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Post00845 Injection Device Security + Abstracts + News 23 March 2016

1. WHO Guiding Principles To Ensure Injection Device Security
2. Abstract: Assessment of medical waste management in seven hospitals in
Lagos, Nigeria
3. Abstract: Usage of ultraviolet test method for monitoring the efficacy
of surgical hand rub technique among medical students
4. News
– India: Plea to launch national injection safety campaign
– Cincinnati USA:: Alert: Look for needles before eggs
– USA: Seattle hospital urges HIV test for 1300 after needle swaps
– China vows crackdown on fake vaccines amid scandal
– China: China reveals deadly vaccine sales ring, hunts 300 suspects
– USA: Hospital Worker Could Have Exposed Thousands to HIV and Hepatitis
– Global: HIV activists fear UN ‘War on Drugs’ conference is already
– Canada: HIV/AIDS lecture series concludes with focus on harm reduction
Lecturer emphasizes need for “political will” to end HIV/AIDS

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1. WHO Guiding Principles To Ensure Injection Device Security

Below is the full text of the revised “Guiding Principles To Ensure
Injection Device Security” WHO/HIS/SDS/2015.30

It has been reformatted to plain ASCII text for fast email download.

the pdf is available to download at

Department of Service Delivery and Safety (SDS)
Health Systems and Innovation (HIS)
World Health Organization

Full Text Full Text Full Text Full Text Full Text Full Text

[page 1]
Guiding Principles To Ensure Injection Device Security


Injections are the most common health- care procedure worldwide. In
developing and transitional countries alone, some 16 billion injections
are administered each year.

Most injections, more than 90%, are given for therapeutic purposes while 5
to 10% are given for preventive services, including immunization and
family planning.

The majority of therapeutic injections in developing and transitional
countries are unnecessary.

A safe injection does not harm the recipient, does not expose the health-
care worker to any avoidable risk and does not result in waste that is
dangerous for the community.

When injections are medically indicated they should be administered
safely. Unsafe injections place patients at risk of disability and death.
Reuse of injection devices without sterilization is of particular concern
as it may transmit hepatitis B virus (HBV), hepatitis C virus (HCV) and
human immunodeficiency virus (HIV), accounting for 30%, 41% and 5% of new
infections in 2000, respectively.

In addition, inappropriate and unhygienic use of multi-dose vials may
transmit bloodborne pathogens.

Best infection control practices for intradermal, subcutaneous and
intramuscular injections recommend the use of a new, single use injection
device for each injection and for the reconstitution of each unit of
medication. The new WHO guidelines recommend using auto disable/reuse
prevention/sharps injury prevention devices for most therapeutic

The approximate cost of these syringes are AD for immunization 0.04-0.06;
RUP for therapeutic injections 0.05-0.08; SIP for therapeutic injections
0.013-0.24 and SIP+RUP 0.09-0.25.

Failure to systematically fund sucient supplies of injection devices was
identied as a key determinant of widespread reuse of syringes and needles
in the absence of sterilization in immunization services.

Interventions to increase the availability of injection devices in
curative services have improved injection safety.

Interventions to prevent infections with bloodborne pathogens through
provision of single use devices are a very cost-effective investment in

Sterile, single use injection devices include sterile hypodermic syringes,
sterile hypodermic needles, auto-disable syringes for immunization
purposes, syringes with a reuse-prevention feature for general purposes
and syringes with needle-stick prevention features (e.g., safety syringes)
for general purposes.

WHO is strengthening its collaboration with national regulatory
authorities to ensure the quality and safety of injection devices through:

(1) the enforcement of national regulations based upon international
standards for injection devices3 and

(2) reliance on internationally accepted certifying bodies that provide
the ISO certication and carry out the auditing function. 8

The safe collection and disposal of used sharps (e.g., needles, syringes
with xed needles) is an integral part of the life cycle of injection

The collection of sharps waste in safety containers (e.g., safety boxes)
at the point of use and their safe and environmentallyresponsible disposal
protect health-care workers and the general public from needle-stick

Interventions to reduce injection overuse reduce waste thereby
facilitating its management. Management choices and technology options
will depend on many considerations, including workers’ safety,
sustainability and acceptability. Low-cost, effective waste treatment
options are available.

UNFPA, UNICEF and WHO have reaffirmed that by the end of the year 2003,
all countries should be using only auto-disable syringes in immunization
services. Auto-disable syringes and safety boxes should be supplied in
adequate quantities with all consignments of vaccines.

Text Box 1

• AD-autodisable syringes

• RUP-reuse prevention

• SIP-sharp injury prevention

Text Box 2


In curative and preventive services, ensuring injection device security
implies appropriate forecasting, nancing, procurement and supply
management so that the following items are available in adequate

– Injectable products (AD/RUP/SIP);

– Appropriate single dose diluents;

– Single use injection devices for injection and reconstitution;

– Safetyboxes.

This procurement policy does not imply that items mentioned above must be
physically packaged together, butultimately theseitems shouldbeavailable
in a timely manner in health-care facilities in adequate quantities.

