*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *SAFE INJECTION GLOBAL NETWORK* SIGN 2009 30 November to 2 December 2009 at WHO HQ Geneva Post00510 New Archive + Abstracts + Video + News 26 August 2009 CONTENTS 0. SIGNpost Archive January - July 2009: Zip File now online for download 1. Abstract: Evaluation of knowledge and practice amongst nursing staff toward infection control measures in a tertiary care hospital in India 2. Abstract: Prevalence of, and attitude towards, needle-stick injuries by Nigerian gynaecological surgeons 3. Abstract: Sharps injuries among medical students 4. Abstract: High Frequencies of Exposure to the Novel Human Parvovirus PARV4 in Hemophiliacs and Injection Drug Users, as Detected by a Serological Assay for PARV4 Antibodies 5. Abstract: Needle-stick injury: a novel intervention to reduce the occupational health and safety risk in the haemodialysis setting 6. Abstract: Perception of nosocomial risk among healthcare workers at "Hopital Principal" in Dakar, Senegal (survey 2004) 8. Abstract: Seroprevalence of Hepatitis C viral antibodies in pregnancy in a tertiary health facility in Nigeria 9. Abstract: Advocacy for harm reduction in China: a new era dawns 10. Abstract: Predictors of intention to change HIV sexual and injection risk behaviors among heterosexual methamphetamine-using offenders in drug treatment: a test of the AIDS Risk Reduction Model 11. Abstract: HIV and hepatitis C virus infections among hanka injection drug users in central Ukraine: a cross-sectional survey 12. Abstract: Opiate replacement therapy in France 13. Abstract: Nursing and the reality of politics 14. Abstract: A review of multiple approaches towards an improved hepatitis B vaccine 15. Abstract: New applications for sublingual immunotherapy in allergy 16. Abstract: Skin disinfection with octenidine dihydrochloride for central venous catheter site care: a double-blind, randomized, controlled trial 17. Abstract: Bacterial biofilm formation, pathogenicity, diagnostics and control: An overview 18. Abstract: Human pharmacology of intravenous lisdexamfetamine dimesylate: abuse liability in adult stimulant abusers 19. HIV Heroes - New series of short films on HIV/AIDS 20. News - India: Indian Police Raid Alleged Illegal Blood Bank - India: Poisoned blood: UP gets tough - USA: US at 'Turning Point' in Fight Against AIDS, Says Health and Human Services Secretary Kathleen Sebelius - USA: 27 Cases of Hepatitis C Now Linked to Suspect - USA: Hepatitis cases spur safety measures - Africa: Editorial - Safer Blood Collection For Africa - Australia: H1N1 jabs plan 'poses infection risk' - USA Puerto Rico: Product recalls: Accusure insulin syringes - Treating heroin addiction with heroin seems viable - USA: Carle RxExpress and Carle Foundation Hospital help ease patients’ medical waste concerns: launch free public medication and needle disposal program - USA: North Miami Man Files Notice to Sue VA over HIV Infection - USA: Premier Healthcare Alliance Expert to Discuss Safe Injection Practices and Improving Patient Safety at Joint Commission Infection Control Conference - USA: Probation revoked for woman who gave fake flu vaccine - Africa: PEPFAR partners with BD to improve blood collection safety in Africa - USA: Autism group softens stance on vaccines - Nasal Vaccine Holds Promise Against Swine Flu This edition of SIGNpost is located at: http://uqconnect.net/signfiles/Archives/SIGN-POST00510.txt and is printer friendly. If your email reader truncates your SIGNpost - click on the link above to download the complete posting. Please send your requests, notes on progress and activities, articles, news, and other items for posting to: sign@uq.net.au Normally, items received by Tuesday will be posted in the Wednesday edition. Subscribe or un-subscribe by email to: sign@uq.net.au, sign@who.int More information follows at the end of this SIGNpost! Visit the WHO injection safety website and the SIGN Alliance Secretariat at: http://www.who.int/injection_safety/en/ __________________________________________________________________________ _____________________________________*____________________________________ 0. SIGNpost Archive January - July 2009: Zip File now online for download __________________________________________________________________________ Download the archive file and unzip it for the full text of all SIGNposts from January 2009 through to the end of July 2009. http://uqconnect.net/signfiles/Archives/SIGNpost-Vol-9a-Jan-July2009.zip __________________________________________________________________________ _____________________________________*____________________________________ 1. Abstract: Evaluation of knowledge and practice amongst nursing staff toward infection control measures in a tertiary care hospital in India __________________________________________________________________________ Can J Infect Control. 2009 Summer;24(2):104-7. Evaluation of knowledge and practice amongst nursing staff toward infection control measures in a tertiary care hospital in India. Taneja J. Department of Microbiology, GB Pant Hospital, New Delhi, India. PURPOSE: A study to assess the level of knowledge and practice of 100 staff nurses on infection control measures was carried out in a tertiary care center. METHOD: A structured questionnaire was used to collect the data. RESULTS: The mean knowledge of staff nurses regarding infection control measures was 75.5% and the mean reported infection control practice was 57.5%. After conducting exhaustive lectures on infection control related topics, a significant decline in the hospital-acquired infection (HAIs) rates was seen in the high-risk areas. CONCLUSION: Training of nursing staff is needed to improve knowledge and practice in infection control. __________________________________________________________________________ _____________________________________*____________________________________ 2. Abstract: Prevalence of, and attitude towards, needle-stick injuries by Nigerian gynaecological surgeons __________________________________________________________________________ Niger J Clin Pract. 2009 Mar;12(1):34-6. Prevalence of, and attitude towards, needle-stick injuries by Nigerian gynaecological surgeons. Efetie ER, Salami HA. Department of Obstetrics and Gynaecology, National Hospital, Abuja, Nigeria. efenae@yahoo.com Health care workers who have occupational exposure to blood and other potentially infectious materials are at increased risk for acquiring blood-borne infections. The emotional impact of a needle-stick injury can be severe and long lasting, even when a serious infection is not transmitted. OBJECTIVE: To assess the prevalence and attitude towards needle-stick injuries by Nigerian gynaecological surgeons. METHODOLOGY: A cross-sectional study was conducted at the 40th Annual General Meeting and Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) held in Ibadan, southwest Nigeria from the 23rd to the 26th of November 2005. Data was collected using a self- administered questionnaire. RESULTS: Seventy two questionnaires out ofa hundred administered were finally analysed. Sixty-five (90.3%) respondents had experienced needle- stick injuries in the workplace. This occurred in the majority of cases (86.2%) during suturing. Only 9.2% of those experiencing a needle-stick injury took the correct or appropriate action afterwards. Consultants were not significantly more likely than Residents to take appropriate actions after needle-stick injuries (p > 0.10, X2 = 2.11, 1 df). Fifty-two (80%) of those with needle-stick injuries did not report the incident to the appropriate office. Only 26 (37.1%) of 70 respondents indicated the presence of a needle-stick policy in their centres. Conclusion: The prevalence of needle-stick injuries among sampled Nigerian gynaecological surgeons is high. Majority are either unaware or do not take appropriate actions after exposure to hazardous body fluids from needle-stick injuries, either through first-aid steps or post-exposure prophylaxis. All health institutions should have a working needle-stick policy in their centres, and health care workers continually educated on it. __________________________________________________________________________ _____________________________________*____________________________________ 3. Abstract: Sharps injuries among medical students __________________________________________________________________________ Occup Med (Lond). 2009 Aug 18. Sharps injuries among medical students. Varsou O, Lemon JS, Dick FD. Department of Environmental and Occupational Medicine, University of Aberdeen, Aberdeen, UK. BACKGROUND: Medical students may be at risk of sharps injuries for several reasons. These exposures can transmit a range of blood-borne pathogens including hepatitis B, hepatitis C and human immunodeficiency virus. AIMS: To evaluate medical students' knowledge regarding the prevention and management of sharps injuries and their experience of such exposures in the calendar year 2007. METHODS: A cross-sectional, web-based, survey of fourth and fifth year medical students enrolled at the University of Aberdeen in Scotland. All students were at the mid-point of their year of study. An invitation e- mail and two electronic reminders were sent, on specified days, to the study population. These contained a summary of the study and the link to the anonymous questionnaire. RESULTS: Of the 395 medical students e-mailed, 238 (60%) responded. When compared with fourth year medical students, final year students had higher mean knowledge scores for sharps injury management (P < 0.01). Of total, 18% reported resheathing used needles and 31% reported disposing of sharps for others, indicating poor compliance with standard precautions. In the event of an injury, 29% stated that they would scrub the wound. Only 44% were familiar with policies for reporting exposures. In all, 11% of students had experienced at least one contaminated sharps injury in 2007 and, of those, 40% had reported the most recent incident. CONCLUSIONS: Medical students are at risk of sharps injuries and their knowledge regarding the prevention and management of these exposures is limited: training on these issues should be increased. __________________________________________________________________________ _____________________________________*____________________________________ 4. Abstract: High Frequencies of Exposure to the Novel Human Parvovirus PARV4 in Hemophiliacs and Injection Drug Users, as Detected by a Serological Assay for PARV4 Antibodies __________________________________________________________________________ J Infect Dis. 2009 Aug 19. High Frequencies of Exposure to the Novel Human Parvovirus PARV4 in Hemophiliacs and Injection Drug Users, as Detected by a Serological Assay for PARV4 Antibodies. Sharp CP, Lail A, Donfield S, Simmons R, Leen C, Klenerman P, Delwart E, Gomperts ED, Simmonds P. Centre for Infectious Diseases, University of Edinburgh, and 2Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, and 3Peter Medawar Centre for Pathogen Research, University of Oxford, Oxford, United Kingdom; 4Department of Biostatistics, Rho, Chapel Hill, North Carolina; 5Blood Systems Research Institute and Department of Laboratory Medicine, University of California, San Francisco, San Francisco, and 6Department of Hematology, Childrens Hospital Los Angeles, Los Angeles, California. Background. PARV4 is a human parvovirus that was first detected in and cloned from an individual with a human immunodeficiency virus (HIV) seroconversion-like illness and that subsequently persisted in the lymphoid tissue and bone marrow. In contrast to human parvovirus B19 infections, PARV4 infections are most frequently detected in injection drug users (IDUs), particularly those who are coinfected with HIV type 1 (HIV-1). To investigate the routes of transmission of PARV4 and to ascertain whether infections are acquired through plasma-derived blood products, we developed a novel anti-PARV4 enzyme-linked immunosorbent assay (ELISA) to determine its seroprevalence in subjects with parenteral exposure. Methods. PARV4 viral protein 2 (VP2) was expressed and used as antigen in an indirect ELISA, to detect anti-PARV4 immunoglobulin G. Results. All 50 adult control subjects who were nonparenterally exposed to PARV4 were anti-PARV4 negative, in contrast to HIV-infected and HIV- uninfected IDUs, who had antibody frequencies of 67% and 33%, respectively. Predominantly parenteral transmission was confirmed by the finding of similar frequencies of infection among HIV-coinfected and HIV- uninfected hemophiliacs (11 of 20 individuals and 4 of 15 individuals, respectively) who were treated with nonvirally inactivated factor VIII/factor IX, whereas all but 1 of the 35 nonhemophiliac siblings of these siblings were found to be seronegative (despite having close household contact). Conclusions. The present study provides convincing evidence that PARV4 is primarily transmitted parenterally. Evidence for widespread infection of hemophiliacs treated with nonvirally inactivated clotting factor creates fresh safety concerns for plasma-derived blood products, particularly because parvoviruses are relatively resistant to virus inactivation. __________________________________________________________________________ _____________________________________*____________________________________ 5. Abstract: Needle-stick injury: a novel intervention to reduce the occupational health and safety risk in the haemodialysis setting __________________________________________________________________________ J Ren Care. 2009 Sep;35(3):120-6. Needle-stick injury: a novel intervention to reduce the occupational health and safety risk in the haemodialysis setting. Chow J, Rayment G, Wong J, Jefferys A, Suranyi M. Cardiovascular Stream, Sydney South West Area Health Service, New South Wales, Australia. Needle-stick injury (NSI) is a major occupational health and safety issue facing healthcare professionals. The administration of erythropoiesis- stimulating agents (ESA) in haemodialysis patients represents a major cause for injections. The purpose of this initiative was to familiarise nursing staff with needle-free administration of an ESA in haemodialysis patients to reduce the risk of NSI. Epoetin beta comes in a commercial presentation with a detached needle. Epoetin beta was administered to 10 haemodialysis patients via the venous bubble trap short line of the haemodialysis circuit. An audit was conducted that included a retrospective assessment of NSI for the previous six months; and a prospective assessment for eight weeks to assess whether there is a nursing staff preference for needle-free administration of ESA. There were no reports of NSI in the needle-free group. Haemoglobin levels were maintained. Ninety-one percent of the nursing staff preferred needle-free administration of ESA. In conclusion, the commercial presentation of epoetin beta with the detached needle presents an opportunity to reduce the potential risk of NSI in haemodialysis units. __________________________________________________________________________ _____________________________________*____________________________________ 6. Abstract: Perception of nosocomial risk among healthcare workers at "Hopital Principal" in Dakar, Senegal (survey 2004) __________________________________________________________________________ Med Trop (Mars). 2008 Dec;68(6):593-6. [Perception of nosocomial risk among healthcare workers at "Hopital Principal" in Dakar, Senegal (survey 2004)] [Article in French] Chevalier B, Margery J, Wade B, Ka S, Diatta B, Gueye M, Mbaye PS, Debonne JM. Service de biologie de l'hôpital Principal de Dakar, Sénégal. be.chevalier@orange.fr Nosocomial Infection (NI) is also observed in healthcare facilities in non-Western countries. The purpose of this report is to describe the findings of a survey undertaken to evaluate hygiene procedures implemented at the "Hopital Principal" in Dakar, Senegal and to assess perception and awareness of nosocomial risk among the hospital staff. A total of 264 healthcare workers were interviewed. Mean age was 39 years (range, 18-60) and the sex ratio was 1.3 (150 men/114 women). Sixty (22.7%) had university degrees, 106 (40.2%) had secondary school diplomas, 50 (18.9%) had attended middle school, and 13 (4.9%) had no schooling. Analysis of interview data showed that 56.1% (157/264) defined NI as infection acquired at the hospital but that only 9.8% (n=26) knew that a minimum 48- hour delay was necessary to distinguish nosocomial from community acquired infection. While understanding about NI was correlated with education level, data showed that 1 out of 3 physicians (13/39) failed to give the exact definition. Hand contact was cited as the second route of transmission. Isolation precautions were understood by 22.7% of personnel (60/264). Systematic handwashing was reported by 363% (96/264) but observation demonstrated that it was not performed properly regardless of the category of personnel. Care protocols were understood by 54.6% of persons interviewed (144/264). A hygiene-training course had been attended by 52.2% (n=138). Two thirds of the staff (69.7%: 54/264) was able to identify the hygiene nurse. Ninety-eight health care providers (37.1%) were familiar with the CLIN (Comités de Lutte contre les Infections Nosocomiales). __________________________________________________________________________ _____________________________________*____________________________________ 8. Abstract: Seroprevalence of Hepatitis C viral antibodies in pregnancy in a tertiary health facility in Nigeria __________________________________________________________________________ Niger J Clin Pract. 2009 Mar;12(1):65-73. Seroprevalence of Hepatitis C viral antibodies in pregnancy in a tertiary health facility in Nigeria. Onakewhor JU, Okonofua FE. Department of Obstetrics and Gynaecology, University of Benin City, Benin City, Nigeria. jonakewhor@yahoo.com BACKGROUND: Liver disease due to Hepatitis C viral (HCV) infection is the most common indication for liver transplant. It is a viral pandemic that is five times as widespread as the human immunodeficiency virus type 1 infection. In spite of this, vaccines were yet unavailable for protection of the human race due to the morphology and fastidious nature of the organism. While the scanty data available on this infection in our environment are limited to blood donors, people continue to be screened for and deprived of renal dialysis if any patient is found to have HCV infection. Also in this environment, data on HCV infection in pregnancy is virtually nonexistent even though the infection can have a deleterious effect on materno-fetal outcome. OBJECTIVE OF THE STUDY: To determine the seroprevalence of hepatitis C viral antibodies among antenatal women attending a tertiary health facility in Nigeria. METHODOLOGY: This was a prospective cross-sectional study whose subjects were booked consecutive antenatal women volunteers attending the University of Benin Teaching Hospital, Benin City, Nigeria between June 1 and December 31, 2005. Hepatitis C viral antibodies were determined and confirmed using a second and a third generation Enzyme Linked immunosorbent assay respectively. Both HCV sero-positive and seronegative women had both pre-and post-test counseling. RESULTS: Of the 269 samples screened for HCV antibodies, 5 (1.86%) samples were confirmed seropositive. None of the HCV seropositive women had liver enzyme derangement. CONCLUSION: Hepatitis C viral infection in pregnancy is not uncommon in Nigeria. It's prevalence in pregnant women South-South of Nigerian is similar to that of their Cameroonian counterparts, an immediate neighbouring country. A multi- centre study to determine the national prevalence of HCV and in addition to elevation of public awareness is suggested. Hepatitis C viral-induced liver disease remains the major indication for liver transplant for which our present levels of economy and health infrastructures can least support. With no vaccines and no cure, the time to act is now. __________________________________________________________________________ _____________________________________*____________________________________ 9. Abstract: Advocacy for harm reduction in China: a new era dawns __________________________________________________________________________ Int J Drug Policy. 