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SIGNpost 00857

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00857 Dental Guidelines + Zika + Abstracts + News 15 June 2016

CONTENTS
0. Moderators Note
1. Blog: US CDC Guidelines on Injection Safety in Dental Settings
2. News: Needle stick infects lab worker with Zika virus
3. Abstract: Psychosocial work characteristics and needle stick and sharps
injuries among nurses in China: a prospective study
4. Abstract: Health-Care Waste Treatment Technology Selection Using the
Interval 2-Tuple Induced TOPSIS Method
5. Abstract: An outbreak of joint and cutaneous infections caused by non-
tuberculous mycobacteria after corticosteroid injection
6. Abstract: The prevalence of HCV infection in Egypt 2015: Implications
for future policy on prevention and treatment
7. Abstract: Children’s behavioral pain reactions during local anesthetic
injection using cotton-roll vibration method compared with routine
topical anesthesia: A randomized controlled trial
8. Abstract: Simple Psychological Interventions for Reducing Pain From
Common Needle Procedures in Adults: Systematic Review of Randomized and
Quasi-Randomized Controlled Trials
9. Abstract: Reviewing harm reduction for people who inject drugs in Asia:
the necessity for growth
10. Abstract: Event-level analyses of sex-risk and injection-risk
behaviors among nonmedical prescription opioid users
11. Abstract: Hepatitis C and HIV incidence and harm reduction program use
in a conflict setting: an observational cohort of injecting drug users
in Kabul, Afghanistan
12. Abstract: Epinephrine auto-injector needle length: what is the ideal
length?
13. Abstract: Opportunities and challenges in delivering influenza vaccine
by microneedle patch
14. Abstract: Inactivated polio vaccination using a microneedle patch is
immunogenic in the rhesus macaque
15. Abstract: Dos and don’ts for hospital cleaning
16. News
– Canada: London declares ‘health emergency’ over rise in HIV & hepatitisC
– China/Florida USA: Coral Springs business owner, taken hostage in China
in 2013, is returning there with new companyWest Virginia USA: Shared
needles aggravate abuse
– California USA: Group reports over 200 dirty needles found in Santa Cruz
County
– China/Hong Kong: Doctors warn of botox risks as fourth Hong Kong woman
develops botulism after treatment in mainland China
– Hong Kong China: 2nd botulism case linked to botulinum toxin injection
reported

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1. Blog: US CDC Guidelines on Injection Safety in Dental Settings

Get the new US CDC Guidelines at:
http://www.cdc.gov/oralhealth/infectioncontrol/pdf/safe-care.pdf

Get the checklist at:
http://www.cdc.gov/oralhealth/infectioncontrol/pdf/safe-care-checklist.pdf
__________________________________________________________________

https://tinyurl.com/zg5rhsk
Blog: CDC Guidelines on Injection Safety in Dental Settings

MAY 24, 2016

As part of its resources for infection control in dental settings, the
Centers for Disease Control and Prevention (CDC) has published a new
summary (and checklist) for facilities to reference when assessing their
current protocols. These documents, which expand upon the CDC’s original
2003 guidelines, include safe injection practices.

In the summary (linked above and starting on page 12), the CDC introduces
safe injection practices by reminding dental health care providers (DHCPs)
about situations that have led to patient harm, including

“use of a single syringe – with or without the same needle – to administer
medication to multiple patients,”

“reinsertion of a used syringe — with or without the same needle — into a
medication vial or solution container (e.g., saline bag) to obtain
additional medication for a single patient and then using that vial or
solution container for subsequent patients” and

“preparation of medications in close proximity to contaminated supplies or
equipment.”

While these circumstances may seem improbable in dental settings today,
they do happen, unfortunately, and it is important to review workflows and
procedures regularly to prevent office and facility standards from getting
lax.

The CDC summary contains a set of nine key recommendations for dental
settings (page 13). MLMIC encourages dental health providers to consult
the list of “do’s” and “do nots” for a refresher in safe injection
practices.

In addition, the CDC provides measures dental practices and facilities can
employ at the administrative level (page 6 of the summary), beginning with
designation of an infection prevention coordinator to “be responsible for
developing written infection prevention policies and procedures based on
evidence-based guidelines, regulations or standards.”

As you review and update your protocols – and reassess them on a regular
basis – you may have questions. Feel free to reach out to MLMIC’s risk
management staff with any questions you have about the CDC guidelines.<
__________________________________________________________________
________________________________*_________________________________

2. News: Needle stick infects lab worker with Zika virus

Crossposted from CIDRAP with thanks.
__________________________________________________________________

https://tinyurl.com/zf3d738

CIDRAP – Center for Infectious Disease Research and Policy Academic Health
Center, University of Minnesota, Minneapolis, MN, USA
Needle stick infects lab worker with Zika virus

Lisa Schnirring, News Editor, CIDRAP News, Minnesota USA (09.06.16)

In another unusual twist in Zika developments, a woman experimenting with
the virus in a laboratory contracted an infection after a needle stick
injury, officials from Pennsylvania’s Allegheny County reported today.

Meanwhile, experts from the National Academy of Sciences, Engineering, and
Medicine (NAS) yesterday weighed in on genetically modified organisms,
including mosquitoes, for battling public health threats such as Zika
virus, saying the technology still needs more research and careful
assessment before the new tools are deployed.

Lab worker on the mend

The Zika case is unique, because the lab worker had not traveled to an
affected area and wasn’t infected through sexual transmission, the
Allegheny County Health Department (ACHD) said in a statement.

The woman’s symptoms have resolved and she is doing well, according to the
ACHD.

Karen Hacker, MD, MPH, director of the ACHD, said in the statement that
despite the rare incident, there is still no risk of contracting Zika
virus from mosquitoes in Allegheny County. “For those traveling to
countries affected by Zika, we urge caution. Pregnant women particularly
should avoid travel to affected countries,” she added.

The US Centers for Disease Control and Prevention (CDC) is aware of the
individual conducting Zika research at a facility in Allegheny County, Ben
Haynes, a CDC spokesman, told CIDRAP News. He said the person tested
positive on a polymerase chain reaction (PCR) test following the needle
stick.

He said the CDC encourages healthcare workers who handle Zika virus to
take precautions to prevent needle sticks and other exposures. On Apr 22
the CDC and the Occupational Safety and Health Administration (OSHA)
released interim guidance for protecting workers, including those in labs,
from occupational exposure to Zika virus.

Michael Osterholm, PhD, MPH, director of the Center for Infectious Disease
Research and Policy (CIDRAP) at the University of Minnesota, said other
arboviruses have been involved in needle stick lab infections, including
dengue and West Nile virus. CIDRAP is the publisher of CIDRAP News.

More research needed for genetically modified organisms

In a statement yesterday, the NAS said a study supported by several
groups, including the National Institutes of Health, said developments
with gene drives—such as genetically modified mosquitoes to help battle
Zika and similar diseases—have the potential to address environmental and
public health threats, but the organisms aren’t ready to be released and
need more research, including highly controlled field trials.

