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SIGNpost 00592


Post00592   IPCAN + APSIC + MDVs + Abstracts + Job + News  30 March 2011

1. Invitation & Call For Abstracts: IPCAN 2011
2. APSIC2011: The 5th International Congress of the Asia Pacific Society
of Infection Control
3. New: WHO Priority medicines for mothers and children 2011
4. India: AEFI-Toxic Shock Syndrome following Immunization-Slides
5. Tracking Killers: The Burden of Disease from Hepatitis A and E
6. Opinion: Effective solutions to prevent 4.1 million healthcare
associated infections in Europe
7. Abstract: Optimal evaluation of infectious medical waste disposal
companies using the fuzzy analytic hierarchy process
8. Abstract: Towards evidence-based management: creating an informative
database of nursing-sensitive indicators
9. Abstract: AIDS in Asia amid competing priorities: a review of national
responses to HIV
10. Abstract: Follow-up on an outbreak in Venezuela of soft-tissue
infection due to Mycobacterium abscessus associated with Mesotherapy
11. Abstract: HIV Transmission in the Dental Setting and the HIV-Infected
Oral Health Care Professional: Workshop 1C
12. Abstract: Hepatitis B prevention and control: Lessons from the East
and the West
13. Abstract: Public awareness of hepatitis B infection: a population-
based telephone survey in Hong Kong
14. Abstract: The provision of non-needle/syringe drug injecting
paraphernalia in the primary prevention of HCV among IDU: a systematic
15. Abstract: Is Vancouver Canada’s supervised injection facility cost-
16. Abstract: Qualitative accounts of needle and syringe cleaning
techniques among people who inject drugs in Sydney, Australia
17. Abstract: Incidence of Hepatitis B and HIV Virus at Cadaver of IV Drug
Abusers in Tehran
18. Abstract: Mortality among a cohort of drug users after their release
from prison: an evaluation of the effectiveness of a harm reduction
program in Taiwan
19. Abstract: HIV prevalence and risk behaviors of male injection drug
users in Cairo, Egypt
20. Abstract: Comparing sexual risks and patterns of alcohol and drug use
between injection drug users (IDUs) and non-IDUs who report sexual
partnerships with IDUs in St. Petersburg, Russia
21. No Abstract: Ocular perforation by an acupuncture needle
22. Job Title: Immunization Technical Officer
23. News
-USA: Health officials investigate bacteria outbreak at Ala. hospitals
-Nepal: Fake vaccinators apprehended in capital
-USA: Several patients die after being treated with contaminated IV bags
-UK: Home tattoo kits ‘are putting teenagers at risk from disease’
-Canada: Saskatoon Fire Department warns people to watch out for needles
Many being uncovered as weather gets warmer
-Australia: Hysteria Takes Hold as Schoolgirls Fear the Needle”
-Canada: Health Officials Credit Harm Reduction for Decline in B.C. HIV
-UK: Hepatitis C compensation boost
-Nevada USA: Nevada Doctor Says Vendor OK’d Needle Guide Reuse

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1. Invitation & Call For Abstracts: IPCAN 2011

Abstract submission deadline: 25 July 2011 at:


Dear Colleagues

After very successful first and second Infection Prevention and Control
Africa Network (IPCAN) conferences in respectively Uganda in 2009 and
South Africa in 2010, it is our pleasure to welcome you to the Third IPCAN
Conference to be held from the 31 October to 3 November 2011 in Namibia at
the Windhoek Country Club Resort and Casino.

The disease profiles in Africa differ from those of the well- resourced
countries and lean towards diseases of poverty as well as healthcare-
associated infections.  The IPCAN conference will address the diversity of
diseases and will address aspects of infection prevention and control
relevant to our continent. Nevertheless infection preventionists speak a
universal language. The presence of international delegates will also
offer a unique opportunity for the sharing of experiences between
infection control professionals from different countries and backgrounds.
We also hope it will initiate contacts between delegates who are
experienced in the subject and others who may just be starting out.

The scientific programme focuses on African and international IPC issues
and also covers decontamination and sterilization.  The inclusion of
francophone African countries will be actively sought and for the first
time, we will learn about what is happening in those African countries.
IPCAN encourages the opportunity for African and other delegates to
present their original scientific research in free paper and discussion

Apart from a robust scientific programme there will be ample opportunity
to network and form new links and support during the conference and the
social occasions which have been organised for you.

Come and experience the world in a grain of sand and heaven in a wild

Shaheen Mehtar

Call for abstracts

Submission deadline: 25 July 2011


2. APSIC2011: The 5th International Congress of the Asia Pacific Society
of Infection Control

Online Abstract Submission Deadline 15 July 2011

The 5th International Congress of the
Asia Pacific Society of Infection Control
8-11 November 2011

Melbourne Convention Centre, Australia

APSIC2011 Congress e-Newsletter Issue #1

The APSIC Congress is the largest international meeting of infection
prevention experts in the Asia Pacific Region. It provides a prime
educational opportunity to bring together renowned international and
regional speakers to present the latest evidence based advancements in
infection prevention and quality improvement strategies.

The challenges of infection prevention and control are the same worldwide
however resources to deal with these issues vary considerably. The
congress will cover topics relevant to all and provides a forum to discuss
ways to move forward in diverse settings.

The Scientific Program will be complemented by an equally exciting social
program allowing delegates to network and catch up with colleagues. The
conference venue is situated in the heart of Melbourne providing easy
access to vibrant culture, cuisine and entertainment precincts.

We hope you will join us in Melbourne for this important event.

Judith Brett
APSIC2011 Congress Convenor

Keynote Speakers

Dr William Jarvis, Jason & Jarvis Associates, USA
Dr Robert Weinstein, John H Stroger Jr (County Cook) Hospital, USA
Prof Andreas Widmer, University Hospital Basel, Switzerland
Prof Anthony McMichael, Australian National University, Australia
Prof Didier Pittet, University of Geneva Hospitals, Switzerland
Call for Abstracts:

Online Abstract Submission Now Open-Abstract Submission Deadline 15 July

Authors are invited to submit abstracts for Oral and Poster presentations
at the APSIC2011 Congress.

Please visit to submit your abstract.

Online Registration Now Open

Early Bird Registration Deadline 31 August 2011
Register at

Sponsorship and Exhibition Opportunities

Organisations are invited to participate as sponsors and/or exhibitors at
the APSIC 2011 Congress, which is the premier infection control congress
in the Asia Pacific region and offers a unique opportunity to promote
products and services to a select and valuable audience of key infection
control professionals.

For more information download the Sponsorship & Exhibition Prospectus.

Click here to subscribe to receive news updates.

All further enquiries please contact the Congress Organiser

ICMS Pty Ltd
84 Queensbridge Street
Phone: +61 3 9682 0244
Fax: +61 3 9682 0288
Southbank VIC 3006

3. New: WHO Priority medicines for mothers and children 2011

Priority medicines for mothers and children

Priority medicines for mothers and children 2011

Priority medicines are medicines with potential to save lives and should
be available in all health systems. The priority medicines list for
mothers and children helps countries select and make available the most
important medicines.

Major causes of death in mothers and children could be prevented or
treated with access to simple and affordable medicines. However, many
medicines are not available in countries.

In order to improve access, priority medicines should be:

-Manufactured according to quality standards
-Licensed for use by regulatory authorities
-On National Essential Medicines lists
-Part of national standard treatment guidelines
-Procured from the supplier of a quality product

In the supply chain

Prescribed by health care professionals who know how to use them
Priority medicines for children under five
Medicines for pneumonia, diarrhoea, malaria, neonatal sepsis, HIV/AIDS and
vitamin A deficiency are included on the priority list. Treatments for
palliative care and pain are also listed.

Medicines for children need to be available in dosage forms that can be
given to children of different weights and ages, that are pleasant tasting
and easy for children to swallow. Solid dosage forms that can be dispersed
in liquid are ideal as they are less costly to store and transport than
bulky and heavy liquid dosage forms.

