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SIGNpost 00864

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00864 India Scales up Safe Injection + Abstracts + News 03 August 2016

CONTENTS
0. Moderators Note: India Scales up Safe Injections
1. Global World Hepatitis Day 2016 commemorated in Mumbai
2. WHO SEARO Regional Director Statement: Scale up efforts against
hepatitis
3. Abstract: Microbiological Contamination of Drugs during Their
Administration for Anesthesia in the Operating Room
4. Abstract: Effectiveness of safety-engineered devices in reducing sharp
object injuries
5. Abstract: Health care worker follow-up compliance after occupational
bloodborne pathogens exposure: A brief report
6. Abstract: Awareness and practices regarding bio-medical waste
management among health care workers in a tertiary care hospital in
Delhi
7. Abstract: The Precautionary Principle, Evidence-Based Medicine, and
Decision Theory in Public Health Evaluation
8. Abstract: “We get by with a little help from our friends”: Small-scale
informal and large-scale formal peer distribution networks of sterile
injecting equipment in Australia
9. Abstract: Prevention of transmission of HIV, hepatitis B virus,
hepatitis C virus, and tuberculosis in prisoners
10. Abstract: The perfect storm: incarceration and the high-risk
environment perpetuating transmission of HIV, hepatitis C virus, and
tuberculosis in Eastern Europe and Central Asia
11. Abstract: HIV, prisoners, and human rights
12. Abstract: HIV Infection Linked to Injection Use of Oxymorphone in
Indiana, 2014-2015
13. Abstract: Staphylococcus aureus bacteraemia associated with injected
new psychoactive substances
14. Abstract: Incompatibility of lyophilized inactivated polio vaccine
with liquid pentavalent whole-cell-pertussis-containing vaccine
15. Abstract: Injection Therapy for Headache and Facial Pain
16. Abstract: Corticosteroid Injections Give Small and Transient Pain
Relief in Rotator Cuff Tendinosis: A Meta-analysis
17. No Abstract: No syringe is approved as a standalone storage container,
FDA says
18. Warning: US FDA expands warning on Becton-Dickinson (BD) syringes
being used to store compounded or repackaged drugs
19. BD Worldwide: Statement on FDA Safety Alert About Compounded Drugs
Stored in BD 3mL and 5mL Syringes
20. News
– India: Safe injection campaign launched to eliminate viral Hepatitis
– India: India joins WHO’s Global Injection Safety Campaign
– India: INJECTION SAFETY PROJECT – WHO team visits Civil Hospital, health
facilities in Mohali
– India: Safe injection campaign launched
– India: World Hepatitis Day: Maharashtra takes stringent measures to stop
disease from spreading
– India: India should double coverage of HBV vaccine at birth: WHO
– India: WHO to launch Injection Safety Project in India on World
Hepatitis Day
– India: World Hepatitis Day: Unsafe needle practices leading cause of
Hepatitis-C in India: Around 5,00,000 people die each year from
hepatitis C-related liver diseases in India
– India: Unsafe needle practices leading cause of Hepatitis-C: Doctors
– India: WHO selects state for injection safety project

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0. Moderators Note: India Scales up Safe Injections
__________________________________________________________________
India Scales up Safe Injections

Congratulations the the many state health departments in India for joining
in the effort to scale up safe injections in India!

Congratulations to the WHO Injection Safety Team for their global
leadership in bringing this massive project into being.

This post includes two formal statements on World Hepatitis day – and Dr
Poonam Khetrapal Singh, SEARO Regional Director announcing the effort to
scale up injection safety in India. [via WHOs South East Asia Regional
Office SEARO website]

The news media coverage in India follows in the News section below.

regards and best,
allan
__________________________________________________________________
________________________________*_________________________________

1. Global World Hepatitis Day 2016 commemorated in Mumbai
__________________________________________________________________

http://www.searo.who.int/india/topics/hepatitis/mumbaihepatitisday2016/en/
Global World Hepatitis Day 2016 commemorated in Mumbai

Commemorating the World Hepatitis Day 2016, the World Health Organization
in collaboration with the Ministry of Health & Family Welfare (MoHFW),
Government of India organized a global event at Mumbai on 28 July 2016 to
raise awareness about hepatitis among general public as well as health
care providers and policy makers at the highest level.

Speaking on the occasion, Ms Anupriya Patel, Minister of State, Health &
Family Welfare, Government of India said, “Through the Health Ministry’s
flagship program of Mission Indradhanush, the government plans to
vaccinate all children (up to the age of two years) by 2020 for seven
diseases that include Hepatitis B vaccine. I am sure like HIV, we would be
able to contain the spread of Hepatitis infection and with access to newer
drugs, the life of those already infected with hepatitis would be
improved.”

Special Guest of Honour, Mr Amitabh Bachchan, highlighted that awareness
and detection is most important, it is a silent killer this Hep B and if
not found out in time it can be lethal.

“The conference speaks of many statistics and details in numbers which is
quite staggering. I stand here today to commit myself absolutely in
furthering the cause,” he added.

Dr Poonam Khetrapal, Regional Director of WHO South-East Asia Region said
that controlling hepatitis in the South-East Asia Region is vitally
important.

“Safe practices related to injections, blood transfusions and other health
care procedures must be advanced; and availability of hygienic and clean
food and water must be scaled-up. We must similarly ensure that all
children receive the hepatitis B vaccine at birth and complete the full
schedule of follow up-shots. These and other interventions are critical to
rolling back the hepatitis epidemic and ending the disease as a public
health threat,” she said

Today, only 1 in 20 people with viral hepatitis know they have it. And
just 1 in 100 with the disease is being treated. In India, viral hepatitis
is now recognised, as a serious public health problem with an estimated 40
million people with chronic hepatitis B and about 6 million people with
hepatitis C, which represents 40% and 20% of the hepatitis B and C burden
respectively in South-East Asian Region.

Speaking at a technical session at the event, Dr Henk Bekedam, WHO
Representative to India highlighted that most people with Hepatitis B and
C, D and E are not aware of their status as the disease in the initial
phase has barely any symptoms. Creating awareness, therefore, is a
priority.

“A major issue to reach elimination is to increase the number of people
who know their status through sound surveillance system, including cost
effective screening and follow-up with particular focus on hotspots with
high prevalence,” he added.

The event was graced by the august presence of Health Ministers from
Haryana, Himachal Pradesh, Jharkhand, Odisha, Sikkim and Uttrakhand; Mr.
N. S. Kang, Secretary & Director General, NACO; Dr Jagdish Prasad,
Director General Health Services, MoHFW; Dr Gottfried Hirnschall, WHO; Dr
S. K. Sarin, Institute of Liver and Biliary Sciences (ILBS); along with
health secretaries, water and sanitation secretaries of the state
governments and senior officials of the Health Ministry and WHO.
Stakeholders from the academia, clinicians, public health experts, civil
society and partner agencies also shared the discussions.

On the occasion, WHO released the Global health sector strategy on viral
hepatitis 2016-2021 and the Report on Blood Banks Assessment and Injection
Safety Project in India.

Mr Nalinikanta Rajkumar, President of the Community Network for
Empowerment from Manipur was presented a WHO-EASL Certificate for an
innovative community-based testing approach.
__________________________________________________________________
________________________________*_________________________________

2. WHO SEARO Regional Director Statement: Scale up efforts against
hepatitis
__________________________________________________________________

https://tinyurl.com/zm36l76
Scale up efforts against hepatitis

By Dr Poonam Khetrapal Singh WHO Regional Director for South-East Asia

Hepatitis is preventable and treatable but continues to be an acute public
health challenge globally and in countries of WHO South-East Asia Region.
Viral hepatitis kills approximately 350 000 people every year in the
Region. It is responsible for more deaths than HIV and malaria together,
and is second only to tuberculosis as a major cause of death among
communicable diseases. Globally, and in the Region the number of deaths
due to viral hepatitis is increasing. There is need for immediate and
urgent action to arrest the spread of hepatitis. In the South-East Asia
Region, viral hepatitis is driving rates of liver cancer and cirrhosis,
and is causing premature death and disease with over 100 million people
chronically infected with hepatitis B and hepatitis C. These numbers are
unacceptable as there is an effective vaccine and treatment for hepatitis
B, and over 90% of people with hepatitis C can be cured with treatment.

One of the main challenges to addressing hepatitis is that 95% of people
with chronic hepatitis do not know they are infected and less than 1% have
access to treatment. To address these issues, people and countries need to
be better equipped and enabled to “know hepatitis” and “act now” – the
theme of this year’s World Hepatitis Day.

One of the main reasons for complication due to hepatitis B is mother-to-
child transmission, which can be prevented by administering the hepatitis
B vaccine within 24 hours of birth, followed by two to three doses in the
first six months of life.

Safe injections, blood transfusions and other healthcare procedures can
further prevent the spread of hepatitis B and C among health care
consumers, while promoting hygienic and clean food and water can reduce
the risk of hepatitis A and E infection.

Increasing access to hepatitis testing is key to scaling up hepatitis
treatment and care. WHO is releasing its first hepatitis testing
guidelines this year which provides guidance on who should be tested, and
recommends simple testing strategies to help scale up hepatitis testing,
treatment and care.

Adequate use of the existing powerful tools and new guidelines can help
prevent and treat hepatitis. National strategies and action plans should
optimally utilize these tools and step up efforts at all levels to address
the growing threat of hepatitis.

