Protection Research Unit in Healthcare Associated Infection
and Antimicrobial Resistance at Imperial College London, London, UK.
2NIHR Health Protection Research Unit in Healthcare Associated Infection
and Antimicrobial Resistance at Imperial College London, London, UK.
Electronic address: e.castro-sanchez@imperial.ac.uk.
3Department of Medicine, University of Cambridge, Cambridge Biomedical
Campus, Cambridge, UK.

BACKGROUND: Improving behaviour in infection prevention and control (IPC)
practice remains a challenge, and understanding the determinants of
healthcare workers’ (HCWs) behaviour is fundamental to develop effective
and sustained behaviour change interventions.

AIM: To identify behaviours of HCWs that facilitated non-compliance with
IPC practices, focusing on how appraisals of IPC duties and social and
environmental circumstances shaped and influenced non-compliant behaviour.
This study aimed to: (1) identify how HCWs rationalized their own
behaviour and the behaviour of others; (2) highlight challenging areas of
IPC compliance; and (3) describe the context of the working environment
that may explain inconsistencies in IPC practices.

METHODS: Clinical staff at a National Health Service hospital group in
London, UK were interviewed between December 2010 and July 2011 using
qualitative methods. Responses were analysed using a thematic framework.

FINDINGS: Three ways in which HCWs appraised their behaviour were
identified through accounts of IPC policies and practices: (1) attribution
of responsibilities, with ambiguity about responsibility for certain IPC
practices; (2) prioritization and risk appraisal, which demonstrated a
divergence in values attached to some IPC policies and practices; and (3)
hierarchy of influence highlighted that traditional clinical roles
challenged work relationships.

CONCLUSIONS: Overall, behaviours are not entirely independent of policy
rules, but often an amalgamation of local normative practices, individual
preferences and a degree of professional isolation.

Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights
reserved.

KEYWORDS: Attribution of responsibility; Healthcare workers’ behaviour;
Healthcare- associated infection; Infection prevention and control; Non-
compliance; Risk appraisal

Free full text http://dx.doi.org/10.1016/j.jhin.2015.01.023
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Adherence to Healthcare Waste Management Guidelines among
Nurses and Waste Handlers in Thika Sub-county- Kenya
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26949293

Ethiop J Health Sci. 2015 Oct;25(4):295-304.
Adherence to Healthcare Waste Management Guidelines among Nurses and Waste
Handlers in Thika Sub-county- Kenya.

Njue PM1, Cheboi KS2, Shadrak O3.

1Ministry of Health, Public Health Nairobi, Kenya.
2National Museums of Kenya, Centre for Biodivesirty, Nairobi, Kenya.
3Great Lakes University of Kisumu – TICH, Nairobi, Kenya.

BACKGROUND: Despite the set guidelines on Healthcare Waste Management in
Kenya, mixing of different categories of waste, crude dumping and poor
incineration are still a common phenomenon in public health facilities in
Thika Subcounty, Kenya.

Thika Subcounty generates 560 Kilograms of healthcare waste daily, which
is risk to the many patients (admission rate of 26%).

This may pose a potential environmental risk and be a source of disease
diffusion. This research explored the adherence to healthcare waste
management waste guidelines in health care facilities among the nurses and
waste handlers.

METHODS: This was a cross sectional survey in which mixed methods were
applied. A census and proportionate random sampling method were used.
Quantitative data was analyzed using Statistical Package for Social
Science (SPSS) version 20.0, while qualitative data was analyzed manually
into themes.

RESULTS: Full adherence to the seven waste disposal guidelines was low
(16.3%).

Knowledge on waste segregation, waste separation then disposal and means
of transports were statistically significant in relation to adherence. The
type of incinerator and burning status, protection maintenance and supply
of adequate waste bins were also important to adherence level.

CONCLUSION: Adherence level was low (16.3%,) and insignificantly different
among nurses and waste handlers.

From this finding, compliance remains a key challenge. Strategies targeted
at contextualizing waste regulations and guidelines into local settings
are necessary and important. Policy makers may design and implement
standard incinerators across all the health facilities. This study is not
exhaustive; therefore, it is necessary to carry out a study linking poor
treatment and disposal of clinical waste to purported health outcomes in
Kenya.

