*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *SAFE INJECTION GLOBAL NETWORK* Post00507 Outbreak + Postings? + IPCAN + Abstracts + ILO 05 August 2009 CONTENTS 1. A Suspected Nosocomial HIV outbreak in Gujrat Pakistan 2. SIGN posting? 3. Updated: 1st African Congress On Infection Prevention Control - 2009 4. Abstract: HIV Infections as Unanticipated Problems During Medical Research in Africa 5. Abstract: Epidemiologic investigation of a 2007 outbreak of Serratia marcescens bloodstream infection in Texas caused by contamination of syringes prefilled with heparin and saline 6. Abstract: Evaluation of home health care nurses' practice and their employers' policies related to bloodborne pathogens 7. Abstract: Infection control practices among interventional radiologists: results of an online survey 8. Abstract: Hepatitis C outbreak in an oncology ward 9. Abstract: Hepatitis C Virus Transmission in Hemodialysis Units: Importance of Infection Control Practices and Aseptic Technique 10. Abstract: Are hospitals too clean to trigger good hand hygiene? 11. Abstract: Limitations of the efficacy of surface disinfection in the healthcare setting 12. Abstract: Self-protection as a driver for hand hygiene among healthcare workers 13. Abstract: Injectable immunotherapy: recommendations for safe allergen vial preparation in the office setting 14. Abstract: Local antibiotics are equivalent to intravenous antibiotics in the prevention of superficial wound infection in inguinal hernioplasty 15. Abstract: Safety evaluation of traditional Chinese medicine injections and study of related key technology 16. Abstract: Immunological risk of injectable drug delivery systems 17. Abstract: Factors associated with an explosive HIV epidemic among injecting drug users in Sargodha, Pakistan 18. Abstract: Injecting drug users' understanding of hepatitis C 19. Abstract: Drug choice, spatial distribution, HIV risk, and HIV prevalence among injection drug users in St. Petersburg, Russia 20. Abstract: Epidemiology of HCV Infection in the General Population: A Survey in a Southern Italian Town 21. Abstract: Nosocomial contamination of laryngoscope handles: challenging current guidelines 22. Abstract: Impact of organisation and management factors on infection control in hospitals: a scoping review 23. Abstract: Comparison of 0.05% Chlorhexidine and 10% Povidone-Iodine as Cutaneous Disinfectant for Prevention of Central Venous Catheter- Related Bloodstream Infection: A Comparative Study 24. Abstract: Arguments for mandatory influenza vaccination 25. Abstract: Evaluation of the exposure equivalence of oral versus intravenous temozolomide 26. ILO - Various Positions 27. News - Handwashing, facemasks to prevent flu spread at home - Australia: Fury over [syringe] drug sale near primary school in NSW - Uzbekistan: Activists Strive To Raise Awareness About HIV/AIDS - African woman infected with gorilla strain of HIV: A woman from Cameroon now living in France is the first person confirmed to have a type of HIV originating in gorillas rather than chimpanzees - Indonesia: Indonesia's drug fight pushing prison AIDS explosion - Philippines: NBI warns public on fake anti-flu vaccines - USA: Washington Supports Exchange of Needles - USA: APIC Promotes Safe Injection Practices to Prevent Bloodborne Infections - USA: VA Victims to File Disability Claims - Iran: Needle and syringe sharing among Iranian drug injectors - China: Hepatitis Group Is Harassed in China - UK: Bristol dentist's patients tested for HIV and hepatitis - Philippines: NBI seizes P4M worth of fake flu vaccines - MedImmune Seeks Fast Track for FluMist - Canada: Review blames old habits for reuse of dirty syringes This edition of SIGNpost is located at: http://uqconnect.net/signfiles/Archives/SIGN-POST00507.txt and is printer friendly. 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A Suspected Nosocomial HIV outbreak in Gujrat Pakistan __________________________________________________________________________ Date: Fri, 17 Jul 2009 From: David Gisselquist Subject: A Suspected Nosocomial HIV outbreak in Gujrat Pakistant To: sign@uq.net.au Response to evidence of nosocomial HIV transmission in Gujrat, Pakistan In mid-2008, the New Light AIDS Control Society, a local NGO, realized that it was finding a higher than usual number of HIV infections during voluntary counseling and testing in Gujrat District, Punjab, Pakistan. To findout what was happening, the NGO organized testing for 254 people in two screening camps on 27 June and 1 July in Jalal Pur Jattan, a small town near Gujrat. Eighty-eight of 246 people tested HIV-positive. By early July 2008 the NGO had found more than 90 people with HIV in the community. Alarmed by this situation, the NGO sought assistance from Canada-Pakistan HIV/AIDS Surveillance Project (HASP). Faran Emmanuel, HASP's Chief Technical Officer, analyzed available data on 91 HIV-positive people in Jalal Pur Jatan, Gujrat District. His mid-2008 report provides the best information available to date on the situation. The report is available at: http://exdimension.net/rashid/work/OUTBRE~1.PDF The report points to a nosocomial outbreak. More than half of those who tested HIV-positive were women. Many HIV-positive women had HIV-negative husbands, or were not married and claimed not to have had any sex partners. Among women, having had a medical injection was the most common risk. Among HIV-positive women with HIV-negative husbands, 87% reported medical injections. Two children were found to be HIV-positive with HIV-negative parents. Out of 91 HIV-positive people, 37 (20 women and 17 men) had an HIV- positive spouse. This suggests that the nosocomial outbreak has been spreading for some time -- long enough for many men and women infected through health care to unknowingly transmit HIV to spouses through sex. Faran's report recommends that "further testing of the community should be done to detect infections that have still gone unnoticed." This is crucial. In comparable situations in Russia in 1988-89, Romania in 1989-91, Libya in 1998-99, and Kazakhstan in 2006, government health officials directed investigations that tested thousands of people who may have been exposed to HIV through health care =E2=80=93 finding hundreds to more than a thousand infections. This allowed health officials to identify the health procedures and clnics that spread HIV, so that transmission could be stopped. In November 2008, four months after an NGO identified the suspected outbreak in Gujrat District, Pakistan's National AIDS Control Program published a short report on the situation. Unfortunately, this report added little to what HASP had already uncovered: http://exdimension.net/rashid/work/REPORT~1.pdf In 2008, the US CDC looked into the situation, and did some limited blood testing. As of mid-July 2009, more than a year after the outbreak was recognized, CDC's report has not been made public. Sources report that CDC's investigation did not adequately address the nosocomial nature of Gujrat's outbreak. In the mean time, doctors treating HIV-positive patients from Gujrat have seen more suspected nosocomial infections. AIDS activists in Pakistan have asked for more attention to injection safety to stop HIV, and have noted that Pakistan already has a high burden of hepatitis in the general population, which is evidence for blood exposures in health care. Reportedly, Government of Pakistan plans to conduct fresh investigations in Gujrat and elsewhere, with attention to nosocomial risks. Further investigations are crucial. Without investigations, testing many more people to find the extent of the outbreak, and to trace the risks, experts can guess about what blood exposures might be spreading HIV, but they don't know. How much of the outbreak is due to quacks giving unsafe injections? How much is due to street dentists reusing instruments without boiling them first? Without an investigation, prevention is a guess. __________________________________________________________________________ _____________________________________*____________________________________ 2. SIGN posting? __________________________________________________________________________ Date: Thu, 30 Jul 2009 From: David Gisselquist david_gisselquist[at]yahoo.com Subject: Sign posting? To: SIGN Moderator Dear Allan, How have you been? Busy, I'm sure! About a week ago, I sent several items to SIGNpost: an abstract from my latest paper just published in Accountability in Research; and a note and links to reports on a nosocomial HIV outbreak in Gujrat, Pakistan. Have you received? Is there any problem with the submissions? If not, when can I expect to see them on SIGNpost. Best regards, .......................................................................... __________________________________________________________________________ From: sign moderator sign[at]uq.net.au Date: 05 Aug 2009 Dear David, Yes! Thanks for your note - your posting on the Nosocomial outbreak in Gujrat Pakistan was lost in my mailbox. Sorry! Now found and it will go out in today's SIGNpost. On the other items posted - you may have missed SIGNpost 00502 during the listserve problems a few weeks ago that seems to have interrupted one or two editions for only some subscribers - now fixed by the UC IT engineers . I'll put the archive links in for you and post a note on SIGNpost for anyone else that missed Post00502 My apologies. If you do not see your postings please check with me again - with a few hundred spams a day sometimes things get lost. regards and best, allan .......................................................................... __________________________________________________________________________ This post was in: Post00502 on 08 July http://uqconnect.net/signfiles/Archives/SIGN-POST00502.txt 4. How to contain generalized HIV epidemics? A plea for better evidence to displace speculation Int J STD AIDS. 2009 Jul;20(7):443-6. How to contain generalized HIV epidemics? A plea for better evidence to displace speculation. Gisselquist D, Potterat JJ, St Lawrence JS, Hogan M, Arora NK, Correa M, Dinsmore WW, Mehta G, Millogo J, Muth SQ, Okinyi M, Ounga T. .......................................................................... __________________________________________________________________________ This was in: Post00497 on 03 June 2009 http://uqconnect.net/signfiles/Archives/SIGN-POST00497.txt 1. Points to Consider now available on-line From: David Gisselquist Subject: Points to Consider now available on-line To: SIGN Moderator Hi Allan, Points to Consider: Responses to HIV/AIDS in Africa, Asia, and the Caribbean is now available online (free download) at: http://davidgisselquist.googlepages.com/pointstoconsider This is an updated version, slightly revised from the 2008 edition published by Adonis & Abbey. See also two on-line reviews of Points to Consider at: http://www.amazon.com/Points-Consider-Responses-Africa-Caribbean/product- reviews/190506845X/ref=dp_top_cm_cr_acr_txt?ie=UTF8&showViewpoints=1 or: http://is.gd/N7tL Best regards, David __________________________________________________________________________ _____________________________________*____________________________________ 3. Updated: 1st African Congress On Infection Prevention Control - 2009 __________________________________________________________________________ 1st African Congress On Infection Prevention Control - 2009 Hosted By Infection Prevention Control African Network (IPCAN) 21 - 23 September 2009 Speke Resort Kampala * Registration can be done by fax * There is a $100 prize for the best free paper * The provisional programme Topics Infection Prevention & Control in Africa Emerging Infectious Diseases: IPC implications Occupationally acquired diseases Water as a vector for infection: concerns in Africa Blood borne virus transmission: safety aspects The World of sterilization of medical devices The impact of HIV on IPC programmes in Africa. The role of copper in IPC- looking into the future Community based IPC, rituals and practice TB containment guidelines: can these be implemented in Africa? Transfer of technologies to manufacture IPC technologies in Africa Monitoring & Evaluation: Getting it right? Education Programmes in IPC: what is happening in Africa Bundling: a new concept in IPC management Managing Healthcare Waste What is new in phlebotomy? WHO draft guidelines Healthcare associated infections: current situation in Africa * Invited speakers from - World Health Organisation - International Federation of Infection Control - World Federation of Hospital Sterile Supplies Please visit the website: http://www.ipcan2009.co.za __________________________________________________________________________ _____________________________________*____________________________________ 4. Abstract: HIV Infections as Unanticipated Problems During Medical Research in Africa __________________________________________________________________________ HIV Infections as Unanticipated Problems During Medical Research in Africa Author: DAVID GISSELQUIST DOI: 10.1080/08989620903065277 Published in: Accountability in Research, Volume 16, Issue 4 July 2009 , pages 199 - 217 Regulations and guidelines in the United States, Canada, and the United Kingdom require institutions that manage medical research on humans anywhere in the world to protect research participants. Analyses of published data from six medical research projects in Africa funded by governments and other organizations in the above countries reveal HIV infections statistically linked to participation in research. Given this evidence, regulations and guidelines obligate institutions that fund, manage, or regulate these projects to investigate to determine if invasive procedures in research clinics infected participants. Findings from such investigations could have a broad and beneficial impact on health care safety in Africa. Keywords: Africa; ethics; HIV; medical research; unanticipated problems __________________________________________________________________________ _____________________________________*____________________________________ 5. Abstract: Epidemiologic investigation of a 2007 outbreak of Serratia marcescens bloodstream infection in Texas caused by contamination of syringes prefilled with heparin and saline __________________________________________________________________________ Infect Control Hosp Epidemiol. 