The authors of the study recommended a collaborative, multidisciplinary,
and cautionary approach to researching and governing gene drive
technologies. They emphasized that through newer and more efficient gene-
editing techniques such as CRISPR/Cas9, gene modifications can spread
through living organism populations more intentionally, quickly, and
thoroughly, some of which could cause unintended consequences.

“Preliminary evidence suggests that gene drives developed in the
laboratory could spread a targeted gene through nearly 100 percent of a
population of yeast, fruit flies, or mosquitoes,” the NAS said.

The group emphasized the importance of considering values and public
engagement and recommended a phased testing approach to guide the
research. They also noted that the current regulatory environment isn’t
yet adapted to assessing the potential risks.

The US Food and Drug Administration (FDA) is currently weighing input on a
draft environmental assessment and preliminary finding of no significant
impact regarding a field trial of Oxitec’s genetically modified Aedes
aegypti mosquitoes in the Florida Keys.

Mosquitoes and money

* CDC-based researchers today published new maps showing county-level
locations of Aedes aegypti and Aedes albopictus mosquitoes that can spread
Zika and other arboviruses. The findings, published in the Journal of
Medical Entomology, pull information from a variety of sources, covering a
span from January 1995 to March 2016. The team reports that A aegypti was
reported by 183 counties, 26 states, and the District of Columbia.
Meanwhile, 1,241 counties, 40 states, and the District of Columbia
detected A albopictus during the same period.

* Senators yesterday agreed on a voice vote to begin House-Senate
conferencing on an appropriations bill that includes $1.1 billion in Zika
virus funding, The Hill reported yesterday. The task for lawmakers is to
reconcile the $1.1 billion Senate bill with a $622 million version
covering the current fiscal year from the House.

See also:

Jun 9 ACHD statement
http://www.achd.net/pr/pubs/2016release/060916_zika.html

Apr 22 CDC/OSHA media statement on worker protection
http://www.cdc.gov/media/releases/2016/s0422-interim-guidance-zika.html

Jun 8 NAS statement
http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=23405

© 2016 Regents of the University of Minnesota.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Psychosocial work characteristics and needle stick and sharps
injuries among nurses in China: a prospective study
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25605612

Int Arch Occup Environ Health. 2015 Oct;88(7):925-32.
Psychosocial work characteristics and needle stick and sharps injuries
among nurses in China: a prospective study.

Loerbroks A1, Shang L2, Angerer P3, Li J3,2; Chinese NEXT Study Group.
Author information
1Faculty of Medicine, Center for Health and Society, Institute of
Occupational and Social Medicine, University of Düsseldorf, Moorenstraße
5, 40225, Düsseldorf, Germany. Adrian.Loerbroks@uni-duesseldorf.de.
2Department of Occupational and Environmental Health, School of Public
Health, Kunming Medical University, Kunming, China.
3Faculty of Medicine, Center for Health and Society, Institute of
Occupational and Social Medicine, University of Düsseldorf, Moorenstraße
5, 40225, Düsseldorf, Germany.

PURPOSE: Psychosocial work characteristics may be associated with needle
stick and sharps injuries (NSIs) among nurses. The current evidence is,
however, sparse, inconclusive, and mainly limited to cross-sectional
investigations. We aimed to contribute prospective data.

METHODS: We conducted a prospective study among 1,791 female hospital
nurses from China. At baseline and at a 1-year follow-up, fourteen
psychosocial work characteristics were assessed by the short Copenhagen
Psychosocial Questionnaire. At follow-up, any NSI in the workplace during
the previous year was measured by participants’ self-reports. We
quantified associations between (1) psychosocial work characteristics at
baseline and NSIs at follow-up by multivariate relative risks (Poisson
regression) and (2) NSIs reported at follow-up with psychosocial work
characteristics at follow-up (multivariate linear regression, among
others, adjusted for psychosocial work characteristics at baseline).

RESULTS: The only psychosocial work characteristic associated with a
slightly increased risk of subsequent NSIs was quantitative demands.
Examining the opposite direction of effect, we found that NSIs during the
year preceding the follow-up were associated with slightly worse ratings
of seven psychosocial work characteristics at follow-up (i.e., influence
at work, meaning of work, commitment to the workplace, quality of
leadership, social support, social community at work, and job insecurity).

CONCLUSIONS: Overall, our study does not provide compelling evidence for
an association of psychosocial work characteristics and subsequent
occurrence of NSIs. By contrast, experience of NSIs may predict less
favorable perceptions of psychosocial work characteristics.

KEYWORDS: China; Epidemiology; Needle stick and sharps injuries; Nurses;
Work stress
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Health-Care Waste Treatment Technology Selection Using the
Interval 2-Tuple Induced TOPSIS Method
__________________________________________________________________

http://www.mdpi.com/1660-4601/13/6/562/htm

Int J Environ Res Public Health. 2016 Jun 4;13(6). pii: E562.
Health-Care Waste Treatment Technology Selection Using the Interval 2-
Tuple Induced TOPSIS Method.

Lu C1, You JX2, Liu HC3,4, Li P5.
Author information
1School of Management, Shanghai University, Shanghai 200444, China.
chaolu@shu.edu.cn.
2School of Economics and Management, Tongji University, Shanghai 200092,
China. yjx2256@vip.sina.com.
3School of Management, Shanghai University, Shanghai 200444, China.
huchenliu@foxmail.com.
4School of Economics and Management, Tongji University, Shanghai 200092,
China. huchenliu@foxmail.com.
5Zhoupu Hospital Affiliated to Shanghai University of Medicine &amp;
Health Sciences, Shanghai 201318, China. yiwuchulp@126.com.

Health-care waste (HCW) management is a major challenge for
municipalities, particularly in the cities of developing nations.
Selecting the best treatment technology for HCW can be regarded as a
complex multi-criteria decision making (MCDM) issue involving a number of
alternatives and multiple evaluation criteria.

In addition, decision makers tend to express their personal assessments
via multi-granularity linguistic term sets because of different
backgrounds and knowledge, some of which may be imprecise, uncertain and
incomplete.

Therefore, the main objective of this study is to propose a new hybrid
decision making approach combining interval 2-tuple induced distance
operators with the technique for order preference by similarity to an
ideal solution (TOPSIS) for tackling HCW treatment technology selection
problems with linguistic information.

The proposed interval 2-tuple induced TOPSIS (ITI-TOPSIS) can not only
model the uncertainty and diversity of the assessment information given by
decision makers, but also reflect the complex attitudinal characters of
decision makers and provide much more complete information for the
selection of the optimum disposal alternative.

Finally, an empirical example in Shanghai, China is provided to illustrate
the proposed decision making method, and results show that the ITI-TOPSIS
proposed in this paper can solve the problem of HCW treatment technology
selection effectively.