KEYWORDS: Adherence; healthcare waste guidelines; nurses; waste handlers
__________________________________________________________________
________________________________*_________________________________

3. Abstract: An unfortunate injection
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26931130

BMJ Case Rep. 2016 Mar 1;2016. pii: bcr2015211127.
An unfortunate injection.

Shah BS1, Yarbrough C2, Price A3, Biswas R4.

1B. J. Medical College, Ahmedabad, Gujarat, India.
2Brigham and Women’s Hospital, Boston, Massachusetts, USA.
3Department of Primary Health Care Sciences and Department of Continuing
Education, University of Oxford, Oxford, UK.
4Department of Medicine, L. N. Medical College, Bhopal, Madhya Pradesh,
India.

Intramuscular injection has been used to administer medications for more
than a hundred years. However, despite our profession’s long experience
with intramuscular administration, preventable complications such as
injection nerve palsies are still prevalent in developing countries.

Injections account for one-fifth of all traumatic nerve injuries. These
injuries largely occur due to indiscriminate use of intramuscular
injections for treating common illnesses, frequently by unlicensed or
undertrained practitioners administering unnecessary treatment to
impoverished patients.

The sciatic nerve is the most commonly injured, and frequently the
resulting muscle weakness and associated disability are irreversible.

This case report includes a video of a patient with foot drop 6 weeks
after gluteal intramuscular injection.

Such injuries can be prevented by proper awareness and training, the
implementation of safer injection techniques, and quality assurance
methods.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Awareness of hepatitis B infection among healthcare students
in a private medical college in Odisha
__________________________________________________________________
Free Full Article http://dx.doi.org/10.4103%2F2231-0762.171260
https://www.ncbi.nlm.nih.gov/pubmed/26942119

J Int Soc Prev Community Dent. 2015 Dec;5(Suppl 2):S63-7.
Awareness of hepatitis B infection among healthcare students in a private
medical college in Odisha.

Choudhury P1, Mishra S1, Kandula S1, Chinnannavar SN1, Rout P1, Panigrahi
R2.
Author information
1Department of Oral Medicine and Radiology, Kalinga Institute of Dental
Sciences, Bhubaneswar, Odisha, India.
2Institute of Dental Sciences, SOA University, Bhubaneswar, Odisha, India.

BACKGROUND: The emergence of the blood-borne pathogens and the increasing
number of infected patients and the increasing interest in dental health
care compel the dental professionals to have thorough knowledge about
communicable diseases and the MBBS and nursing students are always at risk
because of their profession. As hepatitis B infection is a major health
hazard throughout the world, healthcare students should have through
knowledge about this disease. Setia et al. had conducted a similar kind of
study in Punjab in which the sample size was smaller and it included only
the interns, whereas the present study was conducted to assess the level
of knowledge, attitude, and behavior about hepatitis B infection among
healthcare students of all academic years because they are indulged in
clinical work since third year of their curriculum.

MATERIALS AND METHODS: A cross-sectional survey was conducted of all the
students starting from 1(st) year to final year and the interns of MBBS,
BDS, and nursing at KIIT University. The questions were obtained from a
study performed in Turkey in 2010 and were modified by an infection
control expert. Questions in multiple choice format were in English and it
was a self-administered questionnaire consisting of three parts
(knowledge, attitude, behavior). Then, ethical clearance for the study was
obtained from the institutional ethical committee, KIMS. Subsequently, the
students were well informed and explained about the study. Students who
voluntarily wanted to participate were included in the study.
Questionnaire containing 20 questions to assess the level of knowledge,
attitude, and behavior about hepatitis B was distributed among the
students. Data were compiled and statistical analysis was done.

RESULTS: The response rate was 83% (N = 332). In our study, majority
(96.99%) were aware of transmission of HBV infection by blood, body fluid,
and secretion. The level of knowledge was higher in MBBS students than BDS
and nursing students (MBBS > BDS > nursing). Attitude toward the disease
was higher in MBBS students than BDS and nursing students (MBBS > BDS >
nursing), whereas behavior was higher in BDS students than MBBS and
nursing students (BDS > MBBS > nursing).