Suppliers and shipping routes may differ for injectable products,
injection devicesand other infection control supplies. The application and
success of this policy is dependent on a reliable distribution systemfor
health products

Text Box 3


WHO Recommends That Injection Device Security Is Ensured In All Health-
Care Facilities, Including Therapeutic Services (See Box), So That
Injectable Medicines, Diluents, Ad/Rup/Sip Injection Devices And Safety
Boxes Are Supplied In A Timely Manner In Adequate Quantities.

[Page 2]


– WHO reaffirms the need to ensure access to AD/RUP/SIP injection devices
and safety boxes of good quality. Sterile, single use injection devices
for injection and reconstitution and safety boxes must be available in
every health-care facility in sufficient quantities for the number of
injections administered;

– Syringes with a reuse-prevention feature offer the highest level of
safety for injection recipients. They are recommended for use for
therapeutic injections where local data indicate that unsafe practices are
particularly common;

– WHO urges that all injectable medications are supplied with matching
quantities of single use injection devices, appropriate diluents and
safety boxes through essential medicine programmes and other health
programme supply mechanisms;

– To prevent injection overuse, national drug policies should promote the
rational use of therapeutic injections. This may include removing
unnecessary injectable medicines from the national essential medicines

– Health-care services must manage sharps waste as part of the duty of
care in a safe and environmentally responsible way, within a broader
policy of health-care waste management. Awareness and training for
appropriate sharps waste management are required. Sharps waste disposal
management should be costed, budgeted and funded.

– WHO requests all donors and lenders who finance injectable products
(i.e.,v accines,c ontraceptives and medications) to also finance
appropriate quantities of AD/RUP/SIP injection devices, single dose
diluents, safety boxes and the cost of sharps waste management. All
organizations involved in medicine donations should also ensure that they
are following this recommendation


WHO developed a strategy to ensure that special attention is paid to the
safe administration of all types of injections in health-care services. A
set of tools are available to support the assessment, planning,
implementation and evaluation of national injection safety policies for
preventive and curative services.

Ministries of health, donors, lenders and partners who are active in the
health sector, including in essential medicines programmes, are invited to
endorse these recommendations. More information on injection safety is
accessible on the WHO Injection Safety internet site which includes a toolbox of
resources to assist in the management of national safe and appropriate use
of injection policies.

[Text Box 4]

Syringes engineered to prevent reuse are not suitable for certain medical
procedures e.g. when administering multiple medicines, maintenance of IV
lines, local anaesthesia and nasal feeding. Conventional disposable
syringes should be used safely in these and similar instances.

1. Hutin YJF, Hauri AM, Armstrong GL. Use of injections in healthcare
setting worldwide, 2000. Literature review and regional estimates. BMJ
2003; 327:1075-8.

2. WHO Best infection control practices for skin-piercing intradermal,
subcutaneous and intramuscular needle injections. WHO/BCT/DCT 01.02

3. Hauri AM, Armstrong GL, Hutin YJF: Contaminated injections in health
care settings. In Comparative Quantification of Health Risks: Global and
Regional Burden of Disease Attributable to Selected Major Risk Factors.
Ezzati M, Lopez AD, Rodgers A, Murray CJL. Editors. Geneva: World Health
Organization, 2003.

4. Hutin YJF, Hauri AM, Chiarello L, Catlin M, Stilwell B, Ghebrehiwet T
Garner J and the members of the injection safety best practices
development group. Best infection control practices for intradermal,
subcutaneous and intramuscular needle injections. Bull World Health Organ
2003; 81:491-500.01.

5. Dicko M, Oni A-Q Q, Ganivet S, Kone S, Pierre L, Jacquet B. Safety of
immunization injections in Africa: not simply a problem of logistics. Bull
World Health Organ 2000; 78: 163-9.

6. Logez S. Increased Access to Injection Equipment in Burkina Faso: When
Essential Drug programmes Improve Injection Safety. In Safe Injection
Global Network (SIGN), Annual Meeting Report, 30-31 August 2001.

7. Dziekan G, Chisholm D, Johns B, Rovira J, Hutin Y. The cost
effectiveness of policies for the safe and appropriate use of injection in
health care settings. Bull World Health Organ 2003; 81:277-85.

8. ISO standard: ISO 7886 –1: Sterile hypodermic syringes for single use –
Part 1: Syringes for manual use, 1993.

9. WHO-UNICEF-UNFPA Joint statement on the use of auto-disable syringes in
immunization services. WHO/V&B/99.25

10.WHO. Tool for the assessment of injection safety, WHO/V&B/01.30

11.WHO. Managing an injection safety policy. March 2003. WHO/BCT/03.01

12.Hart C, M Usher. Contraceptive Security, What Is It and What Best
Practices Achieve It? Arlington, VA.: DELIVER/John Snow, Inc. Presented in
Cairo at the WHO Intercountry Meeting with Partners and Country Teams:
Best Practices to Improve Reproductive Health. 2002


[Text Box 5]

Department of Service Delivery and Safety (SDS)
Health Systems and Innovation (HIS)
World Health Organization


2. Abstract: Assessment of medical waste management in seven hospitals in
Lagos, Nigeria

Free BMC Article

BMC Public Health. 2016 Mar 15;16(1):269.
Assessment of medical waste management in seven hospitals in Lagos,

Awodele O1, Adewoye AA2, Oparah AC3.