Adapting adult medicines for children by breaking or crushing tablets and
dissolving them in liquid can result in treatment that is ineffective or

Missing medicines

Additional research and development is urgently needed for appropriate
products for prevention and treatment of tuberculosis, particularly in
HIV-infected children, and for newborn care. Optimal dose and strength,
fixed-dose combination products and/or regulatory pathways need to be
defined and determined.

Priority medicines for mothers

Complications during pregnancy and childbirth account for the majority of
maternal deaths. The priority list includes medicines to treat severe
bleeding (postpartum haemorrhage), high blood pressure (pre-eclampsia and
eclampsia) and maternal infection (sepsis). Also include are treatments
for sexually transmitted infections and prevention of preterm birth.

How the list was developed

Medicines were chosen by experts in maternal and child health and
medicines according to the global burden of disease and based on evidence
of efficacy and safety. Medicines were selected from the Model List of
Essential Medicines and are included in current WHO treatment guidelines.

Priority medicines for mothers and children 2011

Ensuring access to Priority Medicines for mothers and children improves
health and saves lives.

Publication details

Number of pages: 4
Publication date: 21 March 2011
Languages: English

WHO reference number: WHO/EMP/MAR/2011.1

Priority medicines             pdf, 215kb

Priority medicines A3 format   pdf, 230kb

4. India: AEFI-Toxic Shock Syndrome following Immunization-Slides

Crossposted from TECHNET21 with thanks.

The link below is an online slideshow  (27 slides) based on the findings
of investigations of recent clusters of post Measles immunization toxic
shock syndrome

Toxic Shock Syndrome following Immunization
Prabir Chatterjee

Have put together some slides on the issues involved.

This is an educational power point-long, but of use to prepare classes
for health workers or doctors

5. Tracking Killers: The Burden of Disease from Hepatitis A and E

Posted from with thanks

Tracking Killers: The Burden of Disease from Hepatitis A and E
RTI International,  (March 2011)

Epidemiologists and public health researchers from multiple institutions
are collaborating to gather and analyze the best available data on deaths
and sick days caused by over 100 diseases and injuries around the world.
The culmination of their work is the Global Burden of Disease (GBD) study.

RTI Senior Health Economist David Rein is leading the modeling of disease
burdens for hepatitis A and E viruses in the 2010 GBD study.

“This is the first time hepatitis A and E are being included,” said Rein.
Both viruses are transmitted by the fecal-oral route-often through
contaminated drinking water or food-and attack the liver, causing
inflammation and possibly jaundice or liver failure.

Rein, along with Rakesh Aggerwal in India and World Health Organization
(WHO) collaborators Steven Wiersma and Gretchen Stevens, reviewed the
existing literature on hepatitis E and performed a meta-analysis of
seroprevalence data to find a probability for various outcomes by country
and age group, including infection, symptomatic disease (i.e., feeling
sick from the infection), death, or stillbirth in the case of pregnant
mothers infected with the virus. The team then modeled the prevalence by
global region using the DisMod III tool developed by the Institute for
Health Metrics and Evaluation at the University of Washington.

“The burden of disease of hepatitis E is pretty substantial in less
developed countries,” said Rein. “It has a 2% death rate among adults,
which jumps up to 20% in pregnant women.”

Through modeling the burden of disease for hepatitis A, RTI found that
fewer children were infected in 2005 than in 1990, raising the average age
of infection around the world. However, the introduction of vaccination
programs in the United States starting in 1999 disrupted the natural
epidemiology of the virus and led to a lower age of infection and far
fewer infections overall in North America.

In the case of hepatitis A, Rein built a model from a literature review
conducted by Kathryn Jacobsen at George Mason University for WHO.

“We found fewer children are infected with the virus, and the overall
incidence is declining,” said Rein. One cause is better water and
sanitation infrastructure.

“On the surface that’s good news, but there is a catch,” Rein said.
Children infected with hepatitis A generally have no symptoms, whereas
youth and adults are more likely to experience severe illness.

“So, paradoxically, in areas where incidence has declined due to
improvements in water and sanitation, the burden shifts, resulting in
outbreaks among youth and adults,” Rein said. “This suggests that
countries experiencing the shift should consider vaccination strategies
against hepatitis A.”

Rein and his collaborators will be publishing results from the hepatitis A
and E modeling later this year.

More information: David Rein,
e-mail drein[at]

6. Opinion: Effective solutions to prevent 4.1 million healthcare
associated infections in Europe

Crossposted from ECOMED Newsletter for March 2011 with thanks.

Effective solutions to prevent 4.1 million healthcare associated
infections in Europe

Though we live in countries with well-funded and advanced healthcare
settings, we all know that receiving medical treatment inevitably carries
risk with it. However, less is known about the procedures in place to
minimise the risk of adverse events. Should I be scared to enter a
healthcare setting? How do I know if the hospital where I am treated has a
procedure in place to minimise risk so that it is not complicated by an

The issue of patient safety, as a critical component of the quality of
healthcare, is of considerable significance to me as a former Minister of
Health, a former Member of the European Parliament and most importantly,
as a patient. In my role as Honorary President of Health First Europe, I
continue to encourage Member States and EU institutions to find avenues to
ensure the patient is capable of choosing where his/her treatment can be
best acquired so that fear of medical procedures is reduced and risk is

Too often, patients enter care settings unaware of possible adverse events
that may occur during a hospital stay. Healthcare Associated Infections
(HAIs) are all too frequent and are one of the most prominent reasons for
failure of advanced medical treatment. I still find it hard to believe
that between 8% and 12% of patients are harmed while receiving healthcare,
even in today’s well-funded and technologically advanced settings. An
estimated 4.1 million patients in the EU will contract an infection while
being treated, causing considerable increases in illness, mortality and
costs. They magnify the burden on medical staff, payors and employers,
with the largest burden falling on the patient. They cause further time
away from work and increase the burden on healthcare systems and the
economy-both in terms of productivity lost and additional services
required. Moreover, there are too many instances in which HAIs could
easily have been prevented. Proper hand hygiene can most certainly have an
impact, but there are numerous other methods which contribute to
effectively reducing HAIs and can decrease the suffering of patients and
healthcare professionals in Europe. What are we waiting for? Why don’t we
embrace them?

I believe that in order to enshrine safety for patients in both the
hospital and homecare settings, Member States must define and engrain
strategies for the reduction of HAIs within their health policy. This
includes determining the continuous training and education of medical
professionals and increasing the access of innovative medical technologies
which are especially designed to reducing the risk of infection. The
medical technology industry is continuously discovering new ways to
deliver effective treatments which reduce the human error and, therefore,
limit the chances of infection. These include antimicrobial coatings,
‘closed’ catheterisation systems which minimise the opportunities for
bloodstream infections, highly efficient surgical site barriers and
dressings, and needlestick prevention mechanisms. Additionally, effective
rapid screening technologies, monitoring systems to identify and limit the
spread of infections, and diagnostic systems to ensure appropriate
targeted usage of antibiotics can play a vital role.

However, policy must develop with technology. The EU is playing a role in
encouraging the adoption of measures to develop national policies which
include reporting systems for HAIs (as part of the Council Recommendations
on Patient Safety 2009) and is facilitating the uptake of medical
technology through the Innovation Union (under the Europe 2020 Strategy).
Yet, both programmes fall short of demanding concrete, quantifiable
measures for the reduction of HAIs and specific benchmarks for monitoring
the uptake of medical technologies that assist in HAI reduction.

As both a patient and a policymaker, I feel strongly that statistics on
the incidence of HAIs and the availability of technologies for patients
must be readily available to patients, allowing them to be assured that
they will receive the best quality of care. Every single patient, myself
included, deserves the peace of mind of knowing that, when entering a
hospital or any other healthcare setting, they will be safe from entry to

– John Bowis
Honorary President Health First Europe

Health First Europe is a non-profit, non-commercial alliance of patients,
healthcare workers, academics and healthcare experts and the medical
technology industry.