At the World Health Assembly this year, WHO adopted the Global Health
Sector Strategy for Hepatitis that calls for eliminating hepatitis by
2030. The SDG 3.3 includes specific mention of the need to strengthen
efforts to combat hepatitis. The World Hepatitis Day is an opportunity to
review and reiterate our commitment and resolve to eliminate hepatitis and
save lives.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Microbiological Contamination of Drugs during Their
Administration for Anesthesia in the Operating Room
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26845141

Anesthesiology. 2016 Apr;124(4):785-94.
Microbiological Contamination of Drugs during Their Administration for
Anesthesia in the Operating Room.

Gargiulo DA1, Mitchell SJ, Sheridan J, Short TG, Swift S, Torrie J,
Webster CS, Merry AF.

1From the Department of Anaesthesiology (D.A.G., S.J.M., T.G.S., J.T.,
C.S.W., A.F.M.), School of Pharmacy (J.S.), Department of Molecular
Medicine and Pathology (S.S.), Centre for Medical and Health Sciences
Education (C.S.W.), University of Auckland, Grafton, Auckland, New
Zealand; and Department of Anaesthesia and Perioperative Medicine (S.J.M.,
T.G.S., J.T., A.F.M.), Auckland City Hospital, Grafton, Auckland, New
Zealand.

BACKGROUND: The aseptic techniques of anesthesiologists in the preparation
and administration of injected medications have not been extensively
investigated, but emerging data demonstrate that inadvertent lapses in
aseptic technique may be an important contributor to surgical site and
other postoperative infections.

METHODS: A prospective, open, microbiological audit of 303 cases in which
anesthesiologists were asked to inject all bolus drugs, except propofol
and antibiotics, through a 0.2-µm filter was performed. The authors
cultured microorganisms, if present, from the 0.2-µm filter unit and from
the residual contents of the syringes used for drawing up or administering
drugs. Participating anesthesiologists rated ease of use of the filters
after each case.

RESULTS: Twenty-three anesthesiologists each anesthetized up to 25 adult
patients. The authors isolated microorganisms from filter units in 19
(6.3%) of 300 cases (3 cases were excluded), including Staphylococcus
capitis, Staphylococcus warneri, Staphylococcus epidermidis,
Staphylococcus haemolyticus, Micrococcus luteus/lylae, Corynebacterium,
and Bacillus species.

The authors collected used syringes at the end of each case and grew
microorganisms from residual drug in 55 of these 2,318 (2.4%) syringes
including all the aforementioned microorganisms and also Kocuria
kristinae, Staphylococcus aureus, and Staphylococcus hominus.

Participants’ average rating of ease of use of the filter units was 3.5
out of 10 (0 being very easy and 10 being very difficult).

CONCLUSIONS: Microorganisms with the potential to cause infection are
being injected (presumably inadvertently) into some patients during the
administration of intravenous drugs by bolus during anesthesia.

The relevance of this finding to postoperative infections warrants further
investigation.

Comment in
Injection Rhymes with Infection? [Anesthesiology. 2016]
https://www.ncbi.nlm.nih.gov/pubmed/26845143
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Effectiveness of safety-engineered devices in reducing sharp
object injuries
__________________________________________________________________

http://occmed.oxfordjournals.org/content/65/1/39.long Free Full Article

Occup Med (Lond). 2015 Jan;65(1):39-44.
Effectiveness of safety-engineered devices in reducing sharp object
injuries.

Lu Y1, Senthilselvan A1, Joffe AM2, Beach J3.

1School of Public Health, University of Alberta, Edmonton, Alberta T6G
1C9, Canada.
2Infection Prevention and Hospital Epidemiology, Royal Alexandra Hospital
and University of Alberta, Edmonton, Alberta T5H 3V9, Canada.
3Division of Preventive Medicine, University of Alberta, Edmonton, Alberta
T6G 2T4, Canada. beach@ualberta.ca.

BACKGROUND: Sharps injuries remain a common factor in occupational
exposure of healthcare workers to blood-borne viruses. The extent to which
the introduction of safety-engineered devices has been effective in
reducing such injuries among healthcare workers is unclear.

AIMS: To investigate the incidence of sharp object injury among healthcare
workers in the Capital Health Region of Alberta, Canada and to determine
the effectiveness of the introduction of safety- engineered devices in
preventing these.

METHODS: All reports of sharp object injuries to Capital Region Workplace
Health and Safety offices from healthcare workers 2003-10 were analysed.
Rates of sharp object injury were compared before (2006), during (2007-08)
and after (2009-10) the introduction of safety-engineered devices,
adjusting for other potential risk factors using Poisson regression and
log-linear models.

RESULTS: Between 2003 and 2010, a total of 4707 sharp object injuries were
reported from 15 healthcare facilities. The sharp object injury rate per
1000 full- time equivalent employees per year declined from 35 before the
introduction period to 30 during the introduction period (rate ratio [RR]:
0.88, 95% confidence interval [CI]: 0.78, 0.99) among most healthcare
workers, but then rebounded again slightly after the intervention.
Physician risks showed little change during the period of introduction
(odds ratio [OR]: 0.99, 95% CI: 0.85, 1.14) but decreased significantly
after the intervention (OR: 0.83, 95% CI: 0.71, 0.97).

CONCLUSIONS: The introduction of safety-engineered devices was associated
with a modest reduction in reported sharp object injuries but this
appeared to be relatively short-lived for most workers.

© The Author 2014. Published by Oxford University Press on behalf of the
Society of Occupational Medicine. All rights reserved. For Permissions,
please email: journals.permissions@oup.com.

KEYWORDS: Hospital staff; needlestick injuries; occupational health law;
safety-engineered devices.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Health care worker follow-up compliance after occupational
bloodborne pathogens exposure: A brief report
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27451313

Am J Infect Control. 2016 Jul 19. pii: S0196-6553(16)30528-4.
Health care worker follow-up compliance after occupational bloodborne
pathogens exposure: A brief report.

Díaz JC1, Johnson LA2.

1Uniformed Services University of the Health Sciences, Bethesda, MD.
Electronic address: juancdiazmd@icloud.com.
2Uniformed Services University of the Health Sciences, Bethesda, MD.

A retrospective cohort study was conducted examining health care worker
(HCW) compliance with Centers for Disease Control and Prevention
recommendations following occupational bloodborne pathogen (BBP) exposure.

HCWs with a BBP exposure from a known HIV- or hepatitis C virus-
seropositive individual were less likely to complete recommended follow-up
compared with HCWs with seronegative source patient exposures (adjusted
odds ratio, 0.02 and 0.09, respectively).

Continued targeted education and extra vigilance in performing
postexposure surveillance are warranted in this higher-risk population.

Published by Elsevier Inc.

KEYWORDS: Public health; Workplace injury
__________________________________________________________________
________________________________*_________________________________

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

http://dx.doi.org/10.4103/0255-0857.167323

Indian J Med Microbiol. 2015 Oct-Dec;33(4):580-2. Free full text
Awareness and practices regarding bio-medical waste management among
health care workers in a tertiary care hospital in Delhi.

Bhagawati G1, Nandwani S, Singhal S.

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

Health care institutions are generating large amount of Bio-Medical Waste
(BMW), which needs to be properly segregated and treated. With this
concern, a questionnaire based cross-sectional study was done to determine
the current status of awareness and practices regarding BMW Management
(BMWM) and areas of deficit amongst the HCWs in a tertiary care teaching
hospital in New Delhi, India.

The correct responses were graded as satisfactory (more than 80%),
intermediate (50-80%) and unsatisfactory (less than 50%). Some major areas
of deficit found were about knowledge regarding number of BMW categories
(17%), mercury waste disposal (37.56%) and definition of BMW (47%).
__________________________________________________________________
________________________________*_________________________________

7. Abstract: The Precautionary Principle, Evidence-Based Medicine, and
Decision Theory in Public Health Evaluation
__________________________________________________________________

http://journal.frontiersin.org/article/10.3389/fpubh.2016.00107/full

Front Public Health. 2016 Jul 7;4:107. Free Full Article
The Precautionary Principle, Evidence-Based Medicine, and Decision Theory
in Public Health Evaluation.

Fischer AJ1, Ghelardi G2.

1Office for Health Economics (OHE) , London , UK.
2London School of Economics , London , UK.

The precautionary principle (PP) has been used in the evaluation of the
effectiveness and/or cost-effectiveness of interventions designed to
prevent future harms in a range of activities, particularly in the area of
the environment.

Here, we provide details of circumstances under which the PP can be
applied to the topic of harm reduction in Public Health. The definition of
PP that we use says that the PP reverses the onus of proof of
effectiveness between an intervention and its comparator when the
intervention has been designed to reduce harm.

We first describe the two frameworks used for health-care evaluation:
evidence-based medicine (EBM) and decision theory (DT). EBM is usually
used in treatment effectiveness evaluation, while either EBM or DT may be
used in evaluating the effectiveness of the prevention of illness.

For cost-effectiveness, DT is always used.

The expectation in Public Health is that interventions employed to reduce
harm will not actually increase harm, where “harm” in this context does
not include opportunity cost. That implies that an intervention’s
effectiveness can often be assumed. Attention should therefore focus on
its cost-effectiveness. This view is consistent with the conclusions of
DT. It is also very close to the PP notion of reversing the onus of proof,
but is not consistent with EBM as normally practiced, where the onus is on
showing a new practice to be superior to usual practice with a
sufficiently high degree of certainty.