2009 Jul;20(4):365-70. Advocacy for harm reduction in China: a new era dawns. Reid G, Aitken C. The Centre for Harm Reduction, The Macfarlane Burnet Institute for Medical Research & Public Health, GPO Box 2284, Melbourne 3001, Australia. reid@burnet.edu.au BACKGROUND: China's initial response to drug use and HIV was largely ineffective but has improved with recent government endorsement of harm reduction interventions. This paper examines the views of senior key informants inside China who articulated core needs and objectives for the development of a harm reduction advocacy strategy. METHODS: Thirty-nine key informants (KI) were interviewed, representing 19 stakeholder bodies selected from the Chinese government public health sector, public security sector, international agencies such as WHO, UNODC and UNAIDS, and international non-government organisations. RESULTS: The concept of harm reduction is widely understood and considered valid. Support for harm reduction is increasing, but KIs perceived an imbalance between the rapid expansion of methadone maintenance treatment programs over needle and syringe programs and other interventions. Challenges for harm reduction identified by KIs included: policy inconsistencies; lack of skilled resources, training programs and technical capacity; poor coverage of interventions; and gaps in the sharing of information. KIs suggested numerous ways to strengthen the capacity of the government and communities to reduce drug related harm. DISCUSSION: Increased acceptance of harm reduction in China, particularly among public security, implies a new level of optimism towards addressing the HIV epidemic among drug users, and parallels an impressive expansion of harm reduction interventions. Nevertheless, scaling up a response to the ongoing dual epidemic of drug use and HIV remains an enormous challenge. With appropriate technical education and training, ongoing advocacy, and a cohesive, coordinated multi-sectoral effort, the capacity of the government and community to adopt, support and promote measures to reduce HIV and other drug related harm would be markedly strengthened. __________________________________________________________________________ _____________________________________*____________________________________ 10. Abstract: Predictors of intention to change HIV sexual and injection risk behaviors among heterosexual methamphetamine-using offenders in drug treatment: a test of the AIDS Risk Reduction Model __________________________________________________________________________ J Behav Health Serv Res. 2009 Apr;36(2):247-66. Predictors of intention to change HIV sexual and injection risk behaviors among heterosexual methamphetamine-using offenders in drug treatment: a test of the AIDS Risk Reduction Model. Brecht ML, Stein J, Evans E, Murphy DA, Longshore D. Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California- Los Angeles, 1640 S. Sepulveda Blvd., Suite 200, Los Angeles, CA 90025, USA. lbrecht@ucla.edu This study tested components of the acquired immunodeficiency syndrome (AIDS) Risk Reduction Model (ARRM) for a sample of methamphetamine-using offenders in drug treatment. Analyses included the first two stages of the ARRM, problem recognition and intention to reduce risk (potential precursors to later possible behavior change), assessing predictors of intentions to increase condom use, reduce other sexual risk, and disinfect needles. Path analysis results showed potential applicability of the ARRM as a basis for intervention development for this population. There was a consistent effect of self-efficacy for risk reduction strategies, as well as direct or indirect effects of problem recognition factors (AIDS knowledge, peer norms), on the three intention indicators. Prior sex risk behavior (condom use) was directly negatively related to intention to use condoms; prior needle use was indirectly negatively related to intention to disinfect. Intention to use condoms was lower for women. Results can help identify areas for intervention development. __________________________________________________________________________ _____________________________________*____________________________________ 11. Abstract: HIV and hepatitis C virus infections among hanka injection drug users in central Ukraine: a cross-sectional survey __________________________________________________________________________ Harm Reduct J. 2009 Aug 23;6(1):23. HIV and hepatitis C virus infections among hanka injection drug users in central Ukraine: a cross-sectional survey. Dumchev KV, Soldyshev R, Qian HZ, Zezyulin OO, Chandler SD, Slobodyanyuk P, Moroz L, Schumacher JE. BACKGROUND: Ukraine has experienced an increase in injection drug use since the 1990s. An increase in HIV and hepatitis C virus infections has followed, but not measures of prevalence and risk factors. The purposes of this study are to estimate the prevalence of HIV, HCV, and co-infection among injection drug users (IDUs) in central Ukraine and to describe risk factors for HIV and HCV. METHODS: A sample of 315 IDUs was recruited using snowball sampling for a structured risk interview and HIV/HCV testing (81.9% male, 42% single, average age 28.9 years [range = 18 to 55]). RESULTS: HIV and HCV antibodies were detected in 14.0% and 73.0%, respectively, and 12.1% were seropositive for both infections. The most commonly used drug was hanka, home-made from poppy straw and often mixed with other substances including dimedrol, diazepines, and hypnotics. The average period of injecting was 8.5 years; 62.5% reported past-year sharing needles or injection equipment, and 8.0% shared with a known HIV- positive person. More than half (51.1%) reported multiple sexual partners, 12.9% buying or selling sex, and 10.5% exchanging sex and drugs in the past year. Those who shared with HIV positive partners were 3.4 times more likely to be HIV positive than those who did not. Those who front- or back-loaded were 4 times more likely to be HCV positive than those who did not. CONCLUSIONS: Harm reduction, addiction treatment and HIV prevention programs should address risk factors to stop further spread of both HIV and HCV among IDUs and to the general population in central Ukraine. __________________________________________________________________________ _____________________________________*____________________________________ 12. Abstract: Opiate replacement therapy in France __________________________________________________________________________ Ann Pharm Fr. 2009 Sep;67(5):360-4. [Opiate replacement therapy in France.] [Article in French] Gatignol C. Mission interministérielle de lutte contre la drogue et la toxicomanie (MILDT), 7, rue Saint-Georges, 75009 Paris, France. France has been implementing a harm reduction based policy toward drug users, mainly based on opiate replacement therapy. The opiate substitution treatment appeared at the beginning of 1990's and was implemented at a large scale to avoid the spread of HIV among injecting drug users and to reduce the large number of drug abuse related deaths. The 15-year experience is conclusive when access to health care had been greatly improved. Moreover, this policy has made a considerable impact on substance users' health in general. It has contributed to the reduction of fatal overdoses, almost brought an end to HIV transmission through needle- sharing; the numbers of offenders for heroine use dramatically decreased. In the same way, adverse consequences occurred, mainly linked to the misuse of buprenorphine. Policy measures have been set up at the end of the consensus conference on June 2004: a national health insurance action plan - aiming at reducing the volume of diverted medicines -, a working group dedicated to opiate replacement therapy on behalf of the Ministry of Health (commission on addiction), regulatory measures to reduce the misuse of opiate maintenance medicines, risk management plan of the French Medicines Agency. The Government Action Plan 2008-11 on drugs and drug addiction provides for proposals aiming at reducing the diversion and the misuse of medicines and protecting their therapeutic value. French advocacy in favour of opiate replacement therapy remains a national and international priority. __________________________________________________________________________ _____________________________________*____________________________________ 13. Abstract: Nursing and the reality of politics __________________________________________________________________________ Nurs Inq. 2009 Sep;16(3):261-72. Nursing and the reality of politics. Betts CE. McMaster University, Hamilton, ON, Canada L8N 3Z5. bettsc@mcmaster.ca Notwithstanding the remarkable achievements made by medical science over the last half of the twentieth century, there is a palpable sense that a strictly medical view of human health, that is one founded on modernist assumptions, has become problematic, if not counterproductive. In this study, I argue that as nursing continues to eagerly welcome and indeed champion medical epistemology in the form of knowledge transfer, evidence- based practice, research utilization, outcomes-based practice, quantifiable efficiency and effectiveness, it risks becoming little more than a medical science addendum and indeed one that inherits the problems now facing contemporary medicine. The purpose of this study then is to attempt to resituate nursing as a discipline at work within an ontopolitical matrix of radical democratic pluralism. I begin by tracing a philosophical line from Kuhn's paradigms to Bloor's strong programme of Sociology of Scientific Knowledge. Following this, I attempt to explicate the thought of Bruno Latour as a philosophical alternative to Sociology of Scientific Knowledge. Next, I outline the radical pluralism of William Connolly in an effort to demonstrate its similarity to Latour's philosophy and finally how such a position is germane to contemporary nursing and the reality of politics. I do this with reference to the controversial issue of illicit drug use and harm reduction. In effect, I argue that such an issue cannot be dealt with using scientific evidence alone, but rather requires a philosophy of advocacy, what I term democratic advocacy, that is capable of responding to the politics of suffering, which is to say suffering that results from identity/difference. __________________________________________________________________________ _____________________________________*____________________________________ 