CONCLUSION: In our study, overall knowledge and attitude toward hepatitis
B infection were higher in MBBS students than in dental and nursing
students, whereas behavior of dental students toward the disease was quite
satisfactory than MBBS and nursing students.

KEYWORDS: Awareness; BDS; MBBS; healthcare students; hepatitis B
infection; nursing

Free Full Article http://dx.doi.org/10.4103%2F2231-0762.171260
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Seroprevalence Of HAV, HBV, HCV, And HEV Among Acute
Hepatitis Patients At Kenyatta National Hospital In Nairobi, Kenya
__________________________________________________________________

East Afr Med J. 2012 Jun;89(6):199-205.

https://www.ncbi.nlm.nih.gov/pubmed/26856042
Seroprevalence Of HAV, HBV, HCV, And HEV Among Acute Hepatitis Patients At
Kenyatta National Hospital In Nairobi, Kenya.

Muchiri I1, Okoth FA, Ngaira J, Tuei S.

1Medical Virology, Kenya Medical Research Institute, P. O. Box 593, Ruiru,
F. A. Okoth, Kenya.

BACKGROUND: Acute viral hepatitis is most frequently caused by the
hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV),
hepatitis D virus (HDV) and hepatitis E virus (HEV).

OBJECTIVES: To determine seroprevalence of HAV, HBV, HCV and HEV among
patients with acute hepatitis in Nairobi, Kenya, elucidate various risk
factors for hepatitis viral infection and determine the co-infection rates
with these viruses in the acute hepatitis patients.

DESIGN: Across sectional descriptive study.

SETTING: Kenyatta National Hospital, from November 2007 to April 2008.

SUBJECTS: One hundred patients were recruited by purposive sampling method
and comprised of 57 males and 43 females.

RESULTS: Among the enrolled patients, twenty three tested positive for one
or more markers of acute viral hepatitis, that is, HAV, HBV, HCV and HEV.
No markers were detected in 77patients, 2% tested positive for IgM anti-
HAV 11% for IgM anti-HBc; 3% for HBsAg; 5% for HCV RNA and 7% for IgM
anti-HEV.

Various risk factors associated with acute viral hepatitis were
identified; poor sanitation, source of water, occupation, place of
residence, level of education, household size, drug abuse and sexual
behaviours.

Co-infection rate with hepatitis Viruses was at 4%, IgM anti-HAV and IgM
anti-HEV 1% (n=1); IgM anti-HBc and IgM anti-HEV 1% (n=1); IgM anti-HBc
and anti-HCV 2% (n=2). Three patients were positive for HBsAg; among this
two were negative for IgM anti-HBc and this accounted for HBV carriage
(2%).

CONCLUSION: Hepatitis viruses’infections are commoncause of hepatitis
among patients with acute hepatitis at Kenyatta National Hospital. Co-
infection with these viruses was also identified among these patients.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Prevalence of human immunodeficiency virus, hepatitis C
virus, and hepatitis B virus infection among heroin injectors in the
central region of Saudi Arabia
__________________________________________________________________
Saudi Med J. 2015 Jul;36(7):802-6.

http://dx.doi.org/10.15537%2Fsmj.2015.7.11475

Prevalence of human immunodeficiency virus, hepatitis C virus, and
hepatitis B virus infection among heroin injectors in the central region
of Saudi Arabia.

Alshomrani AT1.

1Department of Internal Medicine, Psychiatry Unit, College of Medicine, Al
Imam Mohammad Ibn Saud Islamic University, Riyadh, Kingdom of Saudi
Arabia. E-mail. azsham@hotmail.com.

OBJECTIVES: To calculate the prevalence of hepatitis B virus (HBV),
hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections
among inpatient heroin users, and to study the relationships between these
infections and patient demographics.

METHODS: In this retrospective study, heroin users’ inpatient records from
the Alamal Hospital, Riyadh, Saudi Arabia were reviewed for HIV, HBV, and
HCV screening results, age, number of admissions, education, and marital
and occupational status. The study took place between January 2006 and
November 2012. The prevalences of HIV, HBV, and HCV and their associations
to demographics were evaluated.