We aim to ensure that equitable access to modern, innovative and reliable
medical technology and healthcare is regarded as a vital investment in the
future of Europe. We call for truly patient-centred healthcare and believe
that every European citizen should benefit from the best medical
treatments available.

7. Abstract: Optimal evaluation of infectious medical waste disposal
companies using the fuzzy analytic hierarchy process

Waste Manag. 2011 Mar 16.

Optimal evaluation of infectious medical waste disposal companies using
the fuzzy analytic hierarchy process.

Ho CC.

Department of Industrial Management, National Taiwan University of Science
and Technology, Taipei, Taiwan.

Ever since Taiwan’s National Health Insurance implemented the diagnosis-
related groups payment system in January 2010, hospital income has
declined. Therefore, to meet their medical waste disposal needs, hospitals
seek suppliers that provide high-quality services at a low cost.

The enactment of the Waste Disposal Act in 1974 had facilitated some
improvement in the management of waste disposal. However, since the
implementation of the National Health Insurance program, the amount of
medical waste from disposable medical products has been increasing.
Further, of all the hazardous waste types, the amount of infectious
medical waste has increased at the fastest rate. This is because of the
increase in the number of items considered as infectious waste by the
Environmental Protection Administration.

The present study used two important findings from previous studies to
determine the critical evaluation criteria for selecting infectious
medical waste disposal firms. It employed the fuzzy analytic hierarchy
process to set the objective weights of the evaluation criteria and select
the optimal infectious medical waste disposal firm through calculation and

The aim was to propose a method of evaluation with which medical and
health care institutions could objectively and systematically choose
appropriate infectious medical waste disposal firms.

8. Abstract: Towards evidence-based management: creating an informative
database of nursing-sensitive indicators

J Nurs Scholarsh. 2010 Dec;42(4):358-66.

Towards evidence-based management: creating an informative database of
nursing-sensitive indicators.

Patrician PA, Loan L, McCarthy M, Brosch LR, Davey KS.

The University of Alabama at Birmingham, School of Nursing, 1530 3rd
Avenue S., Birmingham, AL 35294-1210, USA.

PURPOSE: The purpose of this paper is to describe the creation, evolution,
and implementation of a database of nursing-sensitive and potentially
nursing-sensitive indicators, the Military Nursing Outcomes Database
(MilNOD). It discusses data quality, utility, and lessons learned.

DESIGN/METHODS: Prospective data collected each shift include direct staff
hours by levels (i.e., registered nurse, other licensed and unlicensed
providers), staff categories (i.e., military, civilian, contract, and
reservist), patient census, acuity, and admissions, discharges, and
transfers. Retrospective adverse event data (falls, medication errors, and
needle-stick injuries) were collected from existing records. Annual
patient satisfaction, nurse work environment, and pressure ulcer and
restraint prevalence surveys were conducted.

FINDINGS AND CONCLUSIONS: The MilNOD contains shift level data from 56
units in 13 military hospitals and is used to target areas for managerial
and clinical performance improvement. This methodology can be modified for
use in other healthcare systems. Clinical Relevance: As standard tools for
evidence-based management, databases such as MilNOD allow nurse leaders to
track the status of nursing and adverse events in their facilities.

9. Abstract: AIDS in Asia amid competing priorities: a review of national
responses to HIV

AIDS. 2010 Sep;24 Suppl 3:S41-8.

AIDS in Asia amid competing priorities: a review of national responses to

Rao PJ, Mboi N, Phoolcharoen W, Sarkar S, Carael M.

UNAIDS Regional Support Team, Bangkok, Thailand.

INTRODUCTION: The paper reviews progress in addressing the HIV epidemic
and questions whether at the midway mark to the conclusion of the
Millennium Development Goal set for 2015, the goal number 6 of halting and
reversing the HIV epidemic will be reached.

METHODS: Fourteen 2008 United Nations General Assembly Special Session on
HIV/AIDS country progress reports and 18 country reports on Universal
Access 2009 were analyzed. Data on national HIV strategic plans was also
provided by 18 countries that participated in the regional training on
costed national strategic plans 15-16 September, in Bangkok in 2008.

RESULTS: Four countries with substantial populations in Asia are on track
to achieve Millennium Development Goal 6. Elsewhere, elements of a
potentially effective response are being introduced, but the degree of
urgency and scale needed to curb the epidemics are not yet evident. Most
national programmes still lack key planning components for the operation
and financing of the response. Only 13 national strategic plans explicitly
address the three key populations at higher risk for HIV. One third of the
countries that have designed plans for effective interventions have not
costed them.

DISCUSSION: Early successes in controlling HIV epidemics in Asia may not
be sustainable in the future. There is an urgent need to make prevention
scale-up as robust as treatment scale-up and to focus programmes on high
impact prevention, which directly contributes to reduction of new HIV
infection. A necessary objective is to convince policy makers that the
emergency posed by HIV continues.

10. Abstract: Follow-up on an outbreak in Venezuela of soft-tissue
infection due to Mycobacterium abscessus associated with Mesotherapy

Enferm Infecc Microbiol Clin. 2010 Nov;28(9):596-601.

[Follow-up on an outbreak in Venezuela of soft-tissue infection due to
Mycobacterium abscessus associated with Mesotherapy].

[Article in Spanish]

Da Mata Jardín O, Hernández-Pérez R, Corrales H, Cardoso-Leao S, de Waard

Instituto de Biomedicina, Laboratorio de Tuberculosis, Caracas, Venezuela.

INTRODUCTION: Skin and soft tissue infections caused by nontuberculous
mycobacteria (NMT) are reported to be associated with injections,
liposuction, plastic surgery, and acupuncture. Herein, we describe an
outbreak of soft tissue infection due to NMT following mesotherapy, a
cosmetic procedure involving injection of poorly defined mixtures alleged
to reduce local adiposity.

METHODS: Patients with skin lesions and a history of mesotherapy
treatment, who visited the dermatology department of the public hospital
in Barinas, Venezuela, from November 2004 to February 2005 were
interviewed. Clinical and environmental samples were taken for
mycobacteria isolation.

RESULTS: The interviews revealed that 68 patients who had been treated for
cosmetic purposes at the same clinic by the same therapist had received
injections with the same product and were infected with NMT. Clinical
specimens from 5 patients grew Mycobacterium abscessus. No mesotherapy
solution was available for analysis but M. abscessus was isolated from an
environmental sample in the clinic. PCR-based strain typing techniques
(ERIC-PCR, BOXA1R and RAPD) showed that the patient’s isolates were
undistinguishable from each other but different from the environmental

CONCLUSIONS: This outbreak was likely caused by a contaminated injectable
mesotherapy product and not by mycobacteria from the clinic environment.
We emphasize the importance of better microbiological control of these
products. To our knowledge, this outbreak, which affected at least 68
patients, appears to be the largest ever associated with mesotherapy and
described in the literature.

Copyright © 2009 Elsevier España, S.L. All rights reserved.

11. Abstract: HIV Transmission in the Dental Setting and the HIV-Infected
Oral Health Care Professional: Workshop 1C

Adv Dent Res. 2011 Apr;23(1):106-11.

HIV Transmission in the Dental Setting and the HIV-Infected Oral Health
Care Professional: Workshop 1C.

Flint SR, Croser D, Reznik D, Glick M, Naidoo S, Coogan M.

Dublin Dental School and Hospital and Trinity College, Dublin, Ireland.

This workshop addressed two important issues: first, the global evidence
of HIV transmission from health care provider to patient and from patient
to health care provider in the general health care environment and the
dental practice setting; second, in the era of highly active
antiretroviral therapy, whether oral health care professionals living with
HIV pose a risk of transmission to their patients and whether standard
infection control is adequate to protect both the patient and the oral
health care professional in dental practice.