2009 Jun;30(6):593-5. Epidemiologic investigation of a 2007 outbreak of Serratia marcescens bloodstream infection in Texas caused by contamination of syringes prefilled with heparin and saline. Su JR, Blossom DB, Chung W, Gullion JS, Pascoe N, Heseltine G, Srinivasan A. Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. john.su@cdc.hhs.gov This retrospective cohort study found that syringes prefilled with heparin flush solution caused an outbreak of Serratia marcescens bloodstream infection at an outpatient treatment center in Texas in 2007. The epidemiologic study supported this conclusion, despite the lack of microbiologic evidence of contamination from environmental and product testing. This report underscores the crucial contributions that epidemiologic studies can make to investigations of outbreaks that are possibly product related. __________________________________________________________________________ _____________________________________*____________________________________ 6. Abstract: Evaluation of home health care nurses' practice and their employers' policies related to bloodborne pathogens __________________________________________________________________________ AAOHN J. 2009 Jul;57(7):275-80. Evaluation of home health care nurses' practice and their employers' policies related to bloodborne pathogens. Scharf BB, McPhaul KM, Trinkoff A, Lipscomb J. University of Maryland, USA. The purpose of this descriptive study was to assess home health care nurses' exposure to bloodborne pathogens, evaluate Medicare Certified Home Healthcare Agency (MCHHA) and hospice organization practices related to the Occupational Safety and Health Administration's (OSHA) Bloodborne Pathogens Standard and the Needlestick Safety and Prevention Act, and link the two to recommend safety improvements. This study evaluated the experiences of 355 home health care nurses and 30 MCHHA and hospice employers in one mid-Atlantic state regarding bloodborne pathogen programs and practices and blood and sharps contact. An index was developed to evaluate employer compliance with OSHA's Bloodborne Pathogens Standard. Employer policies and nurse practice related to the OSHA Bloodborne Pathogens Standard did not meet all requirements despite identified risk. Thirty-eight home health care nurses from 12 of the 30 employers reported needlestick injuries within the past year, yet employers reported only 18 nurse needlestick injuries within the same year. Using the bloodborne pathogen compliance index, employers can review and revise their exposure control plans to ensure compliance. This intervention should benefit both employer policies and nurse practice to improve safety and decrease the risks from bloodborne pathogens in the home health care setting. __________________________________________________________________________ _____________________________________*____________________________________ 7. Abstract: Infection control practices among interventional radiologists: results of an online survey __________________________________________________________________________ J Vasc Interv Radiol. 2009 Aug;20(8):1070-1074.e5. Infection control practices among interventional radiologists: results of an online survey. Reddy P, Liebovitz D, Chrisman H, Nemcek AA Jr, Noskin GA. Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, 645 North Michigan Avenue, Chicago, IL 60611, USA. p-reddy2@md.northwestern.edu PURPOSE: To assess current infection control practices of interventional radiologists (IRs) in the context of recommendations by the Centers for Disease Control and Prevention and the Occupational Safety and Health Administration. MATERIALS AND METHODS: From November 2006 to January 2007, members of the Society of Interventional Radiology (SIR) were invited to participate in an anonymous, online infection control questionnaire. RESULTS: A total of 3,019 SIR members in the United States were contacted via e-mail, and 1,061 (35%) completed the 57-item survey. Of the respondents, 283 (25%) experienced a needlestick injury within the previous year, most often as a result of operator error (76%). Less than 65% reported compliance with annual tuberculosis skin testing; notably, those who received a yearly reminder were much more likely to receive annual testing than those who did not (odds ratio, 19.0; 95% CI, 12.6-28.7; P < .05). During central venous catheter placement, only 56% wore gowns, 50% wore caps, and 54% used full barrier precautions. Only 19% reported routine hand washing between glove applications. More than 40% noted a change in infection control practices within the previous 5 years, citing new hospital guidelines and recommendations by a professional organization as the reasons for change. Only 44% had infection control training at the onset of their practice. CONCLUSIONS: IRs demonstrate a wide variety of infection control practices that are not in accordance with current guidelines. IRs were most likely to change infection control practice if required to do so by their own hospitals or a professional organization. SIR can play an important role in the prevention of health care-associated infection by reinforcing current infection control guidelines as they pertain to interventional radiology. __________________________________________________________________________ _____________________________________*____________________________________ 8. Abstract: Hepatitis C outbreak in an oncology ward __________________________________________________________________________ Enferm Infecc Microbiol Clin. 2009 Jul 29. [Hepatitis C outbreak in an oncology ward.] [Article in Spanish] Rodríguez-Caravaca G, Villar-Del-Campo MC, Casas-Losada ML, Cava- Valenciano F, Gil-De-Miguel A. Unidad de Medicina Preventiva, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España; Departamento de Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Alcorcón, Madrid, España. INTRODUCTION: Study of an outbreak of hepatitis C virus (HCV) infection. METHODS: Case-control study. Odds ratios for various risk factors were studied in patients with acute hepatitis C and an appropriate control group. RESULTS: Seven cases and 46 controls were included. Implantation of a central catheter was found to be an independent risk factor for hepatitis C (OR=35; 95% CI: 16.0-62.0). CONCLUSION: Inadequate manipulation of central catheters with heparinized saline solution, which was likely to be HCV-contaminated, caused the outbreak. __________________________________________________________________________ _____________________________________*____________________________________ 9. Abstract: Hepatitis C Virus Transmission in Hemodialysis Units: Importance of Infection Control Practices and Aseptic Technique __________________________________________________________________________ Infect Control Hosp Epidemiol. 2009 Jul 30. Hepatitis C Virus Transmission in Hemodialysis Units: Importance of Infection Control Practices and Aseptic Technique. Thompson ND, Novak RT, Datta D, Cotter S, Arduino MJ, Patel PR, Williams IT, Bialek SR. From the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (N.D.T., R.T.N., D.D., S.C., I.T.W., S.R.B.) and the Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases (M.J.A., P.R.P.), Centers for Disease Control and Prevention, Atlanta, GA. We investigated 4 hepatitis C virus (HCV) infection outbreaks at hemodialysis units to identify practices associated with transmission. Apparent failures to follow recommended infection control precautions resulted in patient-to-patient HCV transmission, through cross- contamination of the environment or intravenous medication vials. Fastidious attention to aseptic technique and infection control precautions are essential to prevent HCV transmission. __________________________________________________________________________ _____________________________________*____________________________________ 10. Abstract: Are hospitals too clean to trigger good hand hygiene? __________________________________________________________________________ J Hosp Infect. 2009 Jul;72(3):218-20. Are hospitals too clean to trigger good hand hygiene? van der Vegt DS, Voss A. Department of Clinical Microbiology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands. d.vandervegt@mmb.umcn.nl Compliance with hand hygiene in the healthcare setting is generally low. The aim of the present study was to investigate the degree of compliance with hand hygiene after toilet visits inside and outside the hospital. We observed hospital/laboratory staff, participants of the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) 2007, and users of public lavatories. Compliance with hand hygiene after toilet visits was 46% for hospital staff, 84% for conference participants and 75% for members of the public. Healthcare workers show different behaviour regarding hand hygiene inside and outside the healthcare setting. Perhaps the feeling of a 'miasmic' environment such as public toilets triggers better hand hygiene, whereas the relatively clean hospital environment may block the trigger for hand disinfection. __________________________________________________________________________ _____________________________________*____________________________________ 11. Abstract: Limitations of the efficacy of surface disinfection in the healthcare setting __________________________________________________________________________ Infect Control Hosp Epidemiol. 2009 Jun;30(6):570-3. Limitations of the efficacy of surface disinfection in the healthcare setting. Williams GJ, Denyer SP, Hosein IK, Hill DW, Maillard JY. Welsh School of Pharmacy, Cardiff University, Cardiff, Wales, UK. williamsgj3@cf.ac.uk We examined the efficacy of 2 commercially available wipes to effectively remove, kill, and prevent the transfer of both methicillin-resistant and methicillin-susceptible Staphylococcus aureus from contaminated surfaces. Although wipes play a role in decreasing the number of pathogenic bacteria from contaminated surfaces, they can potentially transfer bacteria to other surfaces if they are reused. __________________________________________________________________________ _____________________________________*____________________________________ 12. Abstract: Self-protection as a driver for hand hygiene among healthcare workers __________________________________________________________________________ Infect Control Hosp Epidemiol. 