1Department of Pharmacology, Therapeutics and Toxicology, College of
Medicine, University of Lagos, PMB 12003, Lagos, Nigeria.
2Transnational Environmental Co., 75, Tejuosho Surulere, Yaba, Lagos,
3Department of Clinical Pharmacy and Pharmacy Practice, University of
Benin, Benin City, Edo State, Nigeria.

BACKGROUND: Medical waste (MW) can be generated in hospitals, clinics and
places where diagnosis and treatment are conducted. The management of
these wastes is an issue of great concern and importance in view of
potential public health risks associated with such wastes.

The study assessed the medical waste management practices in selected
hospitals and also determined the impact of Lagos Waste Management
Authority (LAWMA) intervention programs. A descriptive cross-sectional
survey method was used.

METHODS: Data were collected using three instrument (questionnaire, site
visitation and in -depth interview). Two public (hospital A, B) and five
private (hospital C, D, E, F and G) which provide services for low, middle
and high income earners were used. Data analysis was done with SPSS
version 20. Chi-squared test was used to determine level of significance
at p?<?0.05.

RESULTS: The majority 56 (53.3 %) of the respondents were females with
mean age of 35.46 (±1.66) years. The hospital surveyed, except hospital D,
disposes both general and medical waste separately. All the facilities
have the same process of managing their waste which is segregation,
collection/on- site transportation, on-site storage and off-site

Staff responsible for collecting medical waste uses mainly hand gloves as
personal protective equipment. The intervention programs helped to ensure
compliance and safety of the processes; all the hospitals employ the
services of LAWMA for final waste disposal and treatment.

Only hospital B offered on-site treatment of its waste (sharps only) with
an incinerator while LAWMA uses hydroclave to treat its wastes. There are
no policies or guidelines in all investigated hospitals for managing

CONCLUSIONS: An awareness of proper waste management amongst health
workers has been created in most hospitals through the initiative of
LAWMA. However, hospital D still mixes municipal and hazardous wastes.

The treatment of waste is generally done by LAWMA using hydroclave, to
prevent environmental hazards except hospital B that treats its sharp with
an incinerator.

In order to enhance uniform and appropriate waste management practices in
the entire State, there is need for capacity building at all levels and
also policies and guidelines formulations.

KEYWORDS: Environmental hazards; Healthcare workers; LAWMA and Lagos;
Medical waste; Waste management

Free BMC Article

3. Abstract: Usage of ultraviolet test method for monitoring the efficacy
of surgical hand rub technique among medical students

J Surg Educ. 2015 May-Jun;72(3):530-5.
Usage of ultraviolet test method for monitoring the efficacy of surgical
hand rub technique among medical students.

Vanyolos E1, Peto K2, Viszlai A1, Miko I1, Furka I1, Nemeth N1, Orosi P3.

1Department of Operative Techniques and Surgical Research, Institute of
Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
2Department of Operative Techniques and Surgical Research, Institute of
Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
Electronic address:
3Department of Hygiene and Infection Control, Faculty of Public Health,
University of Debrecen, Debrecen, Hungary.

BACKGROUND: Adequate hand movements are essential in surgical hand rub, so
it is important for medical students to learn it correctly. To assess its
efficacy, we aimed to use ultraviolet (UV) light test after applying
fluorescent solution.

METHODS: Digital images of the hands of 253 medical students were analyzed
during “Basic Surgical Techniques” course on the 10th (Survey 1) and 14th
(Survey 2) week of the curriculum to check the process and the skills
development. The last step of the surgical hand rub was performed with a
fluorescent solution, and then the hands were placed under UV light.
Photographs were taken and analyzed. Every uncovered area was considered
an error. Number and the localization of missed spots and its extent was
determined. For evaluation, palmar (P) and dorsal (D) sides of the hands
were divided into regions of interest (1-distal phalanxes, 2-thumb and
first metacarpus, 3-second to fifth fingers, and 4-second to fifth

RESULTS: Various magnitude and number of failure occurred in 123 (48.61%)
students in survey 1 and in 65 (25.69%) in survey 2. The most frequent
sites of the missed spots were D/2 and P/4 region in survey 1 and D/1 and
P/4 in survey 2. There was an improvement seen in survey 2, as shown by a
decrease in the number and extent of missed spots. Right-handed students
made fewer mistakes on their nondominant hands than left-handed students
(n = 23) did.

DISCUSSION: The method was suitable to monitor the efficacy of surgical
hand rub technique and identify the mistakes and the critical sites. The
main advantage of the UV test was the immediate feedback, which resulted
in a distinct improvement.

CONCLUSION: Applying the UV test to the medical education and training may
contribute to improvement in the compliance and the efficacy of the
technique of surgical hand rub among the students. Copyright © 2015
Association of Program Directors in Surgery. Published by Elsevier Inc.
All rights reserved.