Under our definitions, we show that where DT and the PP differ in their
evaluation is in cost-effectiveness, but only for decisions that involve
potential catastrophic circumstances, where the nation-state will act as
if it is risk-averse. In those cases, it is likely that the state will pay
more, and possibly much more, than DT would allow, in an attempt to
mitigate impending disaster. That is, the rules that until now have
governed all cost-effectiveness analyses are shown not to apply to
catastrophic situations, where the PP applies.

KEYWORDS: cost-effectiveness; decision theory; effectiveness; evidence-
based medicine; precautionary principle
__________________________________________________________________
________________________________*_________________________________

8. Abstract: “We get by with a little help from our friends”: Small-scale
informal and large-scale formal peer distribution networks of sterile
injecting equipment in Australia
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27449331

Int J Drug Policy. 2016 Apr 23. pii: S0955-3959(16)30097-4.
“We get by with a little help from our friends”: Small-scale informal and
large-scale formal peer distribution networks of sterile injecting
equipment in Australia.

Newland J1, Newman C2, Treloar C2.

1Centre of Social Research in Health, UNSW Australia, John Goodsell
Building, UNSW 2052, Australia. Electronic address:
jamee.newland@sydney.edu.au.
2Centre of Social Research in Health, UNSW Australia, John Goodsell
Building, UNSW 2052, Australia.

BACKGROUND: In Australia, sterile needles and syringes are distributed to
people who inject drugs (PWID) through formal services for the purposes of
preventing blood borne viruses (BBV). Peer distribution involves people
acquiring needles from formal services and redistributing them to others.
This paper investigates the dynamics of the distribution of sterile
injecting equipment among networks of people who inject drugs in four
sites in New South Wales (NSW), Australia.

METHODS: Qualitative data exploring the practice of peer distribution were
collected through in-depth, semi-structured interviews and participatory
social network mapping. These interviews explored injecting equipment
demand, access to services, relationship pathways through which peer
distribution occurred, an estimate of the size of the different peer
distribution roles and participants’ understanding of the illegality of
peer distribution in NSW.

RESULTS: Data were collected from 32 participants, and 31 (98%) reported
participating in peer distribution in the months prior to interview. Of
those 31 participants, five reported large-scale formal distribution, with
an estimated volume of 34,970 needles and syringes annually. Twenty-two
participated in reciprocal exchange, where equipment was distributed and
received on an informal basis that appeared dependent on context and
circumstance and four participants reported recipient peer distribution as
their only access to sterile injecting equipment. Most (n=27) were unaware
that it was illegal to distribute injecting equipment to their peers.

CONCLUSION: Peer distribution was almost ubiquitous amongst the PWID
participating in the study, and although five participants reported taking
part in the highly organised, large-scale distribution of injecting
equipment for altruistic reasons, peer distribution was more commonly
reported to take place in small networks of friends and/or partners for
reasons of convenience. The law regarding the illegality of peer
distribution needs to change so that NSPs can capitalise on peer
distribution to increase the options available to PWID and to acknowledge
PWID as essential harm reduction agents in the prevention of BBVs.

Copyright © 2016 Elsevier B.V. All rights reserved.

KEYWORDS: Australia; Bloodborne virus; Injecting drug use; Needle and
Syringe Program; Peer distribution; Secondary syringe exchange
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Prevention of transmission of HIV, hepatitis B virus,
hepatitis C virus, and tuberculosis in prisoners
__________________________________________________________________

http://dx.doi.org/10.1016/S0140-6736(16)30769-3 Free Full Text

Lancet. 2016 Jul 14. pii: S0140-6736(16)30769-3.
Prevention of transmission of HIV, hepatitis B virus, hepatitis C virus,
and tuberculosis in prisoners.

Kamarulzaman A1, Reid SE2, Schwitters A3, Wiessing L4, El-Bassel N5, Dolan
K6, Moazen B7, Wirtz AL8, Verster A3, Altice FL9.

1Centre of Excellence for Research in AIDS, Faculty of Medicine,
University Malaya, Kuala Lumpur, Malaysia; Yale School of Medicine, New
Haven, CT, USA. Electronic address: adeeba@ummc.edu.my.
2Centre for Infectious Disease Research in Zambia, Lusaka, Zambia;
University of Alabama at Birmingham, Birmingham, AL, USA.
3Department of HIV/AIDS, WHO, Geneva, Switzerland.
4European Monitoring Centre for Drugs and Drug Addiction, Lisbon,
Portugal.
5Columbia University School of Social Work, New York, NY, USA.
6National Drug and Alcohol Research Centre, University of New South Wales,
Sydney, NSW, Australia.
7Non-Communicable Diseases Research Centre, Endocrinology and Metabolism
Population Sciences Institute, Tehran University of Medical Sciences,
Tehran, Iran; Institute of Public Health, University of Heidelberg,
Heidelberg, Germany.
8Center for Public Health and Human Rights, Department of Epidemiology,
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
9Centre of Excellence for Research in AIDS, Faculty of Medicine,
University Malaya, Kuala Lumpur, Malaysia; Yale School of Medicine, New
Haven, CT, USA.

The prevalence of HIV, hepatitis B virus, hepatitis C virus, and
tuberculosis are higher in prisons than in the general population in most
countries worldwide.

Prisons have emerged as a risk environment for these infections to be
further concentrated, amplified, and then transmitted to the community
after prisoners are released.

In the absence of alternatives to incarceration, prisons and detention
facilities could be leveraged to promote primary and secondary prevention
strategies for these infections to improve prisoners health and reduce
risk throughout incarceration and on release.

Effective treatment of opioid use disorders with opioid agonist therapies
(eg, methadone and buprenorphine) prevents blood-borne infections via
reductions in injection in prison and after release.

However, large gaps exist in the implementation of these strategies across
all regions.

Collaboration between the criminal justice and public health systems will
be required for successful implementation of these strategies.

Copyright © 2016 Elsevier Ltd. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: The perfect storm: incarceration and the high-risk
environment perpetuating transmission of HIV, hepatitis C virus, and
tuberculosis in Eastern Europe and Central Asia
__________________________________________________________________

http://dx.doi.org/10.1016/S0140-6736(16)30856-X Free Full Article

Lancet. 2016 Jul 14. pii: S0140-6736(16)30856-X.
The perfect storm: incarceration and the high-risk environment
perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in
Eastern Europe and Central Asia.

Altice FL1, Azbel L2, Stone J3, Brooks-Pollock E3, Smyrnov P4, Dvoriak S5,
Taxman FS6, El-Bassel N7, Martin NK8, Booth R9, Stöver H10, Dolan K11,
Vickerman P3.

1School of Medicine and School Public Health, Yale University, New Haven,
CT, USA. Electronic address: frederick.altice@yale.edu.
2Public Health and Policy, London School of Hygiene & Tropical Medicine,
London, UK.
3School of Social and Community Medicine, Bristol University, Bristol, UK.
4ICF International Alliance for Public Health, Kiev, Ukraine.
5Ukrainian Institute on Public Health Policy, Kiev, Ukraine.
6Department of Criminology, Law and Society, George Mason University,
Fairfax, VA, USA.
7School of Social Work, Columbia University, New York, NY, USA.
8School of Social and Community Medicine, Bristol University, Bristol, UK;
Division of Global Public Health, University of California San Diego, San
Diego, CA, USA.
9Department of Psychiatry, University of Colorado, Denver, CO, USA.
10Institute of Addiction Research, Frankfurt University of Applied
Sciences, Frankfurt, Germany.
11National Drug and Alcohol Research Centre, University of New South
Wales, Sydney, NSW, Australia.

Despite global reductions in HIV incidence and mortality, the 15 UNAIDS-
designated countries of Eastern Europe and Central Asia (EECA) that gained
independence from the Soviet Union in 1991 constitute the only region
where both continue to rise.

HIV transmission in EECA is fuelled primarily by injection of opioids,
with harsh criminalisation of drug use that has resulted in
extraordinarily high levels of incarceration. Consequently, people who
inject drugs, including those with HIV, hepatitis C virus, and
tuberculosis, are concentrated within prisons.

Evidence-based primary and secondary prevention of HIV using opioid
agonist therapies such as methadone and buprenorphine is available in
prisons in only a handful of EECA countries (methadone or buprenorphine in
five countries and needle and syringe programmes in three countries), with
none of them meeting recommended coverage levels.

Similarly, antiretroviral therapy coverage, especially among people who
inject drugs, is markedly under-scaled. Russia completely bans opioid
agonist therapies and does not support needle and syringe programmes-with
neither available in prisons-despite the country’s high incarceration rate
and having the largest burden of people with HIV who inject drugs in the
region.

Mathematical modelling for Ukraine suggests that high levels of
incarceration in EECA countries facilitate HIV transmission among people
who inject drugs, with 28-55% of all new HIV infections over the next 15
years predicted to be attributable to heightened HIV transmission risk
among currently or previously incarcerated people who inject drugs.

Scaling up of opioid agonist therapies within prisons and maintaining
treatment after release would yield the greatest HIV transmission
reduction in people who inject drugs. Additional analyses also suggest
that at least 6% of all incident tuberculosis cases, and 75% of incident
tuberculosis cases in people who inject drugs are due to incarceration.