2009 Jun;30(6):578-80. Self-protection as a driver for hand hygiene among healthcare workers. Borg MA, Benbachir M, Cookson BD, Redjeb SB, Elnasser Z, Rasslan O, Gür D, Daoud Z, Bagatzouni DP . Infection Control Unit, Mater Dei Hospital, Msida, Malta. michael.a.borg@gov.mt A total of 2,725 healthcare workers in 8 Mediterranean countries replied to a self-assessment questionnaire that assessed their perceptions on hand hygiene. Responses revealed that rates of hand hygiene compliance before patient contact were significantly less than rates after patient contact (P < .001) and that use of soap and water was preferred over use of alcohol- based hand rub. These findings suggest that self-protection could be a major subliminal driver for performance of hand hygiene. __________________________________________________________________________ _____________________________________*____________________________________ 13. Abstract: Injectable immunotherapy: recommendations for safe allergen vial preparation in the office setting __________________________________________________________________________ Curr Opin Otolaryngol Head Neck Surg. 2009 Jun;17(3):223-5. Injectable immunotherapy: recommendations for safe allergen vial preparation in the office setting. Lay PC. Division of Otolaryngology Head and Neck Surgery, Southern Illinois School of Medicine, PO Box 19662, Springfield, IL 62794-9662, USA. play@siumed.edu PURPOSE OF REVIEW: To review the proper technique for preparing allergen vials to be used in subcutaneous immunotherapy in the office setting, examine the potential for bacterial contamination during mixing and handling and associated risk factors and review the data relevant to contamination during vial mixing. RECENT FINDINGS: Existing literature on the subject of safe vial preparation suggests that the incidence of bacterial contamination of allergen vials is very low. Historically, there is no report of bacterial infection for subcutaneous immunotherapy using vials prepared in the office setting or otherwise when using the proper sterile technique. SUMMARY: In-office compounding of vials is a safe practice with literature to support continuing this practice of preparation. __________________________________________________________________________ _____________________________________*____________________________________ 14. Abstract: Local antibiotics are equivalent to intravenous antibiotics in the prevention of superficial wound infection in inguinal hernioplasty __________________________________________________________________________ Asian J Surg. 2009 Jan;32(1):59-63. Local antibiotics are equivalent to intravenous antibiotics in the prevention of superficial wound infection in inguinal hernioplasty. Praveen S, Rohaizak M. Department of Surgery, Hospital University Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia. drpsingam@gmail.com BACKGROUND: Antibiotic prophylaxis for inguinal hernioplasty is still practiced in many hospitals to prevent consequences of infected mesh, mesh removal and hernia recurrence. The common route of administration is intravenous. However this method can be associated with systemic side effects. Alternatively, locally applied antibiotics have been used and proven to significantly reduce the infection rate after inguinal hernioplasty. METHODS: This was a single blinded prospective randomised trial with a primary aim to compare the superficial surgical wound infection (SSSI) rate between locally applied gentamicin against systemic gentamicin in elective unilateral inguinal hernioplasty. All patients underwent the Lichtenstein tensionfree repair. The secondary aim was to identify risk factors associated with the development of SSSI. RESULTS: A total of 202 patients were recruited. There were fourteen SSSI, seven in each arm. The overall SSSI rate was 6.9%. There was no significant difference between the locally applied versus intravenous administered antibiotics (p = 0.97). Factors found to contribute to SSSI were diabetes mellitus (p = 0.006), age 6070 years (p = 0.023), adhesions (p = 0.001), duration of surgery > 90 minutes (p = 0.048), duration of hernia > 24 months (p = 0.001) and the presence of haematoma (p = 0.001). CONCLUSION: Locally applied gentamicin is equivalent to intravenous gentamicin in preventing SSSI post primary inguinal hernioplasty. __________________________________________________________________________ _____________________________________*____________________________________ 15. Abstract: Safety evaluation of traditional Chinese medicine injections and study of related key technology __________________________________________________________________________ Zhongguo Zhong Yao Za Zhi. 2009 Apr;34(8):1052-4. [Safety evaluation of traditional Chinese medicine injections and study of related key technology] [Article in Chinese] Cheng F, Liu Z. Center for New Drugs Evaluation of Shandong University, Jinan 250012, China. Traditional Chinese medicine (TCM) injections originated in China and have been extensively used in clinic. However, some events the adverse drug reactions (ADRs) have been reported, among which, hypersensitivity reactions (HSRs) are the main ADRs of TCM injections. To solve the ADRs of TCM injections will be the key to proceed of the modernization of TCM. This paper reviewed the current situation and causes of the ADRs of TCM injections. On the basis of primary findings obtained from the project granted by the Ministry of Science and Technology, two pivotal technologies of the safety evaluation of TCM injections were introduced, which are anaphylactoid reaction ussessment and metabonomics for TCM injections. It is expected to provide some new ideas for the breakthrough of the safety evaluation of TCM injections. __________________________________________________________________________ _____________________________________*____________________________________ 16. Abstract: Immunological risk of injectable drug delivery systems __________________________________________________________________________ Pharm Res. 2009 Jun;26(6):1303-14. Immunological risk of injectable drug delivery systems. Jiskoot W, van Schie RM, Carstens MG, Schellekens H. Division of Drug Delivery Technology, Leiden/Amsterdam Center for Drug Research, Leiden University, Leiden, The Netherlands, w.jiskoot@lacdr.leidenuniv.nl Injectable drug delivery systems (DDS) such as particulate carriers and water-soluble polymers are being used and developed for a wide variety of therapeutic applications. However, a number of immunological risks with serious clinical implications are associated with administration of DDS. These immunological events can compromise the efficacy and safety of these systems by changing the pharmacokinetics, biodistribution and targeting capability of DDS, and by inducing hypersensitivity reactions. Antibodies induced by administration of DDS can be directed against the carrier material, the drug and/or targeting ligands associated with the DDS. Complement activation and opsonization of DDS, which may or may not be associated with antibody formation, may lead to accelerated clearance, hypersensitivity reactions and formation of membrane attack complexes resulting in premature release of the drug. Also platelets have been reported to play a role in DDS immunogenicity. Despite our curtailed understanding of the relationships between physicochemical characteristics and immunogenicity of DDS, several risk factors have been identified. Insight into these factors should be employed in the development of novel DDS with low immunological risk. __________________________________________________________________________ _____________________________________*____________________________________ 17. Abstract: Factors associated with an explosive HIV epidemic among injecting drug users in Sargodha, Pakistan __________________________________________________________________________ J Acquir Immune Defic Syndr. 2009 May 1;51(1):85-90. Factors associated with an explosive HIV epidemic among injecting drug users in Sargodha, Pakistan. Emmanuel F, Archibald C, Razaque A, Sandstrom P. HIV/AIDS Surveillance Project, AIDS Block, National Institute of Health, Chak Shehzad, Islamabad, Pakistan. faran_emmanuel@yahoo.com BACKGROUND: During a routine surveillance round, an extremely high prevalence of 51.3% was found among injecting drug users (IDUs) in Sargodha, a small town in Pakistan. This sharp increase of HIV among this group warranted an urgent need to explore the factors leading toward this explosion of HIV infection among IDUs at this very location to direct the policy makers in designing preventive activities, especially in the context of HIV prevention. METHODS: In 2007, 400 current IDUs were recruited through multistage cluster sampling based on mapping studies. Participants provided dried blood spot samples for HIV testing and completed a questionnaire on demographic characteristics and sexual/drug injecting behaviors. Logistic regression was used to examine the independent association of multiple variables with HIV infection. RESULTS: Of the 400 IDUs tested, 205 (51.3%) were HIV positive confirmed through enzyme-linked immunosorbent assay and Western blot. In multivariate analysis, geographical location of IDUs [adjusted odds ratio (aOR) 2.4 for IDUs located in the northern zone vs southern zone, 95% confidence interval (CI) 1.5 to 3.7], injected in groups (aOR 1.8, 95% CI 1.1 to 3.1), and sharing injecting paraphernalia with other IDUs (aOR 1.5, 95% CI 1.0 to 2.4) were strong correlates of HIV infection. CONCLUSIONS: Effective outreach programs need to be developed to provide a comprehensive package of HIV prevention services to IDUs not reached by existing services, entry into drug abuse treatment and medical care needs to be facilitated, and essential legal and social services need to be provided with community participation. __________________________________________________________________________ _____________________________________*____________________________________ 18. Abstract: Injecting drug users' understanding of hepatitis C __________________________________________________________________________ Addict Behav. 2008 Dec;33(12):1602-5. Injecting drug users' understanding of hepatitis C. O'Brien S, Day C, Black E, Dolan K. National Drug and Alcohol Research Centre, University of New South Wales, NSW 2052, Australia. s.obrien@unsw.edu.au This cross-sectional survey examined IDUs' understanding of HCV, their knowledge of virus transmission, clinical markers, symptoms and treatment. IDUs were recruited through and interviewed at a range of settings in inner-city, suburban and regional sites of New South Wales, Australia; 149 IDUs were recruited. Recent HCV testing was reported by 74% of participants, but a number of IDUs were confused about the results of the various tests, e.g. 19% of participants who stated they had HCV believed they could not infect others or were immune. Significant gaps in IDUs' knowledge of HCV were uncovered with respect to transmission risks (48% believed HCV could be contracted from re-using one's own, unshared needle), symptoms and clinical markers (42% believed HCV antibodies gave protection against HCV infection), and treatment. F indings warrant further development of, and research into, strategies to improve IDUs' understanding of HCV. __________________________________________________________________________ _____________________________________*____________________________________ 19. Abstract: Drug choice, spatial distribution, HIV risk, and HIV prevalence among injection drug users in St. Petersburg, Russia __________________________________________________________________________ Harm Reduct J. 2009 Jul 31;6(1):22. Drug choice, spatial distribution, HIV risk, and HIV prevalence among injection drug users in St. Petersburg, Russia. Kruse GR, Barbour R, Heimer R, Shaboltas AV, Toussova OV, Hoffman IF, Kozlov AP. BACKGROUND: The HIV epidemic in Russia has been driven by the unsafe injection of drugs, predominantly heroin and the ephedrine derived psychostimulants. Understanding differences in HIV risk behaviors among injectors associated with different substances has important implications for prevention programs. METHODS: We examined behaviors associated with HIV risk among 900 IDUs who inject heroin, psychostimulants, or multiple substances in 2002. Study participants completed screening questionnaires that provided data on sociodemographics, drug use, place of residence and injection- and sex- related HIV risk behaviors. HIV testing was performed and prevalence was modeled using general estimating equation (GEE) analysis. Individuals were clustered by neighborhood and disaggregated into three drug use categories: Heroin Only Users, Stimulant Only Users, and Mixed Drug Users. RESULTS: Among Heroin Only Users, younger age, front/backloading of syringes, sharing cotton and cookers were all significant predictors of HIV infection. In contrast, sharing needles and rinse water were significant among the Stimulant Only Users. The Mixed Drug Use group was similar to the Heroin Only Users with age, front/back loading, and sharing cotton significantly associated with HIV infection. These differences became apparent only when neighborhood of residence was included in models run using GEE. CONCLUSIONS: The type of drug injected was associated with distinct behavioral risks. Risks specific to Stimulant Only Users appeared related to direct syringe sharing. The risks specific to the other two groups are common to the process of sharing drugs in preparation to injecting. Across the board, IDUs could profit from prevention education that emphasizes both access to clean syringes and preparing and apportioning drug with these clean syringes. However, attention to neighborhood differences might improve the intervention impact for injectors who favor different drugs. __________________________________________________________________________ _____________________________________*____________________________________ 20. Abstract: Epidemiology of HCV Infection in the General Population: A Survey in a Southern Italian Town __________________________________________________________________________ Am J Gastroenterol. 