KEYWORDS: Medical Knowledge; Patient Care; Practice-Based Learning and
Improvement; UV test; evaluation; medical education; surgical hand rub

4. News

– India: Plea to launch national injection safety campaign

– Cincinnati USA:: Alert: Look for needles before eggs

– USA: Seattle hospital urges HIV test for 1300 after needle swaps

– China vows crackdown on fake vaccines amid scandal

– China: China reveals deadly vaccine sales ring, hunts 300 suspects

– USA: Hospital Worker Could Have Exposed Thousands to HIV and Hepatitis

– Global: HIV activists fear UN ‘War on Drugs’ conference is already

– Canada: HIV/AIDS lecture series concludes with focus on harm reduction
Lecturer emphasizes need for “political will” to end HIV/AIDS

Selected news items reprinted under the fair use doctrine of international
copyright law:
India: Plea to launch national injection safety campaign

Our Bureau, Mumbai,, India (22.03.16)

Safe Point India, leading voluntary organization in India working towards
enhanced patient and health worker’s safety and to bring down overall
healthcare cost through safe injection practices, has urged Prime Minister
Narendra Modi to launch a nationwide “Rashtriya Swachh Injections Abhiyan”
to end the continued practice of unsafe injections which result in
avoidable loss of life, serious health risks and increased healthcare

“We wish to draw the attention of Prime Minister Narendra Modi towards the
menace of unsafe injection practices and sincerely urge him to use his
good office to launch ‘Rashtriya Swachh Injections Abhiyan’, said Rajiv
Nath, project director & Trustee, Safe Point India.

Explaining the urgent need for such a nationwide programme, Nath pointed
out that “Injections should be life giver, not life taker but unsafe
injection practices, mostly in the form of reuse of safety injections from
dirty contaminated needles, continues to be a serious threat to life of
patients and health workers, casting shadows over public healthcare and
immunization programme while raising individual and national healthcare
cost burden.”

Nath added that such a campaign would be relatively lower cost but
concomitant benefits in terms of health, safety and hidden savings in
saving lives or loss from income due to extra days on a hospital bed or
taxpayers money in treatment costs, would be humungous.

Studies and common medical observations have found that unsafe injections
can result in the transmission of blood-borne pathogens from patient to
patient (through reuse of syringes); patient to healthcare worker (through
needle-stick injuries) and at times from health worker to patient. The
community at large is also at risk when used injection equipment is not
safely disposed of. Unsafe injection practices have also been the cause of
outbreaks of viral hepatitis B and C and HIV in healthcare settings
including in high income countries.

The threat resulting from unsafe injection practices in India is real and
widespread due to inadequate laws, lax regulation as well as low awareness
among countryside.

The Safe Injection campaign would be all the more relevant as recently the
WHO Director General, Dr Margaret Chan called out for WHO’s 3rd Public
Healthcare initiative viz. Injection Safety through deployment of Smart
Auto Disable Syringes in all developing countries by 2020 and the need for
partnership between all stakeholders in public and private sector to
achieve this. (The first two initiatives were eradication of Polio & Hand
Washing). And India has been chosen to be one of the three ‘Pilot
Countries’ along with Egypt and Uganda to launch the WHO’s Injection
Safety Initiative. All donors had been urged to fund procurement of only
safety engineered injection devices which prevent reuse and don’t lead to
accidental needle stick injuries among healthcare workers and provide
funding for ancillary needs including appropriate quantities of single
dose diluents and safety boxes, sharps waste management and health worker

According to a WHO study, for every 1$ invested in injection safety,
savings are to the tune of over $14 in hidden cost of public healthcare
spending for treatment of ailments. This is substantial and to correlate
one can compare with another WHO study – every $ one invested in
immunisation has been resulting in $16 savings to a nation. Prevention is
far less cost than cure.

Nath believes Andhra Pradesh as a pilot state would be ideal to start this
Clean Injection- Swach Injection campaign as they received encouraging
response from AP CM Chandra Babu Naidu and his health dept. on this.

According to WHO, every year over 16 billion injections are administered
worldwide in developing world. India alone has over four billion
injections currently per annum. The vast majority – around 90 per cent –
are given in curative care. Immunization accounts for around five to 10
per cent of all injections where AD syringes are already deployed while
the remaining indications include transfusion of blood and blood products,
intravenous and intramuscular administration of drugs and fluids and
administration of injectable contraceptives.

Cincinnati USA:: Alert: Look for needles before eggs

A public service announcement Terry DeMio/Enquirer

Terry DeMio,, Cincinnati Ohio USA (21.03.16)

With the proliferation of discarded needles in the region due to the
heroin epidemic, NKY coalitions and the Cincinnati Exchange Project warn
to hunt for needles before kids hunt for Easter eggs.

SyringeBuy Photo (Photo: Enquirer file photo)
Hunt for discarded syringes before your kids hunt for Easter eggs.

The public service announcement issued Monday from the Northern Kentucky
Heroin Impact Response Taskforce has become an annual message since the
heroin epidemic became apparent in the region. It was echoed by officials
with the Cincinnati Exchange Project, a needle exchange in Greater

The epidemic has spawned a public side effect, needles discarded
haphazardly on roadsides, along river banks, in parks and playgrounds and
even residential yards.