KEYWORDS: HCW treatment technology; TOPSIS; distance measures; health-care
waste management; interval 2-tuple

Free full text http://www.mdpi.com/1660-4601/13/6/562/htm
__________________________________________________________________
________________________________*_________________________________

5. Abstract: An outbreak of joint and cutaneous infections caused by non-
tuberculous mycobacteria after corticosteroid injection
__________________________________________________________________

http://www.ijidonline.com/article/S1201-9712(15)00126-5/abstract

Int J Infect Dis. 2015 Jul;36:62-9. Open Access
An outbreak of joint and cutaneous infections caused by non-tuberculous
mycobacteria after corticosteroid injection.

Jung SY1, Kim BG1, Kwon D2, Park JH3, Youn SK2, Jeon S4, Um HY1, Kwon KE1,
Kim HJ1, Jung HJ1, Choi E1, Park BJ5.

1Korea Institute of Drug Safety and Risk Management (KIDS), Boryung Bldg,
136 Changgyeonggung-ro, Jongno-Gu, Seoul 110-750, South Korea.
2Division of Epidemic Intelligence Service, Korea Centers for Disease
Control and Prevention (KCDC), Osong-eup, Cheongwon-gun, Chungcheongbuk-
do, South Korea.
3Department of Preventive Medicine, Dongguk University College of
Medicine, Gyeongju-si, Gyeongsangbuk-do, South Korea.
4Division of Tuberculosis and Bacterial Respiratory Infection, Center for
Infectious Diseases, Korea National Institute of Health (KNIH), Osong-eup,
Cheongwon-gun, Chungcheongbuk-do, South Korea.
5Korea Institute of Drug Safety and Risk Management (KIDS), Boryung Bldg,
136 Changgyeonggung-ro, Jongno-Gu, Seoul 110-750, South Korea; Department
of Preventive Medicine, Seoul National University College of Medicine,
Seoul, South Korea. Electronic address: bjpark@snu.ac.kr.

OBJECTIVES: An outbreak of joint and cutaneous infections among patients
who had been injected at a single clinic in South Korea was investigated.

METHODS: In this retrospective case-control study, 61 cases were diagnosed
based on symptoms and signs of septic arthritis or cutaneous infection
that developed after injections at the clinic between April and September
2012; 64 controls were investigated by administering questionnaires on
risk factors and analyzing the clinic medical records. An environmental
investigation was performed, and clinical specimens of the cases were
analyzed by pulsed-field gel electrophoresis.

RESULTS: All cases were injected with triamcinolone. A greater number of
triamcinolone injections (adjusted odds ratio 4.3, 95% confidence interval
1.5-12.1 for six or more visits, compared with one or two visits) was
associated with the development of an infection. In the clinic, only the
triamcinolone injection was prepared by mixing with lidocaine and normal
saline, and an alcohol swab was prepared using boiled tap water by members
of the clinic staff. Although injected medications and environmental
cultures were not found to be responsible, a single strain of
Mycobacterium massiliense was isolated from the affected sites of 16
cases.

CONCLUSIONS: Repeated injection of triamcinolone contaminated with NTM
from the clinic environment may have caused this post-injection outbreak.

Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights
reserved.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: The prevalence of HCV infection in Egypt 2015: Implications
for future policy on prevention and treatment
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27275625

Liver Int. 2016 Jun 8.
The prevalence of HCV infection in Egypt 2015: Implications for future
policy on prevention and treatment.

Kandeel A1, Genedy M1, El-Refai S2, Funk AL2, Fontanet A2,3, Talaat M4,5.

1Ministry of Health and Population, Cairo, Egypt.
2Institut Pasteur, Paris, France.
3Conservatoire National des Arts et Métiers, Paris, France.
4Global Disease Detection Regional Center, US Centers for Disease Control
and Prevention, Cairo, Egypt.
5US Naval Medical Research Unit, No.3, Cairo, Egypt.

BACKGROUND AND AIMS: In 2015, a national Egyptian health issue survey
(EHIS) was conducted to describe the prevalence of hepatitis C virus (HCV)
infection. In this paper, we describe the HCV burden in 2015, compare the
results with the national survey conducted in 2008, and discuss the
implications of the new findings on prevention of HCV in Egypt.

METHODS: A multistage probability sampling approach was used, similar to
the national demographic survey conducted in 2008. More than 90% of
sampled individuals complied with the interview and provided blood
samples.

RESULTS: In the 15-59 year age groups, the prevalence of HCV antibody was
found to be 10.0% [95% CI 9.5-10.5] and that of HCV RNA to be 7.0% [95% CI
6.6-7.4]. In children, 1-14 years old, the prevalence of HCV antibody and
HCV RNA were 0.4% [95% CI 0.3-0.5] and 0.2% [95% CI 0.1-0.3] respectively.
Approximately 3.7 million persons have chronic HCV infection in the age
group 15-59 in 2015. An estimated 29% reduction in HCV RNA prevalence has
been seen since 2008, which is largely attributable to the aging of the
group infected 40-50 years ago during the mass schistosomiasis treatment
campaigns. Prevention efforts may have also contributed to this decline,
with an estimated 75% [95% CI 6-45] decrease in HCV incidence in the 0-19
year age groups over the past 20 years.

CONCLUSIONS: These findings can be used to shape future HCV prevention
policies in Egypt.

This article is protected by copyright. All rights reserved.

KEYWORDS: Hepatitis C Egypt; Incidence HCV; Prevalence HCV; nation-wide
surveys
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Children’s behavioral pain reactions during local anesthetic
injection using cotton-roll vibration method compared with routine
topical anesthesia: A randomized controlled trial
__________________________________________________________________
Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4878213/
Dent Res J (Isfahan). 2016 May-Jun;13(3):272-7.

Children’s behavioral pain reactions during local anesthetic injection
using cotton-roll vibration method compared with routine topical
anesthesia: A randomized controlled trial.

Bagherian A1, Sheikhfathollahi M2.

1Dental Research Center, School of Dentistry, Mashhad University of
Medical Sciences, Mashhad, Iran.
2Department of Social Medicine and Environment Research Center, Medical
School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.

BACKGROUND: Topical anesthesia has been widely advocated as an important
component of atraumatic administration of intraoral local anesthesia. The
aim of this study was to use direct observation of children’s behavioral
pain reactions during local anesthetic injection using cotton-roll
vibration method compared with routine topical anesthesia.

MATERIALS AND METHODS: Forty-eight children participated in this
randomized controlled clinical trial. They received two separate inferior
alveolar nerve block or primary maxillary molar infiltration injections on
contralateral sides of the jaws by both cotton-roll vibration (a
combination of topical anesthesia gel, cotton roll, and vibration for
physical distraction) and control (routine topical anesthesia) methods.
Behavioral pain reactions of children were measured according to the
author-developed face, head, foot, hand, trunk, and cry (FHFHTC) scale,
resulting in total scores between 0 and 18.