RESULTS: A sample of 357 inpatients Saudi male heroin users (all
injectors) aged 40 (±8.6) years with lifetime admissions averaged 5.8 (±5)
times were studied. Screening results revealed that 20.1% of subjects were
infection- free, 56.6% had a single infection, 13.2% were infected by 2
viruses, and 1.1% were infected by 3 viruses. Prevalence of HBV surface
antigen was 7.7%, antibodies for HCV 77.8%, and HIV 9.8%. A significant
association was found between positive HCV and positive HIV tests.
Furthermore, HCV was more common among patients aged 20-29 years, those
who were unemployed, and who had primary, secondary, or postsecondary
education. Finally, HBV was associated in patients aged 30-39 years and
those with secondary educations.

CONCLUSION: Contracting serious contagious viral infections is very common
among Saudi heroin injectors at rates similar to those seen among
injectors in Western countries. Infection control, education, and harm
reduction programs are of paramount importance.

Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4503898/
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Hepatitis C in Australian prisons: a national needs
assessment
__________________________________________________________________
https://www.ncbi.nlm.nih.gov/pubmed/26933988

Int J Prison Health. 2016 Mar 14;12(1):3-16.
Hepatitis C in Australian prisons: a national needs assessment.

Mina MM1, Herawati L, Butler T, Lloyd A.

1Inflammation and Infection Research Centre (IIRC), School of Medical
Sciences, University of New South Wales, Australia.

Purpose – Hepatitis C (HCV) infections are prevalent in custodial settings
worldwide, yet provision of antiviral therapies is uncommon. Approximately
30,000 prisoners are held in Australian prisons at any one time, with more
than 30 per cent testing positive for HCV antibodies. Prisoners have been
identified in the National Hepatitis C Strategy as a priority population
for assessment and treatment.

The purpose of this paper is to examine the rates of HCV testing and
treatment, as well as barriers and opportunities for development of
infrastructure for enhanced services.

Design/methodology/approach – Interviews were conducted with 55
stakeholders from the correctional sector in each state and territory in
Australia in two stages: service directors to gather quantitative data
regarding rates of testing and treatment; and other stakeholders for
qualitative information regarding barriers and opportunities.

Findings – Of more than 50,000 individuals put in in custody in Australian
prisons in 2013, approximately 8,000 individuals were HCV antibody
positive, yet only 313 prisoners received antiviral treatment.

The barriers identified to assessment and treatment at the prisoner-level
included: fear of side effects and the stigma of being identified to
custodial authorities as HCV infected and a likely injecting drug user.
Prisoners who came forward may be considered unsuitable for treatment
because of prevalent mental health problems and ongoing injecting drug
use. Provision of specialist hepatitis nurses and consultants were the
most frequently recommended approaches to how prison hepatitis services
could be improved.

Originality/value – Many personal and systems-level barriers relevant to
the delivery of HCV treatment services in the custodial setting were
identified. Ready access to skilled nursing and medical staff as well as
direct acting antiviral therapies will allow the prison-sector to make a
major contribution to control of the growing burden of HCV disease.

KEYWORDS: Antiviral treatment; HCV; Harm reduction; Hepatitis C; Injecting
drug use; Prisons
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Syringe exchange in the United States: a national level
economic evaluation of hypothetical increases in investment
__________________________________________________________________
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4211599/ Free Full Text

AIDS Behav. 2014 Nov;18(11):2144-55.
Syringe exchange in the United States: a national level economic
evaluation of hypothetical increases in investment.

Nguyen TQ1, Weir BW, Des Jarlais DC, Pinkerton SD, Holtgrave DR.

1Department of Health, Behavior and Society, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD, USA, nqtrang.hanoi@gmail.com.

To examine whether increasing investment in needle/syringe exchange
programs (NSPs) in the US would be cost-effective for HIV prevention, we
modeled HIV incidence in hypothetical cases with higher NSP syringe supply
than current levels, and estimated number of infections averted, cost per
infection averted, treatment costs saved, and financial return on
investment.