“Discarding used syringes in public places is a real health hazard, with
risks to children and adults, first responders, sanitation workers and
parks and recreation workers,” said Dr. Judith Feinberg, founder of the
Cincinnati Exchange Project and a professor of behavioral medicine and
psychiatry at the University of West Virginia. “Used syringes can be
contaminated with infectious hepatitis C, and since they were not likely
used in a sterile environment and have been left on the ground, can
certainly cause bacterial infection as well if someone is stuck.” It’s
part of why she supports needle exchange.

“The Heroin Impact Response Task Force is still urging adults to be
vigilant in their outdoor environments – for themselves and their own or
others’ children,” according to the NKY heroin task force statement issued
through coordinator Bonnie Hedrick. “Routinely, watch for hypodermic
needles or other drug paraphernalia. Be even more cautious in light of the
upcoming outdoor egg hunts.”

Hedrick suggested calling public safety offices to do a sweep of parks or
playgrounds before you host an Easter egg hunt. “They have the proper
equipment and know-how needed to be safe,” she said. But if your
department does not respond to such requests, look carefully for signs of
IV drug use, especially needles.

If you get stuck to a syringe, the federal Centers for Disease Control and
Prevention recommends you wash the injury thoroughly with soap and water
and seek medical help.

Learn more about proper needle disposal at
USA: Seattle hospital urges HIV test for 1300 after needle swaps

By Sherry Padilla,, Washington USA (21.03.16)

Patients in several states including Washington are looking at their legal
options because of a possible exposure risk Patients in several states
including Washington are looking at their legal options because of a
possible exposure risk

The patients could be at a “very small” risk of contracting hepatitis B
and C and HIV, said Lugano Regional Hospital after the error involving
endoscopy instruments at its Civic Hospital site during the week of
February 15th.

“We are deeply saddened that the actions of a former employee may have
placed our patients at risk, and we understand the concern this
notification may cause our patients and their loved ones”, Northwest
Hospital said in a statement on its website.

The technician, Rocky Allen, 28, had worked at the Northwest Hospital and
Medical Center in Seattle for a short time in 2012, but was ultimately

Naval Hospital Bremerton said Allen didn’t have access to controlled
substances when he was stationed there between 2008 and 2011.
It stressed there has been no evidence of patient exposure thus far.
In Colorado, Arizona, California and Washington, almost 5,000 patients
have been told they could have been exposed to hepatitis B, hepatitis C or
HIV when they underwent surgery.

Earlier estimates that 2,000 people were possibly at risk have been
revised, she said. That is why Navy is not asking patients to be tested.
He was most recently fired from Swedish Medical Center in the Denver area
after he was seen taking a syringe filled with painkillers from an
operating room on January 22, officials said.

Late Wednesday morning, KIRO 7 News learned that the former surgical
technician who is accused of tampering with narcotics in a way that could
have exposed patients to diseases worked at three Western Washington
medical facilities, according to the Washington Department of Health. He
later tested positive for fentanyl and marijuana, federal court records

Speaking to The Local, hospital spokesperson Mariano Masserini said the
staff member involved had been temporarily suspended pending an internal

The results of the tests are due in two to three weeks.
China vows crackdown on fake vaccines amid scandal

By Adam Jourdan, Reuters, Shanghai China (20.03.16)

Chinese authorities have pledged to crack down on the black market sale of
vaccines after a case was made public involving nearly $90 million worth
of illegal vaccines that are suspected of being sold in dozens of
provinces around the country.

The drug regulator in Shandong, the province at the heart of the scandal,
said on Monday it would work with police forces and the health ministry to
inspect vaccine stocks to ascertain where 570 million yuan ($88 million)
worth of vaccines had ended up.

The case, which involves vaccines against meningitis, rabies and other
illnesses, underlines the challenge the world’s second-largest drug market
faces to regulate its fragmented supply chain, even as Beijing looks to
support home-grown firms.

“We will thoroughly investigate all clues in the case and once we get to
the bottom of it then we will severely punish those found to have violated
the law,” the Shandong food and drug administration said in a statement
posted on its website.

Local police said a mother and daughter in Shandong had illegally bought
vaccines from traders and sold them on to hundreds of re-sellers around
the country, according to a notice from the Shandong Public Security

The vaccines, which police said were made by licensed producers, were not
kept and transported in the required cold chain conditions, which could
mean that patients taking them could suffer severe side effects or even

China’s national food and drug regulator also called on other regions
which might have bought the illegal vaccines to investigate the issue in a
statement posted online on Sunday.

The case also points to frustrations aired by some doctors and patients
within China, who say access to some drugs is limited due to red tape
around approvals, creating demand for medicines through unapproved
channels and the black market.

Pfizer Inc shut its vaccine sales business in China last year after a
license for its Prevenar vaccine, the only vaccine it sold in the country,
was not renewed. Prevenar protects against pneumococcal disease, an
illness that can lead to pneumonia, meningitis and sepsis.

The mother – a former doctor – and daughter were detained last April, but
the case was not widely publicized until now.

(Reporting by Adam Jourdan; Editing by Richard Pullin)
China: China reveals deadly vaccine sales ring, hunts 300 suspects

By Haze Fan, CNBC International, USA (20.03.16)

Chinese authorities are hunting 300 people suspected of illegally selling
deadly, spoiled vaccines, in what could be the country’s biggest case of
its kind.