2009 Jul 28. Epidemiology of HCV Infection in the General Population: A Survey in a Southern Italian Town. Cozzolongo R, Osella AR, Elba S, Petruzzi J, Buongiorno G, Giannuzzi V, Leone G, Bonfiglio C, Lanzilotta E, Manghisi OG, Leandro G. Division of Gastroenterology 1, National Institute of Gastroenterology "S. de Bellis", Castellana Grotte, Bari, Italy. OBJECTIVES:The objective of this study was to estimate the seroprevalence of hepatitis C virus (HCV) in the general population older than 18 years of age in a southern Italian town. METHODS:The survey was conducted from July 2005 through January 2007 in Putignano, Bari, Apulia. A random 1:5 sampling from the list of records maintained by general practitioners was used. Serology for HCV, hepatitis B surface antigen (HBsAg), antibodies to hepatitis B core antigen (anti- HBc), and genotyping for HCV were performed. RESULTS:Of a total of 2,195 serum samples tested, 58 (2.6%) were positive for anti-HCV antibodies. The prevalence increased from 1% in subjects aged <30 years to 7.7% in those aged 70 years and was similar in both males and females (3.1 vs. 2.4%, P=0.4). Approximately one-third of 58 positive subjects also showed alanine transaminase levels and 53.5% tested positive for HCV RNA by TaqMan PCR. Genotypes 2a and 1b were represented in 21 and 10 subjects, respectively. In a multivariate logistic regression analysis, age (adjusted odds ratio (OR) 1.05; 95% confidence interval (CI): 1.03-1.07), blood transfusion (adjusted OR 3.3; 95% CI: 1.7-6.3), and household contact with HCV-infected individuals (adjusted OR 4.8; 95% CI: 1.8-13.1) were the independent variables predictive of HCV infection. The overall HBsAg and anti-HBc prevalence rates were 0.5 and 12%, respectively. CONCLUSIONS:This survey confirms that HCV infection is clearly also declining in southern Italy, especially among the elderly. HCV genotype 2a predominates, reflecting the current epidemiology of HCV in Italy. Age, blood transfusion, and household contact with HCV-infected individuals may have had a role in the spread of HCV infection. __________________________________________________________________________ _____________________________________*____________________________________ 21. Abstract: Nosocomial contamination of laryngoscope handles: challenging current guidelines __________________________________________________________________________ Anesth Analg. 2009 Aug;109(2):479-83. Nosocomial contamination of laryngoscope handles: challenging current guidelines. Call TR, Auerbach FJ, Riddell SW, Kiska DL, Thongrod SC, Tham SW, Nussmeier NA. Department of Anesthesiology, College of Medicine, State University of NY Upstate Medical University, Syracuse, New York 13210, USA. BACKGROUND: Laryngoscope blades are often cleaned between cases according to well-defined protocols. However, despite evidence that laryngoscope handles could be a source of nosocomial infection, neither our institution nor the American Society of Anesthesiologists has any specific guidelines for handle disinfection. We hypothesized that laryngoscope handles may be sufficiently contaminated with bacteria and viruses to justify the implementation of new handle-cleaning protocols. METHODS: Sixty laryngoscope handles from the adult operating rooms were sampled with premoistened sterile swabs. Collection was performed between cases, in operating rooms hosting a broad variety of subspecialty procedures, after the room and equipment had been thoroughly cleaned for the subsequent case. Samples from 40 handles were sent for aerobic bacterial culture, and antimicrobial susceptibility testing was performed for significant isolates. Samples from 20 handles were examined for viral contamination using a polymerase chain reaction assay that detects 17 respiratory viruses. RESULTS: Of the 40 samples sent for culture, 30 (75%) were positive for bacterial contamination. Of these positive cultures, 25 (62.5%) yielded coagulase-negative staphylococci, seven (17.5%) Bacillusspp. not anthracis, three (7.5%) alpha-hemolytic Streptococcusspp., and one each (2.5%) of Enterococcusspp., Staphylococcus aureus(S. aureus), and Corynebacteriumspp. No vancomycin-resistant enterococci, methicillin- resistant S. aureus, or Gram-negative rods were detected. All viral tests were negative. CONCLUSION: We found a high incidence of bacterial contamination of laryngoscope handles despite low- level disinfection. However, no vancomycin-resistant enterococci, methicillin-resistant S. aureus, Gram- negative rods, or respiratory viruses were detected. Our results support adoption of guidelines that include, at a minimum, mandatory low-level disinfection of laryngoscope handles after each patient use. __________________________________________________________________________ _____________________________________*____________________________________ 22. Abstract: Impact of organisation and management factors on infection control in hospitals: a scoping review __________________________________________________________________________ J Hosp Infect. 2009 Jul 30. Impact of organisation and management factors on infection control in hospitals: a scoping review. Griffiths P, Renz A, Hughes J, Rafferty AM. National Nursing Research Unit, King's College London, London, UK. This scoping review sought evidence about organisational and management factors affecting infection control in general hospital settings. A literature search yielded a wide range of studies, systematic reviews and reports, but high quality direct evidence was scant. The majority of studies were observational and the standard of reporting was generally inadequate. Positive leadership at ward level and above appears to be a prerequisite for effective action to control infection, although the benefits of good clinical leadership are diffused by supervision of large numbers of staff. Senior clinical leaders need a highly visible presence and clear role boundaries and responsibilities. Team stability and morale are linked to improved patient outcomes. Organisational mechanisms for supporting training, appraisal and clinical governance are important determinants of effective practice and successful change. Rates of infection have been linked to workload, in terms of nurse staffing, bed occupancy and patient turnover. The organisational characteristics identified in the review should be considered risk factors for infection. They cannot always be eliminated or avoided completely, but appropriate assessment will enable targeted action to protect patients. __________________________________________________________________________ _____________________________________*____________________________________ 23. Abstract: Comparison of 0.05% Chlorhexidine and 10% Povidone-Iodine as Cutaneous Disinfectant for Prevention of Central Venous Catheter- Related Bloodstream Infection: A Comparative Study __________________________________________________________________________ Eur Surg Res. 2009 Aug 1;43(3):286-290. Comparison of 0.05% Chlorhexidine and 10% Povidone-Iodine as Cutaneous Disinfectant for Prevention of Central Venous Catheter-Related Bloodstream Infection: A Comparative Study. Ishizuka M, Nagata H, Takagi K, Kubota K. Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan. Background: The Centers for Disease Control and Prevention guideline recommended the use of 2% chlorhexidine as a percutaneous disinfectant for central venous catheter (CVC) insertion. However, in Japan, 0.05% chlorhexidine is commonly used as well as 10% povidone-iodine, instead of 2% chlorhexidine. Purpose: It was the aim of this study to examine whether the use of 0.05% chlorhexidine is inferior to conventional 10% povidone- iodine as a percutaneous disinfectant for preventing CVC-related bloodstream infection (CVC-RBSI). Methods: Between September 2006 and July 2008, the time interval from insertion to development of CVC-RBSI was compared prospectively between patients prepared with 0.05% chlorhexidine (group 1, n = 286 CVCs) and those prepared with conventional 10% povidone- iodine (group 2, n = 298 CVCs). Results: Two hundred and thirty-nine patients received 584 CVCs for a total of 6,205 catheter-days. CVC-RBSI (3.22 per 1,000 catheter-days) was diagnosed in 20 cases. There were no significant differences in patient background factors between group 1 and 2, except for blood culture positivity (p = 0.0450). However, Kaplan-Meier analysis and the log rank test revealed no significant difference between group 1 and 2 in the time interval from insertion until development of CVC-RBSI. Conclusions: Use of 0.05% chlorhexidine is not inferior to conventional 10% povidone-iodine as a cutaneous disinfectant for the prevention of CVC- RBSI. Copyright © 2009 S. Karger AG, Basel. __________________________________________________________________________ _____________________________________*____________________________________ 24. Abstract: Arguments for mandatory influenza vaccination __________________________________________________________________________ Dtsch Med Wochenschr. 2009 Aug;134(33):1650-1652. Arguments for mandatory influenza vaccination. Wicker S, Rabenau HF, Marckmann G, Sträter B, Pollandt A, Gottschalk R. The question about the legality of implementation mandatory flu vaccination for healthcare workers will be commented from different points of view: occupational medicine, medical ethics, infection control, virology and legal system. In our opinion an annual influenza vaccination should be required for health care workers who care for immunocompromised patients and residents in long-term care if there will be a failure of voluntary vaccination programs. An informed declination should be obtained from employees who decline vaccination and these healthcare workers ought to work in uncritical areas of patient care. © Georg Thieme Verlag KG Stuttgart · New York. __________________________________________________________________________ _____________________________________*____________________________________ 25. Abstract: Evaluation of the exposure equivalence of oral versus intravenous temozolomide __________________________________________________________________________ Cancer Chemother Pharmacol. 2009 Jul 30. Evaluation of the exposure equivalence of oral versus intravenous temozolomide. Diez BD, Statkevich P, Zhu Y, Abutarif MA, Xuan F, Kantesaria B, Cutler D, Cantillon M, Schwarz M, Pallotta MG, Ottaviano FH. Department of Neuro-Oncology, Institute of Neurological Research Dr Raul Carrea (FLENI), Montañeses 2325, Buenos Aires, 1428, Argentina, bdiez@fleni.org.ar. PURPOSE: Oral temozolomide is approved in many countries for malignant glioma and for melanoma in some countries outside the USA. This study evaluated the exposure equivalence and safety of temozolomide by intravenous infusion and oral administration. METHODS: Subjects with primary central nervous system malignancies (excluding central nervous system lymphoma) received 200 mg/m(2) of oral temozolomide on days 1, 2 and 5. On days 3 and 4, subjects received 150 mg/m(2) temozolomide either as a 90-min intravenous infusion on one day or by oral administration on an alternate day. RESULTS: Ratio of log-transformed means (intravenous:oral) of area under the concentration-time curve and maximum concentration of drug after dosing for temozolomide and 5-(3- methyltriazen-1-yl)imidazole-4- carboxamide (MTIC) met exposure equivalence criteria (90% confidence interval = 0.8-1.25). Treatment-emergent adverse events were consistent with those reported previously in subjects with recurrent glioma treated with oral temozolomide, except for mostly mild and transient injection site reactions with intravenous administration. CONCLUSIONS: This study demonstrated an exposure equivalence of a 90-min intravenous infusion of temozolomide and an equivalent oral dose. __________________________________________________________________________ _____________________________________*____________________________________ 26. ILO - Various Positions Crossposted with thanks: from SmartBrief UN Wire > Industry Job Listing __________________________________________________________________________ Various Positions Company Name: International Labour Office Job Location: Worldwide URL: Various Positions http://www.ilo.org/public/english/bureau/pers/intro/ Date posted: 03/08/2009 The International Labour Office is the U.N. specialized agency that works with governments, employers and workers to advance opportunities for women and men to obtain decent and productive work in conditions of freedom, equity, security and human dignity. Our values of integrity and respect for diversity guide everything that we do as individuals, as teams, and as an organization. If you would like to work within an internationally diverse, globally challenging, highly principled environment, and you are a collaborative and organized person, with excellent analytical and communication skills, a proven track record of high performance, and a hunger to learn and develop, then the ILO may well be