The workshop culminated in a general discussion and the formulation of a
consensus statement from the participating delegates, representing more
than 30 countries, on the criteria under which an HIV-infected oral health
care professional might practice dentistry without putting patients at
risk. This consensus statement, the Beijing Declaration, was agreed nem

12. Abstract: Hepatitis B prevention and control: Lessons from the East
and the West

World J Hepatol. 2011 Feb 27;3(2):31-7.

Hepatitis B prevention and control: Lessons from the East and the West.

Robotin MC.

Monica C Robotin, NSW Cancer Council, School of Public Health University
of Sydney, Sydney, NSW 2011, Australia.

Despite being ten times more common than HIV infection, viral hepatitis
has so far not commanded the same public health response worldwide, so a
global viral hepatitis treatment program is still a long way from becoming
a reality.

However, much progress has occurred over the last few decades, with the
screening of blood products, sound infection control practices and the
introduction of disposable needles and syringes leading to significant
reductions in nosocomial hepatitis B transmission in the developed world
and increasingly in other countries.

The introduction of hepatitis B vaccination in the 1980s and its
integration into the Expanded Immunization Program have led to substantial
reductions in chronic hepatitis B infection rates in children and to
millions of lives saved.

The availability of effective antiviral treatment has revolutionized
treatment prospects, although access to treatment remains a significant
challenge for most developed countries and remains out of reach for
developing nations. Some of these breakthroughs have occurred in Asian
countries, others in the West, but their unifying features are innovative
research, timely clinical translation and a commitment to apply their
findings to improve the health of populations, not just individuals.

This paper reviews some of the challenges and opportunities for hepatitis
B control at the end of the first decade of the third millennium and
argues for closer East-West collaborations, to bring in fresh
perspectives, avoid duplications of effort and in order to help answer
many of the remaining challenges in making hepatitis B history.

13. Abstract: Public awareness of hepatitis B infection: a population-
based telephone survey in Hong Kong

Hong Kong Med J. 2010 Dec;16(6):463-9.

Public awareness of hepatitis B infection: a population-based telephone
survey in Hong Kong.

Leung CM, Wong WH, Chan KH, Lai LS, Luk YW, Lai JY, Yeung YW, Hui WH.

Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai
Wan, Hong Kong.
OBJECTIVE: To test our hypothesis that there is inadequate knowledge and
awareness of hepatitis B infection among the general population in Hong

DESIGN: A random telephone survey using a structured multiple-choice

SETTING: Hong Kong community.

PARTICIPANTS: Hong Kong residents aged 18 years or above.

RESULTS: A total of 506 respondents were successfully interviewed in
February 2010.

Approximately half of respondents (55%) were aware that hepatitis B virus
is the most common cause of chronic viral hepatitis in Hong Kong.

Regarding knowledge about the mode of transmission, mother-to- infant
transmission and blood contact were recognised as risk factors by 67% and
65% of respondents, respectively. Transmission by sexual contact, sharing
a razor or toothbrush, and tattooing or body piercing were appreciated by
44%, 41%, and 37% of respondents, respectively. A majority (73%) had the
mistaken belief that the virus is transmitted by eating contaminated

Over half of respondents (53%) knew nothing about the clinical
presentation of acute hepatitis B. Only 35% of respondents realised that
periodic abdominal ultrasonographic examinations are indicated for
asymptomatic hepatitis B carriers. While 51% of respondents reported being
tested for hepatitis B virus infection, only 36% acknowledged being
vaccinated against the infection. Education level, occupation, and marital
status were factors associated with both hepatitis B virus screening and

CONCLUSION: These findings support our hypothesis that there is inadequate
knowledge and awareness about hepatitis B infection in the general
population in Hong Kong.

Free Article

14. Abstract: The provision of non-needle/syringe drug injecting
paraphernalia in the primary prevention of HCV among IDU: a systematic

BMC Public Health. 2010; 10: 721.

Published online 2010 November 23.

Copyright ©2010 Gillies et al; licensee BioMed Central Ltd.

The provision of non-needle/syringe drug injecting paraphernalia in the
primary prevention of HCV among IDU: a systematic review

Michelle Gillies,1 Norah Palmateer,2 Sharon Hutchinson,2,3 Syed Ahmed,4
Avril Taylor,5 and David Goldberg2

1Department of Public Health-Faculty of Medicine, University of Glasgow,
G12 8QR, UK
2BBV and STI Section, Health Protection Scotland, Clifton House, Clifton
Place, Glasgow, G3 7LN, UK
3Department of Mathematics and Statistics, University of Strathclyde,
Livingstone Tower, 26 Richmond Street, Glasgow, G1 1XH, UK
4Public Health Protection Unit, NHS Greater Glasgow & Clyde, Dalian House,
350 St Vincents Street, Glasgow, G3 8YU, UK
5Institute for Applied Social and Health Research, University of the West
of Scotland, Paisley, PA1 2BE, UK

Corresponding author.
Michelle Gillies:; Norah Palmateer:; Sharon Hutchinson:;
Syed Ahmed:; Avril Taylor:; David Goldberg:

Sharing drug injecting paraphernalia other than needles and syringes (N/S)
has been implicated in the transmission of Hepatitis C virus (HCV) among
injecting drug users (IDU). We aimed to determine whether the provision of
sterile non-N/S injecting paraphernalia reduces injecting risk behaviours
or HCV transmission among IDU.

A systematic search of seven databases and the grey literature for
articles published January 1989-February 2010 was undertaken. Thirteen
studies (twelve observational and one non-randomized uncontrolled pilot
intervention) were identified and appraised for study design and quality
by two investigators.

No studies examined the association between the provision of non-N/S
injecting paraphernalia and incident HCV infection. One cross-sectional
study found that individuals who frequently, compared to those who
infrequently, used sterile cookers and water, were less likely to report
prevalent HCV infection. Another found no association between the uptake
of sterile non-N/S injecting paraphernalia and self-reported sharing of
this paraphernalia. The remaining observational studies used attendance at
needle and syringe exchange programmes (NSP) or safer injection facilities
(SIF) that provided non-N/S injecting paraphernalia as a proxy measure.

Eight studies presented adjusted odds ratios, ranging from 0.3 to 0.9,
suggesting a reduced likelihood of self-reported sharing of non-N/S
injecting paraphernalia associated with use of NSP or SIF. There was
substantial uncertainty associated with these estimates however. Three
unadjusted studies reported a reduction in the prevalence of sharing of
non-N/S injecting paraphernalia over time among NSP users. Only one study
reported an adjusted temporal trend in the prevalence of sharing non-N/S
injecting paraphernalia, finding higher rates among non-NSP users than NSP
users at each time point, and a greater reduction in sharing among non-NSP
than NSP users over time. Study limitations included the use of
convenience samples, self-reported exposure and outcome measures, flawed
classification of the exposed and unexposed groups, and inadequate
adjustment for potential confounding variables.

The evidence to demonstrate that the provision of sterile non-N/S
injecting paraphernalia reduces HCV transmission or modifies injecting
risk behaviours is currently limited by an insufficient volume and quality
of studies. Further research is required to inform practice and policy in
this area.

This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (<url></url>), which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited.

15. Abstract: Is Vancouver Canada’s supervised injection facility cost-

Addiction. 2010 Aug;105(8):1429-36.

Is Vancouver Canada’s supervised injection facility cost-saving?

Pinkerton SD.

Center for AIDS Intervention Research, Department of Psychiatry and
Behavioral Medicine, Medical College of Wisconsin, 2071 North Summit
Avenue, Milwaukee, WI 53202, USA.

Comment in: Addiction. 2010 Aug;105(8):1437-8.

OBJECTIVE: To determine whether Vancouver’s Insite supervised injection
facility and syringe exchange programs are cost-saving–that is, are the
savings due to averted HIV-related medical care costs sufficient to offset
Insite’s operating costs?

METHODS: The analyses examined the impact of Insite’s programs for a
single year. Mathematical models were used to calculate the number of
additional HIV infections that would be expected if Insite were closed.
The life-time HIV-related medical costs associated with these additional
infections were compared to the annual operating costs of the Insite

RESULTS: If Insite were closed, the annual number of incident HIV
infections among Vancouver IDU would be expected to increase from 179.3 to
262.8. These 83.5 preventable infections are associated with $17.6 million
(Canadian) in life-time HIV-related medical care costs, greatly exceeding
Insite’s operating costs, which are approximately $3 million per year.