Late on Friday authorities issued a public notice of the identities of the
suspects, who are thought to have been involved a vaccine trading ring
worth as much as 570 million yuan ($88 million), state media reported.

The authorities called on the public to help track down the dealers
involved, the reports said.

According to Xinhua News Agency, the suspects sold compromised vaccines,
which were neither adequately refrigerated for storage nor transported in
approved conditions, to hospitals and disease control centers in at least
24 provinces and municipalities, including Beijing, where they were used
over a number of years

The vaccines had the potential to cause disability or death, Xinhua

The reports said that although the case was not made public until Friday,
the illegal operation was first discovered in April 2015.

Since then, the police had made over 20 raids across the country to
confiscate unsafe products and had arrested a former doctor only
identified by her surname, Pang, as well as her daughter, a medical school
graduate, in eastern China’s Shandong Province, the reports said.

The women had profited from the illegal sale of vaccines since early 2010,
the State Public Security Bureau alleged.

The duo are accused of purchasing 25 types of vaccines from more than 100
pharmaceutical salesmen, both licensed and unlicensed, then selling them
on to illegal agents as well as local medical facilities at higher prices.

So far, authorities have been unable to work out precisely what quantity
of compromised vaccine entered the market, media reports said.

The vaccines the suspects allegedly sold included ones used against
chicken pox, rabies, meningitis and hepatitis A, none of which are
mandatory injections in the mainland., the digital news outlet that first broke the story, reported
that Pang, 47, had worked as a doctor at a public hospital but in 2009 was
given a three-year prison sentence, suspended for five years, after she
was convicted of illegally selling vaccines worth almost five million yuan

Angry Chinese asked on social media why the case was only revealed almost
a year after police had solid evidence that unsafe vaccines had been
widely used, and how the justice system had allegedly allowed the former
doctor to commit the same crime twice.

China is one of the world’s largest pharmaceutical markets but also the
biggest producer of counterfeit pharmaceuticals, according to a report by
the London-based International Policy Network.

Plagued by drug scandals, Beijing has ramped up its policing of the drug
sector and called on hospitals and clinics to improve transparency on
their drug purchases.

However, the crackdown, which includes more severe punishments for the
production and sale of fake or substandard pharmaceuticals, so far appears
to have had little impact.
USA: Hospital Worker Could Have Exposed Thousands to HIV and Hepatitis

By Russell Saunders, (18.03.16)

A former hospital employee who stole Fentanyl may have put patients in
Colorado and Washington at risk for infectious diseases.

For thousands of unwitting residents of Colorado and Washington, the reach
of the nation’s opioid addiction crisis just got closer to home.

As reported by The Seattle Times, patients who underwent surgery at two
area hospitals over the span of several months from 2011 to 2012 are being
contacted and told to be tested for HIV, hepatitis B, and hepatitis C.
Concern about possible exposure to these blood-transmitted illnesses stems
from the indictment this year of a man briefly employed as a surgical
technician at both institutions.

Rocky Allen, 28, was indicted this February in Denver on charges of
tampering with a consumer product and obtaining a controlled substance by
deceit. According to the indictment, in January Allen swapped a syringe
containing the narcotic painkiller Fentanyl for a similar syringe filled
with an unspecified substance. At the time, he was working at that city’s
Swedish Medical Center, and as in Seattle, thousands of Colorado residents
who had surgery there are now advised to get tested for the same

Because the potentially tainted Fentanyl is an injected medication, if
other substitutions by Allen went undetected, screening for blood-borne
infections is prudent.

The recommendation to be tested springs from an “overabundance of
caution,” according to Karen Peck, a spokesperson for Northwest Hospital
and Medical Center, one of the two Washington hospitals where Allen had
been employed. (The other, nearby Lakewood Surgical Center, has issued
similar advice to a little over 100 patients who received care there when
Allen was an employee.) A statement from Northwest stresses that there is
no evidence that any patients there were actually exposed to tainted
medication, and that actual risk is extremely low.

“We know patients are very concerned,” Peck told The Daily Beast. However,
while an investigation is ongoing, at this time there is no evidence that
Allen made a similar swap while employed there. Peck hastened to reassure
that patients currently receiving care at Northwest are not being exposed
to risk.

Fentanyl is a particularly potent opioid pain medication, and comes in
numerous dosage forms. It is often used as an adulterant or substitute for
heroin, and using both in combination poses a substantial risk for

This week, the Centers for Disease Control (CDC) issued new guidelines for
prescribing narcotic pain medications. In its report, the CDC notes that
since the turn of the new century over 165,000 people have died of such
overdoses. Over the past decade, this trend has been on the incline, in
contrast to falling rates of death from other causes like heart disease
and cancer. This increase in mortality parallels the increase in sales of
opioid medications (which also includes drugs like Oxycontin and Vicodin,
among numerous others). The authors note that in 2012 alone, enough of
these prescriptions were written to supply every adult in America with
their own bottle.

In an attempt to stem this tide, the CDC advises that for management of
pain lasting more than three months, non-pharmacological and non-opioid
medications are preferred. For those for whom narcotic prescriptions are
appropriate, providers should proceed with caution, starting with low-
dose, short-acting options.