the right place for you. For further information on our vacancies including details of terms and conditions and how to apply, please visit the website listed above. The closing date for applications is 3 September 2009. The ILO is currently filling positions in the following areas/fields: Technical Fields Internal Management & Administration International Labour Standards Administration Employment Management Skills, Knowledge and Employability Programming Economic Policy and Labour Market Finance Research Economist Human Resources Social Security Legal * Occupational Safety and Health Translation/Revision/Editing Migration IT Dialogue Labour Administration/Labour Inspection __________________________________________________________________________ _____________________________________*____________________________________ 27. News - Handwashing, facemasks to prevent flu spread at home - Australia: Fury over [syringe] drug sale near primary school in NSW - Uzbekistan: Activists Strive To Raise Awareness About HIV/AIDS - African woman infected with gorilla strain of HIV: A woman from Cameroon now living in France is the first person confirmed to have a type of HIV originating in gorillas rather than chimpanzees - Indonesia: Indonesia's drug fight pushing prison AIDS explosion - Philippines: NBI warns public on fake anti-flu vaccines - USA: Washington Supports Exchange of Needles - USA: APIC Promotes Safe Injection Practices to Prevent Bloodborne Infections - USA: VA Victims to File Disability Claims - Iran: Needle and syringe sharing among Iranian drug injectors - China: Hepatitis Group Is Harassed in China - UK: Bristol dentist's patients tested for HIV and hepatitis - Philippines: NBI seizes P4M worth of fake flu vaccines - MedImmune Seeks Fast Track for FluMist - Canada: Review blames old habits for reuse of dirty syringes Selected news items reprinted under the fair use doctrine of international copyright law: http://www4.law.cornell.edu/uscode/17/107.html __________________________________________________________________________ Handwashing, facemasks to prevent flu spread at home By Tan Ee Lyn, Reuters (04.08.09) HONG KONG (Reuters) - Frequent handwashing and the wearing of face masks at home can help reduce the transmission of influenza viruses within the household if the measures are implemented in good time, a study in Hong Kong has found. The findings, published in the Annals of Internal Medicine, are seen as important as patients may need to be quarantined at home in a pandemic if hospitals run short of isolation facilities. "During a pandemic, resources may not be available to isolate all infected individuals, and home isolation of some patients may be required," the researchers wrote. "Our results suggest that hand hygiene and facemasks can reduce influenza virus transmission if implemented early after symptom onset in an index patient." Led by public health expert Ben Cowling at the University of Hong Kong, the researchers recruited patients who tested positive for either influenza A or B. Along with other household members, they were then randomly assigned to one of three groups - one with some health education, a second that undertook to wash hands frequently and a third undertook to wash hands and wear surgical facemasks. Of the 259 households completing the study, 60 household members were found infected in the seven days after the measures were introduced. But there were fewer transmissions in households where the two measures were implemented in timely fashion. "Hand hygiene and facemasks seemed to prevent household transmission of influenza virus when implemented within 36 hours of index patient symptom onset," the researchers wrote. "These findings suggest that non-pharmaceutical interventions are important for mitigation of pandemic and interpandemic influenza." .......................................................................... __________________________________________________________________________ Australia: Fury over [syringe] drug sale near primary school in NSW NEWS.com.au - Australia, The Daily Telegraph (04.08.09) PARENTS are furious about plans to install a vending machine to sell syringes to drug-takers less than 100m from a primary school. Families fearing for the safety of their children have signed a petition against the plan by the South East Sydney and Illawarra Area Health Service, claiming the vending machine would be dangerously close to the school. Parents told yesterday how used druggies' syringes had been found in and around Crown Street Public School, putting young children at serious risk. A development application for the needle machine, outside the Albion Street Centre in Crown St, was considered by a City of Sydney committee last night but had yet to be approved by the complete council. Mother-of-three Heather Laurie was one of a number of parents who expressed concern yesterday, and said she was worried about the impact on her daughter's school. "It's like a target suggesting drug-takers can come in here (Crown Street Public) to shoot up. There's already an issue with used syringes being found in the school," she said. Another mum, Michelle Mika, said children could easily stand on discarded needles. "I agree with them having a machine but not near a school," she said. Area health service spokeswoman Dr Ingrid van Beek said the machine would be monitored over six to 12 months in consultation with the school, police, the council and residents. "The NSW needle syringe program has been shown to be the cornerstone in preventing HIV/AIDS and hepatitis C in our community. To date there have been no incidents involving children associated with needle and syringe machines." A council spokesman said it had no power to refuse the machine because it was a Crown application," she said. .......................................................................... __________________________________________________________________________ Uzbekistan: Activists Strive To Raise Awareness About HIV/AIDS EurasiaNet (03.08.09) Fueled by cheap heroin from neighboring Afghanistan, Uzbekistan's drug problem is growing, and with it, the incidence of HIV/AIDS. Yuri Bartenev, a pediatrician-turned-playwright, is trying to do something to soften the social impact of the spread of HIV/AIDS. Bartenev, 35, has seen a number of friends die from the disease, and he has witnessed how HIV-positive people are often shunned by family, friends, and society at large. In an effort to raise awareness - and confront the lack of public discussion about the illness - Bartenev decided to mount a series of one- act plays that directly addressed the issue. He visited several Tashkent's theaters in search of a space, only to have his request rejected at each venue. At one theater, he was told that if he altered the play so that its protagonist was not a gay man, he would be allowed to perform there. Homosexuality is a crime in Uzbekistan, and theaters are state-run entities that cannot risk angering officials. Bartenev refused. Though AIDS education in schools is widespread, and young people are often well informed about the topic, the official press rarely acknowledges problems within the country, most especially the growing number of HIV infections. The Uzbek government is also reluctant to openly address a drug or HIV/AIDS problem. For example, in the eastern city of Namangan last November, an HIV crisis came to light only after the British Broadcasting Corp. reported that many children there had been infected with the virus. The government at first denied the report. Eventually, officials declared that 28 babies had been infected, but some observers believe the actual number to be higher. The means of infection has not yet been confirmed, according to a health worker close to the investigation, although unsterile needles are widely believed to have played a role. Bartenev's window into this world was his longtime friend Sergei Uchaev. Uchaev leads support groups for those with HIV/AIDS at the government AIDS clinic in Tashkent's Chilonzar District. Those with HIV/AIDS are often fiercely protective of their status, Bartenev noticed; the stigma that surrounds the issue often leads them to cut themselves off from society. When Bartenev visited one of Uchaev's support groups, for example, he was the first non-HIV positive person allowed to take part in a meeting. "I saw how they were socially unaccepted and discriminated against," he said. Bartenev was moved to act "because I wanted to do something positive and attract attention to the issue." Uchaev, 36, discovered he was infected with the HIV virus 12 years ago after an operation; a long-term heroin addict, he had regularly shared dirty needles with others. The doctor who informed him he was HIV positive turned her back on him in apparent disgust, he recalled. After a year of deep depression during which he rarely left the apartment he shared with his family, he eventually emerged to visit the Chilonzar center. Bartenev and others offer praise for the Ministry of Health for providing free treatment to those with HIV/AIDS, clean needles to drug users, and publishing informational materials about HIV/AIDS. "But people always close their eyes," Bartenev noted, and meanwhile "the situation is deteriorating." Officially, 16,588 persons are HIV positive in Uzbekistan, although as with many official statistics in the country, the number is considered inexact. In 2007, the official number was 13,184 registered infections. After an extended search, Bartenev finally found a space for his performance at the avant-garde Ilkhom Theater. The one-day show - providing practical information such as how HIV can be transmitted and clarifying the difference between HIV and AIDS - ran in March. The performance, which sought to humanize those with HIV/AIDS, also highlighted how HIV can be managed with proper treatment, a fact that seems widely misunderstood. "My goal was to make people react to those with HIV/AIDS as 'normal' people," Bartenev said. Underlining that effort, five members of Uchaev's support group performed in the show that night. After the production, called "Status Plus" - which featured three one-act pieces by playwrights from Kazakhstan, Belarus, and Uzbekistan - Bartenev invited spectators to discuss the plays. In the audience that night was Gulnara, 35, a business professional from Tashkent, and her 15-year-old daughter. Although drawn to attend, she says, because she felt that "finally someone is going to discuss the problems we have in Uzbekistan, which we usually pretend we do not have," she, like many others, felt a profound discomfort talking about such issues. "I come from a very conservative Uzbek family, and I don't know how to talk with my daughter about sexual relationships and topics such as sexually transmitted diseases," Gulnara admitted. "Mothers always hope that their children are taught such things at school, but I found out they never had lessons on sex matters," she said. "After the play, we had a long discussion, and she asked me a million questions." People with HIV/AIDS provoke anger, she said, because "many think it is acquired from unacceptable sexual relationships." The plays showed her that was "a mistake." Sexual taboos play a big role. "Our parents never teach us how to be tolerant," Gulnara explained. "Abnormal" sexual behaviors, which she defined as "homosexuality, fellatio, and prostitution," are considered "disgusting and dirty." "HIV/AIDS is still something dark and unknown [in Uzbekistan]," says Dr. Ruslon Remetov, who works at the Chilonzar AIDS clinic. For patients, fully comprehending that HIV is not a death sentence takes repeated visits to understand, he says. "No one is aware of the possibility of living." If Bartenev can secure the funding - this year's show was self-financed - he plans to produce the performances again next March. He hopes also to produce a series of plays that confront other unexplored social problems. As for Uchaev, he is working to register an NGO called "Network HIV Positive" to spread a simple message: "it's OK to be HIV positive." .......................................................................... __________________________________________________________________________ African woman infected with gorilla strain of HIV: A woman from Cameroon now living in France is the first person confirmed to have a type of HIV originating in gorillas rather than chimpanzees Associated Press, guardian.co.uk,(03.08.09) The gorilla strain of HIV may have spread to people in wild animals hunted and butchered for human consumption. Photograph: Getty A new strain of HIV has been discovered in a woman from Cameroon. It differs from the three known strains and appears to be closely related to a form of the virus recently discovered in wild gorillas, researchers reported today in the journal Nature Medicine. The finding "highlights the continuing need to watch closely for the emergence of new HIV variants, particularly in western central Africa," said the