CONCLUSIONS: Insite’s safe injection facility and syringe exchange program
substantially reduce the incidence of HIV infection within Vancouver’s IDU
community. The associated savings in averted HIV-related medical care
costs are more than sufficient to offset Insite’s operating costs.

16. Abstract: Qualitative accounts of needle and syringe cleaning
techniques among people who inject drugs in Sydney, Australia

Drug Alcohol Rev. 2010 Jul;29(4):413-9.

Qualitative accounts of needle and syringe cleaning techniques among
people who inject drugs in Sydney, Australia.

Nathani J, Iversen J, Shying K, Byrne J, Maher L.

Viral Hepatitis Epidemiology and Prevention Program, National Centre in
HIV Epidemiology and Clinical Research, University of New South Wales,
Sydney, NSW 2010, Australia.

INTRODUCTION AND AIMS: Cleaning needles/syringes is an important second-
line harm reduction strategy, yet there is limited information on
practices employed by people who inject drugs in Australia. This study
attempts to identify and assess cleaning practices in terms of the
techniques involved and the social contexts in which cleaning takes place.

DESIGN AND METHODS: As part of an exploratory qualitative study in south-
west Sydney, in-depth interviews and simulated cleaning exercises were
conducted with 12 people who inject drugs. Interviews were digitally
recorded and transcribed verbatim. Open coding was used to inductively
classify data into themes, and data were examined for patterns and
variations in the relationships within and between themes.

RESULTS: Data indicate that cleaning and reuse of needles/syringes was
common in this small sample. The most frequently utilised reagent was cool
water. While all participants reported cleaning and reusing only their own
equipment, none of the techniques demonstrated would have been sufficient
to deactivate human immunodeficiency virus or hepatitis C virus.

DISCUSSION AND CONCLUSIONS: Results suggest that even where cleaning of
needles and syringes is widespread, people who inject drugs may not engage
in efficacious cleaning. The combination of the complexity of current
cleaning messages and a lack of accurate information about efficacious
techniques are likely to contribute to poor cleaning practice. Australia
could benefit from the development of a nationally consistent cleaning
message; however, the evidence would suggest that this would need to be
accompanied by strategies designed to simplify and disseminate this
information in order to increase the uptake of efficacious cleaning
methods by people who inject drugs.

17. Abstract: Incidence of Hepatitis B and HIV Virus at Cadaver of IV Drug
Abusers in Tehran

Acta Med Iran. 2011 Jan;49(1):59-63.

Incidence of Hepatitis B and HIV Virus at Cadaver of IV Drug Abusers in

Tofigi H, Ghorbani M, Akhlaghi M, Yaghmaei A, Mostafazadeh B, Farzaneh E,
Mohaghegh AR.

Department of Legal Medicine, School of Medicine, Tehran University of
Medical Sciences, Tehran, Iran.

Injection drug use has been the most growing rout of drug abuse in Iran in
the past decade and it has been responsible for the transmission of HIV
virus in more than two third of cases.

The aim of the present study was to determine the prevalence of HIV and
hepatitis B in a group of IDU cadavers and to compare the results to a
group of cadavers of the normal population.

In a case-control study the blood samples of the cadavers of 400 randomly
chosen IDUS and 400 other cadavers as control group were checked for HBS
antigen and Anti HIV antibody in the forensic medicine center of Tehran.
The prevalence of HIV and HBV infection was compared in two groups
according to their demographic characteristics.

The number of HIV and HBV positive cadavers was significantly higher in
the IDU group than the controls (6.25% vs 0.5%, P<0.001, 27.5% vs 3%,
P<0.001). The risk of getting infected by HIV virus was 13.27 times
greater in the IDU group and the risk of HBV infection was 12.26 times
greater in this group as compared to the control group. The age
distribution of IDU cadavers indicated that the percentage of IDU cadavers
in the reproductive (21-40 years old) age was 80%.

The greater prevalence of the HIV and HBV infection especially in the
reproductive age of IDUS indicates a greater concern to the authorities
for more attention to prevention and harm reduction programs.

18. Abstract: Mortality among a cohort of drug users after their release
from prison: an evaluation of the effectiveness of a harm reduction
program in Taiwan

Addiction. 2011 Mar 25. doi: 10.1111/j.1360-0443.2011.03443.x.

Mortality among a cohort of drug users after their release from prison: an
evaluation of the effectiveness of a harm reduction program in Taiwan.

Huang YF, Kuo HS, Lew-Ting CY, Tian F, Yang CH, Tsai TI, Gange SJ, Nelson

Centers for Disease Control, Department of Health, Taipei 10049, Taiwan.
Institute of Health Policy and Management, College of Public Health,
National Taiwan University, Taipei 10055, Taiwan. Department of Public
Health, College of Public Health, National Taiwan University, Taipei
10055, Taiwan. Department of Epidemiology, Bloomberg School of Public
Health, Johns Hopkins University, Baltimore 21205, USA. School of Nursing,
National Yang Ming University, Taipei 11272, Taiwan.

Aims:  To determine the effect of methadone maintenance therapy (MMT) on
mortality among injection drug users.

Design:  A cohort of prisoners with a history of injecting opiates who
were followed after their release from prison in July, 2007. Mortality
between July 2007 and December, 2008 was determined by linking the
National Death Registry with the Methadone Maintenance Treatment (MMT)

Setting:  Taiwan Participants: 4,357 amnestied prisoners with a history of
opiate injection Measurements: The total mortality rates (MR) among the
cohort were calculated based on their person-time contribution to
methadone attendance and re- incarceration during follow-up. We used
survival methods with MMT and re- incarceration as time-varying covariates
adjusted for length of follow-up in the community.

Results:  A total of 142 deaths occurred: 13 in the 1(st) week after
release (MR = 13.7/100 pyrs), which was greater than that in the next 4
weeks (MR = 3.2/100 pyrs, RR = 4.3, P < 0.001). Overall 1,982 (46%)
subjects enrolled in MMT; however, 1,282 of them discontinued MMT after
enrolling. The mortality among those who continued in MMT attendance was
lower (MR = 0.24/100 pyrs) than those who never enrolled in MMT (MR =
2.6/100 pyrs) or those who enrolled but dropped out of MMT (MR = 7.0/100
pyrs) after adjusting for age, gender, and HIV status at amnesty (RR =

Conclusions:  In ex-prisoners in Taiwan with a history of opiate
injecting, enrollment and continued participation in methadone maintenance
treatment (MMT) is associated with substantially lower mortality.

© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

19. Abstract: HIV prevalence and risk behaviors of male injection drug
users in Cairo, Egypt

AIDS. 2010 Jul;24 Suppl 2:S33-8.

HIV prevalence and risk behaviors of male injection drug users in Cairo,

Soliman C, Rahman IA, Shawky S, Bahaa T, Elkamhawi S, El Sattar AA, Oraby
D, Khaled D, Feyisetan B, Salah E, El Taher Z, El Sayed N.

aFamily Health International, Egypt bMinistry of Health, Egypt cSocial
Research Center, The American University in Cairo, Cairo, Egypt.

OBJECTIVE: To measure HIV prevalence and related risk behaviors among male
injection drug users (IDUs) in Cairo, Egypt in the context of the first
survey wave of an integrated biological and behavioral surveillance

DESIGN AND METHODS: Given the hidden nature of injection drug use, we used
the peer-referral methodology of respondent-driven sampling in a cross-
sectional study to recruit a sample of male IDUs in Cairo between May and
August 2006. Behavioral data were collected through face-to-face
interviews and serum was obtained for HIV antibody testing. Population
estimates were produced using respondent-driven sampling Analysis Tool.