We modified Pinkerton’s model, which was an adaptation of Kaplan’s
simplified needle circulation theory model, to compare different syringe
supply levels, account for syringes from non-NSP sources, and reflect
reduction in syringe sharing and contamination.

With an annual $10 to $50 million funding increase, 194-816 HIV infections
would be averted (cost per infection averted $51,601-$61,302).

Contrasted with HIV treatment cost savings alone, the rate of financial
return on investment would be 7.58-6.38. Main and sensitivity analyses
strongly suggest that it would be cost-saving for the US to invest in
syringe exchange expansion.

Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4211599/
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Efficacy of the jet injector in local anaesthesia for small
wound sutures: a randomised clinical trial compared with the needle
infiltration technique
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25052218

Emerg Med J. 2015 Jun;32(6):478-80.
Efficacy of the jet injector in local anaesthesia for small wound sutures:
a randomised clinical trial compared with the needle infiltration
technique.

Saghi B1, Momeni M2, Saeedi M2, Ghane M3.

1Emergency Medicine Department, Tehran University of Medical Sciences,
Imam Khomeini Hospital, Tehran, Iran.
2Emergency Medicine Department, Tehran University of Medical Sciences,
Shariati Hospital, Tehran, Iran.
3Emergency Medicine Department, Baqiyatollah University of Medical
Sciences, Baqiyatollah Hospital, Tehran, Iran.

Erratum in Correction. [Emerg Med J. 2015]

BACKGROUND: Despite advances in the application of needle free devices in
medical procedure, there is a paucity of knowledge on the efficacy of the
jet injector for suturing skin wounds.

AIMS: Our study aimed to compare the severity of pain and time to
initiation of anaesthesia between two methods of local anaesthesia for
skin suturing of small facial wounds.

METHODS: We conducted a double blind randomised clinical trial between
December 2012 and February 2013 at a university hospital in Tehran, Iran.
53 patients with small facial wounds needing skin closure with sutures
were assigned to either the jet injection group or the needle infiltration
group. Pain severity after administration of local anaesthesia and during
the stitching procedure, and time to initiation of skin numbness were
evaluated.

RESULTS: Mean pain score during the anaesthetic procedure was 1.1±1 in the
jet injector group compared with 4.4±1.4 in the needle infiltration group
(p<0.0001). Moreover, time to initiation of local numbness was
significantly longer in the jet injection group than in the needle
infiltration group (p<0.0001). Nevertheless, suture procedure related pain
scores did not differ significantly between the two groups (p>0.05).

CONCLUSIONS: The jet injector is an effective device in reducing the pain
of the anaesthetic procedure for small facial wounds. However, the
remarkably lower pain should be evaluated in light of other parameters,
including acceptance and preference of the newly introduced technique.

TRIAL REGISTRATION NO: IRCT201201308872N3.

Published by the BMJ Publishing Group Limited.

KEYWORDS: Anaesthesia – Local
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Using a Vibration Device to Ease Pain During Facial Needling
and Injection
__________________________________________________________________

Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4750366/

Eplasty. 2016 Feb 4;16:e9. eCollection 2016.
Using a Vibration Device to Ease Pain During Facial Needling and
Injection.

Kuwahara H1, Ogawa R2.

1Department of Plastic and Reconstructive Surgery Aidu-Chuo Hospital,
Fukushima, Japan; Department of Plastic, Reconstructive and Aesthetic
Surgery, Nippon Medical School Hospital, Tokyo, Japan.
2Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon
Medical School Hospital, Tokyo, Japan.

OBJECTIVE: In general, needling and injection are painful procedures,
especially when the face is the target. Although local anesthetics (cream
or tape) can be used to reduce the pain, they are not sufficiently
effective. It has been suggested that vibration can reduce pain. The aim
of this case study was to determine whether application of a vibration
device to an area adjacent to the facial target area to be
injected/needled would relieve pain.

METHODS: Consecutive women scheduled to undergo facial injection with
hyaluronic acid or botulinum toxin were recruited. Half of the face was
injected with concomitant vibration, whereas the other half was injected
without vibration. The pain experienced by the women during both
procedures was assessed using the Numeric Rating Scale. The safety of
injection with vibration was also assessed.