researchers, led by Jean-Christophe Plantier of the University of Rouen, France. The three previously known HIV strains are related to the simian virus that occurs in chimpanzees. The most likely explanation for the new find is gorilla-to-human transmission, Plantier's team said. But they added they cannot rule out the possibility that the new strain arose in chimpanzees and moved into gorillas and then humans, or moved directly from chimpanzees to both gorillas and humans. The 62-year-old patient tested positive for HIV in 2004, shortly after moving to Paris from Cameroon, according to the researchers. She had lived near Yaoundé, the capital of Cameroon, but said she had no contact with apes or bushmeat. The woman currently shows no signs of Aids and is not yet receiving antiviral drug treatment, the researchers said. How widespread this strain is remains to be determined. The researchers said it could be circulating unnoticed in Cameroon or elsewhere. The virus's rapid replication indicates that it is adapted to human cells, they reported. .......................................................................... __________________________________________________________________________ Indonesia: Indonesia's drug fight pushing prison AIDS explosion Agence France-Presse - (3.8.2009) Their tattooed skin hanging loosely from hollowed-out limbs, the young men in the clinic at the edge of Jakarta's Cipinang Narcotic Prison lie limply across black vinyl beds. The half-dozen inmates are in the advanced stages of HIV/AIDS, and are part of a crisis that has seen the disease sweep through Indonesia's overcrowded, squalid and corrupt prisons. The root of the problem, activists say, is a war on drugs that treats injecting users -- many of them already HIV positive -- with the same harsh punishments as dealers, flooding jails where opportunities to get drugs and spread the disease are plentiful. "People who are selling drugs, buying drugs, bringing drugs, abusing drugs, whatever, are being locked in the same place in the same situation -- no treatment, no nothing," said Baby Jim Aditya, the head of Partisan, a non-governmental organisation dealing with public health. A 27-year-old, HIV-positive former heroin addict who goes by the nickname Black is a recently released veteran of that system. Arrested by an enraged crowd in 2007 as he attempted to shoot up with a friend in a quiet corner of a Jakarta market, Black spent 20 months in jail for possession of one-tenth of a gram of low-grade heroin, or "putaw". While in police detention, his friend, Rahman, died after being cut off from access to anti-retroviral medication and going through heroin withdrawal. Black then graduated to Jakarta's Salemba prison. "When I was still inside, there were lots of drugs, all sorts," Black said. Prison gangs would sell drugs such as marijuana, crystal methamphetamine and heroin with the connivance of guards, for very little difference in price compared to the outside world, he said. A small packet of heroin that would cost 40,000 rupiah (four dollars) on the outside costs 50-60,000 rupiah in Salemba, and is usually better quality, he said. Needles to shoot up are also readily available. A "used" needle costs 2,000 rupiah per shot, while a "new" needle -- which does not necessarily mean it is sterile, but just that it is not yet blunt -- is more expensive. "For a putaw user, it's like that. They use it once, twice and it's still sharp so they see it as new," Black said. "(The dealers usually) have a stock of needles, let's say 15. When they open it, 15 people will line up. When they finish, others will use them." In numbers, the HIV/AIDS crisis in Indonesia's prisons is striking. Roughly a third of the 254 prison deaths recorded in May this year were due to HIV/AIDS, according to official statistics. Nearly 12,000 people are locked up in Jakarta prisons built to house just 5,056 inmates. Almost 6,900 inmates -- more than the entire Jakarta prisons system's official capacity -- are in for drug crimes. The number of inmates infected with HIV/AIDS is imprecise, but Partisan's Aditya reckons somewhere between a quarter and 40 percent of prisoners locked up on drug-related crimes are HIV positive, and most of them are unaware of their status. The authorities at Cipinang Narcotic -- capacity 1,084, real population 2,297 -- estimate 20 to 30 percent of their inmates are infected. Those arguing for drug law reform in Indonesia say it should not be like this. A war on drugs spearheaded by President Susilo Bambang Yudhoyono and an impending bill introducing heavy minimum sentences are part of a push that has seen prisons overflow, Atma Jaya University law lecturer Asmin Fransiska said. "The policy on drugs is much harsher right now than 10 years ago. (Former president) Abdurrahman Wahid's drug user policy put it as a social issue but since Susilo Bambang Yudhoyono, drugs have been put on the level of security," Fransiska said. Although in theory the law allows for light sentences and rehabilitation for addicts, in practice authorities opt for a tough line, she said. "This has become a huge problem, because we know you can't put a drug addict in prison and everything will be alright." While underfunded prison authorities are attempting to test and treat infected inmates, so-called "harm reduction" treatments to stop the spread of the disease inside are all but taboo, Aditya said. "If we promote clean needles they will point at our face: 'you're promoting injecting drugs'. If you're promoting safe sex it means you're promoting free sex," she said. The head of Indonesia's prison system, Untung Sugiyono, said the data showed the problem was not transmission inside prisons, but the fact that infected drug users were entering custody and promptly succumbing to the disease amid squalid conditions. "A person comes in and before they know it, in one to six months, they get sick and die," he said. "It's too extreme to say there are still a lot of drugs (in prisons). I don't want to skim over it if there are any, but it is relatively small." Despite the grimness of its infirmary ward, Cipinang Narcotic is the closest thing Indonesia has to a model prison when it comes to dealing with HIV/AIDS and drug addiction. The prison conducts basic tests on all inmates for HIV, deals out anti- retroviral drugs and has a methadone programme. But the prison's chief, Ibnu Chauldun, believes the effectiveness of all this has been undermined by a dysfunctional system that has overwhelmed his jail with users who should not be there. "What are they the victims of? They are the victims of drugs. They have to be rehabilitated, not jailed," Chauldun said. "You think we have a rehabilitation centre? We don't have one. We're not a rehabilitation centre. We're an institute for reforming criminals." .......................................................................... __________________________________________________________________________ Philippines: NBI warns public on fake anti-flu vaccines Manila Bulletin, Manila Philippines (01.08.09) The National Bureau of Investigation (NBI) and the Bureau of Food and Drugs (BFAD) have warned drugstores, pharmacists and the public in the general against falling prey to unscrupulous traders selling fake anti-flu vaccines. The NBI issued the warning on Friday as it expanded its monitoring of drugstores to the entire Luzon, including Metro Manila, following reports of the selling of a fake anti-flu vaccine called Vaxigrip. Last week, a medical representative was arrested during an operation conducted by operatives of the NBI Anti-Fraud and Computer Crimes Division (AFCCD) in Laguna. "We are warning drugstore owners and pharmacists against fake flu vaccines. We advise them to check on the lot number and manufacturing and expiration date and carefully examine the appearance of the vials to know what is genuine or not," said BFA director Nancy Tacandong. The NBI expanded its monitoring after reports that the fake drugs were being sold in some stores in Luzon, including stores in Laguna, Manila and Makati. "Samples of the content of the alleged fake flu vaccines are now being examined in a lab test to know what is the effect of the substance," said the BFAD official, adding that the public may call up BFAD Hotline 842-5606 and 809-4390 or NBI Hotline 524-5395 and 525-4093 regarding any information about the fake flu vaccines. Last week, NBI agents arrested a former medical representative of a drug company and seized several cartons of fake flu vaccines worth R4 million during a raid in San Pedro, Laguna. NBI Director lawyer Nestor M. Mantaring also warned the public against purchasing fake anti-flu vaccines. Mantaring identified the suspect as Jennifer M. Cristobal, 28, businesswoman, and resident of 19 Lily St., Sampaguita Village, San Pedro, Laguna. She is said to be a former medical representative of Sanofi Pasteur. "We estimated that the amount of confiscated fake vaccines from the raided house-establishment amounted to P4 million," said Deputy Director for Special Investigation Services lawyer Rickson L. Chiong. The raid stemmed from the complaint of Sanofi Pasteur, a BFAD-registered company that manufactures and markets pharmaceutical products including Vaxigrip (Inactivated Influenza Vaccine). The products and trademark of Sanofi Pasteur are also registered with the Intellectual Property Office. The investigation conducted by the NBI-AFCCD headed by Assistant Regional Director Vicente de Guzman III showed that the bureau had received information that certain individuals in Laguna were engaged in the sale and distribution of fake anti-flu vaccines. Sanofi Pasteur requested the NBI to conduct an investigation into the reported selling of the fake anti-flu vaccine. Head Agent Palmer Mallari, executive officer of the NBI-AFCCD, said surveillance conducted confirmed the report. He said the NBI learned that Cristobal of KNJ Marketing and Prime Gold Enterprises at 19 Lily St., Sampaguita Village, San Pedro, was engaged in the illegal and unauthorized manufacture, distribution and sale of counterfeit products, particularly Sanofi Pasteur pharmaceutical products such as but not limited to Vaxigrip. Published on Manila Bulletin http://www.mb.com.ph Copyright 2009. Manila Bulletin .......................................................................... __________________________________________________________________________ USA: Washington Supports Exchange of Needles By Ian Urbina, New York Times - New York,NY,USA (31.07.09) WASHINGTON -- City officials on Friday called on Congress not to reinstate a ban that prevented the nation’s capital from using local money to distribute clean needles to drug users. Until 2007, when the ban was lifted, Washington was the only city in the country forbidden by Congress from using both local and federal tax dollars to distribute clean needles to drug addicts. The capital has one of the fastest-growing H.I.V. and AIDS problems in the country. A House amendment now under consideration would essentially reinstate that ban by prohibiting the city from providing money to any needle exchange program that operates within 1,000 feet of virtually any location where children gather. Citing the effort to reinstate the ban as both a public health concern and the violation of a basic political right of home rule, Eleanor Holmes Norton, Washington’s delegate to the House, said the ban would be a "disaster" for the city. "The Republican minority wants to bring back the old days when they had a field day with D.C. appropriations, imposing their personal views or those of their constituents on a self-governing jurisdiction of 600,000 residents in the nation’s capital," Ms. Norton said. "This is just wrong." The amendment is part of the bill that gives the District of Columbia its federal appropriation for 2010. Since Washington is not part of a state, Congress controls its system of government. And for nearly a decade, members -- citing concerns about worsening drug abuse -- inserted language into the city’s budget bill that prohibited financing needle exchange programs. "Children should not be out playing kickball and watching people exchange needles for illegal drug use," said Representative Jack Kingston, Republican of Georgia and the sponsor of the current amendment. A spokesman for Mr. Kingston added that the congressman was willing to work toward a compromise regarding the distance from places where children gather but that he had not heard from Ms. Norton or Mayor Adrian M. Fenty on the matter. The city, which first financed needle exchange programs in April 2008, already prohibits needle exchanges within 1,000 feet of schools. The amendment expands on that prohibition by forbidding such programs within 1,000 feet "of a public or private day care center, elementary school, vocational school, secondary school, college, junior college, or university, or any public swimming pool, park, playground, video arcade, or youth center, or an event sponsored by any such entity." "We mapped