RESULTS: The study enrolled 413 male IDUs. The population estimated HIV
prevalence was 0.6% (95% confidence interval 0.1-1.8). More than half
(53.0%) reported injecting drugs with used needles or syringes and nearly
one-third (32.4%) shared their used needle or syringe with one or more
persons in the preceding month. Overall, 70.5% had sex in the preceding
year, of whom 9.4% reported sex with male partners and 13.2% reported sex
with commercial sex workers in the preceding 12 months. Ever use of a
condom during sex was low with all partner types and only 5.8% ever had an
HIV test.

CONCLUSION: This first survey wave of integrated biological and behavioral
surveillance system in Egypt to track the HIV epidemic among male IDUs
found relatively low prevalence of infection compared to global estimates,
though the figure is many times higher than the general population. In
addition, risky injection practices and unprotected sex were high with
sexual networks including men who have sex with men, female sex workers,
wives, and other regular and casual partners. The respondent-driven
sampling method was effective in recruiting male IDUs and the results are
being used to inform surveillance and prevention programs.

20. Abstract: Comparing sexual risks and patterns of alcohol and drug use
between injection drug users (IDUs) and non-IDUs who report sexual
partnerships with IDUs in St. Petersburg, Russia

BMC Public Health. 2010 Nov 5;10:676.

Comparing sexual risks and patterns of alcohol and drug use between
injection drug users (IDUs) and non-IDUs who report sexual partnerships
with IDUs in St. Petersburg, Russia.

Abdala N, White E, Toussova OV, Krasnoselskikh TV, Verevochkin S, Kozlov
AP, Heimer R.

Department of Epidemiology and Public Health, Yale University School of
Medicine, New Haven, CT, USA.

BACKGROUND: To date, the great majority of Russian HIV infections have
been diagnosed among IDUs and concerns about the potential for a sexual
transmission of HIV beyond the IDU population have increased. This study
investigated differences in the prevalence of sexual risk behaviors
between IDUs and non-IDUs in St. Petersburg, Russia and assessed
associations between substance use patterns and sexual risks within and
between those two groups.

METHODS: Cross-sectional survey data and biological test results from 331
IDUs and 65 non-IDUs who have IDU sex partners were analyzed. Multivariate
regression was employed to calculate measures of associations.

RESULTS: IDUs were less likely than non-IDUs to report multiple sexual
partners and unprotected sex with casual partners. The quantity, frequency
and intensity of alcohol use did not differ between IDUs and non-IDUs, but
non-IDUs were more likely to engage in alcohol use categorized as risky
per the alcohol use disorders identification test (AUDIT-C). Risky sexual
practices were independently associated with monthly methamphetamine
injection among IDUs and with risky alcohol use among non-IDUs. Having sex
when high on alcohol or drugs was associated with unprotected sex only
among IDUs.

CONCLUSIONS: Greater prevalence of sexual risk among non-IDUs who have IDU
sex partners compared to IDUs suggests the potential for sexual
transmission of HIV from the high-prevalence IDU population into the
general population. HIV prevention programs among IDUs in St. Petersburg
owe special attention to risky alcohol use among non-IDUs who have IDU sex
partners and the propensity of IDUs to have sex when high on alcohol or
drugs and forgo condoms.

21. No Abstract: Ocular perforation by an acupuncture needle

Can J Ophthalmol. 2011 Feb;46(1):94-5.

Ocular perforation by an acupuncture needle.

Fielden M, Hall R, Kherani F, Crichton A, Kherani A.

22. Job Title: Immunization Technical Officer

Apply online at:

Job Title: Immunization Technical Officer

Posting Date: 03/25/2011

Deadline Date: 04/15/2011

Starting Date: 04/18/2011


MCHIP (Maternal and Child Health Integrated Program) is the USAID/Bureau
for Global Health’s flagship maternal, newborn and child health (MNCH)
program. Implemented by Jhpiego in partnership with JSI, Save the
Children, MACRO International, PATH, JHU/IIP, Broad Branch Associates, and
PSI, MCHIP addresses the barriers to accessing and using focused,
evidence-based MNCH interventions from pre-pregnancy to age five. The
Program is designed to achieve impact at scale by maximizing the
contributions of each level of the health system-from the community to
the national level. MCHIP works with countries based on their individual
needs and circumstances and contributes technical leadership at the global
and regional levels, as well. JSI leads MCHIPs work in child health,
immunization and pediatric HIV/AIDS and brings several decades of
experience in health systems strengthening and MNCH to the project team.
MCHIP’s immunization team develops and supports country, regional and
global initiatives and provides technical leadership through direct
consultations, operations research, and the transfer of information and
promising program approaches to the field.


Approximately 60-80% of this team member’s time will be spent on New and
Underutilized Vaccine Introduction (NUVI). In alignment with the
principles of the U.S. Government’s Global Health Initiative (GHI), MCHIP
provides technical support to MOHs and national partners in sub-Saharan
Africa to introduce highly efficacious, affordable, safe, high-quality new
and/or underutilized vaccines and innovative technologies. To ensure that
countries can make rational, evidence-based decisions about the choice of
new vaccines and technologies, the TO will work with USAID MCH and GHI
priority countries to prioritize among the available vaccine products;
review vaccine product characteristics to ensure selection of
programmatically suitable products; address delivery systems issues
including cold chain and logistics; plan advocacy and communication
activities; weigh the cost-effectiveness of various strategies; assist
countries to prepare for introduction through updating comprehensive
multi-year plans; preparation of NUVI plans and GAVI applications; and
integrate vaccination within the broader context of disease prevention and

An estimated 20-40% of the TO’s level of effort will be spent on other
MCHIP immunization activities. To those developing countries that request
technical assistance from MCHIP (e.g. Zimbabwe), the TO will provide
expertise towards the design, implementation, evaluation and documentation
of interventions leading to sustainable and high quality routine
immunization coverage. This may include providing technical input to
improve the planning, management, coordination, training, monitoring,
and/or evaluation of routine immunization services.

In all activities, the TO will be called upon to work with technical staff
from other international partner organizations at country, regional and
global levels on key policies and program strategies.

Responsibilities will include, but not be limited to, the following
assigned duties:

Participate in defining and implementing MCHIP’s technical agenda with
particular focus on new and underutilized vaccine introduction;
Provide technical assistance for preparedness, implementation and/or
monitoring/evaluation of new vaccine introductions (pneumococcal
conjugate, rotavirus, meningitis conjugate) in up to 8-10 sub-Saharan
African countries

Provide guidance to USAID/Washington bureaus and country missions in the
areas of immunization and the control of vaccine-preventable disease;
Identify the needs and provide technical support and backstopping for
regional and country interventions related to routine immunization,
introduction of new vaccines, accelerated disease control, and other
aspects of quality immunization service delivery;

Work with USAID missions and projects, Ministries of Health, other
international partners, and MCHIP country advisors in developing planning,
implementation and evaluation capacity at national and sub-national

Participate in the selection, orientation and supervision of MCHIP country
and regional staff and consultants;

Provide direct on-site technical assistance to country programs and other
field activities;

Participate in the development and monitoring of annual work plans,
budgets, reports, and performance reviews and requirements;

Participate in and train others in use of data at national and sub-
national levels to strengthen planning, management and monitoring of
progress towards achievement of new vaccine and/or routine immunization

Prepare issues papers, technical documents, presentations and peer-
reviewed articles on program strategies, findings and research results;
Perform other technical duties as assigned by the Immunization Team


Graduate degree in public health or equivalent and a minimum 10 years
working in the field of international public health

At least seven years direct experience providing technical assistance on
routine immunization at national or sub-national level in developing
countries, including at least three years in Africa

Experience as an advisor to ministries of health, international agencies
and/or NGO public health programs

Proven ability to assess routine immunization needs and to develop and
implement successful program interventions, including prior experience
with: 1) national or sub-national immunization planning; 2) capacity
building for system strengthening; 3) design of community-oriented
strategies to increase coverage; 4) use of immunization data for
monitoring and decision making; 5) assessment of cold chain and logistics
performance and needs; and, 6) other actions to sustain quality
immunization services.