Interventions that reduce incarceration itself and effectively intervene
with prisoners to screen, diagnose, and treat addiction and HIV, hepatitis
C virus, and tuberculosis are urgently needed to stem the multiple
overlapping epidemics concentrated in prisons.

Copyright © 2016 Elsevier Ltd. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: HIV, prisoners, and human rights
__________________________________________________________________

http://dx.doi.org/10.1016/S0140-6736(16)30663-8 Free Full Article

Lancet. 2016 Jul 14. pii: S0140-6736(16)30663-8.
HIV, prisoners, and human rights.

Rubenstein LS1, Amon JJ2, McLemore M3, Eba P4, Dolan K5, Lines R6, Beyrer
C7.

1Center for Public Health and Human Rights, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Berman
Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA.
Electronic address: lrubenstein@jhu.edu.
2Department of Epidemiology, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD, USA; Health and Human Rights Division, Human Rights
Watch, New York, NY, USA.
3Health and Human Rights Division, Human Rights Watch, New York, NY, USA.
4UNAIDS, Geneva, Switzerland; College of Law and Management Studies,
University of KwaZulu-Natal, Pietermaritzburg, South Africa.
5National Drug and Alcohol Research Centre, Sydney, NSW, Australia.
6Harm Reduction International, London, UK.
7Center for Public Health and Human Rights, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Worldwide, a disproportionate burden of HIV, tuberculosis, and hepatitis
is present among current and former prisoners. This problem results from
laws, policies, and policing practices that unjustly and discriminatorily
detain individuals and fail to ensure continuity of prevention, care, and
treatment upon detention, throughout imprisonment, and upon release. These
government actions, and the failure to ensure humane prison conditions,
constitute violations of human rights to be free of discrimination and
cruel and inhuman treatment, to due process of law, and to health.

Although interventions to prevent and treat HIV, tuberculosis, hepatitis,
and drug dependence have proven successful in prisons and are required by
international law, they commonly are not available.

Prison health services are often not governed by ministries responsible
for national public health programmes, and prison officials are often
unwilling to implement effective prevention measures such as needle
exchange, condom distribution, and opioid substitution therapy in
custodial settings, often based on mistaken ideas about their
incompatibility with prison security.

In nearly all countries, prisoners face stigma and social marginalisation
upon release and frequently are unable to access health and social support
services.

Reforms in criminal law, policing practices, and justice systems to reduce
imprisonment, reforms in the organisation and management of prisons and
their health services, and greater investment of resources are needed.

Copyright © 2016 Elsevier Ltd. All rights reserved.
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12. Abstract: HIV Infection Linked to Injection Use of Oxymorphone in
Indiana, 2014-2015
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27468059

N Engl J Med. 2016 Jul 21;375(3):229-39.
HIV Infection Linked to Injection Use of Oxymorphone in Indiana,
2014-2015.

Peters PJ1, Pontones P1, Hoover KW1, Patel MR1, Galang RR1, Shields J1,
Blosser SJ1, Spiller MW1, Combs B1, Switzer WM1, Conrad C1, Gentry J1,
Khudyakov Y1, Waterhouse D1, Owen SM1, Chapman E1, Roseberry JC1, McCants
V1, Weidle PJ1, Broz D1, Samandari T1, Mermin J1, Walthall J1, Brooks JT1,
Duwve JM1; Indiana HIV Outbreak Investigation Team.

Collaborators (49)

1From the Division of HIV/AIDS Prevention, National Center for HIV, Viral
Hepatitis, STD, and TB Prevention, Centers for Disease Control and
Prevention, Atlanta (P.J.P., K.W.H., M.R.P., R.R.G., M.W.S., W.M.S., Y.K.,
S.M.O., V.M., P.J.W., D.B., T.S., J.M., J.T.B.); and the Indiana State
Department of Health (P.P., S.J.B., C.C., J.G., E.C., J.C.R., J.W.,
J.M.D.), Indiana University School of Medicine (J.W.), and Indiana
University Richard M. Fairbanks School of Public Health (J.M.D.),
Indianapolis, Clark County Health Department, Jeffersonville (J.S., D.W.),
and Scott County Health Department, Scottsburg (B.C.) – all in Indiana.

BACKGROUND: In January 2015, a total of 11 new diagnoses of human
immunodeficiency virus (HIV) infection were reported in a small community
in Indiana. We investigated the extent and cause of the outbreak and
implemented control measures.

METHODS: We identified an outbreak-related case as laboratory-confirmed
HIV infection newly diagnosed after October 1, 2014, in a person who
either resided in Scott County, Indiana, or was named by another case
patient as a syringe-sharing or sexual partner. HIV polymerase (pol)
sequences from case patients were phylogenetically analyzed, and potential
risk factors associated with HIV infection were ascertained.

RESULTS: From November 18, 2014, to November 1, 2015, HIV infection was
diagnosed in 181 case patients. Most of these patients (87.8%) reported
having injected the extended-release formulation of the prescription
opioid oxymorphone, and 92.3% were coinfected with hepatitis C virus.
Among 159 case patients who had an HIV type 1 pol gene sequence, 157
(98.7%) had sequences that were highly related, as determined by
phylogenetic analyses. Contact tracing investigations led to the
identification of 536 persons who were named as contacts of case patients;
468 of these contacts (87.3%) were located, assessed for risk, tested for
HIV, and, if infected, linked to care. The number of times a contact was
named as a syringe-sharing partner by a case patient was significantly
associated with the risk of HIV infection (adjusted risk ratio for each
time named, 1.9; P<0.001). In response to this outbreak, a public health
emergency was declared on March 26, 2015, and a syringe-service program in
Indiana was established for the first time.

CONCLUSIONS: Injection-drug use of extended-release oxymorphone within a
network of persons who inject drugs in Indiana led to the introduction and
rapid transmission of HIV. (Funded by the state government of Indiana and
others.).
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13. Abstract: Staphylococcus aureus bacteraemia associated with injected
new psychoactive substances
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26548371

Epidemiol Infect. 2016 Apr;144(6):1257-66.
Staphylococcus aureus bacteraemia associated with injected new
psychoactive substances.

Griffith DJ1, Mackintosh CL1, Inverarity D2.

1Regional Infectious Diseases Unit,Western General Hospital,Edinburgh,UK.
2Department of Microbiology,Royal Infirmary of Edinburgh,UK.

Injecting drug use is often associated with deep-seated infection. In
Lothian in Scotland there has been a recent increase in the use of
injected new psychoactive substances (NPS).

Patients who have injected NPS have presented with Staphylococcus aureus
bacteraemia (SAB) with life-threatening complications. We describe a
unique case-series of 14 episodes of SAB in ten patients.

Users of injected NPS had a significantly higher incidence of endocarditis
and cavitating pulmonary lesions (P < 0·05) compared to those who inject
only opiates.

Cases of SAB in people who inject NPS have contributed to a significant
rise in the overall incidence of SAB in people who inject drugs (P < 0·05)
which has in turn impacted on the ability of Lothian to meet national
targets for reducing the incidence of SAB.

KEYWORDS: Bloodstream infections; Staphylococcus aureus; endocarditis;
injecting drug use; pulmonary abscess
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Incompatibility of lyophilized inactivated polio vaccine
with liquid pentavalent whole-cell-pertussis-containing vaccine
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27470209

Vaccine. 2016 Jul 25. pii: S0264-410X(16)30613-2.
Incompatibility of lyophilized inactivated polio vaccine with liquid
pentavalent whole-cell-pertussis-containing vaccine.

Kraan H1, Ten Have R2, van der Maas L1, Kersten G3, Amorij JP4.

1Intravacc (Institute for Translational Vaccinology), Antonie van
Leeuwenhoeklaan 9, P.O. Box 450, 3720 AL Bilthoven, The Netherlands.
2Intravacc (Institute for Translational Vaccinology), Antonie van
Leeuwenhoeklaan 9, P.O. Box 450, 3720 AL Bilthoven, The Netherlands.
Electronic address: rimko.ten.have@intravacc.nl.
3Intravacc (Institute for Translational Vaccinology), Antonie van
Leeuwenhoeklaan 9, P.O. Box 450, 3720 AL Bilthoven, The Netherlands;
Division of Drug Delivery Technology, Leiden Academic Center for Drug
Research, Leiden University, Leiden, The Netherlands.
4Intravacc (Institute for Translational Vaccinology), Antonie van
Leeuwenhoeklaan 9, P.O. Box 450, 3720 AL Bilthoven, The Netherlands.
Electronic address: jp.amorij@virtuvax.nl.

A hexavalent vaccine containing diphtheria toxoid, tetanus toxoid, whole
cell pertussis, Haemophilius influenza type B, hepatitis B and inactivated
polio vaccine (IPV) may: (i) increase the efficiency of vaccination
campaigns, (ii) reduce the number of injections thereby reducing
needlestick injuries, and (iii) ensure better protection against pertussis
as compared to vaccines containing acellular pertussis antigens.

An approach to obtain a hexavalent vaccine might be reconstituting
lyophilized polio vaccine (IPV-LYO) with liquid pentavalent vaccine just
before intramuscular delivery. The potential limitations of this approach
were investigated including thermostability of IPV as measured by D-
antigen ELISA and rat potency, the compatibility of fluid and lyophilized
IPV in combination with thimerosal and thimerosal containing hexavalent
vaccine.