RESULTS: Of the 32 patients, 28 indicated that vibration relieved the
pain, 3 stated that it had no effect, and 1 (who received deep botulinum
toxin injections to the masseter muscle) complained that it made the pain
worse. Vibration did not affect the safety of the injections. The average
Numeric Rating Scale scores for the no-vibration and vibration injections
were 4.5 ± 1.5 and 2.3 ± 0.9, respectively (P < .001).

CONCLUSIONS: The Gate Control Theory of Pain explains why vibration
reduces pain.

KEYWORDS: face; gate control theory; pain; the trigeminal nerve; vibration

Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4750366/
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Post-injection endophthalmitis rates and characteristics
following intravitreal bevacizumab, ranibizumab and aflibercept
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26944277

Am J Ophthalmol. 2016 Mar 1. pii: S0002-9394(16)30078-2.
Post-injection endophthalmitis rates and characteristics following
intravitreal bevacizumab, ranibizumab and aflibercept.

Rayess N1, Rahimy E1, Storey P1, Shah CP2, Wolfe JD3, Chen E4, DeCroos
FC5, Garg SJ1, Hsu J6.

1The Retina Service of Wills Eye Hospital, Mid Atlantic Retina,
Philadelphia, Pennsylvania.
2Ophthalmic Consultants of Boston, Boston, Massachusetts.
3Associated Retinal Consultants at William Beaumont Hospital, Royal Oak,
Michigan.
4Retina Consultants of Houston, Houston, Texas.
5Southeastern Retina Associates, Chattanooga, Tennessee.
6The Retina Service of Wills Eye Hospital, Mid Atlantic Retina,
Philadelphia, Pennsylvania. Electronic address:
jhsu@midatlanticretina.com.

PURPOSE: To compare the incidence and clinical outcomes of endophthalmitis
following intravitreal injections of bevacizumab, ranibizumab and
aflibercept.

DESIGN: Multicenter, retrospective cohort study.

METHODS: All included patients had received intravitreal injections of
bevacizumab, ranibizumab or aflibercept between January 1, 2009 and
September 30, 2013 at 5 retina practices. Billing records were used to
identify the total number of anti-vascular endothelial growth factors
(VEGF) injections administered. Patients who developed endophthalmitis
were ascertained from endophthalmitis logs and billing records. Chart
review of these patients was performed to confirm that the endophthalmitis
was related to the antecedent anti-VEGF injection. Visual outcomes,
causative organisms and clinical course were also recorded.

RESULTS: A total of 503,890 anti-VEGF injections were included, from which
183 cases of presumed endophthalmitis were identified. The rate of
endophthalmitis for bevacizumab was 0.039% (60/153,812), which was similar
to ranibizumab 0.035%; (109/309,722; P=0.522) and aflibercept 0.035%
(14/40,356; P=0.693). Similarly, there was no difference in the rates
between ranibizumab and aflibercept (P=0.960). The culture positive rate
of the vitreous/aqueous tap was 38% for both bevacizumab and ranibizumab
and was 43% for aflibercept. Furthermore, visual acuity remained decreased
at 3 months follow-up for bevacizumab (P=0.005), ranibizumab (P<0.001) and
aflibercept (P=0.07) compared to vision at causative injection.

CONCLUSIONS: Endophthalmitis following intravitreal bevacizumab,
ranibizumab and aflibercept injection appears to occur at similar rates
and have comparable visual outcomes. This study suggests that the choice
of anti-VEGF agent should be primarily based on efficacy and patient
response rather than concern for risk of infection.

Copyright © 2015 Elsevier Inc. All rights reserved.

KEYWORDS: Endophthalmitis; aflibercept; anti-vascular endothelial growth
factor; bevacizumab; diabetic macular edema; intravitreal injection;
neovascular age-related macular degeneration; ranibizumab; retinal vein
occlusion
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Global analysis of a mathematical model for Hepatitis C
virus transmissions
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26940946

Virus Res. 2016 Feb 29. pii: S0168-1702(16)30136-8.
Global analysis of a mathematical model for Hepatitis C virus
transmissions.