what was left, and we essentially could only operate in graveyards or in the middle of the Potomac River," said Mary Beth Levin, director of programs and services at Prevention Works, one of the city’s needle exchange programs. Most exchange programs are mobile and occur near parks, Ms. Levin said. Mr. Fenty said he intended to get the amendment "stripped from the final appropriations bill for this budget year." Washington had one of the highest rates of reported AIDS cases among American cities, according to the Centers for Disease Control and Prevention. The rate in 2007 was 34.5 reported cases per 100,000 people, compared with 41.7 in San Francisco; 36.6 in New York; 36.5 in Fort Lauderdale, Fla.; and 35.4 in Miami, a disease centers report said. While the centers estimate that a quarter of Americans living with H.I.V. do not know they are infected, one-third to one-half of city residents may be unaware of their positive status, according to a report by Washington’s Department of Health. A spokeswoman for the department, Dena Iverson, said that from October 2008 to June 2009, about 210,000 needles were exchanged and the city enrolled more than 1,000 new clients. The program also distributed 200,000 condoms and referred nearly 300 clients into drug detox/treatment. Roughly 15 percent of all new infections are related to injection drug use, according to a city health report that used 2007 data. .......................................................................... __________________________________________________________________________ USA: APIC Promotes Safe Injection Practices to Prevent Bloodborne Infections Infection Control Today (30.08.09) In response to continued reports of infection control flaws in outpatient healthcare clinics that have put thousands of patients at risk for serious infections, the Association for Professionals in Infection Control and Epidemiology (APIC) today announced its strong support for adherence to safe injection practices in clinical settings throughout the U.S. The recommendations are published in the APIC position paper, "Safe Injection, Infusion and Medication Vial Practices in Healthcare." This position paper was endorsed by the Society for Healthcare Epidemiology of America (SHEA). More than 35 outbreaks of viral hepatitis have occurred in the U.S. in the past 10 years due to unsafe injection practices including syringe re-use between patients, contamination of medication vials or intravenous bags and inappropriate sharing of blood sugar testing equipment. One of the largest outbreaks occurred in Nevada in 2008 in which 63,000 people were notified of their possible risk of hepatitis C due to re-use of syringes and sharing of single-use medication vials at a Las Vegas endoscopy center. "APIC recognizes these outbreaks as unacceptable," said Susan Dolan, RN, MS, CIC, lead author of the position paper and epidemiologist at The Children’s Hospital in Aurora, Colo. "There is no excuse for failure to follow basic infection prevention practices when preparing and administering medications, giving injections and obtaining blood samples." The APIC position paper comes on the heels of increased government attention to infection prevention in outpatient clinics. In February, the Government Accountability Office released a report highlighting the need for nationwide data on the risk of healthcare-associated infections in ambulatory surgery centers, and in April the Department of Health and Human Services announced that they are using $10 million from the economic stimulus law to strengthen inspections of outpatient facilities. "The ongoing reports of hepatitis B and C transmission demonstrate that much more is needed to assure that preventive practices are being scrupulously followed in all healthcare settings," said Dolan. "Administrators of medical facilities must support safe injection practices and provide resources to ensure employees have the training and equipment to safely implement these procedures. Safe injection, infusion and medication vial practices must be the absolute standard of care in every clinical setting." Copyright 2009 by Virgo Publishing. http://www.infectioncontroltoday.com/ .......................................................................... __________________________________________________________________________ USA: VA Victims to File Disability Claims Newsinferno.com (30.07.09) We recently wrote that the Department of Veterans Affairs (VA) was roundly criticized at a hearing before a House VA committee for not increasing safeguards and improving procedures at VA health facilities after shoddy colonoscopies and endoscopies were potentially linked to the spread of dangerous, deadly pathogens. Now, an attorney is planning on asking the U.S. Department of VA to pay disability benefits and damages for these mistakes, reported the Associated Press (AP). We also recently wrote that despite a nationwide scare, media attention, and suspected links to HIV, hepatitis B, and hepatitis C, less than half of all VA facilities were operating under appropriate procedures based on surprise investigations spurred by the scandal, which broke months earlier, citing a prior AP report. HIV and hepatitis B and C are spread by contact with infected body fluids, especially blood. HIV--the human immunodeficiency virus--is the virus that causes AIDS (acquired immunodeficiency syndrome); AIDS is the final stage of HIV infection. Hepatitis B and C are liver diseases that can lead to cirrhosis or cancer of the liver. Vaccines exist only for hepatitis B. HIV/AIDS and hepatitis B and C can all be fatal. The complaint is for about 60 veterans, three of whom are women, said the AP, and includes veterans who tested positive for the blood borne illnesses and who also allege to suffering emotional distress. In those cases, according to the AP, the distress occurred after the VA provided initial positive blood tests for infections but were, in fact, negative. According to the AP, current VA records indicate that of those patients who received testing, eight have tested positive for HIV, 12 for hepatitis B, and 37 for hepatitis C. In all, 9,141 patients have received test results of the 10,320 patients who received letters suggesting they to undergo testing due to potential exposure, said the AP. Meanwhile, the shoddy endoscopies and colonoscopies were conducted as far back as five years ago and put VA patients at risk because they were treated with equipment that was not appropriately sterilized, thus exposing them to the bodily fluids of other patients, noted the AP previously. The VA acknowledged in its warnings letters that the invasive procedures potentially exposed them to other patients’ bodily fluids. Also, the VA admitted in late March that water tubes and reservoirs it used in colonoscopies and endoscopies were rinsed--not disinfected-- between procedures, which could expose subsequent patients to contamination. The VA has admitted to the mistakes, which, it said, were caused by human error, reported the AP earlier, but says that it is unable to prove if the infections are directly linked to VA procedures. The VA said the errors were isolated to three of its hospitals: Murfreesboro, Tennessee; Miami, Florida; and Augusta, Georgia, according to the AP. Many believe dirty equipment is to blame and, last month, the AP reported that other VA patients were not warned about similar mistakes with the same equipment at more than 12 other VA centers. .......................................................................... __________________________________________________________________________ Iran: Needle and syringe sharing among Iranian drug injectors 7thSpace Interactive (p30.07.09)) ObjectiveThe role of needle and syringe sharing behavior of injection drug users (IDUs) in spreading of blood-borne infections - specially HIV/AIDS - is well known. However, very little is known in this regard from Iran. The aim of our study was to determine the prevalence and associates of needle and syringe sharing among Iranian IDUs. Methods: In a secondary analysis of a sample of drug dependents who were sampled from medical centers, prisons and streets of the capitals of 29 provinces in the Iran in 2007, 2091 male IDUs entered. Socio-demographic data, drug use data and high risk behaviors entered to a logistic regression to determine independent predictors of lifetime needle and syringe sharing. Results: 749(35.8%) reported lifetime experience of needle and syringe sharing. The likelihood of lifetime needle and syringe sharing was increased by female gender, being jobless, having illegal income, drug use by family members, pleasure/enjoyment as causes of first injection, first injection in roofless and roofed public places, usual injection at groin, usual injection at scrotum, lifetime experience of nonfatal overdose, and history of arrest in past year and was decreased by being alone at most injections. Conclusion: However this data has been extracted from cross-sectional design and we can not conclude causation, some of the introduced variables with association with needle and syringe sharing may be used in HIV prevention programs which target reducing syringe sharing among IDUs. Author: Hassan RafieyHooman NarenjihaPeymaneh ShirinbayanRoya NooriMorteza JavadipourMohsen RoshanpajouhMercedeh SamieiShervin Assari Credits/Source: Harm Reduction Journal 2009, 6:2 .......................................................................... __________________________________________________________________________ China: Hepatitis Group Is Harassed in China By Andrew Jacobs, New York Times (30.07.09) BEIJING -- In the realm of potential threats to China’s stability, an organization that advocates on behalf of people infected with hepatitis B would seem to be low risk. But on Wednesday, the group’s director, Lu Jun, found himself squaring off against four security officials who were trying to cart away stacks of literature they claimed had been printed without official permission. In the end, Mr. Lu scored a partial victory. After eight hours looking through drawers and photographing volunteers, the inspectors walked off with 90 pamphlets, but Mr. Lu prevented them from delving into the group’s computer files. "I fear this is not the end of it," he said Thursday. The raid on Mr. Lu’s organization, the Yi Ren Ping Center, comes at a precarious time for China’s nongovernmental organizations, many of which operate in a kind of legal gray zone. Two weeks ago, officials used a bureaucratic infraction as the reason to shut down the country’s pre- eminent legal rights center, Gongmeng, or Open Constitution Initiative. The closing followed a separate disbarment of 53 lawyers known for taking on civil rights and corruption cases. Just before dawn on Wednesday, the founder of Gongmeng, Xu Zhiyong, was taken into police custody, and he has not been heard from since. "The permissible space in which civil society groups can operate was already small, but right now that circle is getting smaller and smaller," said Sharon Hom, the executive director of Human Rights in China, which is based in New York. "If an organization is creating an independent voice, putting together a newsletter or organizing people in any way, it’s going to feel the full brunt of the authorities." Although it is unclear exactly why the government is tightening its grip on such organizations, legal experts and rights activists generally agree that it may be related to the celebrations, three months from now, of the 60th anniversary of China’s Communist revolution. A similar clampdown took place in the months before the 2008 Summer Olympics, when security officials in Beijing stepped up the harassment of dissidents and encouraged thousands of migrant workers to return to the countryside. "It’s basically a foolish attempt to make the year as peaceful and uneventful as possible," said Jiang Tianyong, a lawyer who was among those blocked from renewing their licenses. Another explanation, Mr. Jiang and others say, is that some powerful segments of China’s leadership feel threatened by the rise of independent entities working to advance causes like labor rights or clean water, or in the case of the Yi Ren Ping Center, protection for people with hepatitis B. There is widespread trepidation over hepatitis B in China, a fear that has been intensified by an explosion in advertising for medical testing services and sham cures. Even though it is preventable with a vaccine -- and most of those infected will not become ill -- state-owned companies, medical schools and food-processing plants have come to believe that it is sensible policy to bar the infected. Under Chinese law, carriers of hepatitis B cannot work as teachers, elevator operators, barbers or supermarket cashiers. In a recent survey of 113 colleges and universities, conducted by the Yi Ren Ping Center, 94 acknowledged that infected applicants, required to take blood tests, would be summarily rejected. * Many of the 120 million carriers in China got the virus in the 1970s and 1980s, when a single contaminated syringe was sometimes used to inoculate hundreds of people at a time against diseases. The second-biggest group of carriers, about 40 percent of the total, according to the government, got the virus from their mothers during childbirth. An online bulletin board maintained by Mr. Lu’s group is a heart-rending clearinghouse for stories of people fired from jobs, or students denied college educations, after mandatory blood tests revealed their statuses. There are also scores of tales about the ashamed and the distraught who killed themselves. "People are so afraid of this virus, they don’t act responsibly," said Wang Li, an engineer who just graduated from a prestigious Beijing university and saw two job offers evaporate this year when blood tests showed that he had the virus. "The only thing they told me was, ‘You are not suitable for work.’ " Founded in 2006 by Mr. Lu, who is also infected, the Yi Ren Ping Center provides up-to-date medical information and tries to arrange legal help for those it considers wrongly dismissed from jobs. It also encourages its 300,000 members to press for antidiscrimination laws. Last summer the center was forced to move its Web site to an overseas server after it mysteriously vanished from the Internet. Although his organization does not seek to challenge the government’s authority, Mr. Lu recognizes that its mission can stir discomfort among the powerful and mighty. "After all, it is these people who are maintaining the status quo of discrimination," he said in his office on Thursday. "And of course, according to the government, there is no such thing as discrimination in China. There are only misunderstandings." Xiyun Yang contributed research. .......................................................................... __________________________________________________________________________ UK: Bristol dentist's patients tested for HIV and hepatitis Bristol Evening Post - Bristol,Bristol,UK (30.07.09) Hundreds of Bristol patients underwent blood tests to check they had not contracted HIV or hepatitis after it emerged that there were concerns about the hygiene practices of their dentist. People were notified that the dentist, who previously worked at two surgeries in the Bristol area, was not cleaning his instruments properly. As previously reported in the Bristol Evening Post, NHS South Gloucestershire and its Bristol counterpart sent out 4,000 letters last month to patients who may have been treated by the dentist at Frenchay Dental Practice and East Street Dental Practice in Bedminster. The health trust said that further investigations were being made following a handful of blood tests that resulted from the letters. A report to NHS South Gloucestershire's board stated that there had been at least one positive result following the exercise, but it was not clear how the patient had been affected. The trust said it could not confirm how many people had tested positive in total for fear of identifying individuals. More than 1,200 patients contacted the helpline and about 830 people attended the clinic that was set up to deal with the issue. Of those, 790 opted to have a blood test. A handful of patients also had blood tests at their own GP practices. The dentist worked at Frenchay Dental Practice between January 2003 and July 2007 and at East Street Dental Practice in Bedminster for two weeks in December 2007. The health trusts would not name the individual involved but said that there had been no reports of concerns when the dentist worked in the Bristol surgeries. Issues were raised when the individual worked in the Poole Lane Dental Practice in the Bournemouth area last year. When NHS South Gloucestershire sent out the letters it said that the risk of infection was low but it had taken the precaution to reassure people. Among the patients at Frenchay Dental Practice who went for a blood test was Sarah Behling, 27, of Frampton Cotterell, whose results were negative. She said: "I wasn't sure whether to be concerned or not, I felt a bit lost as one piece of information seemed to keep contradicting the other." NHS South Gloucestershire said that the number of tests it was following up was well below the Health Protection Agency national rates of infection. Dr Chris Payne, director of public health for South Gloucestershire, said: "We explained that if there was poor infection control practice, there is a very low risk that blood borne infections may have been passed from one patient to the next. "We invited former patients to discuss the matter with a qualified healthcare professional and to have a blood test. "This was understandably an anxious time for people and we thank them for their understanding." .......................................................................... __________________________________________________________________________ Philippines: NBI seizes P4M worth of fake flu vaccines GMA news.tv - Quezon City,Metro Manila,Philippines (29.07.09) Amid the scramble for immunity against the dreaded A(H1N1) virus, government agents seized some P4 million worth of fake flu vaccines in a sting operation targeting a businesswoman in Laguna province last week. The National Bureau of Investigation (NBI) has said its agents nabbed the suspect Jennifer Cristobal, 28, in her home at 19 Lily St., Sampaguita Village in San Pedro City in Laguna. Radio dzBB reported Wednesday that Cristobal sold the vaccines at P3,000 per vial, about P1,000 cheaper than the genuine product. NBI Anti-Fraud and Computer Crimes Division agents seized several cardboard boxes of fake flu vaccines, which turned out to contain water, during the raid on Cristobal's house. A press statement on the NBI Web site said Cristobal's arrest stemmed from a complaint lodged by Sanofi Pasteur, maker of the Vaxigrip (inactivated influenza vaccine). Investigation showed Cristobal's KNJ Marketing was selling fake products and passing them off as products of Sanofi Pasteur. After a test-buy of Cristobal's vaccines proved positive, the NBI obtained a search warrant from San Pedro Regional Trial Court Branch 31. Last Friday, the NBI arrested Cristobal and raided her house, where they found 180 vials of Vaxigrip vaccines, 10 boxes of syringes, official and delivery receipts, certificate of product registration, labels, marketing paraphernalia, computers, a telefax machine, and printers. Cristobal is being detained at the NBI jail and is facing charges of sale of counterfeit drugs. - GMANews.TV .......................................................................... __________________________________________________________________________ MedImmune Seeks Fast Track for FluMist Washington Post (07/24/09) P. A18 MedImmune, the maker of FluMist, is working with the U.S. government to develop an alternate method for production. The company is currently producing so many doses of FluMist each month that it cannot keep up with putting them into the special sprayer needed to use it. The proposed alternate method involves using a dropper to insert the nasal-spray vaccine instead of a sprayer. .......................................................................... __________________________________________________________________________ Canada: Review blames old habits for reuse of dirty syringes By Bob Weber in Edmonton, The Canadian Press, Canada (21.07.09) CALGARY -- Isolation and old habits were the main reasons why a remote northern Alberta hospital recycled syringes that were meant to be used only once, says a report by the province’s health watchdog. The report concludes staff at the High Prairie Health Complex were unaware it was no longer a medical practice to reuse needles to inject medicines into intravenous tubes. "In this rural setting, they had become isolated from the evolution of these standards," Dr. John Cowell of the Health Quality Council of Alberta said Tuesday. "This was a failure of education and being aware of standards and working fundamentally in isolation from the rest of the system." But Cowell added that didn’t let the hospital off the hook. "Regardless of where your location is, you must be aware of changing standards." The report recommends closer monitoring of far-flung facilities and better staff training. Last fall, provincial officials revealed that hundreds of patients at the hospital would need to be tested for blood-borne diseases after it was learned that nurses were reusing syringes, which were intended to be used once and discarded. The needles were used to inject IV tubes and were never directly used on patients. Still, Alberta Health Services tested about 1,500 dental and endoscopic patients for diseases from HIV to hepatitis. No infections related to the used syringes were found. The practice introduces a remote chance of both infection and mis- medication and was largely phased out nearly a decade ago, the council found. But, somehow, High Prairie never got the message. The report blames a local "culture of autonomy" that was "linked with physical isolation from external influences" for the survival of techniques banned everywhere else. It also says some nurses didn’t entirely understand the intravenous equipment. The council recommends the province tighten up reporting and review requirements to make sure all facilities use best practices. "We think it’s a combination of the administration as well as the professions not being enabled to stay up-to-date," Cowell said. Last year’s elimination of regional health boards in favour of one provincial "superboard" should help ensure knowledge is up-to-date across Alberta, said Health Department spokesman John Tuckwell. Cowell said that in an age of electronic communications, there’s no reason for any geographic area to remain isolated. The High Prairie case also initiated a risk review in several Saskatchewan hospitals into the reuse of needles. The findings are expected to be released in August. __________________________________________________________________________ _____________________________________*____________________________________ __________________________________________________________________________ * 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 latest injection safety Best Practices review at: http://www.uqconnect.net/signfiles/Files/BestPracticesJul2003.pdf Use the Toolbox at: http://www.who.int/injection_safety/toolbox/en/ Subscribe or un-subscribe by email to: sign@uq.net.au, sign@who.int or on subscribe online at: http://www.who.int/injection_safety/sign/en/ Get SIGN files on the web at: http://www.uqconnect.net/signfiles/Files/ get SIGNpost archives at: http://www.uqconnect.net/signfiles/Archives/?M=D The SIGN Secretariat, the Department of Essential Health Technologies, WHO, Avenue Appia 20, CH-1211 Geneva 27, Switzerland. Telephone: +41 22 791 3680, Facsimile: +41 22 791 4836, E- mail: sign@who.int _____________________________________*____________________________________ __________________________________________________________________________ SIGN meets annually to aid collaboration and synergy among SIGN network participants worldwide. The 2009 SIGN annual meeting will be held from 30 November to Wednesday 2 December 2009 at WHO Headquarters in Geneva Switzerland. The PQS (performance Quality and Safety) consultative meeting with the industry, will be held back to back with the SIGN meeting on 3rd and 4th December 2009. Get the final report of the SIGN Meeting 2008, Moscow, Russian Federation [2.36Mb] at: http://www.who.int/injection_safety/2008MeetingReport.pdf Many SIGN files can be opened in Acrobat Reader. To access all the features in Adobe Acrobat documents download the Acrobat Reader at: http://www.adobe.com/products/acrobat/readstep2.html Translation tools are available at: http://www.google.com/language_tools or http://www.freetranslation.com __________________________________________________________________________ All members of the SIGN Forum are invited to submit messages, comment on any posting, or to use the forum to request technical information in relation to injection safety. The comments made in this forum are the sole responsibility of the writers and does not in any way mean that they are endorsed by any of the organizations and agencies to which the authors may belong. Use of trade names and commercial sources is for identification only and does not imply endorsement. Contributions to: sign@uq.net.au or use your reply button! The SIGN Forum welcomes new subscribers who are involved in injection safety. Please subscribe by sending an email to: sign@who.int _____________________________________*____________________________________ The SIGN Internet Forum was established at the initiative of the World Health Organization's Department of Essential Health Technologies. The SIGN Forum is moderated by Allan Bass and is hosted on the University of Queensland computer network. http://www.uq.edu.au __________________________________________________________________________