The rat potency of polio type 3 in IPV-LYO was 2 to 3-fold lower than
standardized on the D-antigen content, suggesting an alteration of the
polio type 3 D-antigen particle by lyophilization. Type 1 and 2 had
unaffected antigenicity/immunogenicity ratios. Alteration of type 3 D-
antigen could be detected by showing reduced thermostability at 45°C
compared to type 3 in non-lyophilized liquid controls.

Reconstituting IPV-LYO in the presence of thimerosal (TM) resulted in a
fast temperature dependent loss of polio type 1-3 D-antigen. The presence
of 0.005% TM reduced the D-antigen content by ~20% (polio type 2/3) and
~60% (polio type 1) in 6h at 25°C, which are WHO open vial policy
conditions.

At 37°C, D-antigen was diminished even faster, suggesting that very fast,
i.e., immediately after preparation, intramuscular delivery of the
conceived hexavalent vaccine would not be a feasible option.

Use of the TM-scavenger, l-cysteine, to bind TM (or mercury containing TM
degradation products), resulted in a hexavalent vaccine mixture in which
polio D-antigen was more stable.

Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights
reserved.

KEYWORDS: Hexavalent vaccine; Inactivated polio vaccine; Lyophilization;
Rat potency; Thimerosal

DOI: 10.1016/j.vaccine.2016.07.030
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Injection Therapy for Headache and Facial Pain
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27475516

Oral Maxillofac Surg Clin North Am. 2016 Aug;28(3):423-34.
Injection Therapy for Headache and Facial Pain.

Kleen JK1, Levin M2.

1UCSF Department of Neurology, University of California San Francisco
Medical Center, 505 Parnassus Avenue, Box 0114, San Francisco, CA 94143,
USA.
2UCSF Headache Center, UCSF Department of Neurology, University of
California San Francisco Medical Center, 2330 Post Street, San Francisco,
CA 94115, USA. Electronic address: morris.levin@ucsf.edu.

Peripheral nerve blocks are an increasingly viable treatment option for
selected groups of headache patients, particularly those with intractable
headache or facial pain.

Greater occipital nerve block, the most widely used local anesthetic
procedure in headache conditions, is particularly effective, safe, and
easy to perform in the office. Adverse effects are few and infrequent.
These procedures can result in rapid relief of pain and allodynia, and
effects last for several weeks or months.

Use of nerve block procedures and potentially onabotulinum toxin therapy
should be expanded for patients with intractable headache disorders who
may benefit, although more studies are needed for efficacy and clinical
safety.

Copyright © 2016 Elsevier Inc. All rights reserved.

KEYWORDS: Headache; Injection; Local anesthetic; Migraine; Onabotulinum
toxin
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________________________________*_________________________________

16. Abstract: Corticosteroid Injections Give Small and Transient Pain
Relief in Rotator Cuff Tendinosis: A Meta-analysis
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27469590

Clin Orthop Relat Res. 2016 Jul 28.
Corticosteroid Injections Give Small and Transient Pain Relief in Rotator
Cuff Tendinosis: A Meta-analysis.

Mohamadi A1, Chan JJ1, Claessen FM1, Ring D2, Chen NC1.

1Department of Orthopaedics, Hand and Upper Extremity Service,
Massachusetts General Hospital, Boston, MA, USA.
2Comprehensive Care, Dell Medical School, The University of Texas at
Austin, Austin, TX, 78701, USA. david.ring@austin.utexas.edu.

BACKGROUND: The ability of injection of corticosteroids into the
subacromial space to relieve pain ascribed to rotator cuff tendinosis is
debated. The number of patients who have an injection before one gets
relief beyond what a placebo provides is uncertain.

QUESTIONS/PURPOSES: We asked: (1) Do corticosteroid injections reduce pain
in patients with rotator cuff tendinosis 3 months after injection, and if
so, what is the number needed to treat (NNT)? (2) Are multiple injections
better than one single injection with respect to pain reduction at 3
months?

METHODS: We systematically searched seven electronic databases for
randomized controlled trials of corticosteroid injection for rotator cuff
tendinosis compared with a placebo injection. Eligible studies had at
least 10 adults and used pain intensity as an outcome measure. The
Hedges’s g as adjusted pooled standardized mean difference (SMD) (which
expresses the size of the intervention effect in each study relative to
the total variability observed among pooled studies) and NNT were
calculated at assessment points less than 1 month, 1-2 months, and 2-3
months. The protocol of this study was registered at the international
prospective register of systematic reviews. Eleven studies of 726 patients
satisfied our criteria for data pooling. Three studies containing 292
patients used repeat injections. A random effects model was used owing to
substantial heterogeneity among studies. The funnel plot indicated the
possibility of some missing studies, but Orwin’s fail-safe N and Duval and
Tweedie’s trim and fill suggested that missing studies would not
significantly affect the results.

RESULTS: Corticosteroid injection did not reduce pain intensity in adult
patients with rotator cuff tendinosis more than a placebo injection at the
3-month assessment.

A small transient pain relief occurred at the assessment between 4 and 8
weeks with a SMD of 0.52 (range, 0.27-0.78) (p < 0.001).

At least five patients must be treated for one patient’s pain to be
transiently reduced to no more than mild. Multiple injections were not
found to be more effective than a single injection at any time.

CONCLUSIONS: Corticosteroid injections provide-at best-minimal transient
pain relief in a small number of patients with rotator cuff tendinosis and
cannot modify the natural course of the disease.

Given the discomfort, cost, and potential to accelerate tendon
degeneration associated with corticosteroids, they have limited appeal.

Their wide use may be attributable to habit, underappreciation of the
placebo effect, incentive to satisfy rather than discuss a patient’s drive
toward physical intervention, or for remuneration, rather than their
utility.

LEVEL OF EVIDENCE: Level I, therapeutic study.
__________________________________________________________________
________________________________*_________________________________

17. No Abstract: No syringe is approved as a standalone storage container,
FDA says
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26490809

Am J Health Syst Pharm. 2015 Nov 1;72(21):1831-2.

No syringe is approved as a standalone storage container, FDA says.

Thompson CA.
__________________________________________________________________
________________________________*_________________________________

18. Warning: US FDA expands warning on Becton-Dickinson (BD) syringes
being used to store compounded or repackaged drugs
__________________________________________________________________

http://www.fda.gov/Drugs/DrugSafety/ucm458952.htm
US FDA expands warning on Becton-Dickinson (BD) syringes being used to
store compounded or repackaged drugs

[9-8-15] FDA is expanding its alert regarding compounded or repackaged
drugs stored in Becton-Dickinson (BD) general use syringes to include
certain additional syringe sizes including 1mL, 10mL, 20mL and 30mL BD
syringes, and BD oral syringes. The FDA’s original alert applied to
compounded or repackaged drugs that have been stored in 3 mL and 5mL BD
syringes. This expansion of the alert to additional sizes of syringes is
based on BD reports that an interaction with the rubber stopper in certain
lots of these syringes can cause some drugs stored in these syringes to
lose potency if filled and not used immediately.

BD reports that the following drugs in particular can be affected by the
stoppers, but we do not know whether other drugs can be affected:
fentanyl, rocuronium, neostigmine, morphine, midazolam, methadone,
atropine, hydromorphone, cisatracurium, and remifentanyl. BD has created a
webpage to assist customers in determining if their lots are affected.

Hospital pharmacies and staff should:

Contact any outsourcers to determine if affected lots of BD syringes were
used for compounded or repackaged products

Not administer compounded or repackaged drugs that have been stored in any
of these syringes unless there is no suitable alternative available.

FDA continues to investigate this issue and will provide more information
when it is available.

FDA asks health care professionals and patients to report any adverse
reactions to FDA’s MedWatch program:

Complete and submit the report online at www.fda.gov/medwatch/report.htm

Download and complete the form, then submit it via fax at 1-800-FDA-0178

BD issued letters to their customers on July 31, 2015disclaimer icon and
September 1, 2015disclaimer icon, and provides an Alternate Stopper Quick
Reference Guidedisclaimer icon on their webpagedisclaimer icon. The
Institute for Safe Medication Practices (ISMP) issued statements regarding
this issue in Julydisclaimer icon and Augustdisclaimer icon 2015.
FDA warns health care professionals not to use compounded or repackaged
drugs stored in Becton-Dickinson (BD) 3 milliliter (ml) and 5 ml syringes
unless there is no suitable alternative available

[8-19-2015] FDA is alerting health care professionals not to administer to
patients compounded or repackaged drugs that have been stored in 3
milliliter (ml) and 5ml syringes manufactured by Becton-Dickinson (BD)
unless there is no suitable alternative available. Preliminary
information indicates that drugs stored in these syringes may lose potency
over a period of time due to a possible interaction with the rubber
stopper in the syringe.

If you have been using products packaged in these syringes, be aware that
using a substitute product may require a dosage adjustment in case the
patient has been receiving a subpotent product, or adverse consequences
could occur.

BD’s 10ml, 20ml and 30ml syringes may also contain the same rubber
stopper. The company is alerting their customers not to use these syringes
as a closed container system for compounded and repackaged drugs.

FDA has cleared these syringes as medical devices for general purpose
fluid aspiration and injection only. These syringes were not cleared for
use as a closed container storage system for drug products, and the
suitability of these syringes for that purpose has not been established.

This issue may extend to other general use syringes made by other
manufacturers that were not cleared for the purpose of closed-container
storage usage.