RESULTS: The total scores on the FHFHTC scale ranged between 0-5 and 0-10
in the cotton-roll vibration and control methods, respectively. The mean ±
standard deviation values of total scores on FHFHTC scale were lower in
the cotton-roll vibration method (1.21 ± 1.38) than in control method
(2.44 ± 2.18), and this was statistically significant (P < 0.001).

CONCLUSION: It may be concluded that the cotton-roll vibration method can
be more helpful than the routine topical anesthesia in reducing behavioral
pain reactions in children during local anesthesia administration.

KEYWORDS: Dental fear; local anesthesia; pediatric dentistry

Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4878213/
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Simple Psychological Interventions for Reducing Pain From
Common Needle Procedures in Adults: Systematic Review of Randomized and
Quasi-Randomized Controlled Trials
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26352921

Clin J Pain. 2015 Oct;31(10 Suppl):S90-8.
Simple Psychological Interventions for Reducing Pain From Common Needle
Procedures in Adults: Systematic Review of Randomized and Quasi-Randomized
Controlled Trials.

Boerner KE1, Birnie KA, Chambers CT, Taddio A, McMurtry CM, Noel M, Shah
V, Pillai Riddell R; HELPinKids&Adults Team.

Collaborators (19)
MacDonald N, Rogers J, Bucci L, Mousmanis P, Lang E, Halperin S, Bowles S,
Halpert C, Ipp M, Asmundson G, Rieder M, Robson K, Uleryk E, Antony M,
Dubey V, Hanrahan A, Lockett D, Scott J, Votta Bleeker E.

1*Departments of Psychology and Neuroscience, IWK Health Centre
‡Pediatrics and Psychology & Neuroscience, Dalhousie University †Centre
for Pediatric Pain Research, IWK Health Centre, Halifax, NS §Leslie Dan
Faculty of Pharmacy §§Health Policy Management and Evaluation, Faculty of
Medicine, University of Toronto ?The Hospital for Sick Children ??York
University, Toronto ¶Department of Psychology, University of Guelph,
Guelph #Children’s Health Research Institute **Department of Paediatrics,
University of Western Ontario, London, ON ††Department of Psychology,
University of Calgary, AB, Canada ‡‡Mount Sinai Hospital, Toronto, ON.

BACKGROUND: This systematic review evaluated the effectiveness of simple
psychological interventions for managing pain and fear in adults
undergoing vaccination or related common needle procedures (ie,
venipuncture/venous cannulation).

DESIGN/METHODS: Databases were searched to identify relevant randomized
and quasi-randomized controlled trials. Self-reported pain and fear were
prioritized as critically important outcomes. Data were combined using
standardized mean difference (SMD) or relative risk (RR) with 95%
confidence intervals (CI).

RESULTS: No studies involving vaccination met inclusion criteria; evidence
was drawn from 8 studies of other common needle procedures (eg, venous
cannulation, venipuncture) in adults. Two trials evaluating the impact of
neutral signaling of the impending procedure (eg, “ready?”) as compared
with signaling of impending pain (eg, “sharp scratch”) demonstrated lower
pain when signaled about the procedure (n=199): SMD=-0.97 (95% CI, -1.26,
-0.68), after removal of 1 trial where self-reported pain was
significantly lower than the other 2 included trials. Two trials evaluated
music distraction (n=156) and demonstrated no difference in pain: SMD=0.10
(95% CI, -0.48, 0.27), or fear: SMD=-0.25 (95% CI, -0.61, 0.10). Two
trials evaluated visual distraction and demonstrated no difference in pain
(n=177): SMD=-0.57 (95% CI, -1.82, 0.68), or fear (n=81): SMD=-0.05 (95%
CI, -0.50, 0.40). Two trials evaluating breathing interventions found less
pain in intervention groups (n=138): SMD=-0.82 (95% CI, -1.21, -0.43). The
quality of evidence across all trials was very low.

CONCLUSIONS: There are no published studies of simple psychological
interventions for vaccination pain in adults. There is some evidence of a
benefit from other needle procedures for breathing strategies and neutral
signaling of the start of the procedure. There is no evidence for use of
music or visual distraction.
__________________________________________________________________
________________________________*_________________________________

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

https://www.ncbi.nlm.nih.gov/pubmed/26472335
Open Access Free Full Text https://tinyurl.com/zmmfwvn

Harm Reduct J. 2015 Oct 16;12:32. doi: 10.1186/s12954-015-0066-x.
Reviewing harm reduction for people who inject drugs in Asia: the
necessity for growth.

Stone KA1.

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

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

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

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

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

10. Abstract: Event-level analyses of sex-risk and injection-risk
behaviors among nonmedical prescription opioid users
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27285847

Am J Drug Alcohol Abuse. 2016 Jun 10:1-9.
Event-level analyses of sex-risk and injection-risk behaviors among
nonmedical prescription opioid users.

Zule WA1, Oramasionwu C2, Evon D3, Hino S3, Doherty IA1, Bobashev GV4,
Wechsberg WM1.

1a Substance Abuse Treatment Evaluations and Interventions Program, RTI
International , Research Triangle Park , NC , USA.
2b UNC Eshelman School of Pharmacy , University of North Carolina at
Chapel Hill , Chapel Hill , NC , USA.
3c Department of Medicine , University of North Carolina at Chapel Hill ,
Chapel Hill , NC , USA.
4d Center for Data Science, RTI International , Research Triangle Park ,
NC , USA.

BACKGROUND: Nonmedical prescription opioid use has been linked to
hepatitis C virus (HCV) infection among people who inject drugs and with
using high dead space syringes that retain more blood and transfer more
HIV if shared. Little is known regarding its effects on sex-risk
behaviors.

OBJECTIVES: This paper examines event-level associations between
nonmedical prescription opioid use and sharing high dead space syringes
(injection risk) and unprotected intercourse (sex risk) behaviors.

METHODS: We recruited 1,985 participants from two overlapping risk groups-
drug users and men who have sex with men (MSM)-and their sex partners.
Participants completed an interview that included event-level sex
questions with recent sex partners and injection questions with recent
injection partners. We used multivariable generalized estimating equations
(GEE) to assess the associations between nonmedical prescription opioid
use and unprotected intercourse during sexual encounters and sharing
syringes during injection episodes, while adjusting for within-person
correlations.

RESULTS: When both partners used nonmedical prescription opioids, its use
was independently associated with unprotected intercourse in sexual
encounters (OR = 2.24; 95% CI = 1.12, 4.49). The use of nonmedical
prescription opioids was also associated with sharing high dead space
syringes during injection episodes (OR = 6.57; 95% CI = 1.63, 26.51).

CONCLUSION: Nonmedical prescription opioid use is associated with an
increase in the risk of unprotected sex and sharing high dead space
syringes. HIV and HCV prevention interventions for nonmedical prescription
opioid users should address sex-risk behaviors and encourage the use of
acceptable low dead space needles and syringes.