Shi R1, Cui Y2.

1School of Mathematics and Computer Science, Shanxi Normal University,
Linfen 041004, China. Electronic address: shirq1979@163.com.
2School of Mathematics and Computer Science, Shanxi Normal University,
Linfen 041004, China.

In this paper, a mathematical model is proposed and analyzed for Hepatitis
C virus (HCV) infection transmissions. In this model, both of chronic
primary infection and possibility of reinfection are considered.

Two thresholds of basic reproduction number R0 and control reproduction
number Rc are derived. We get the sufficient conditions for the existence
of infection-free equilibrium and endemic equilibrium.

The sufficient conditions for the local and global stability of the
equilibria are also obtained.

Some numerical simulations are performed to prove the theoretical results.
At last, some discussions are presented.

Copyright © 2016. Published by Elsevier B.V.

KEYWORDS: Basic reproduction number; Control reproduction number; Endemic
equilibrium; Hepatitis C virus (HCV); Infection-free equilibrium;
Reinfection; Stability
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Comparison of Immunogenicity and Safety of Pentavalent
Vaccine Quinvaxem® in Compact Prefilled Auto-disabled (cPAD) Injection
System versus Single-dose Vials in Healthy Infants: A Phase-3, Open-
Label, Randomized, Parallel-Group, Noninferiority Study
__________________________________________________________________

http://www.ijidonline.com/article/S1201-9712(16)00035-7/abstract

Int J Infect Dis. 2016 Feb 25. pii: S1201-9712(16)00035-7. Open Access
Comparison of Immunogenicity and Safety of Pentavalent Vaccine Quinvaxem®
in Compact Prefilled Auto-disabled (cPAD) Injection System versus Single-
dose Vials in Healthy Infants: A Phase-3, Open-Label, Randomized,
Parallel-Group, Noninferiority Study.

Capeding MR1, Alberto E2, Versteilen A3, Rauscher M4, Bagchi P5, Ibarra de
Palacios P4.

1Research Institute for Tropical Medicine, Muntinlupa City 1781,
Philippines. Electronic address: lerosecap@gmail.com.
2Research Institute for Tropical Medicine, Muntinlupa City 1781,
Philippines.
3Crucell Holland BV, Leiden 2333CP, The Netherlands.
4Crucell Switzerland AG, Bern CH-3018, Switzerland.
5Janssen Research and Development, Raritan NJ 08869, USA.

OBJECTIVE: To evaluate noninferiority of 3 doses of Quinvaxem® in a
compact prefilled auto-disabled (cPAD) injection system versus Quinvaxem®
in a single-dose vial administered with conventional syringe in terms of
seroconversion/seroprotection rates for all antibodies (anti-hepatitis B
[HB], anti-haemophilus influenzae type-b polyribosylribitol phosphate [Hib
PRP], anti-diphtheria, anti-tetanus, anti-Bordetella pertussis) one month
after primary vaccination.

METHODS: 400 healthy infants aged 42-65 days were randomized (1:1) to
receive Quinvaxem® in cPAD or single-dose vial at 6, 10 and 12 weeks of
age. Blood samples were collected before vaccination and one month after
third dose for seroconversion/seroprotection rates. Safety was assessed
from solicited and unsolicited adverse events, and serious adverse events
(SAE).

RESULTS: Of 400 infants randomized, 395 (98.8%) received all three vaccine
doses. In cPAD vs. single-dose vial groups, seroprotection rates against
Hib PRP (98.5% both), HB (92.9% vs. 93.4%), diphtheria (100% vs. 99%) and
tetanus toxoids (100% both), and seroconversion against B. pertussis
(95.4% vs. 97%) were =92% one month after third vaccination (lower limits
of 95% CIs simultaneously >-10%). Geometric mean concentrations exceeded
seroprotection/seroconversion thresholds by large margins. Incidence of
induration and erythema was comparable between groups, tenderness was
slightly higher in cPAD group (85.5% vs 76.5%). No vaccine-related SAEs
occurred.