14. Abstract: A review of multiple approaches towards an improved hepatitis B vaccine __________________________________________________________________________ Expert Opin Ther Pat. 2009 Jan;19(1):59-72. A review of multiple approaches towards an improved hepatitis B vaccine. Sanyal G, Shi L. Infection Discovery, AstraZeneca R&D Boston, 35 Gatehouse Drive, Waltham, MA 02451, USA. Gautam.Sanyal@astrazeneca.com BACKGROUND: Hepatitis B is a DNA virus that can cause liver inflammation, cirrhosis, and cancer in chronically infected and symptomatic carriers. Antiviral treatments are usually limited in their effectiveness in treating the disease states. Vaccination against hepatitis B in pediatric and adolescent populations has proven to be a generally effective means for preventing diseases that could be potentially caused by this virus. Some 5 - 10% of the vaccinees do not develop protective immunity against the virus. Therefore, a significant amount of effort has been made in many research laboratories across the world to increase the potency of the vaccine by various innovative means, e.g., increasing the immunogenicity of the antigen or through introduction of novel adjuvants that elicit strong humoral and cell-mediated immune responses. OBJECTIVES/METHODS: The objective of this review is to highlight publications of significant developments that have been made over the past decade and efforts that are continuing towards producing an improved vaccine. A number of patents that protect novel hepatitis B vaccine formulations, including those claiming novel hepatitis B core antigen formulations and combinations of a vaccine with small molecule therapeutics, are discussed. CONCLUSION: There have been promising developments in the area of new adjuvants and delivery systems. The practical need for reducing the total number of childhood vaccinations has driven development of, and patent filings on, multivalent and combination vaccine formulations in which the hepatitis B vaccine is included as one component. Efforts and some advances have also been made in the critical area of therapeutic application of the vaccine. The existence of a large population of already infected patients and the inadequacy of most of the current antiviral drugs against hepatitis B diseases have also inspired efforts to produce a vaccine that would be efficacious in clearing an exiting infection. __________________________________________________________________________ _____________________________________*____________________________________ 15. Abstract: New applications for sublingual immunotherapy in allergy __________________________________________________________________________ Recent Pat Inflamm Allergy Drug Discov. 2009;3(2):113-7. New applications for sublingual immunotherapy in allergy. Incorvaia C, Mauro M, Cappelletti T, Pravettoni C, Leo G, Riario-Sforza GG. Allergy/Pulmonary Rehabilitation, ICP Hospital, Milan, Italy. cristoforo.incorvaia@gmail.com Specific immunotherapy is the only treatment targeting the causes, and not only the symptoms, of allergic diseases. Sublingual immunotherapy (SLIT) was introduced and developed to solve the problem of the adverse reactions, uncommon but possibly severe and rarely fatal, to the traditional subcutaneous immunotherapy (SCIT). The evidence of SLIT efficacy concerns rhinitis and asthma caused by sensitization to pollens and to house dust mites, but there are increasing data suggesting that SLIT could be applied in forms of allergy hardly feasible for SCIT because of its poor safety (this is true for food allergy and latex allergy) or could be considered for new applications, such as atopic dermatitis or baker's asthma. In particular, there are placebo-controlled trials indicating good efficacy and safety of SLIT in patients allergic to latex and to foods and in children with atopic dermatitis, that indicate SLIT as a real treatment option in such clinical entities. This article also discusses some patent related to the field. __________________________________________________________________________ _____________________________________*____________________________________ 16. Abstract: Skin disinfection with octenidine dihydrochloride for central venous catheter site care: a double-blind, randomized, controlled trial __________________________________________________________________________ Clin Microbiol Infect. 2009 Aug 17. Skin disinfection with octenidine dihydrochloride for central venous catheter site care: a double-blind, randomized, controlled trial. Dettenkofer M, Wilson C, Gratwohl A, Schmoor C, Bertz H, Frei R, Heim D, Luft D, Schulz S, Widmer AF. Division of Infection Control and Hospital Epidemiology, Department of Environmental Health Sciences, University Medical Center Freiburg, Freiburg, Germany. Clin Microbiol InfectAbstract To compare the efficacy of two commercially available, alcohol-based antiseptic solutions for preparation and care of central venous catheter (CVC) insertion sites, with and without octenidine dihydrochloride, a double-blind, randomized, controlled trial was undertaken in the haematology units and in one surgical unit of two university hospitals. Adult patients with a non-tunnelled CVC were randomly assigned to two different skin disinfection regimens at the insertion site: 0.1% octenidine with 30% 1-propanol and 45% 2-propanol, and as control 74% ethanol with 10% 2-propanol. Endpoints were (i) skin colonization at the insertion site; (ii) positive culture from the catheter tip (>/=15 CFU); and (iii) occurrence of CVC-associated bloodstream infection (defined according to criteria set by the CDC). Four hundred patients with inserted CVC were enrolled from May 2002 through April 2005. Both groups were similar in respect of patient characteristics and co-morbidities. Skin colonization at the CVC insertion site during the first 10 days was significantly reduced by octenidine treatment (relative difference octenidine vs. control: 0.21; 95%CI: 0.11-0.39, p <0.0001). Positive culture of the catheter tip was significantly less frequent in the octenidine group (7.9%) than in the control group (17.8%): OR = 0.39 (95%CI: 0.20-0.80, p 0.009). Patients treated with octenidine had a non- significant reduction in catheter-associated bloodstream infections (4.1% vs. 8.3%; OR = 0.44; 95%CI: 0.18-1.08, p 0.081). Side effects were similar in both groups. This randomized controlled trial supports the results of two observational studies demonstrating octenidine in alcoholic solution to be a better option than alcohol alone for the prevention of CVC- associated infections. __________________________________________________________________________ _____________________________________*____________________________________ 17. Abstract: Bacterial biofilm formation, pathogenicity, diagnostics and control: An overview __________________________________________________________________________ Indian J Med Sci. 2009 Jul;63(7):313-21. Bacterial biofilm formation, pathogenicity, diagnostics and control: An overview. Sawhney R, Berry V. Department of Applied Biology, Hawassa University, Ethiopia, . sawhneyrajesh@yahoo.com. Bacterial biofilms are complex, mono- or poly-microbialn communities adhering to biotic or abiotic surfaces. This adaptation has been implicated as a survival strategy. The formation of biofilms is mediated by mechanical, biochemical and genetical factors. The biofilms enhance the virulence of the pathogen and have their potential role in various infections, such as dental caries, cystic fibrosis, osteonecrosis, urinary tract infection and eye infections. A number of diagnostic techniques, viz., bright-field microscopy, epifluorescence microscopy, scanning electron microscopy, confocal laser scanning microscopy and amplicon length heterogeneity polymerase chain reaction, have been employed for detection of these communities. Researchers have worked on applications of catheter lock solutions, a fish protein coating, acid shock treatment, susceptibility to bacteriophages, etc., for biofilm control. However, we need to rearrange our strategies to have thorough insight and concentrate on priority basis to develop new accurate, precise and rapid diagnostic protocols for detection and evaluation of biofilm. Above all, the strict compliance to these techniques is required for accurate diagnosis and control. __________________________________________________________________________ _____________________________________*____________________________________ 18. Abstract: Human pharmacology of intravenous lisdexamfetamine dimesylate: abuse liability in adult stimulant abusers __________________________________________________________________________ J Psychopharmacol. 2009 Jun;23(4):410-8. Human pharmacology of intravenous lisdexamfetamine dimesylate: abuse liability in adult stimulant abusers. Jasinski DR, Krishnan S. Department of Medicine, Johns Hopkins University, Baltimore, MD 21224, USA. drjasins@jhmi.edu The objective of this study is to determine the safety, tolerability and abuse liability of single intravenous (i.v.) doses of lisdexamfetamine dimesylate (LDX) and immediate-release d-amphetamine sulphate in adult stimulant abusers compared with placebo. Adult substance abusers were enrolled in this phase I, randomized, single- centre, double-blind study. An initial cohort of three subjects was enrolled to assess safety followed by a primary cohort that consisted of nine subjects. Single i.v. doses of LDX (25 or 50 mg), immediate-release d-amphetamine sulphate (10 or 20 mg) or placebo were administered at a minimum of 48-h intervals in a single- dose, three-way crossover design. 