KEYWORDS: HCV; HIV; Nonmedical prescription opioids; high dead space
syringes; injection drug use
__________________________________________________________________
________________________________*_________________________________

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

https://tinyurl.com/h9dyn8s Open Access Free Full Text

Harm Reduct J. 2015 Oct 16;12:22.
Hepatitis C and HIV incidence and harm reduction program use in a conflict
setting: an observational cohort of injecting drug users in Kabul,
Afghanistan.

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

1Department of Obstetrics & Gynecology, College of Physicians and
Surgeons, and Heilbrunn Department of Population & Family Health, Columbia
University, Mailman School of Public Health, PH 16-69, 622 West 168th
Street, New York, NY, 10032, USA. CTodd@fhi360.org.
2Asia Pacific Business Unit and Clinical Sciences Division, FHI 360,
Sindhorn Building, 130-132 Wittayu Road, Bangkok, 10330, Thailand.
CTodd@fhi360.org.
3Health Protection and Research Organisation, Street 4, Taimani, Kabul,
Afghanistan. abdulnasir39@yahoo.com.
4Health Protection and Research Organisation, Street 4, Taimani, Kabul,
Afghanistan. mohammad-raza.stanikzai@unodc.org.
5Health Protection and Research Organisation, Street 4, Taimani, Kabul,
Afghanistan. k.fiekert@gmail.com.
6Department of Epidemiology, Yale School of Public Health, 60 College
Street, P.O. Box 208034, New Haven, CT, 06520-8034, USA. sipsmah@uic.edu.
7Department of Community Health Systems, University of California, San
Francisco School of Nursing, 2 Koret Way, #N-319X UCSF Box 0602, San
Francisco, CA, 94143-0602, USA. dvlahov@nyam.org.
8Division of Global Public Health, University of California San Diego
School of Medicine, 9500 Gilman Drive, MC 0507, La Jolla, CA, 92093-0507,
USA. sstrathdee@ucsd.edu.

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

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

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

CONCLUSION: There is high HCV incidence and high numbers of reported
deaths among male Kabul IDUs despite relatively consistent levels of harm
reduction program use; peak violence periods did not independently predict
HCV and HIV risk.

Programming should increase awareness of HCV transmission and overdose
risks, prepare clients for harm reduction needs during conflict or other
causes of displacement, and continue efforts to engage community and
police force support.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Epinephrine auto-injector needle length: what is the ideal
length?
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27271769

Curr Opin Allergy Clin Immunol. 2016 Jun 7. [Epub ahead of print]
Epinephrine auto-injector needle length: what is the ideal length?

Song TT1, Lieberman P.

1aUniversity of Washington, Department of Medicine, Division of Allergy
and Infectious Diseases, Seattle, WashingtonbDepartment of Medicine and
Pediatrics, University of Tennessee College of Medicine, Memphis,
Tennessee, USA.

PURPOSE OF REVIEW: The purpose of this manuscript is to review the
literature on the clinical effects of the needle length of epinephrine
(adrenaline) auto-injectors.

RECENT FINDINGS: Epinephrine has maximal pharmacodynamic effect within 10
min of intramuscular administration into the thigh. Prefilled epinephrine
auto-injectors are designed for simplicity of use and safety. Auto-
injectors are primarily used by patients in an unsupervised setting in
cases of anaphylaxis. There are weight-appropriate doses of epinephrine
available with auto-injectors that are prefilled, to prevent dosing
errors, with 0.15, 0.30, and 0.50?mg amounts. In addition, needle lengths
vary from 1.17 to 2.50?cm. The recommended needle lengths differ between
adults and pediatric patients. In addition, the needle lengths differ
between devices as well.

There are concerns that the needle length may be too short in select obese
patients. Yet, there are also concerns that the needle length may be too
long in some patients.

Factors that affect the depth of the injection, and therefore the
pharmacokinetics of the drug, include not only the needle length but also
the BMI, obesity, compression of soft tissue, and propulsion.

SUMMARY: Epinephrine auto-injectors have different needle lengths. Using
the right device with appropriate needle length based on BMI, obesity, and
employing the proper technique can improve the outcome in an anaphylactic
event.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Opportunities and challenges in delivering influenza vaccine
by microneedle patch
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25842218

Vaccine. 2015 Sep 8;33(37):4699-704.
Opportunities and challenges in delivering influenza vaccine by
microneedle patch.

Jacoby E1, Jarrahian C1, Hull HF2, Zehrung D3.

1PATH, PO Box 900922, Seattle, WA 98109, USA.
2HF Hull & Associates, 1200 Riverside Dr., Reno, NV 89503, USA.
3PATH, PO Box 900922, Seattle, WA 98109, USA. Electronic address:
dzehrung@path.org.

INTRODUCTION: Simple and efficacious delivery methods for influenza
vaccines are needed to improve health outcomes and manage possible
pandemics both in the United States and globally. One approach to meeting
these needs is the microneedle patch (MNP), a small array of micron-scale
needles that is applied to the skin like a bandage.

METHODS: To inform additional technical developments and the eventual
introduction of MNPs for influenza vaccination, we interviewed key opinion
leaders in the United States for insights into the opportunities and
challenges associated with this technology, particularly its potential for
self- administration.

RESULTS: All interviewees expressed high support for administration of
influenza vaccine in MNPs by health care providers and for self-
administration in groups supervised by a provider. Self-administration via
prescription and over-the-counter purchase of MNPs received lower levels
of support. Interviewees also highlighted priorities that should be
considered in the ongoing development of an influenza vaccine MNP, such as
confirming efficacy and ensuring safety for self-administration. For
patient and health care provider acceptability, important attributes are
ease of use, short wear times, and an easily accessible application site.

DISCUSSION AND CONCLUSIONS: Stakeholders agreed that using MNPs can help
increase coverage, facilitate easy and safe delivery, reduce the cost of
vaccination, and decrease the global morbidity and mortality associated
with influenza. Another opportunity for this delivery method is the
potential for self- administration. The prospect of reduced provider
training requirements, increased thermostability, and high patient and
provider acceptability makes it an attractive option for use in remote and
low-resource settings worldwide. However, in addition to the technological
challenges associated with producing the patch, developers must be mindful
of cost considerations and key product attributes or requirements, such as
usability, wear time, and proper disposal, that can affect how the product
will be received in the marketplace. Copyright © 2015 The Authors.
Published by Elsevier Ltd.. All rights reserved.

KEYWORDS: Immunization safety; Influenza; Microneedle; Public health;
Vaccine delivery; Vaccines
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Inactivated polio vaccination using a microneedle patch is
immunogenic in the rhesus macaque
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25749246

Vaccine. 2015 Sep 8;33(37):4683-90.
Inactivated polio vaccination using a microneedle patch is immunogenic in
the rhesus macaque.

Edens C1, Dybdahl-Sissoko NC2, Weldon WC2, Oberste MS2, Prausnitz MR3.