Excellent interpersonal and team skills–demonstrated ability to interact
professionally with culturally and linguistically diverse staff, clients,
and consultants

Ability to work independently, manage multiple tasks concurrently, and
meet deadlines with attention to detail and quality

Fluent spoken and written English; ability in French desirable
Excellent written and oral communication and computer skills

Willingness to travel up to 40% of the time in the Africa region
Prior experience working with USAID development projects

Salary commensurate with experience.

Interested candidates should submit their resumes and cover letters online
by 04/15/2011.

No phone calls please.
Principals only please.

JSI is an Equal Opportunity, Affirmative Action Employer committed to
workplace diversity. Women and minority candidates are encouraged to
apply. M/F/H/V/D

23. News

-USA: Health officials investigate bacteria outbreak at Ala. hospitals
-Nepal: Fake vaccinators apprehended in capital
-USA: Several patients die after being treated with contaminated IV bags
-UK: Home tattoo kits ‘are putting teenagers at risk from disease’
-Canada: Saskatoon Fire Department warns people to watch out for needles
Many being uncovered as weather gets warmer
-Australia: Hysteria Takes Hold as Schoolgirls Fear the Needle”
-Canada: Health Officials Credit Harm Reduction for Decline in B.C. HIV
-UK: Hepatitis C compensation boost
-Nevada USA: Nevada Doctor Says Vendor OK’d Needle Guide Reuse

Selected news items reprinted under the fair use doctrine of international
copyright law:

USA: Health officials investigate bacteria outbreak at Ala. hospitals
By Margo Gray, WAFF, Huntsville, AL USA (30.03.11)

MONTGOMERY, AL (WAFF)-Health officials are investigating a bacteria
outbreak at six Alabama hospitals.

State Health Officer Don Williamson said nine deaths are being
investigated in connection to the outbreak of Serratia marcescens.

On March 16, ADPH was notified that an outbreak had occurred in two
hospitals among patients receiving TPN (total parenteral nutrition).

TPN is liquid nutrition fed through an IV using a catheter. Use of
contaminated products may lead to bacterial infection of the blood.

ADPH requested assistance from the Centers for Disease Control and
Prevention. CDC’s initial investigation identified TPN produced by Meds
IV, a Birmingham based pharmacy, as a potential common source. All of the
hospitals received TPN from this pharmacy.

Affected hospitals are Baptist Princeton, Baptist Shelby, Baptist
Prattville, Medical West, Cooper Green Mercy and Select Specialty Hospital
in Birmingham.

Meds IV was notified and informed its customers of potential
contamination. All six of the impacted hospitals immediately stopped using
TPN from Meds IV. Med IV also discontinued all production.

On March 24, Meds IV recalled all of its IV compounded products. The U.S.
Food and Drug Administration is aware of the voluntary recall. The
pharmacy and the hospitals are cooperating with the investigation.

Williamson said ADPH is aware of 19 cases in these six hospitals of
Serratia marcescens bacteremia related to this outbreak.

Copyright 2011 WAFF. All rights reserved

Nepal: Fake vaccinators apprehended in capital
Arjun Poudel, Republica, Kathmandu Nepaql (29.03.11)

KATHMANDU, March 29: Police apprehended four people for administering fake
hepatitis B vaccine to the public in Boudha following the tip-off from the
District Public Health Office (DPHO), Kathmandu.

DPHO Chief Bisho Ram Shrestha said the police have handed over the quack
vaccinators to Kathmandu District Administration Office for punishment.
Claiming such vaccines can have disastrous impact on human health,
Shrestha said, “Preventing fake vaccinators from selling unapproved
vaccines has become a major challenge for us.”

According to DPHO, all vaccines must have quality approval from World
Health Organization (WHO) before being administered. Likewise, vaccines
must also get approval from the Department of the Drug Administration
(DDA). The vaccines administered by the arrested vaccinators had approval
from neither of the agencies.

“We have not given consent to any organization in the country to
administer hepatitis B vaccines,” Shrestha said. The government does not
have a policy to give consent for administrating hepatitis B vaccine. The
vaccines for hepatitis B, the most common serious liver infection, are
administered in Nepal only through those authorized by the government.

The arrested vaccinators were found to possess identity cards of a fake
non-governmental organization.

“We confiscated bills and identity cards of ´Heal Nepal´ and ´Janasewa
Nepal´ from them,” Dhurba Adhikari, a public health officer at DPHO,
Kathmandu, revealed. Adhikari said the vaccinators smuggled unapproved
vaccines from India. “We do not know about the quality of the vaccines
they were using. It could be distilled water or something else,” Adhikari

The vaccinators were found charging Rs 50 for administering vaccine to
children aged 10 years, and Rs 100 to those above the age. DPHO chief
Shrestha revealed that such fake vaccinators influence school principals
to sell vaccine to students. Due to open border, the DDA faces difficulty
in curbing the flow of unapproved medicines into the Nepali market. Though
DDA has prohibited pharmacies from selling unregistered drugs, the
agency´s latest report indicate their existence in the market.

The government has been providing free hepatitis B vaccine to children
since past 10 years. “We administer the vaccine through our regular
programs, thus, children below 10 years do not have to take additional
vaccines,” chief Shrestha said.

Published on 2011-03-29 06:00:53

USA: Several patients die after being treated with contaminated IV bags
By Scott Brown, Alabama’ Alabama USA (29.03.11)

BIRMINGHAM – Several deaths in Alabama hospitals have been linked to a
bacteria infection from IV bags.

The Alabama Department of Public of Health and Centers for Disease Control
and Prevention have been working together to investigate the deaths.

Wednesday they released their findings during a live webcast.

According to the agencies, nine patients have died from the bacteria

Several Birmingham hospitals including, Baptist Princeton, Baptist Shelby,
Medical West, Cooper Green Mercy and Select Specialty Hospital in
Birmingham in addition to Baptist Prattville have reported the bacterial

A single pharmacy provided the hospitals with the contaminated product.

That pharmacy, Meds IV, has voluntarily recalled all of the products.

UK: Home tattoo kits ‘are putting teenagers at risk from disease’
By Martin Hickman, The Independent, UK (29.03.11)

Teenagers are putting themselves at risk of debilitating and potentially
deadly blood diseases by buying DIY tattoo kits over the internet. At £60
a time, the kits come with inks, needles and designs but there are no
controls over age of the recipient, infectious diseases, or cleanliness.
Children have caught hepatitis from such kits, which are cheaper than
visiting a professional, particularly if used several times.

The Chartered Institute of Environmental Health (CIEH) sounded the alarm
after carrying out an investigation into tattooing trends and practise.
Professional parlours are legally required not to tattoo anyone under 18
and are licensed and inspected by local authorities. By contrast, Chinese-
made kits often have no instructions.

Julie Barratt, the CIEH director, said: “The age of consent goes out the
window. You are not going to ask questions about health. You could be
tattooing your mates all in one go and passing on infections. You also
cannot trace people if anything goes wrong. You wouldn’t do this with
anything else-you can’t stroll into Boots and buy a needle.”

Unsafe tattooing-without health screening and cleanliness-risks
spreading HIV/Aids and hepatitis. In Llanelli, south Wales, in 2008,
teenagers as young as 14 using DIY kits found that their tattoos becoming
infected and Several contracted hepatitis.

In a study to be published on Thursday, the CIEH’s Wales researcher,
Stephanie Powell, found that more than half of professional tattooists
broke rules on best practise. Students visited parlours posing as
potential customers and asked by telephone whether tattooists would work
at an all-weekend 30th birthday party.

Of the 33 parlours visited, only 61 per cent screened for medical
conditions and only 52 per cent offered any advice. Only 7 per cent asked
for proof that the client was an adult. Of 56 licensed parlours asked
whether they would attend the party, 49 rejected the idea. However, seven
accepted despite the likelihood of the clients’ decisions being influenced
by alcohol or peer pressure. Conditions might have been unclean or unsafe
for other reasons. The research, carried out in Cardiff, Caerphilly,
Newport, Bridgend, Monmouthshire, Rhondda-Cynon Taf, Torfaen and the Vale
of Glamorgan, will be presented to a CIEH conference on Thursday.