20 mg of d- amphetamine showed significantly increased abuse-related liking scores compared with placebo (P < 0.05), whereas the liking effects of 50 mg LDX did not significantly differ from placebo. The mean C(max) of d- amphetamine was 38.9 +/- 8.1 and 105 +/- 91.4 ng/ml after the administration of 50 mg LDX and 20 mg d- amphetamine respectively. The mean T(max) of d-amphetamine was 2.51 h after the administration of 50 mg LDX and 0.82 h after the administration of 20 mg d-amphetamine. LDX was well tolerated in this population. In contrast to d-amphetamine, LDX administered intravenously did not produce significant subjective abuse-related liking scores at assessed doses. __________________________________________________________________________ _____________________________________*____________________________________ 19. HIV Heroes - New series of short films on HIV/AIDS __________________________________________________________________________ Subject: HIV Heroes - New series of short films on HIV/AIDS Dear friends and colleagues, IRIN Films is pleased to announce the launch of "Heroes of HIV" a powerful and moving new series of short films on HIV/AIDS. The film profiles the work of people involved in the fight against HIV/AIDS. Their stories are sometimes sad, sometimes uplifting, always inspiring. Click here to watch the films http://www.irinnews.org/Report.aspx?ReportId=85824 As usual we'd be grateful for any feedback you might have at feedback@irinnews.org. IRIN - humanitarian news and analysis http://www.irinnews.org __________________________________________________________________________ _____________________________________*____________________________________ 20. News - India: Indian Police Raid Alleged Illegal Blood Bank - India: Poisoned blood: UP gets tough - USA: US at 'Turning Point' in Fight Against AIDS, Says Health and Human Services Secretary Kathleen Sebelius - USA: 27 Cases of Hepatitis C Now Linked to Suspect - USA: Hepatitis cases spur safety measures - Africa: Editorial - Safer Blood Collection For Africa - Australia: H1N1 jabs plan 'poses infection risk' - USA Puerto Rico: Product recalls: Accusure insulin syringes - Treating heroin addiction with heroin seems viable - USA: Carle RxExpress and Carle Foundation Hospital help ease patients’ medical waste concerns: launch free public medication and needle disposal program - USA: North Miami Man Files Notice to Sue VA over HIV Infection - USA: Premier Healthcare Alliance Expert to Discuss Safe Injection Practices and Improving Patient Safety at Joint Commission Infection Control Conference - USA: Probation revoked for woman who gave fake flu vaccine - Africa: PEPFAR partners with BD to improve blood collection safety in Africa - USA: Autism group softens stance on vaccines - Nasal Vaccine Holds Promise Against Swine Flu Selected news items reprinted under the fair use doctrine of international copyright law: http://www4.law.cornell.edu/uscode/17/107.html __________________________________________________________________________ India: Indian Police Raid Alleged Illegal Blood Bank CNN (25.08.09) NEW DELHI, India (CNN) -- Police in northern India have arrested six men for running a "fake" blood bank, authorities said Monday. The operation had been in place for two to three years in Lucknow, the capital of Uttar Pradesh, said Vinay Chandra, a deputy superintendent of police. Some 100,000 units of blood, many of which may have been contaminated, could have been sold from the raided address, he told CNN. Preliminary investigation showed that the suspects had been buying blood mainly from urchins, beggars and drug addicts in and around Lucknow for some 400 rupees, or about $8, per unit. A standard unit of blood is 450 milliliters, or just under a pint. They would take it from donors in a tiny room, store it in a refrigerator, package it with fake labels of authorized facilities and sell it off to attendants of patients in need, Chandra said. In their raid Saturday, police seized plasma, empty pouches, fake labels, and syringes, he said. Lucknow is home to an estimated 5 million-plus people, according to the district's Web site. There are some 10 authorized blood banks in Lucknow, Chandra said. --CNN's Harmeet Shah Singh contributed to this report The-CNN-Wire/Atlanta TM & © 2009 Cable News Network, Inc., a Time Warner Company .......................................................................... __________________________________________________________________________ India: Poisoned blood: UP gets tough Subhash Mishra, India Today (24.08.09) Lucknow, As the penetration of the sale and supply of contaminated blood units in the private hospitals and nursing home is getting exposed, the state government is adopting a tough posture by deciding to slap the Gangster's Act against them and seize their properties as well. Lucknow Police, on getting a tip off, had raided a private blood bank on Saturday and recovered dozens of units of blood donated by professional donors (PDs), who are banned by courts and medical authorities. The police nabbed six youth from the spot who admitted themselves to be the PDs. During the raid, the police recovered equipment for blood transfusion, syringes, fake slips of famous hospitals while the arrested persons confessed before the police that they had been taking the blood from the PDs on a nominal payment and selling them to the nursing homes and hospitals. The masterminds of the blood scandal are reported to have escaped while one of the main accused, Alok Diwedi, has been caught by the police. Since then, the police collected lots of information from the arrested youth and other suspects and raided nursing homes and hospitals to delve deep into the illegal sale of the blood in Lucknow. Speaking to India Today, a top police officer informed that the state government has decided to impose Gangster's Act on them and also seize their properties as punishment. The samples of the blood units, recovered during the police raid, have been sent to the SGPGI for analysis. A medical department source revealed that on an average there is a need of 4.5 lakh units of blood every year in Lucknow, but the total availability of the blood is about 3.5 lakh units and the remaining demand is being filled by the flouring illicit market of blood sale. .......................................................................... __________________________________________________________________________ USA: US at 'Turning Point' in Fight Against AIDS, Says Health and Human Services Secretary Kathleen Sebelius Dyana Bagby, Southern Voice - Atlanta, Georgia USA (24.08.09) Speaking to a capacity crowd at the 2009 National HIV Prevention Conference in Atlanta on Monday, US Secretary of Health and Human Services (HHS) Kathleen Sebelius said Americans' attitudes about HIV/AIDS are at a crossroads. "We are at a turning point as a country. Either we choose to get used to HIV/AIDS. to accept that it is a permanent feature of society. to be satisfied with lengthening lives instead of saving them," Sebelius told the afternoon plenary. "Or we decide to double our efforts and start bringing the number of new infections down. President Obama has chosen the second course, by calling on us to focus our efforts on reducing HIV incidence, getting people living with HIV into care and working to reduce HIV-related disparities." The United States has made great strides fighting HIV/AIDS globally, Sebelius said. "PEPFAR [the President's Emergency Plan for AIDS Relief] has been a great success," she said, noting it "combined a new level of focus, new funding and a new commitment to using proven approaches." "But while we've made strides in Africa and around the world, our progress towards ending the disease here in the US has stalled." Sebelius called the more than 56,000 new US HIV infections in 2006 - a rate that has remained level over the 10 years - "a tragedy." These numbers are what prompted the president to initiate the creation of the first-ever national HIV/AIDS strategy, she said. .......................................................................... __________________________________________________________________________ USA: 27 Cases of Hepatitis C Now Linked to Suspect Denver Post, Denver Colorado USA (22.08.09) According to an updated tally released Friday, state health officials have now tentatively linked 27 hepatitis C cases to an infected surgical technician's drug-theft scheme. The worker is alleged to have injected herself with a painkiller, then refilled the syringes with saline that was administered to patients. In the subsequent investigation, 2,214 patients have been tested at Rose Medical Center in Denver, and 1,374 have been tested at Audubon Surgery Center in Colorado Springs. All but one of the 27 cases were associated with Rose Medical. In CDC's genetic testing, only one case so far has been definitively linked to the fired employee. .......................................................................... __________________________________________________________________________ USA: Hepatitis cases spur safety measures Deedee Correll, The Los Angeles Times (22.08.09) DENVER - By her own admission, Kristen Diane Parker, a surgical technician, cruised for empty operating rooms at the Denver hospital where she worked. Parker would slip into the rooms and steal syringes of fentanyl, a powerful painkiller, replacing them with syringes she had filled with a saline solution. Parker, who has hepatitis C, allegedly had used those decoy syringes - the source of transmission, authorities believe - on at least 23 Coloradans now infected with the liver-damaging disease, according to her confession to investigators. Parker's arrest this summer has reverberated through the state, prompting the testing of nearly 6,000 patients at a hospital and surgery center and focusing scrutiny on health-care safety. "The system is broken," said a 41-year-old Denver woman who contracted hepatitis C after minor surgery at Rose Medical Center. She spoke on the condition of anonymity. "The system failed not only me but Kristen. She has an addiction. It was too easy for her to get that drug." As Colorado wraps up its testing, with more than half of the exposed patients believed to be infection-free and results pending for about 2,100 people, two other states where Parker worked are probing for any damage she may have wrought. Transmitted by blood, hepatitis C is treatable but incurable, and it can cause lifelong health problems and death. In Mount Kisco, N.Y., about 2,700 patients at Northern Westchester Hospital are being tested; the hospital has reported five cases, three of which it says are not linked to Parker. She worked there for about five months in 2007 and 2008. Further testing will determine whether the remaining two infections are linked to Parker, said hospital spokesman Mark Vincent. In Nassau Bay, Texas, authorities are trying to determine