Of course, there are times when such prescriptions truly are appropriate.
The period immediately after major surgery would certainly be one of them.
Medications like Fentanyl are often necessary for patients who are being
treated for truly painful conditions.

But as the situation plays out in Washington and Colorado, it serves as a
stark reminder that the fallout from the opioid addiction crisis can land
in very unexpected places. Even patients whose own pain management was
entirely appropriate have now been affected by it, albeit distantly.

Efforts to combat the growing health problem are needed not only for those
now struggling with addiction to pain medication, but for those who might
be touched by it in ways they could never have predicted.
Global: HIV activists fear UN ‘War on Drugs’ conference is already doomed

Text by Tony TODD, (15.03.16)

On April 19, the UN is set to hold its first major conference on drugs
policies in nearly 20 years. But activists are warning that certain member
states are clinging to status quo policies that have failed in the past
and will fail in the future.

In 2012, Colombia, Guatemala and Mexico, countries suffering rampant
violence, addiction and disease as a result of the illegal drug trade, in
desperation called on the UN to host the first international conference on
drug policy since 1998.

The UN General Assembly Session (UNGASS) on Drugs, which was due to take
place in 2019, was duly brought forward to April 2016.

UN Secretary General Ban Ki-moon called for the 2016 UNGASS to be a “wide-
ranging and open debate that considers all options”, while promising an
inclusive discussion that considers the perspectives of all stakeholders,
member states, UN agencies and civil society

But campaigners, NGOs and civil society groups fear the UNGASS will do
little beyond re-affirming a conservative status quo, while perpetuating
misery and instability in some of the world’s most fragile states.

Across much of the world, the War on Drugs (a US term for the anti-
narcotics campaign employed since the 1970s) remains a purely punitive

It is blamed for entrenching organised crime and violence, encouraging the
spread HIV/AIDS by denying users in many countries access to clean needles
and Opiod Substitution Therapies (OST) therapy, while needlessly
criminalising and incarcerating addicts.

‘Devastating failure’

Advocates for reform are dismayed by the UNGASS “outcome document” (which
is not legally binding but will set the direction and content of the
discussions), currently being drafted by the UN’s Commission on Narcotic
Drugs (CND) in Vienna.

They say the document is devoid of any meaningful measures to change what
they insist is a failed policy, while making no explicit reference to
“harm reduction”.

*** This is despite a report released Monday by the United Nations Office
on Drugs and Crime (UNDOC) that unequivocally states: “Scaling up proven
interventions including needle syringe programmes, opioid substitution
therapy and antiretroviral therapy as part of a package of related health
services would represent a major step towards ending AIDS as a threat to
public health by 2030.”

An open letter published by the International Drugs Policy Consortium
(IDPC) on March 14, signed by nearly 200 charities, NGOs and civil society
groups, blasted the CND’s latest draft of the document, saying it had
failed to take into account any progressive ideas – even those made by UN

“Rather than considering ‘all options’, the draft simply reaffirms the
current approach and is devastating in its failure to acknowledge the
damage of punitive policies,” the letter states.

“The current draft is not a balanced reflection of the formal UNGASS
submissions and recommendations made by UN agencies,” it continues. “Many
of these submissions explicitly call for ending the criminalisation of
people who use drugs, but this point has been excluded from successive
drafts of the outcome document.”

The statement adds that “there is no acknowledgement of the need for a
harm reduction response to drug use … despite the fact that the European
Union and multiple countries of Latin America and Africa have called for
its explicit recognition”.

Hard-line policies

Polarised attitudes between member states on drugs policy inevitably make
it difficult to form a coherent global policy, especially while the UN
funds anti-drugs programmes in many of these countries to the tune of
billions of dollars.

Countries such as Russia and China (both members of the UN Security
Council), as well as Saudi Arabia and Iran, are far from ready to relax
their hard-line policies.

Their weight and influence is being felt in Vienna as the CND prepares its
“outcome document” ahead of April’s UNGASS. Harm reduction is a particular
case in point.

Russia, for example, has such strict anti-opiate laws that morphine,
widely available to doctors in most western hospitals, is severely
restricted, even for patients suffering the extreme pain of terminal

OSTs such as methadone, meanwhile, are completely illegal in Russia, where
there is not one publicly-funded needle exchange programme because
officials maintain that they increase injecting drug use despite evidence
to the contrary.

HIV explosion in Ukraine

The UK-based International HIV AIDS Alliance, which signed the IDPC
letter, has highlighted the impact of Russia’s intransigence in Ukraine,
where as many as 30,000 people rely on HIV prevention services in the war-
torn east of the country.

When Russia annexed Crimea from Ukraine in 2014, OST and needle exchange
services stopped overnight, leading to a rise in HIV infections, according
to the Ukraine-based International Renaissance Foundation.

In the rebel-held eastern Ukrainian city of Donetsk, which is heavily
influenced by Russian interests, methadone supplies will run out by the
end of March, HIV AIDS Alliance said.

“Drug users, in desperation, will seek out replacement illicit drugs,” the
charity said in a statement. “HIV and overdose risks [will] rise
dramatically as a result.”