Describing some of the findings as “astonishing”, Ms Barratt said tattoos
should be regulated more closely because they were occasional purchases as
well as being permanent. “It’s not like having your fringe cut-it’s not
going to grow back,” she said.

Charles Gore, the Chief Executive of The Hepatitis C Trust, said: “The
rise in DIY tattooing is particularly alarming when you consider viruses
such as hepatitis C. Most people don’t realise that transmission’s not
just about needles: sharing any equipment, including things like ink pots,
is a risk. Often hepatitis C has no symptoms for decades so anyone who has
had a tattoo that might not have been safe, at home or on holiday, should
think about getting tested. Like everything, hepatitis C is a lot easier
to treat if it’s caught early.”

Canada: Saskatoon Fire Department warns people to watch out for needles
Many being uncovered as weather gets warmer
Reported By Chris Carr, NewsTalk650, Canada (28.03.11)

The Saskatoon Fire Department is warning people to be on the lookout for
dirty needles in parks and playgrounds around the city as the snow
continues to melt.

Assistant Fire Chief Dan Paulsen says many needles are already being
reported, adding many more will likely be found as the weather get warmer
in the coming days.

“We should all be paying care and attention. And as the snow reduces,
really look after where the kids start to be active for the safety
concern,” said Paulsen.

People are urged to use gloves, pliers, or tweezers if removing a needle
on their own. If they aren’t comfortable doing that, people can call the
city’s health hotline at 655-4444 and they will come remove it.

Australia: Hysteria Takes Hold as Schoolgirls Fear the Needle”
Jim O’Rourke, Sydney Morning Herald, Sydney Australia (27.03.11)

A new study examines the fear response of girls in a school-based human
papillomavirus (HPV) vaccination program and suggests ways to alleviate
their distress.

All Australian girls ages 11 to 13 are offered the HPV vaccine Gardasil in
a free, voluntary, school-based immunization program; however, only 75
percent of 12- to 13-year olds have gotten the shots. Principal
investigator Rachel Skinner, an associate professor in pediatrics and
child health at the University of Sydney, and colleagues were surprised at
the distress the girls suffered.

“There was intense fear and anxiety among the girls. It bordered on
hysteria,” Skinner said. “Some of them couldn’t be calmed down. It was
having a domino effect on the other girls.”

“The lack of information within the schools’ immunization program causes a
vacuum, an environment where myths and rumors spread,” Skinner said. “Some
girls thought they were going to be injected with a ‘little bit of
cancer.’ Others thought they would be injected in the cervix.” In fact,
the shots block the HPV strains linked to most cervical cancer cases.

The study was based upon observations of three schools on vaccination days
and interviews with 130 adolescents, 38 parents, 10 teachers, and seven

“Our results indicated that fear was promoted by witnessing the fear
reactions of peers; perceived judgment by peers; lack of information or
misinformation; and being vaccinated later in the day,” the authors wrote.
“Fear was moderated by procedural factors, the support of peers,
appropriate knowledge, and nurses’ distraction techniques or approaches.”
These steps could include using puzzles, iPods or stress toys to distract
the girls waiting for their injection.

“Fear of HPV vaccination was a near-universal experience among adolescents
in the school setting and was often associated with significant distress
that had an adverse impact on the vaccination process,” the authors
concluded. “School vaccination could be improved by proactively managing
fear and distress.”

The study, “The Domino Effect: Adolescent Girls’ Response to Human
Papillomavirus Vaccination,” was published in the Medical Journal of
Australia (2011;194(6):297-300).

Canada: Health Officials Credit Harm Reduction for Decline in B.C. HIV
Canadian Press, Canada (24.03.11)

New HIV cases among injection drug users are down in British Columbia,
report health officials who cite an aggressive test-and-treat campaign and
harm reduction programs. In 2009, the province recorded 64 new HIV cases
among IDUs, down from 137 cases in 2000, an expert working group found.

The overall number of HIV-positive tests also declined in 2008-09, for all
ethnic groups and in both males and females, the province reported. The
most apparent decrease was in people ages 20-39.

While the number testing for hepatitis C virus has grown, reported HCV
cases are down-another proxy for potential HIV transmissions among IDU.
In 2009, 120,000 people were tested for HCV, up from 64,000 in 1998.
Reported HCV cases fell from 4,353 in 2000 to 2,444 in 2009. The report
also noted an increase in crack use and fewer young IDUs.

“The recent decline in new HIV cases is encouraging, especially since a
significant decrease has been seen amongst vulnerable populations like
those who use injectable drugs,” said Dr. Perry Kendall, provincial health
officer. “This decrease is more proof that highly active antiretroviral
therapy and other harm reduction services are working and should be

In February 2010, the province launched the four-year, $48 million (US
$49.1 million) Seek and Treat to Optimally Prevent HIV/AIDS (STOP AIDS)
pilot. Led by Dr. Julio Montaner and his colleagues at the B.C. Center for
Excellence in HIV/AIDS, STOP AIDS helps link at-risk populations in Prince
George and inner-city Vancouver to testing and treatment services.

STOP AIDS follows the province’s success in boosting treatment uptake
among those who are HIV-positive. Between 1996 and 2009, the number of
British Columbian HIV/AIDS patients on antiretroviral therapy grew 547
percent, while new HIV diagnoses fell 52 percent.

To access the report, visit

UK: Hepatitis C compensation boost
Belfast Telegraph, Northern Ireland (24.03.11)

Northern Ireland people who contracted hepatitis C from contaminated blood
through the NHS will receive extra compensation.

Health minister Michael McGimpsey said a one-off payment will rise to
£50,000 for some, and there will also be an annual payment of £12,800 for
patients with hepatitis C from blood transfusions who develop serious
liver disease.

Mr McGimpsey said: “It is only right and proper that people in Northern
Ireland whose lives, and families, have been adversely affected by NHS
treatment with infected blood should be appropriately supported.

“These new measures will ensure that additional financial support will be
provided to people who have been affected, particularly those who are
suffering most or experiencing financial hardship as a result of their

“I hope these additional financial measures will go some way towards
helping to improve the lives of those tragically infected with hepatitis C
by contaminated blood products.”

It follows a similar decision in England, Wales and Scotland. Almost 4,300
people across the UK, mainly haemophiliacs, were infected after being
treated in the 1970s and 1980s.

The new provisions include doubling the one-off payment made to those with
the most serious hepatitis C-related diseases to £50,000. Annual payments
will rise in line with the cost of living.

The Haemophilia Society welcomed the extra support. Chief executive Chris
James said on Thursday: “Today’s announcement is a step in the right

“However, the society remains deeply concerned that the levels of
compensation for all those affected are far too low. There is little or no
provision for the majority of those living with the real and potentially
devastating impact of hepatitis C.

“There is also no provision to help with access to insurance-a major
concern for those affected. We continue to press health ministers in all
parts of the UK to work together to produce a fair and consistent approach
to supporting people affected by the contaminated blood disaster.”

Nevada USA: Nevada Doctor Says Vendor OK’d Needle Guide Reuse
Associated Press  (23.03.11)

In a half-page ad in Wednesday’s Las Vegas Review-Journal, lawyers for Dr.
Michael Kaplan said the urologist was following a vendor’s instructions
when he reused needle guides during biopsies. Kaplan ceased the practice
“the moment a question arose,” the ad says. The Nevada Board of Medical
Examiners said Kaplan, whose license was suspended Monday, told his staff
to reuse the single-use guides three to five times.

The Southern Nevada Health District has said it is unknown whether any
diseases were transmitted, but it is advising more than 100 patients who
underwent prostate biopsy from Dec. 20 to March 11 to undergo testing for
HIV and hepatitis.
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