when Parker contracted hepatitis before they order tests on patients at Christus St. John Hospital, where Parker worked from 2005 to 2006. Although cases in which health-care workers transmit their own diseases to patients are relatively rare, the effects are far-reaching. The Centers for Disease Control and Prevention have documented four such cases in which 70 patients were infected with hepatitis C between 1992 and 2003, the most recent years for which data were available. Parker, 26, told police she believes she contracted hepatitis in 2008, when she became addicted to heroin and shared needles. Authorities say she learned of her illness in October, when she began work at Rose and a pre- employment test detected the disease. However, Parker maintains that she didn't realize she had hepatitis, saying hospital staff told her only that her test results warranted follow-up, said her attorney, Gregory Graf. She didn't pursue it because she didn't have health insurance or a doctor, he said. "Obviously, she's upset she may have put other people at risk, something she never intended." Parker aroused co-workers' suspicions in April when she was caught leaving an operating room to which she wasn't assigned. A drug screen tested positive for fentanyl, and she was fired. She moved on to the Audubon Ambulatory Surgery Center in Colorado Springs, where she had applied and been accepted shortly before her firing. As police began investigating the hospital's report of a potential fentanyl theft, health officials were trying to track the source of two recent hepatitis C infections. By the time they identified Parker as the suspected source, she had been at her new job for more than a month - a fact that has sparked criticism of health officials for not linking the cases more rapidly. Colorado's chief medical officer, Dr. Ned Calonge, defends the health department, citing the difficulty of tracing the cases to an employee seemingly unassociated with some of the patients. Parker, who is in custody, is federally charged with tampering with a consumer product and obtaining a controlled substance by deceit. If convicted of all 42 counts, she faces life in prison. Her alleged victims are devastated, said Jim Leventhal, a Denver attorney representing seven patients. "How do you go to a hospital and then walk out of the hospital with hepatitis C from a dirty needle?" said Leventhal. He faults Rose Medical Center for not having "a system in place to make it impossible for someone like Kristen Parker to accomplish what she accomplished." Rose spokeswoman Cara Harshberger declined to discuss Parker's alleged methods of obtaining drugs but said the hospital has tightened access to drugs. It is also reviewing its hiring practices, although she noted that a criminal background check of Parker raised no red flags. At Audubon, spokeswoman Amy Triandiflou said the surgery center was awaiting investigation results before making any changes. Health officials have connected one of the 18 cases to Audubon, but the center disputes a link. Parker's case has prompted a number of proposed and planned changes. State officials are considering licensing medical assistants, a move that potentially could have barred Parker from obtaining a new job after Rose reported its suspicions. Health officials will begin cross-referencing drug-diversion reports they receive against infection reports, Calonge said. In this case, different divisions in the department had received reports about thefts and infections but did not link the two. Calonge said they also will probe health facilities for more detail about people suspected of drug thefts. Other measures, such as making syringes that can't be reused, are needed to prevent future outbreaks, said Evelyn McKnight, president of Hepatitis Outbreaks National Organization for Reform. The group also advocates greater oversight of outpatient facilities. "Nineteen cases are 19 too many," said McKnight, who contracted hepatitis at her doctor's clinic in Nebraska. .......................................................................... __________________________________________________________________________ Africa: Editorial - Safer Blood Collection For Africa Voice of America, USA (21.08.09) "The following is an editorial reflecting the views of the US Government" Safer blood collection is a growing concern for Sub-Saharan African nations and other developing countries severely impacted by the HIV/AIDS pandemic. Access to HIV treatment in developing countries has significantly increased in recent years, which in turn has expanded the quantity of blood drawing for HIV screening and monitoring tests. Health care workers who perform those vital tests in Sub-Saharan countries will be better protected thanks to a new initiative by the U.S. President's Emergency Plan for AIDS Relief, or PEPFAR, and a leading global medical technology company, Becton, Dickinson and Company. Ambassador Elizabeth Bagley, the U.S. Department of State's Special Representative for Global Partnerships, and Gary Cohen, Executive Vice President of Becton, Dickinson and Company signed a memorandum of understanding in Washington D.C. this month to improve blood collection safety in clinics and hospitals in sub-Saharan Africa. The 3-year initiative -- which may be extended up to 2 additional years -- is scheduled to begin in October in Kenya and expand to include up to four additional PEPFAR-supported countries. It will ultimately support in- service training for as many as 10,000 healthcare workers. When fully implemented, the monitoring component of the initiative aims to track as many as 2 million blood draws within each participating country. The program will help hospital and clinical personnel improve their blood- drawing procedures and specimen handling, processes that are critical to the proper management of HIV/AIDS patients. The initiative will also work to control exposure to HIV among health workers by providing post-exposure prophylaxis. In addition, the program will help prevent needle stick injuries by establishing or enhancing needle stick injury preventive surveillance. These monitoring measures can identify practices that pose risks to health workers and patients. Reflecting PEPFAR's focus on empowering developing nations in the battle against HIV/AIDS, Ministries of Health in participating countries will take the lead in developing individualized policies, guidelines and standard operating procedures for blood drawing and specimen handling. As part of their collaboration, PEPFAR and Becton, Dickinson and Company will work on the ground with Ministries of Health, national reference laboratories and various implementing partners. Working with its African nation partners, international organizations, and the private sector, the United States is committed to helping improve health care for the people of Sub-Saharan Africa. .......................................................................... __________________________________________________________________________ Australia: H1N1 jabs plan 'poses infection risk' WA today, Western Australia (21.08.09) A planned national swine flu vaccination could lead to an outbreak of blood-borne diseases, infectious diseases experts say. The warning comes after federal Health Minister Nicola Roxon announced on Thursday that the government would release the first batch of swine flu vaccine, supplied by CSL, within weeks. * The Australasian Society for Infectious Diseases, in a letter to Commonwealth Chief Medical Officer Jim Bishop, expressed concern about CSL's use of multi-dose vials for the vaccination. Fairfax newspapers said the letter, from the society's president, Associate Professor Tom Gottlieb, urged the government to postpone the vaccinations until single-dose vials became available. * While the risk was slight, use of the larger multi-dose bottles could transmit infectious if syringes and needles were reused, "resulting in considerable morbidity and mortality", the letter said. * "Many members are concerned that there is a risk of adverse outcomes if a mass vaccination campaign was conducted using multi-dose vials," it said. There was no guarantee stringent infection-control guidelines would be followed in hospitals, "let alone clinics and general-practice units in the community", the letter said. But Professor Bishop said the government's pandemic plan had always included the use of multi-dose vials because they were more efficient and could be distributed more quickly. .......................................................................... __________________________________________________________________________ USA Puerto Rico: Product recalls: Accusure insulin syringes The Associated Press (20.08.09) The following recall has been announced: Qualitest Pharmaceuticals Inc. is recalling two lots of Accusure insulin syringes because the products' needles can detach from the syringes. When the needle becomes detached from the syringe during use, it can become stuck in the insulin vial, push back into the syringe, or remain in the skin after an injection, the Huntsville, Ala., company said. The company is aware of three complaints, including reports of the needle sticking in the skin after the insulin was administered and the needle sliding back into the syringe, spokeswoman Julie Schwarz said. The recall involves Accusure Insulin Syringes (1/2 cc - 31 G - Short Needle) with lot number 6JCB1 and NDC 0603-7001-21. This lot was distributed between January and June 2007 to wholesalers and retail pharmacies nationwide and in Puerto Rico. Also recalled are Accusure Insulin Syringes (1 cc - 31 G - Short Needle) with lot number 7CPT1 and NDC 0603-7002-21. This lot was distributed between May 2007 and June 2008 to wholesalers and retail pharmacies nationwide and in Puerto Rico. The lot number can be found on the white paper backing of each individual syringe. Consumers who have these products should stop using them and contact the company at 800-444-4011 for product replacement instructions. Adverse reactions can be reported to the Food and Drug Administration at http://www.fda.gov/medwatch/report.htm. .......................................................................... __________________________________________________________________________ Treating heroin addiction with heroin seems viable By Gene Emery, Reuters (20.08.09) BOSTON (Reuters) - Injections of the active ingredient of heroin work far better than oral methadone for keeping addicts in treatment, away from illegal drugs and out of trouble, Canadian researchers reported on Wednesday. But the researchers cautioned that the treatment carries a risk of overdose and seizures, so the injections should only be done in a medical setting. "Methadone, provided according to best-practice guidelines, should remain the treatment of choice for the majority of patients," Eugenia Oviedo- Joekes of the University of British Columbia and colleagues wrote in the New England Journal of Medicine. But when that does not work, they said, giving heroin's active ingredient, diacetylmorphine, appears to be an effective alternative. Methadone treatment fails in 15 to 25 percent who seek care. Oviedo-Joekes and colleagues studied 226 addicts in Montreal and Vancouver. Only 54 percent of those who got methadone stayed in treatment for a year, they found. But 88 percent of those who got diacetylmorphine shots did. And those who got diacetylmorphine cut back on illicit drugs by 67 percent, compared to 48 percent who got methadone. All the addicts who received diacetylmorphine spent at least 45 minutes per visit in the clinic to check for side effects. Some were there three times a day. While three quarters of the addicts said they had engaged in non-drug- related illegal activities in the previous month, the rate dropped to 5.4 percent with methadone treatment and 0.9 percent for the diacetylmorphine recipients. "Once you open your mind to the idea of getting people off the streets, out of crime, out of the back alleys and into clinics where they're going to be treated by doctors and nurses and counselors, some people will say, 'Ah ha! I get it now.' They begin to see the pragmatic side of the argument," Dr. Martin Schechter of the University of British Columbia, who worked on the study, said in a telephone interview. The cost of heroin treatment is less than $10,000 per year. "We know a person who is out of treatment, their cost to society is over $50,000 a year, and that includes emergency room visits, doctors, courts, police and jail and so on," he said. North America has about a million heroin addicts. The results are expected to have little impact in Europe, where similar tests have produced comparable results. Switzerland has been prescribing heroin for a decade. "The prescription of heroin is now recognized in some European countries as the optimal treatment for patients for whom options are running out and in whom methadone maintenance has not worked, and it keeps the user in contact with drug services," Virginia Berridge of the University of London wrote in a commentary. (Editing by Maggie Fox and Todd Eastham) .......................................................................... __________________________________________________________________________ USA: Carle RxExpress and Carle Foundation Hospital help ease patients’ medical waste concerns: launch free public medication and needle disposal program PRLog.Org (press release) - TX,USA (20.08.09) PRLog (Press Release) - Aug 20, 2009 - To help address the threat unwanted medications and needles pose to the environment and the community, Carle RxExpress and Carle Foundation Hospital are offering the new Carle RxExpress Medication and Needle Disposal Program beginning Monday, Aug. 31. James C. Leonard, MD, President and CEO of Carle Foundation Hospital, took note of a local newspaper article last year about the challenges of medical waste. He and the administration reviewed the collective resources and decided that implementing a free, year-round program would provide a sustainable, ongoing solution. Carle RxExpress’ successful annual Medication Drop-Off Week, which has been held the last two years, served as a model for the new ongoing program. "Carle Foundation Hospital has safely and responsibly disposed of its medical waste for years," said Dr. Leonard. "This program extends our environmental stewardship into the communities we serve, allowing residents to discard their medical waste in a way that’s safer for their households, neighbors and the environment." The goals of the Carle RxExpress Medication and Needle Disposal Program, part of the Hospital’s Healthy People. Happy Planet.sm environmental initiative, are to decrease the accidental consumption of potentially dangerous medications, reduce pollution of local water sources and prevent transmission of blood-borne diseases through improperly discarded needles. To kick off and call attention to the new program, Carle Foundation Hospital is sponsoring a booth at the farmer’s Market at the Square in Urbana on Saturday, Aug. 29. At the event, residents can learn about program and for those who need them, free needle disposal boxes will be available. Additional free gifts will be offered at the booth while supplies last. Needle Disposal Improperly discarded needles pose a threat to family members, sanitation workers and the environment. When used needles are thrown into household trash, the needles carry the risk of accidentally injuring someone or transmitting blood-borne illnesses such as hepatitis or HIV. Beginning Aug. 31, Carle RxExpress is providing free needle disposal boxes at all 10 locations throughout east central Illinois. The boxes allow consumers to safely store used needles until they’re ready for disposal. Once the box is full, it can be exchanged for a new one, free of charge, during regular business hours. Carle RxExpress then disposes of the needles according to local, state and federal regulations. While consumers can use this program regardless of whether they use Carle RxExpress to fill their prescriptions, only approved Carle RxExpress needle boxes will be accepted. Also as part of this program, Carle Foundation Hospital has installed individual needle drop boxes in 15 public restrooms for those who must use medical needles while visiting the hospital. Medication Disposal Unwanted medications, many of which are thrown in the trash, can end up in the wrong hands, especially with children who run the risk of ingesting those medications. Further, pharmaceuticals are generally not removed by water treatment facilities, so flushing medications down the toilet allows trace amounts of medicines to enter our watersheds. Illinois American Water is partnering with Carle RxExpress to help reduce the amount of pharmaceuticals in public water sources. Barry Suits, operations manager for Illinois American Water’s Champaign District, said, "Illinois American Water is committed to protecting the environment and water resources to maintain high-quality water supply for future generations. Partnerships like this one with Carle RxExpress to establish two pharmaceutical disposal sites in Champaign-Urbana are an important part of our environmental stewardship efforts." Residents can drop off prescription and over-the-counter, non-narcotic medications, liquids or inhalers to the Carle RxExpress locations on Fairchild Street in Danville, at Old Farm Shops in Champaign or in Carle Foundation Hospital’s lobby in Urbana. They are asked to mark out or remove all personal information from the prescription containers before placing them in the drop box. The medication drop boxes are designed like public mailboxes. They are affixed to the floor or wall, prevent individuals from reaching into the boxes and are emptied regularly. "We collected more than 800 pounds of medications, inhalers and thermometers during this year’s Medication Drop-Off Week alone," said Greg Puszkiewicz, Director of Carle RxExpress. "With a year-round community program, Carle RxExpress can expand its positive impact on our planet and our lives." For more information about the Carle RxExpress Medication and Needle Disposal Program, visit www.carle.org/environment. Carle Foundation Hospital’s Healthy People. Happy Planet. is a new initiative that provides home- and healthcare-related solutions to help protect the environment. # # # Carle Foundation Hospital is a 315-bed regional care hospital located in Urbana, Illinois. It is the region's only Level 1 Trauma Center, Co- Perinatal Center, and serves as the primary teaching hospital for the University of Illinois College of Medicine. .......................................................................... __________________________________________________________________________ USA: North Miami Man Files Notice to Sue VA over HIV Infection Fred Tasker, Miami Herald (20.08.09) On July 20, Army veteran Juan Rivera filed notice that he is suing the federal government after allegedly becoming infected with HIV during a colonoscopy at the Miami VA hospital. The 55-year-old married father of five claims he was infected by improperly sterilized endoscopy equipment around May 19, 2008. According to Rivera's attorney, Ira Leesfield, the six-month notice is a requirement of suing the federal government under the Federal Torts Claim Act. The veteran is seeking $20 million in damages, said Leesfield. The government has six months to settle before the case goes to trial in a US federal court, he added. Earlier this year, the VA sent notices to some 11,000 veterans who received care at its facilities in Miami, Murfreesboro, Tenn., and Augusta, Ga., warning that they may have been exposed to HIV and hepatitis B and C due to improperly cleaned endoscopy equipment. Among the veterans who have undergone follow-up blood tests, eight have tested positive for HIV, 12 for hepatitis B and 37 for hepatitis C. VA officials have said there is no way to know whether the patients were infected due to infection-control lapses at the three locations or if they were already infected prior to their procedures. The VA has said the rate of infections is consistent with or less than what would typically be found among similar populations. However, it has promised to care for all .......................................................................... __________________________________________________________________________ USA: Premier Healthcare Alliance Expert to Discuss Safe Injection Practices and Improving Patient Safety at Joint Commission Infection Control Conference Business Wire (press release) (19.08.09) Charlotte, N.C.