In the Donbas area of eastern Ukraine that includes Donetsk, an extra 495
new cases of HIV were detected in 2015, according to the HIV AIDS

It is a situation that could easily be avoided, according to Susie McLean,
Senior Advisor Drug Use and HIV at the HIV AIDS Alliance, who pointed to
successful harm reduction programmes in countries such as Australia, Viet
Nam, Ukraine, Malaysia, China, Portugal, Mauritius and Switzerland.

“We will not end AIDS by 2030 unless countries commit to evidence-based
harm reduction policies,” she told FRANCE 24. “It is vital at a global
level that UN institutions like the CND commit to language that explicitly
backs harm reduction and that such language is included in the outcome of
the UNGASS on Drugs process.”

A final draft of the “outcome document” is expected to be published within
a week, but it is unlikely to be substantially different to the latest

The UNGASS will take place in New York from April 19 to 21.
Canada: HIV/AIDS lecture series concludes with focus on harm reduction
Lecturer emphasizes need for “political will” to end HIV/AIDS

by Xavier Richer Vis, The McGill Daily (12.03.16)

On March 10 McGill University hosted the final event of Concordia
University’s Community Lecture Series, “Ending HIV/AIDS.” The main speaker
was M-J Milloy, an infectious disease epidemiologist and assistant
professor at the University of British Columbia and Principal Investigator
of the AIDS Care Cohort to Evaluate Access to Survival Services (ACCESS).
Although the talk was called “Ending HIV/AIDS” Milloy focused largely on
HIV, speaking about the rise and decline of its prevalence in Vancouver’s
Downtown Eastside.

Milloy said in his talk that in the mid-1990s, Vancouver saw the worst HIV
outbreak ever observed in the Western world: within 12 months, the level
of HIV infection in Vancouver’s Eastside went from 1 in 100 individuals to
1 in 4. Milloy said that this rise stemmed primarily from a shift from
heroin, which is often injected up to five times a day, to cocaine, which
can be injected up to 50 times a day. A rise in the demand of needles led
to a decrease in supply, encouraging needle sharing.

Those hit hardest by the crisis were men who had sex with men (MSM),
Indigenous peoples, people who were incarcerated, and other disadvantaged
groups, a trend that has persisted to this day, noted Milloy.

“The vast majority of people we work with are marginalized and there exist
many barriers in their accessing social services,” said Geneviève Fortin,
a representative from CACTUS Montréal, a Montreal community organization
with needle exchange and collection services. “Many suffer from
homelessness, mental health issues, and live in extremely precarious
situations,” Fortin continued.

“What our scientists and I have concluded is that what really happened in
Vancouver was not as much a story of drug use as much as it was a story
about deadly public policy,” said Milloy.

He elaborated that the HIV crisis in Vancouver was exacerbated by the
effects of a “public order-based” response to drugs: the fear of arrest
and heightened stigma surrounding drug use pushed drug users away from
healthcare facilities, resulting in less medical help for drug users.
Correctional facilities lacked harm reduction initiatives and effective
HIV/AIDS treatment.

Regarding the low rate of HIV infection in Vancouver today, Milloy said,
“This was not a quirk of nature, but rather very specific actions [that]
were taken during the outbreak which led us to the point where we could
actually believe we could end the disease.”

These actions included a reorientation of Vancouver’s public safety
agenda, with the city’s Health Board declaring a state of public health
emergency, and adopting harm reduction initiatives to curb future drug
use. Harm reduction can be defined as a policy that does not prohibit or
eradicate a harmful act itself, such as drug use, but works to reduces the
harmful effects of it.

Insite, the first legal supervised drug injection site in North America,
opened in 2003 in Vancouver’s Downtown Eastside. Unlike a hospital or free
clinic, Insite presented itself as “low-barrier,” allowing for a
judgement-free zone where drug users were not afraid to seek out
treatment. Over the next decade, some studies showed a 35 per cent
decrease in the rate of fatal overdoses in the neighborhood.

Clinics like Insite saw opposition from both provincial and federal
Conservative governments, who believed that harm reduction techniques were
encouraging drug use in urban areas.

Even today, cities like Montreal grapple with the political challenges of
setting up safe injection sites.

“The Harper government lost their attempt to close Insite in 2011,” said
Milloy. “In response, what they did was pass Bill C-2, a federal law
governing the opening of new facilities. [The bill] made it very difficult
to [open new facilities], putting in a lot of unjustified conditions in
front of organizations who wanted to open.” For example, letters from
chiefs of police were required, but law enforcement agencies are
traditionally against harm reduction methods.

Milloy concluded by saying that little additional research was needed to
eradicate HIV in Canada.

“If I leave you with one idea from this talk, it’s that eradicating HIV
among drug users is no longer a medical concern,” said Milloy. “We no
longer need to figure out the medical tools to end this pandemic.”

He continued, “What Vancouver shows is that we need the political will to
do something. We need politicians with the political will, who will not
only devote the resources required, but who will also dismantle the
structures of stigma, discrimination, criminalization and impoverishment
which lead to HIV in these communities.”

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:

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]

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:

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* Visit the WHO injection safety website and the SIGN Alliance Secretariat

* Download the WHO Best Practices for Injections and Related Procedures
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