FDA has received several reports of compounded and repackaged drugs, such
as fentanyl, morphine, methadone and atropine, losing potency when stored
in BD 3ml and 5ml general purpose syringes. It is possible that this
chemical reaction may affect other compounded and repackaged drugs stored
in syringes not FDA cleared for closed-container storage.

Hospital and pharmacy staff should check supply stocks and remove drug
products that were filled by pharmacies or outsourcing facilities and
stored in general purpose BD 3ml and 5ml syringes. These syringes are
marked with the BD logo at the base of the syringe.

At this time, FDA does not have information on how long drugs can be
stored in these syringes before degrading. There is no information to
suggest that there is a problem with potency or drug degradation when
medication is administered promptly after the syringes are filled.

This warning does not extend to products approved by FDA for marketing as
pre-filled syringes, because as part of the approval process, FDA has
determined that these products have been shown to maintain stability in
the syringe container through the expiration date on the product.

On July 30, 2015, the Institute for Safe Medication Practices (ISMP)
issued a Special Alert regarding this problem. See
www.ismp.org/newsletters/acutecare/articles/loss-of-drug-potency.aspx

The FDA is continuing to investigate this issue and will provide more
information when it is available.

FDA asks health care professionals and patients to report any adverse
reactions to the FDA’s MedWatch program:

Complete and submit the report online at www.fda.gov/medwatch/report.htm
Download and complete the form, then submit it via fax at 1-800-FDA-0178
The BD logo is marked on the base on the syringe, and may be covered by a
label on the product.
__________________________________________________________________
________________________________*_________________________________

19. BD Worldwide: Statement on FDA Safety Alert About Compounded Drugs
Stored in BD 3mL and 5mL Syringes
__________________________________________________________________

http://www1.bd.com/alerts-notices/

Alerts and Notices – BD Worldwide
Statement on FDA Safety Alert About Compounded Drugs Stored in BD 3mL and
5mL Syringes

On Aug. 18, 2015, the FDA issued a safety alert for BD’s 3mL and 5mL
general use plastic syringes related to reduced drug potency. BD’s 3mL and
5mL plastic syringes are not to be used for drug storage, but rather are
indicated as fluid aspiration and injection devices. BD syringes are safe
when used as indicated.

The safety alert is relevant to a small percentage of customers, such as
drug compounders, who are storing certain types of medications in the
syringes. Decreased potency has only been reported in general use plastic
syringes, primarily in 3mL and 5mL sizes, and appears to be related to
BD’s alternate supplier for the plunger’s stopper. These syringes are not
intended or FDA-cleared for drug storage.

BD shares the FDA’s vigilance to educate healthcare providers about the
proper use of its products to ensure safe medication practices and the
safety of patients. On July 31, BD reached out to customers to inform them
of potential issues with drug storage. BD will continue to diligently
investigate the matter while transparently communicating relevant
information in a timely manner.

This safety alert does not pertain to BD prefilled, prefillable, heparin
flush, saline flush or insulin syringes.

BD Worldwide site http://www.bd.com/
__________________________________________________________________
________________________________*_________________________________

20. News

– India: Safe injection campaign launched to eliminate viral Hepatitis

– India: India joins WHO’s Global Injection Safety Campaign

– India: INJECTION SAFETY PROJECT – WHO team visits Civil Hospital, health
facilities in Mohali

– India: Safe injection campaign launched

– India: World Hepatitis Day: Maharashtra takes stringent measures to stop
disease from spreading

– India: India should double coverage of HBV vaccine at birth: WHO

– India: WHO to launch Injection Safety Project in India on World
Hepatitis Day

– India: World Hepatitis Day: Unsafe needle practices leading cause of
Hepatitis-C in India: Around 5,00,000 people die each year from
hepatitis C-related liver diseases in India

– India: Unsafe needle practices leading cause of Hepatitis-C: Doctors

– India: WHO selects state for injection safety project

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/j2zubkf
India: Safe injection campaign launched to eliminate viral Hepatitis

The Hindu, India, Rupnagar, Punjab (31.07.16)

A ‘Global Safe Injection’ campaign was on Saturday launched by the Centre
and World Health Organisation here to eliminate viral Hepatitis by 2030.

A pilot project in this regard was started in Punjab, which has the
highest incidence of Hepatitis C.

Arshad Altaf, WHO Consultant, Geneva, said a number of pilot projects on
injection safety would be undertaken by the Government of India and WHO.

The other States reported with high incidence of Hepatitis C are Haryana,
north-eastern States and coastal areas of Andhra Pradesh and Tamil Naidu.
Beside India, Uganda and Egypt are the other countries where the project
is being launched, he said.

Benedetta Allegranzi, Coordinator and Team leader of WHO Injection Safety
Project, from Switzerland said the project was aimed at eliminating viral
Hepatitis by 2030.

As per WHO, 33 per cent of Hepatitis B and 42 per cent of Hepatitis C
cases are attributed to unsafe injections, she said.

The WHO official said unsafe injections, mostly in the form of reuse of
safety injections, continues to be a serious threat to life of patients
and health workers.

Globally, 400 million people (about 40 million in India) are estimated to
be infected by Hepatitis, with 95 per cent patients being unaware of their
condition as Hepatitis C is a slow killer, as per WHO data.

Harminder Kaur Sandhu, Civil Surgeon, Rupnagar, said the WHO team has
visited Public Health Centre in Bharatgarh to make the staff aware of safe
injection campaign.

She said the focus of the programme was to appeal people to make minimum
use of injections.

Shashi Kant, Director, NRHM Punjab, said the global health body has
recommended one-time use injections, and that Punjab will take lead in
eliminating Hepatitis B and C.
__________________________________________________________________
__________________________________________________________________

http://www.pharmabiz.com/NewsDetails.aspx?aid=96611&sid=2
India: India joins WHO’s Global Injection Safety Campaign

Pharmbiz.com, Mumbai India (30.07.16)

The Safe Point India, a frontline not-for profit society working in the
field of public health and safety, has lauded and fully endorsed the WHO’s
and government of India’s noble initiative to eliminate viral hepatitis by
2030 by launching Global Safe Injection Campaign. It is especially happy
to note the acknowledgment of the role that safe injections can play in
eliminating a health scourge that claims over 3,50,000 lives each year
globally and is the number two communicable disease killer of human lives
after tuberculosis.

On World Hepatitis Day, India became one of the first countries to join
WHO’s Safe Injection Campaign which is integral to eliminating strategy of
hepatitis by 2030. As per WHO, 33 per cent of hepatitis B and 42 per cent
of hepatitis C cases are attributed to unsafe injections. It may also be
noted that in the South-East Asia region, viral hepatitis is driving rates
of liver cancer and cirrhosis, and is causing premature death and disease
with over 100 million people chronically infected with hepatitis B and
hepatitis C.

Government of India on the World Hepatitis Day committed to renew the
effort to eliminate unsafe injections and has announced 3-year transition
time for manufacturers to phase out standard disposable syringes and
switch to auto disable syringes and safety syringes as part of hepatitis
elimination intervention strategy.

“Injections should be life giver, not life taker and prevention is always
better than cure. Sadly, as pointed out by WHO, nearly 33 per cent of
hepatitis B and 42 per cent of hepatitis C are attributed to unsafe
injections. Unsafe injections mostly in the form of reuse of safety
injections continues to be a serious threat to life of patients and health
workers, casting shadows over public healthcare and immunisation
programmes while raising individual and national healthcare cost burden,”
said Rajiv Nath, project director & trustee, Safe Point India, a frontline
not-for-profit society working in the field of public health and safety.

“I am especially happy to note that safe injections along with vaccination
and better access to healthcare has been now been officially endorsed as
key to eliminating a major public health scourge. Swach Bharat Campaign
for addressing hepatitis A & E and a Swach Injection Abhiyan has long been
needed for addressing hepatitis B&C for ensuring Clean Healthcare and
Clean Needles. This will not only ensure better health to common Indians
but would also bring in great savings in terms of public health spending
in the long run,” added Nath.

“For WHO to hold its global conference in India and the presence of
Amitabh Bachchan as the brand ambassador to lead the campaign to decimate
hepatitis by 2030 is indicative of the importance of the issue. Globally
400 million persons (approx 40 million in India) are estimated to be
infected by hepatitis and WHO estimates that 95 per cent patients are
unaware that they are infected as hepatitis C is a slow killer. 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.

According to a WHO study, for every 1$ (Rs. 67) invested in injection
safety, savings are to the tune of over 14 $ (Rs. 938) 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 1$ invested in immunisation has been resulting in 16$
savings to a nation. Prevention is far less cost than cure.

“We fully laud WHO and government of India’s initiative and determination
to eliminate viral hepatitis by 2030. Hepatitis remains a major public
health scourge in India. Its not only a killer disease but also severely
impairs quality of life besides causing heavy financial burden on infected
who mostly happens to be from the poor strata of society. This is a great
initiative which has our full support and endorsement,” said Pradeep
Sareen, marketing head of HMD, Hindustan Syringes & Medical Devices,
makers of the renowned Dispovan disposable syringes and also of Kojak
AutoDisable syringes. “Yes it means a lot of efforts and investments to
upgrade our technology and shift of capacities from STD disposable to Auto
Disable syringes for the curative injections but we appreciate the need
for this change in the interest of patient safety. And we have the
experience as we are the leading supplier globally of AutoDisable Syringes
both for immunisation and therapeutic injections,” he explained, when
queried on the threat to their business. At a meeting recently called by
DGHS with us manufacturers we had requested for phased implementation plan
to allow for smooth transition, he added.