CONCLUSION: Quinvaxem® in cPAD was noninferior to single-dose vial with
respect to seroprotection/seroconversion rates for all antibodies. Both
presentations were well-tolerated.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT01349283.

Copyright © 2016. Published by Elsevier Ltd.

KEYWORDS: Immunogenicity; Quinvaxem(®); compact prefilled auto-disabled
injection; pentavalent vaccine; single-dose vials

Free full text
http://www.ijidonline.com/article/S1201-9712(16)00035-7/abstract
http://dx.doi.org/10.1016/j.ijid.2016.02.015
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Knowledge and practices of barbers regarding HIV
transmission in Karachi: a cross-sectional study
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/24504994

J Community Health. 2014 Oct;39(5):951-5.
Knowledge and practices of barbers regarding HIV transmission in Karachi:
a cross-sectional study.

Bawany FI1, Khan MS, Shoaib AB, Naeem M, Kazi AN, Shehzad AM.

1Dow Medical College, Dow University of Health Sciences, Karachi,
Pakistan.

A barber shop is a potential place for non-sexual transmission of deadly
blood borne diseases such as acquired immuno-deficient syndrome. Few
researches have been conducted to assess the knowledge of barbers
regarding human immunodeficiency virus (HIV) transmission in Pakistan.
With majority of the population visiting roadside saloons, it is
imperative to have local data in this regard.

The objective of this study was to investigate the knowledge and practices
of barbers with reference to razor use and steps taken to sterilize their
instruments.

A total of 300 barber saloons were conveniently selected for this cross-
sectional study during a time period of 5 months from May 2012 till
September 2012. The shops were categorized into three groups: big saloons,
small saloons and roadside saloons based on the inclusion criteria. One
barber was randomly selected as a representative from each saloon. Data
collection from each barber shop was carried out by an interviewer using a
pre-coded questionnaire.

Majority of the barbers had low school education. Awareness regarding
sharing of blades as a route of HIV transmission was known by 90 % (n =
90) of big saloon barbers with awareness decreasing in small (n = 55) and
roadside saloon barbers (n = 27). Only 60.3 % (n = 181) of the barbers
used new blades between customers.

In comparison to big saloon barbers, the majority (n = 53) of roadside
saloon barbers used tap water for cleaning purposes. Only 40 % of the
roadside barbers used antiseptic after shaving.

The results of our study indicate that roadside saloon barbers, to whom
majority of Pakistani population visit, have inadequate awareness
regarding HIV transmission. Their poor barbering practices were mainly due
to their low education. This potentiates a great risk for aggravating the
HIV endemic in Pakistan.
__________________________________________________________________
________________________________*_________________________________

15. News

– Angola: Country free from fake yellow fever vaccine

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/z49xaw4
Angola: Country free from fake yellow fever vaccine

Angola Press, Angola(26.02.16)

Luanda – The general inspector for health, Miguel de Oliveira, on Friday
in Luanda said that fortunately in Angola there is no fake yellow fever
vaccine.

Considering that there are warnings about fake yellow fever vaccines from
the Pasteur Institute of Senegal, the technician said this counterfeit
amount of vaccines, issued on July 2012 and which is set to expire on July
2017, did not enter the country.

He said that this information was released by the World Health
Organisation (WHO), which also revealed that the counterfeit vaccines were
founds in some countries of Asia and west Africa.

“The population has to be vaccinated because it is very important, but the
health authorities and partners are attentive to a possible entry of fake
vaccines or medicines in the country”, he stressed.

An outbreak of yellow fever has been hitting some parts of the country,
reason why the authorities are implementing a vaccination campaign against
this disease.
__________________________________________________________________
________________________________*_________________________________

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
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The comments made in this forum are the sole responsibility of the writers
and does not in any way mean that they are endorsed by any of the
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The SIGN Forum welcomes new subscribers who are involved in injection
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We would like your help in building this archive. Please send your old
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__________________________________________________________________
________________________________*_________________________________

The SIGN Internet Forum was established at the initiative of the World
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The SIGN Secretariat home is the Service Delivery and Safety (SDS)
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The SIGN Forum is moderated by Allan Bass and is hosted on the University
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__________________________________________________________________

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