1Coulter Department of Biomedical Engineering at Georgia Tech and Emory
University, Georgia Institute of Technology, Atlanta, GA 30332, USA.
2Division of Viral Diseases, National Center for Immunization and
Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta,
GA 30333, USA.
3Coulter Department of Biomedical Engineering at Georgia Tech and Emory
University, Georgia Institute of Technology, Atlanta, GA 30332, USA;
School of Chemical and Biomolecular Engineering, Georgia Institute of
Technology, Atlanta, GA 30332, USA. Electronic address:
prausnitz@gatech.edu.

The phased replacement of oral polio vaccine (OPV) with inactivated polio
vaccine (IPV) is expected to significantly complicate mass vaccination
campaigns, which are an important component of the global polio
eradication endgame strategy.

To simplify mass vaccination with IPV, we developed microneedle patches
that are easy to administer, have a small package size, generate no sharps
waste and are inexpensive to manufacture.

When administered to rhesus macaques, neutralizing antibody titers were
equivalent among monkeys vaccinated using microneedle patches and
conventional intramuscular injection for IPV types 1 and 2.

Serologic response to IPV type 3 vaccination was weaker after microneedle
patch vaccination compared to intramuscular injection; however, we suspect
the administered type 3 dose was lower due to a flawed pre-production IPV
type 3 analytical method.

IPV vaccination using microneedle patches was well tolerated by the
monkeys.

We conclude that IPV vaccination using a microneedle patch is immunogenic
in rhesus macaques and may offer a simpler method of IPV vaccination of
people to facilitate polio eradication.

Copyright © 2015 Elsevier Ltd. All rights reserved.

KEYWORDS: Inactivated polio vaccine; Microneedle patch; Poliomyelitis;
Rhesus macaque; Sharps waste; Vaccination
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Dos and don’ts for hospital cleaning
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27272734

Curr Opin Infect Dis. 2016 Jun 7.

Dos and don’ts for hospital cleaning.

Dancer SJ1.

1aDepartment of Microbiology, Hairmyres Hospital, NHS Lanarkshire, Glasgow
bEdinburgh Napier University, Edinburgh, Scotland, UK.

PURPOSE OF REVIEW: More evidence is emerging on the role of cleaning and
decontamination for reducing hospital-acquired infection. Timely and
adequate removal of environmental pathogens leads to measurable clinical
benefits for patients. This article considers studies published from 2013
examining hospital decontamination technologies and evidence for cost-
effectiveness.

RECENT FINDINGS: Novel biocides and cleaning products, antimicrobial
coatings, monitoring practices and automated equipment are widely
accessible. They do not necessarily remove all environmental pathogens,
however, and most have yet to be comprehensively assessed against patient
outcome. Some studies are confounded by concurrent infection control and/
or antimicrobial stewardship initiatives. Few contain data on costs.

SUMMARY: As automated dirt removal is assumed to be superior to human
effort, there is a danger that traditional cleaning methods are devalued
or ignored. Fear of infection encourages use of powerful disinfectants for
eliminating real or imagined pathogens in hospitals without appreciating
toxicity or cost benefit. Furthermore, efficacy of these agents is
compromised without prior removal of organic soil. Microbiocidal activity
should be compared and contrasted against physical removal of soil in
standardized and controlled studies to understand how best to manage
contaminated healthcare environments.
__________________________________________________________________
________________________________*_________________________________

16. News

– Canada: London declares ‘health emergency’ over rise in HIV & hepatitisC

– China/Florida USA: Coral Springs business owner, taken hostage in China
in 2013, is returning there with new companyWest Virginia USA: Shared
needles aggravate abuse

– California USA: Group reports over 200 dirty needles found in Santa Cruz
County

– China/Hong Kong: Doctors warn of botox risks as fourth Hong Kong woman
develops botulism after treatment in mainland China

– Hong Kong China: 2nd botulism case linked to botulinum toxin injection
reported

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/jxygfsk
Canada: London declares ‘health emergency’ over rise in HIV & hepatitis C

‘There is an urgent need to do more outreach to both understand and manage
this complex problem’

By Derek Spalding, CBC News , Canada (14.06.16)

Injection drug in the London region use has caused a spike in HIV and
[Photo: Hepatitis C infection rates, according to health officials. (David
Ryder/REUTERS)]

The Middlesex London Health Unit is asking for more resources to combat an
alarming increase in HIV and hepatits C infections, a situation it calls
“a public health emergency.”

Injection drug use is a major cause for the skyrocketing rates, according
to a statement from health officials issued Tuesday.

London hands out 2.5M needles to addicts every year

“The Middlesex London Health Unit will ask its board to consider
reallocating health unit resources to … address what is being called a
local public health emergency,” the statement reads.

According to the health unit, HIV infections in London nearly doubled in
the past decade, going from 5.9 cases per 100,000 people in 2005 to 9.0
last year.

Those figures stand in contrast to the rest of the province. HIV rates
across Ontario dropped from 7.4 cases per 100,000 people down to 5.5 cases
in the past 10 years.

London has also seen a spike in hepatitis C rates, which climbed from 32.2
cases per 100,000 people to 53.7 cases, an increase of more than 60 per
cent.

The figures show a clear need for a supervised injection program, said Dr.
Chris Mackie, medical health officer for the region.

“There is an urgent need to do more outreach to both understand and manage
this complex problem,” he said in a news release. “What we’re seeing is an
indication that we need a supervised injection site in London.”

More than 2.5 million needles are handed out to drug users each year in
London, Ont., making the city second to only Vancouver when it comes to
publicly funded needle use in Canada.

Health officials have been studying the need for an injection site program
in the region in a bid to prevent overdoses and the spread of diseases.
Should a London program move ahead, it would likely include several
locations instead of just one, Mackie explained.

“Forcing everybody to come to one place to get all that is not a great
model,” he said.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/zbxdeqh
China/Florida USA: Coral Springs business owner, taken hostage in China in
2013, is returning there with new company

By Marcia Heroux Pounds, Sun Sentinel, Florida USA (14.06.16)

[Video at the link]

Coral Springs business owner taken hostage by factory workers in 2013 plan
new product in China

A Coral Springs medical device maker, who was taken hostage in 2013 by
workers at his factory in China, is getting ready on the third anniversary
of the international incident to again work in that country.

Charles “Chip” Starnes, who couldn’t leave his Beijing factory for six
days, is working with business partner Les Capella on a new company, Prism
Medical & Design, that will manufacture its product in a different part of
China.

Last week, Prism received FDA clearance to sell the company’s first
product, a needle system designed to protect health care workers from
dangerous pricks when injecting a patient, as well as provide safer needle
disposal.

Starnes and Capella say they have developed many relationships outside the
Beijing factory walls, and are ready to manufacture Prism’s products in
Shenzhen, the Guangdong Province of China. Manufacturing is expected to
begin in mid-July, the partners said.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/zphass5
West Virginia USA: Shared needles aggravate abuse

By Wendy Holdren Register-Herald (12.06.16)

Southern West Virginia has become a Petri dish for the study of opioid
drug abuse, overdose deaths and social conditions that have created an
environment highly vulnerable to the spread of HIV and hepatitis C.