Nath informed that a number of pilot projects on injection safety would be
undertaken by GoI and WHO starting from Punjab which has the highest
incidence of hepatitis C even though it is an affluent state possibly due
to dangerous cocktail of drug abuse and unsafe injection practices. The
other states reported with high incidence of hepatitis C are Haryana,
North Eastern States and coastal areas of Andhra Pradesh and Tamil Naidu.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/jp7ms3b
India: INJECTION SAFETY PROJECT – WHO team visits Civil Hospital, health
facilities in Mohali

Tribune News Service, India (31.07.16)

Photo: Members of the WHO team at the Civil Hospital in Phase VI, Mohali.
A Tribune photograph
A three-member team of the World Health Organisation (WHO) visited Mohali
Civil Hospital and other health facilities here and at Ropar today to get
firsthand experience of injection safety being practised here.

The purpose of the team’s field visit was to observe the current practices
with the conventional syringes so that the technical expert group is able
to form guidelines for shifting to the reuse prevention syringes (RUPs).

“More or less the team expressed its satisfaction over the injection
safety being practised in the hospitals. The little concern was over post-
injection practises, including hand washing by some nurses and other
staff,” said Dr Shashi Kant, director of the NRM, who accompanied the WHO
team to the local hospitals.

It is to be noted that the WHO has selected Punjab for its ‘Injection
Safety Project’. The WHO has selected only three countries – Egypt, Uganda
and India – for the project and the Punjab is the first state in the
country for the project.

“It was the first filed visit of the WHO team in the state today. More
such visits will take place soon,” said Dr Shashi Kant.

WHO officials said as per the studies conducted worldwide and in the
country, it had been found that a significant number of injections given
were not required and many were unsafe that could lead to spread of
infections such as hepatitis-C, hepatitis-B and HIV. Punjab would
constitute a state technical expert group in collaboration of the WHO to
prepare a timeframe and plan of activities to be undertaken for the
implementation of the Injection Safety Project in Punjab.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/hxll8xg
India: Safe injection campaign launched

Press Trust of India, PTI, India (30.07.16)

Rupnagar (Pb), Jul 30 (PTI) A Global Safe Injection campaign was today
launched by the Centre and World Health Organisation here to eliminate
viral Hepatitis by 2030.

A pilot project in this regard was started in Punjab which has the highest
incidence of Hepatitis C.

Arshad Altaf, WHO Consultant, Geneva said a number of pilot projects on
injection safety shall be undertaken by Government of India and WHO.
The other states reported with high incidence of Hepatitis C are Haryana,
north eastern states and coastal areas of Andhra Pradesh and Tamil Naidu.
Beside India, Uganda and Egypt are the other countries where the project
is being launched, he said.

Benedetta Allegranzi, Coordinator and Team leader of WHO Injection Safety
Project, from Switzerland said the project was aimed at eliminating viral
Hepatitis by 2030.

As per WHO, 33 per cent of Hepatitis B and 42 per cent of Hepatitis C
cases are attributed to unsafe injections, she said.

The WHO official said unsafe injections, mostly in the form of reuse of
safety injections, continues to be a serious threat to life of patients
and health workers.

Globally, 400 million people (about 40 million in India) are estimated to
be infected by Hepatitis, with 95 per cent patients being unaware of their
condition as Hepatitis C is a slow killer, as per WHO data.

Harminder Kaur Sandhu, Civil Surgeon, Rupnagar said the WHO team has
visited Public Health Center in Bharatgarh to make the staff aware of safe
injection campaign. She said the focus of the programme was to appeal
people to make minimum use of injections.

Shashi Kant, Director NRHM Punjab, said the global health body has
recommended one-time use injections, and that Punjab will take lead in
eliminating hepatitis B and C. PTI CORR CHS SRY RG SRY

This is unedited, unformatted feed from the Press Trust of India wire.
__________________________________________________________________
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https://tinyurl.com/h884329
India: World Hepatitis Day: Maharashtra takes stringent measures to stop
disease from spreading

Also present at the event was Amitabh Bachchan, ambassador of the
Hepatitis campaign in India and a patient of acute liver cirrhosis.

By Express News Service, Mumbai, India (29.07.16)

Photo: India is slated to conduct a national project with WHO in Punjab
where the incidence of the viral disease is the highest. (Source: Express
photo by Amit Chakravarty)

The state government has issued a Government Resolution which calls for
transitioning from disposable syringes to auto-disable syringes. The
transition will enable single use of syringes and prevent the risk of
spreading Hepatitis B or Hepatitis C infections.

With this move, Maharashtra becomes one of the first states from across
the country to adopt safe injection practice.

On World Hepatitis Day on Thursday, Union minister of state (Health)
Anupriya Patel, said, “We conducted a meeting with manufacturers two days
ago and have informed them about our plans to transition to safe syringes
by 2018.”

The move comes after the World Health Organization (WHO) came out with
their “Injection Safety Project” that states that 16.7 billion injections
are used worldwide, with estimates saying unsafe injections have caused 21
million Hepatitis B and two million Hepatitis C infection globally.

“Along with syringe safety, we also plan to educate health workers on
this. A portion of budget will be allocated for procuring locally
manufactured syringes,” said principal health secretary (Maharashtra)
Sujata Saunik.

WHO estimates claim India sees a yearly burden of 40 million Hepatitis B
and six million Hepatitis C cases.

“While the deaths due to HIV and malaria are coming down, Hepatitis deaths
are rising,” said Gottfried Hirnschak, director of WHO’s HIV and Hepatitis
program.

India is also slated to conduct a national project with WHO in
Punjab where the incidence of the viral disease is the highest.

Also present at the event was Amitabh Bachchan, ambassador of the
Hepatitis campaign in India and a patient of acute liver cirrhosis.

WATCH VIDEO: Amitabh Bachchan Spreads Awareness About Hepatitis On World
Hepatitis Day 2016

He said, “It is important to train Anganwadi workers on counselling
pregnant women on vaccines after birth. This can help curb mother to child
transmission.” The Union health ministry has included vaccination of
Hepatitis B disease in its national immunization programme ‘Indradhanus’
along with six other diseases. Three doses of HBV vaccination soon after
birth can help prevent the disease infection.

According to NACO deputy director general R C Gupta, attempts are also
underway to improve testing facilities in 2,780 blood banks across India
in detecting infectious diseases like Hepatitis B, C and HIV.
“In a recent decision, all AIIMS will now have nucleic acid test for
reducing window period of Hepatitis and HIV detection,” Gupta said.
__________________________________________________________________
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https://tinyurl.com/hhptyga
India: India should double coverage of HBV vaccine at birth: WHO

Business Standard, Press Trust of India, Kolkata India (29.07.16)

Coverage of Hepatitis B vaccine at birth in India should be doubled by
2020 from the current 45 per cent by addressing the administrative and
logistic issues to safeguard the young against the deadly disease,
according to the World Health Organisation.

WHO representative to India, Henk Bekedam, described “the administration
of Hepatitis B dose within 24 hours of birth as a key challenge.”

Hepatitis B is a contagious liver disease. If babies get infected, the
virus usually remains in the body for a lifetime.

Bekedam said non-availability of Hepatitis B vaccine at all delivery
points, lack of awareness amongst healthcare workers and private sector
adopting a different policy for the birth dose vaccination are some of the
challenges in India.

“There are administrative and logistic challenges in the uptake of
Hepatitis B birth dose. It is proposed that challenges identified be
addressed systematically to increase coverage of Hepatitis B vaccine birth
dose,” Bekedam told PTI.

According to the WHO official, “The convergence of efforts between RMNCH+A
(Reproductive, Maternal, Newborn, Child and Adolescent Health) and the
immunisation programme is necessary to improve birth dose coverage. India
should set a national target of 90 per cent birth dose coverage by 2020.”

Bekedam, however, described India reaching 86 per cent coverage of
Hepatitis B third dose in 2015 as a “commendable” performance.

“In 2015, India reached 86 per cent coverage of Hepatitis B third dose
which is commendable,” he said.

The WHO is committed to supporting the Centre in “designing a
comprehensive action plan for prevention and treatment of viral hepatitis
with clear targets towards elimination as a public health issue”, Bekedam
elaborated while talking about how agency was assisting the India tackling
the disease.

Recently, the WHO supported the National AIDS Control

Organisation (NACO) with evidence generation on Hepatitis C prevalence in
various population groups nationwide, in order to provide more reliable
estimates of the Hepatitis C disease burden, he stated.
*****
“WHO is also supporting Ministry of Health and Family Welfare (MoHFW) with
an injection safety project aiming to reduce demand for injections and
increase the use of safety-engineered syringes for injections in health
care settings.

“And as a part of this project in India, WHO is closely working with MoHFW
and select state governments to take concrete steps for making injections
safe, both in public and private sector,” the WHO representative to India
said.

It is part of WHO’s project in three countries – India, Egypt and Uganda.
*****

In 2015, the Institute of Liver and Biliary Sciences (ILBS) New Delhi was
formally inaugurated as a WHO Collaborating Centre for Viral Hepatitis and
Liver Diseases, he added.

Asked whether India’s target towards becoming Hepatitis Free is an
achievable target, Bekedam said, “Easy and affordable access to services
and medicines for all people in need is the key to treatment and
prevention of hepatitis infection.

“It is possible to significantly increase the number of people accessing
treatment through a public health programme with standard screening and
treatment strategies and guidelines as also affordable hepatitis C drugs.
Drugs for hepatitis B and hepatitis C infections are already being
manufactured in India,” he said.

Indian government is making concentrated efforts to understand better the
epidemiological situation of viral hepatitis, he said.

“Current challenges for hepatitis B control include the low hepatitis B
birth dose coverage, injection safety issue and limited access to
diagnosis and treatment of hepatitis infection,” he stressed.

On how can the population prevalence of chronic HCV infection in India,
which is around one per cent, be improved Bekedam said,” Ensuring safe
injection practice in India is the key to improve this situation.

“To reduce transmission (new infections) of hepatitis C in India, we need
to make medical injections safe and treat people who have active
infection. Hepatitis C can be cured and people who are cured do not
transmit the virus anymore.”

On the issue of “expensive” drugs for treating the disease Hepatitis C,
the WHO official said, “Indian generic companies produce the new direct
acting antivirals drugs for Hepatitis C.

“Some state governments have negotiated prices for a 12 week treatment
course at Rs 20,000-Rs 24,000. This is a much lower cost than in other
countries.

“The price of same treatment in Egypt is USD 900. Prices can be negotiated
further down if more people are put on treatment. The Punjab Government
has been a flag bearer for Hepatitis C treatment in India.
__________________________________________________________________
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https://tinyurl.com/zbjq522
India: WHO to launch Injection Safety Project in India on World Hepatitis
Day

Rupali Mukherjee, TNN, Times of India, Mumbai India, (28.07.16)

MUMBAI: World Health Organization is launching an `Injection Safety
Project’ in India on World Hepatitis Day, along with guidelines to scale
up treatment and care of Hepatitis. Hepatitis is preventable and
treatable, but continues to be an acute public health challenge globally,
and in south-east Asian countries.

Safe injections, blood transfusions and other healthcare procedures can
prevent the spread of hepatitis B and C, while promoting hygienic and
clean food and water can reduce the risk of hepatitis A and E infection.
Around 33% of Hepatitis B and 42% of Hepatitis C cases are attributed to
unsafe injections.

The Injection Safety Project was globally started by WHO in 2015, and is
expected to be kick-started in India on Thursday. The campaign stresses
injection safety through deployment of `smart auto disable (AD) syringes’
in developing countries by 2020, and the need for partnership between
stakeholders in public and private sector.

India has a poor penetration of AD syringes, even though there is not much
cost involved in upgrading the facilities to manufacture these devices. At
present, AD syringes are being imported from China as these are a bit
cheaper than those indigenously produced, industry experts say.

The government should lay down a policy and standards for procurement, use
and safe disposal of SMART syringes, as well as switch completely to AD
syringes over the next couple of years, they added.

The cost of an injection from AD syringe is 8 times less than of glass
syringe, and 6 times less than standard disposable syringe, Rajiv Nath
president, AISNMA (All India Syringes & Needle Manufacturers Association)
told TOI.

Hepatitis, an inflammation of the liver, can be self-limiting or can
progress to fibrosis (scarring), cirrhosis or liver cancer. Hepatitis
viruses are the most common cause of hepatitis in the world but other
infections, toxic substances (e.g. alcohol, certain drugs), and autoimmune
diseases can also cause hepatitis. There are five main hepatitis viruses,
referred to as types A, B, C, D and E, and can cause millions of deaths,
with types B and C being the most common cause of liver cirrhosis and
cancer.

Viral hepatitis has been recognized as a serious public health problem in
India by WHO, with over 52 million people infected with chronic hepatitis
in the country.

WHO is releasing its first hepatitis testing guidelines this year which
provides guidance on who should be tested, and recommends simple testing
strategies to help scale up hepatitis testing, treatment and care.

Countries have been urged to procure safety engineered injection devices,
which prevent reuse and hence don’t lead to accidental needle stick
injuries. 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 these ailments.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/j98xt2g
India: World Hepatitis Day: Unsafe needle practices leading cause of
Hepatitis-C in India: Around 5,00,000 people die each year from hepatitis
C-related liver diseases in India.

New Indian Express, By: PTI, New Delhi, India (28.07.16)

Photo: Hepatitis-C is 10 times more infectious than HIV. (Source:
Thinkstock Images)

Unsafe injection practices such as reuse, incorrect disposal and poor
sterilisation of syringes are increasingly contributing to Hepatitis-C
Virus infection in India, doctors have cautioned on World Hepatitis Day.

The disease, that does not have a vaccine and spreads mainly through
unsafe blood transfusion and needles, can be completely cured if detected
at an early stage. But prolonged neglect may lead to liver cirrhosis and
even cancer, they said.

“Hepatitis-C (HCV) is 10 times more infectious than HIV. It is
asymptomatic, which means it does not exhibit any obvious symptoms of
sickness in its initial stages. If it does, it can be easily diagnosed
with a blood test and treated,” Dr Manav Wadhawan, a gastroenterologist
with the Fortis Escorts Liver and Digestive Diseases Institute, said.

He identified exhaustion, jaundice, abdominal pain, loss of appetite as
some of the symptoms of HCV. According to a WHO estimate, around 12
million people are affected by the disease in India.

Dr Siddharth Srivastava, who works with the Department of Gastroenterology
in GB Pant Hospital, underscored the need for patients to be vigilant and
be aware of safe injection practices like the use of sterile, single-use
or preventing reuse of syringes.

“The irony is that Hepatitis-B has a vaccine, but no cure, while hepatitis
C has no vaccine, it does have a cure. Laid down WHO safe injection
protocols should be followed by healthcare practitioners. Staff should
wash their hands before administering injections, and they should clean
the area of the injection adequately,” he said.

According to health experts, around 5,00,000 people die each year from
hepatitis C-related liver diseases in India and an estimated 4.7 million
HCV infections can be attributed to poor needle practices.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/gosst3j
India: Unsafe needle practices leading cause of Hepatitis-C: Doctors

New Indian Express, By PTI (27.07.16)

NEW DELHI: Unsafe injection practices such as reuse, incorrect disposal
and poor sterilisation of syringes are increasingly contributing to
Hepatitis-C Virus infection in India, doctors have cautioned on the eve of
World Hepatitis Day.

The disease, that does not have a vaccine and spreads mainly through
unsafe blood transfusion and needles, can be completely cured if detected
at an early stage. But prolonged neglect may lead to liver cirrhosis and
even cancer, they said.

“Hepatitis-C (HCV) is 10 times more infectious than HIV.

It is asymptomatic, which means it does not exhibit any obvious symptoms
of sickness in its initial stages. If it does, it can be easily diagnosed
with a blood test and treated,” Dr Manav Wadhawan, a gastroenterologist
with the Fortis Escorts Liver and Digestive Diseases Institute, said.

He identified exhaustion, jaundice, abdominal pain, loss of appetite as
some of the symptoms of HCV. According to a WHO estimate, around 12
million people are affected by the disease in India.

Dr Siddharth Srivastava, who works with the Department of Gastroenterology
in GB Pant Hospital, underscored the need for patients to be vigilant and
be aware of safe injection practices like the use of sterile, single-use
or preventing reuse of syringes.

“The irony is that Hepatitis-B has a vaccine, but no cure, while hepatitis
C has no vaccine, it does have a cure. Laid down WHO safe injection
protocols should be followed by healthcare practitioners. Staff should
wash their hands before administering injections, and they should clean
the area of the injection adequately,” he said.

According to health experts, around 5,00,000 people die each year from
hepatitis C-related liver diseases in India and an estimated 4.7 million
HCV infections can be attributed to poor needle practices.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/gltp4nt
India: WHO selects state for injection safety project

By Nitin Jain, Tribune News Service, Chandigarh, Punjab India (20.07.16)

The World Health Organisation (WHO) has selected Punjab to roll out an
injection safety implementation project in India. Punjab will be the only
state to be covered under this global project, which will be launched in
Chandigarh on July 30 and continue till December 2018.

The WHO will be launching a global campaign on injection safety to reduce
the overall burden of diseases caused by unsafe injection practices,
Health Secretary Vini Mahajan said.

Under this project, WHO will be supporting the Union Government to develop
and implement a national initiative to improve injection safety. It will
include a transition to exclusive use of safety syringes, fostering new
training approaches for healthcare workers to achieve changes in practice
as well as measures to educate and engage the community in the promotion
of safe injection practices.

These areas of prevention are critical to reduce the transmission of
Hepatitis B, C and other serious blood-borne diseases such as HIV. At the
start of the project, an independent assessment will be done to quantify
the injection safety situation in the state. It will focus on safety of
the injection recipient, provider and community at large vis-à- vis sharp
waste management. ______________________

Why it is important

A national study published in 2012 found that the frequency of injections
was 2.9 per person per year.

It also found that 62.9 per cent injections were unsafe.

Injections administered for curative purposes constituted 82.5 per cent
and a majority of these were prescribed for common symptoms like fever,
cough and diarrhoea.

The study estimated that about 3 billion injections were administered
annually in India and of those, 1.89 billion were unsafe.
__________________________________________________________________
________________________________*_________________________________

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

The SIGN Forum welcomes new subscribers who are involved in injection
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* Subscribe or unsubscribe by email: signmoderator@googlegroups.com

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.
__________________________________________________________________
________________________________*_________________________________

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
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