Of the 220 counties in the United States that the Center for Disease
Control and Prevention cited recently as at-risk for an HIV and hepatitis
C outbreak, Raleigh County ranks No. 18.

Twenty-eight of West Virginia’s 55 counties were included in the list,
including Wyoming (No. 16), Fayette (No. 27), Monroe (No. 47), Nicholas
(No. 98), and Summers (No. 110).

After an outbreak of HIV infections related to injection of prescription
opioids in late 2014 in the small, rural, Scott County community of
Austin, Ind., the CDC became concerned about the possible rapid spread of
disease in similar communities.

The CDC looked at a number of indicators including drug overdose death
rates, prescription opioid sales and unemployment rates, to determine the
at-risk counties.

West Virginia’s drug overdose death rate is more than double the national
average — 34 drug overdose deaths were reported per 100,000 residents from
2011-13.

West Virginia’s prescribing rate in 2012 was the third highest in the
country — 137.6 opioid prescriptions per 100 residents. West Virginia’s
unemployment rate was 6.2 percent, 1.2 percent higher than the national
average as of April this year.

“During the past decade, the U.S. opioid epidemic has fueled an increase
in illicit, unsterile injection drug use and new hepatitis C infections,
especially within non-urban communities,” the CDC report said.

Prescription opioids are the most commonly abused prescription drug, the
report stated, and an estimated 10 to 20 percent of people who abuse
prescription opioids escalate to injection of prescription opioids or
heroin, creating risk of HIV or hepatitis C.

Rates of acute hepatitis C infection have increased steadily nationwide
from 2006-2012, the CDC said, most notably east of the Mississippi River
and particularly among states in central Appalachia. The counties
identified in the vulnerability analysis were “overwhelmingly rural.”

The CDC said the outbreak in Scott County, Ind., was especially notable
because of the absence or minimal availability of harm-reduction
strategies to prevent injection drug use-associated HIV and Hep C
infections, such as addiction treatment and rehabilitation, medication-
assisted therapy (MAT), and syringe service programs (SSPs).

”This outbreak illustrated the need for harm-reduction strategies suited
to the rural context,” the CDC report states. “Our analysis can help
identify those rural areas at highest risk of infectious complications
from IDU (injection drug use) where interventions can be prioritized.”

According to Help4WV literature from late 2015, 17 counties throughout the
state have no treatment services or facilities available, including
Wyoming County, which ranked No. 16 on the list. Only one treatment
facility, Southern Highlands Community Health Center, is located in
McDowell County, which ranked No. 2.

Needle exchange programs are currently available in four counties
throughout the state — Cabell, Kanawha, Ohio, and Monongalia.

• • •

The first needle exchange program opened in September 2015 at the Cabell-
Huntington Health Department.

Dr. Michael Kilkenny, physician director of the Cabell-Huntington Health
Department, announced the program under an initiative called the Harm
Reduction Program, which not only allows patients who inject drugs to
trade used syringes for new ones, but also allows patients to speak with
recovery coaches from Recovery Point of Huntington and HER Place.

Kilkenny said the cost of needle exchange is relatively inexpensive — each
syringe costs 10 cents or less.

However, HIV treatment over the course of a lifetime costs $450,000 per
patient. A cure for hepatitis C costs a minimum of $100,000, Kilkenny
said, but if the patient goes untreated, liver failure could result, and a
transplant costs roughly $500,000.

”If they get hep C, B, or HIV, not only does the state pay for those
services, but private insurance pays for those. All employed, insured
people share those costs. Nobody gets off free for paying for this.”

Just since the start of the program, needle sharing is down from 23
percent to 8 percent.

Whether or not the program has helped lower the spread of disease will
take a few more years of data, but Kilkenny is confident in the program’s
effectiveness.

When you get people to stop sharing needles, “You drop the spread of
disease,” Kilkenny said.

Since opening the state’s second needle exchange program in December, Tina
Ramirez, director of prevention and wellness at Charleston-Kanawha Health
Department, said the department has distributed 33,000 new needles and
taken in 15,000 used needles.

Currently, the program offers harm reduction services to approximately 475
patients, all of whom remain anonymous. Ramirez said the goal is to get
people in the door, to exchange syringes first, then to talk about
testing, recovery and immunization.

She expressed the importance of community partnerships. Recovery coaches
from Recovery Point and Prestera have encouraged 15 individuals to enroll
in treatment programs. Charleston Area Medical Center’s Women and
Children’s Hospital also offers IUD services, which helps reduce the
number of babies born with neonatal abstinence syndrome.

Patients are also given information about local Narcotics Anonymous and
Alcoholics Anonymous meetings.

• • •

Last year, Huntington’s overdose death rate was more than 10 times the
national average, but Kilkenny said efforts are being made to reduce those
numbers. Huntington EMS now carries naloxone, which is a lifesaving drug
used to reverse the effects of opioid overdose. The fire and police
department carry the drug as well, and naloxone education classes are
offered to community members.

”We still have a big overdose problem, but we’ve reduced it by 40 percent
through education, awareness and naloxone.”

While Charleston and Huntington officials are almost universally on board,
Kilkenny said he understands city leaders’ hesitation to tackle these
situations; the admission that the city has a drug problem brings bad
press.

”But sticking your head in the sand only makes the problem worse and hurts
your community.”

Although the cost savings of the needle exchange programs are evident,
Kilkenny said he knows some county health departments will struggle with
implementation of harm reduction programs, especially with state budget
cuts and the need to provide “core services.”

”I certainly can argue that the cost benefit analysis benefits are there
and it’s the state’s obligation to provide assistance for these services,
but you can’t get blood out of a turnip.”

The Cabell-Huntington Health Department has been successful with grant
applications through the Benedum Foundation and private philanthropy. The
Huntington Mayor’s Office has offered assistance with grant writing. A
local pharmacy also donated syringes to get the program started.

The Charleston-Kanawha Health Department has received many donations from
local hospitals and pharmacies to keep the program running.

”The biggest obstacle they’ll run into is funding,” Ramirez said of
departments trying to start a harm reduction program. Some grant funds
cannot be used to purchase syringes or materials that potentially promote
drug use.

She said it’s key for everyone to realize health departments are not
promoting drug abuse, nor are they providing drugs to use. It’s a matter
of public health.

• • •

According to the Department of Health and Human Resources’ Bureau for
Public Health, more than 700 West Virginians died from drug overdoses in
2015.

The West Virginia Controlled Substances Monitoring Program reported
4,863,000 million opioid prescriptions were distributed last year.

Dr. Rahul Gupta, commissioner for the Bureau for Public Health and state
health officer, said people who are on prescription drugs are 40 times
more likely to be addicted to heroin.

The closure of many pain clinics across the state and actions from the
Board of Pharmacy have led to a reduced supply in the market, Gupta said,
but the demand continues — that’s why West Virginia is seeing a demand for
heroin, a cheaper alternative.

Although the Bureau for Public Health does not regulate any of the harm
reduction programs, Gupta said many health departments across the state
are reaching out for technical assistance.

”We’re trying to develop an evidence-based toolkit for harm reduction
programs. Needle exchange is part of that, but it’s not just the act of
giving needles to people. It’s part of a comprehensive program.”

From counseling, treatment and workforce training, Gupta hopes health
departments will be able to offer all these services and more to residents
in their area.

”It’s going to take a lot of partnerships to happen,” he said, noting the
importance of supportive law enforcement and local healthcare providers.

Gupta pointed out that this heroin epidemic is much different from the
usage in the 1950s and 80s. This time, the population is the “working age
group,” 20 to 60 years old. Getting folks into treatment and getting them
rehabilitated will allow them to re-enter the workforce, which could aid
the state’s economy.

The CDC notes that financial stressors cause increased vulnerability to
drug use; therefore, young adults in “economically deprived areas” may be
more at risk to establish drug dependencies at a younger age than people
in more economically privileged areas.

Gupta encouraged anyone looking for treatment or resources in their area
to reach out to Help4WV by calling 1-844-HELP4WV (1-844-435-0484) or
visiting help4wv.com.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/z8cgaob
California USA: Group reports over 200 dirty needles found in Santa Cruz
County

One needle found by 2-year-old at the beach

By Barry Brown, Digital Content Director, KIONrightnow.com (10.06.16)

More used needles are turning up in public areas around Santa Cruz County.

The group “Take Back Santa Cruz” reported Friday that 229 needles were
found between May 9 and June 9 of this year.

According to the group’s report, 188 dirty needles were found by city
officials, and 41 were found by community groups and residents, including
a 2-year-old at Cowell Beach.

Over the past 3-and-a-half years, more than 10,000 needles have been found
in Santa Cruz County.

KION Copyright 2016
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/gwqtmjj
China/Hong Kong: Doctors warn of botox risks as fourth Hong Kong woman
develops botulism after treatment in mainland China

Local clinics see rise in number of patients requiring follow-up treatment
after visiting beauty centres across the border

By Elizabeth Cheung, South China Morning Post, Hong Kong China (06.06.16)

Doctors warned of botox-related side effects after four cases of botulism,
all involving local women getting injections in mainland China, were
reported the space of a week.

The four women, aged between 21 and 47, developed potentially fatal
complications such as difficulty in swallowing and breathing, and were
admitted into hospitals for further treatment.

The Medical Association advised the public to understand the functions and
potential risks of botox injections before getting them, and to have the
procedures performed by qualified doctors in Hong Kong.

Third Hong Kong woman develops suspected botulism after Botox treatment in
Shenzhen

Compared to last year, private dermatologists this year noticed a 20 to 30
per cent rise in the number of patients who required follow-up treatment
at local clinics after receiving beauty treatments on the mainland.
“All information available now only highlights the benefits without
mentioning the risks,” Dr Kingsley Chan Hau-ngai, a private dermatologist
and council member of the Medical Association, said.

Apart from patients suffering less severe side effects such as headaches
and bruising, Chan has treated a 47-year-old woman who could not open her
right eye after having botox done elsewhere.

“The dosage used might be too high … and the injection site might not be
accurate enough,” Chan said, adding that it could take up to six months
for the symptoms to disappear, after effects from the botox dispersed.
Each month, his clinic treats two to three cases which need follow-up
after beauty treatments, including botox injection, on the mainland.

Series of severe post-botox complications prompts Hong Kong authorities to
set up helpline

Of those with botulism – a serious possible side effect from the injection
– 5 to 10 per cent of them could die, according to the World Health
Organisation.

While aesthetic doctors said on Saturday that this would take around six
times the normal dosage, Chan said receiving injections on the entire body
at once would lead to potential risks, as the diluted level of the toxin
was not the same for different body parts.

There could be an issue if the same tube was used for the entire body, he
said, adding that various brands had their own methods of dilution even
for the same body part.

Dr Chow Pak-chin, the association’s vice-president, advised the public to
receive high-risk beauty treatments in the city.

“Doctors are trained and are under strict regulation by the Medical
Council,” said Chow.
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https://tinyurl.com/z3995sr
Hong Kong China: 2nd botulism case linked to botulinum toxin injection
reported

Outbreak News Today, USA (30.05.16)

In a follow-up to a report Friday concerning a botulism case in Hong Kong
linked to receiving botulinum toxin injection in China, Hong Kong health
officials report an additional suspected case of botulism after receiving
injections of botulinum toxin in the Mainland, prompting officials to urge
the public that such injections should only be prescribed and performed by
registered doctors.

The Centre for Health Protection (CHP) was notified by Caritas Medical
Centre (CMC) Sunday that a female patient, aged 41 with good past health,
had developed difficulty in swallowing and breathing as well as weakness
of neck muscle since May 11. She attended the Accident and Emergency
Department of CMC today and was admitted for management. She has been in
stable condition all along.

The patient traveled to Shenzhen this month during which she received at
least three injections of botulinum toxin to her forehead, face and neck.
The preliminary clinical diagnosis was suspected iatrogenic botulism. This
follows the first case in a female patient aged 47 reported on May 27. It
was revealed that she had traveled to Shenzhen on May 15 and visited a
beauty premises where she received botulinum toxin injections to each leg.

“We are very concerned about this additional case and recent reports of
consultations following botulinum toxin injections in the Mainland. We are
maintaining close liaison with the Hong Kong Poison Information Centre of
the Hospital Authority and relevant medical professionals for more
information to identify if there are similar cases,” a spokesman for the
Department of Health (DH) said.

Concerning the investigation into the cases, a DH spokesman said, “As the
first patient refused to provide further information and the second
patient cannot recall the exact location, we have no evidence at this
stage that both patients received injections at the same premises.
Epidemiological investigations are ongoing.”

“Botulinum toxin can be used for medical purposes, such as treatment of
overactive bladder, and cosmetic purposes. Injections should only be
performed by registered doctors,” the spokesman said.

The DH has informed the National Health and Family Planning Commission and
the Health and Family Planning Commission of Guangdong Province as well as
the China Food and Drug Administration, the Guangdong Food and Drug
Administration and the Food and Drug Administration of Shenzhen
Municipality of both cases to alert them to the patients’ exposure history
in the Mainland,” the spokesman said.
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New WHO Injection Safety Guidelines

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

The new guideline is:

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

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

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

This is an illustrated summary brochure for the general public.

pdf, 554kb [6 pages]

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

SIGN Meeting 2015

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The SIGNpost Website is http://SIGNpostOnline.info

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

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

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

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

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

The SIGN Forum is moderated by Allan Bass and is hosted on GoogleGroups

Subscribe or unsubscribe by email: sign.moderator@gmail.com or
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