--(Business Wire)--Premier healthcare alliance’s Gina Pugliese, vice president of Premier’s Safety Institute, will share insights on safe injection practices to improve patient and worker safety at the Joint Commission Infection Control Conference on August 21 in Crystal City, Va. Pugliese will discuss the risks of patient-to-patient transmission of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections from unsafe injection practices, such as reuse of syringes and needles on more than one patient. There have been more than 33 outbreaks of HBV and HCV in the past 10 years in nonacute healthcare settings from improper needle and syringe use and poor infection control practices, resulting in nearly 500 patients becoming infected. Occupational needlestick injuries also pose risks of HBV and HCV infection to healthcare workers, and the Centers for Disease Control and Prevention (CDC) estimates that more than 800,000 needlestick injuries occur annually in the United States from needles and other sharps. The use of safety devices with engineered sharps injury protection can eliminate 90 percent of occupational needlestick injuries; however, they have not been universally adopted in all settings where exposures may occur. Patient-to-patient transmission of HBV, HCV and other pathogens can also be prevented by adherence to standard infection control precautions and safe injection practices, such as never reusing any syringes, needles, cannulas, lancets, insulin pens and medication vials labeled as single use. Safe injection practices also include never administering medications from a syringe to multiple patients, even if the needle or cannula on the syringe is changed. Premier, in collaboration with the CDC, offers healthcare administrators and staff a comprehensive workbook on CD-ROM for sharps injury prevention, and others tools and guidelines on injection safety. About Premier Inc., 2006 Malcolm Baldrige National Quality Award recipient The Premier healthcare alliance is more than 2,200 U.S. hospitals and 63,000-plus other healthcare sites working together to improve healthcare quality and affordability. Premier maintains the nation's most comprehensive repository of clinical, financial and outcomes information and operates a leading healthcare purchasing network. A world leader in helping deliver measurable improvements in care, Premier works with the Centers for Medicare & Medicaid Services and the United Kingdom's National Health Service North West to improve hospital performance. The Premier Safety Institute offers publicly accessible tools and resources on patient, worker and environmental safety on its Web site at www.premierinc.com/safety Premier has offices in San Diego, Charlotte, N.C., Philadelphia and Washington. .......................................................................... __________________________________________________________________________ USA: Probation revoked for woman who gave fake flu vaccine By Cindy George, Houston Chronicle, Texas USA (18.08.09) A Houston woman has been ordered into federal prison for violating the terms of the probation sentence she received two years ago for her part in a phony flu vaccine scam. Martha Denise Gonzales, 52, who arranged for fake flu shots to be injected into more than 1,100 Exxon Mobil employees, received five years probation in 2007 for her role in a similar ruse at a nursing home. On Monday, U.S. District Judge Kenneth Hoyt sentenced Gonzales to 21 months in prison after she admitted committing three felonies in Liberty County, including two check forgeries and stealing four night deposits from an area restaurant. She also admitted failing to report to her probation officer for nearly a year and failing to alert probation that her address changed. It was during a vaccine shortage that Gonzales assisted Iyad Abu El Hawa in providing the fake flu shots during a 2005 health fair at the Baytown Exxon Mobil refinery. El Hawa, who owned several Houston health care businesses but is not a physician, directed another licensed employee to fill syringes with sterile water. Gonzales pleaded guilty to health care fraud in connection with administering phony vaccines at a nursing home and billing Medicare through her employer, a doctor unaware of the scam. El Hawa received a nearly four-year sentence. After the scheme was exposed, Exxon Mobil spent more than $700,000 on blood tests to determine whether employees were harmed. .......................................................................... __________________________________________________________________________ Africa: PEPFAR partners with BD to improve blood collection safety in Africa Kaisernetwork.org (16.08.09) PEPFAR and the global medical technology company BD announced an iniative Tuesday that will work to improve blood collection safety in clinics and hospitals in sub-Saharan Africa -- an issue that PANA/Afrique en ligne reports has "become more critical than ever in sub-Saharan nations and other developing countries severely impacted by the HIV/AIDS pandemic" (8/12). "The program will help hospital and clinical personnel improve their blood-drawing procedures and specimen handling, processes that are critical to the proper management of HIV/AIDS patients," and teach health workers methods to control their exposure to the virus, according to a BD release (8/11). "The three-year initiative -- which may be extended up to two additional years -- is scheduled to begin in October in Kenya" before expanding into four other PEPFAR-supported countries. It is expected to "ultimately support in-service training for as many as 10,000 healthcare workers" and "track as many as two million blood draws within each participating country," PANA/Afrique en ligne writes (8/12). Eric Goosby, U.S. global AIDS coordinator, said in the release, "Efforts like these build the capacity of partner countries, support the scale up of proven HIV interventions, and ultimately help create a sustainable response to HIV/AIDS" (8/11). .......................................................................... __________________________________________________________________________ USA: Autism group softens stance on vaccines By Mark Roth, Pittsburgh Post-Gazette, Pittsburgh PA USA (16.08.09) The autism wars aren't over -- but they may have entered a new phase. Autism Speaks, the nation's largest autism advocacy group, recently made its clearest public statement yet that minimizes the link between vaccines and autism. In a prepared interview posted on the Autism Speaks Web site, the group's chief science officer, Dr. Geri Dawson, says that scientific studies have found no link between thimerosal, a mercury preservative used in certain vaccines, and autism. Nor have they found a connection between the measles-mumps-rubella vaccine and autism. "So ... given what the scientific literature tells us today," she says, "there is no evidence that thimerosal or the MMR vaccine cause autism" and "evidence does not support the theory that vaccines are causing an autism epidemic." Dr. Dawson's statement still allows for the possibility that reactions to vaccinations might cause autism in a small subset of children, but it seems to go further than ever before in ruling out vaccines as a major trigger for the neurodevelopmental disorder. The Autism Speaks pronouncement comes at a time when some parents have stopped inoculating their children or are spreading out their shots, to the consternation of public health officials, who fear the resurgence of such childhood diseases as measles and whooping cough. Much of the parents' resistance to immunization has been driven by fear that vaccines can cause autism, a disorder that affects an estimated 1 out of 150 children. Autism is characterized by poor social and communication skills, repetitive behaviors, fixation on certain interests and, in some cases, retardation. A spokeswoman for Autism Speaks said Dr. Dawson did not want to be interviewed about her latest statement, and contended it is not a new position for the organization. But several scientists and others who have been involved in the autism debate said her views, which were posted July 30, are a clear departure from past statements, and probably reflect the ongoing tug-of-war over the vaccine issue. Dr. Neal Halsey, director of the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health in Baltimore, said the new position is "two steps in the right direction. This is a substantial change and improvement in Autism Speaks in acknowledging that vaccines do not cause autism, and that the evidence is overwhelming that neither the MMR vaccine nor thimerosal in vaccines causes autism." Still, Dr. Halsey said he wishes Dr. Dawson would have emphasized that thimerosal no longer is used with vaccines given to children under 6 months of age, because "unfortunately, parents still fear they might be causing their children some harm by getting their kids vaccinated." Thimerosal, an organic mercury compound, was used for decades as a preservative in multidose vials of some vaccines to keep them from being contaminated when needles were repeatedly inserted into them. It has now been removed from all childhood vaccines except some versions of the flu vaccine. The MMR vaccine scare came primarily from a study done in the United Kingdom about a decade ago that suggested the measles portion of the vaccine caused intestinal inflammation that led to autism. Later studies failed to confirm those findings. While federal agencies have pushed manufacturers to remove thimerosal from as many vaccines as possible, many scientists say it never posed a threat to children's health. A 2007 study of more than 1,000 children between the ages of 7 and 10 who had been exposed to varying amounts of thimerosal during vaccinations and other treatments found no link between the preservative and any cognitive or language problems, for instance. None of the studies, however, have swayed one group of parents and activists who believe that vaccines are a major cause of autism, particularly in children who appeared to be developing normally before they got their vaccinations. One of those activists is Katie Wright, who has an autistic child and is the daughter of Robert and Suzanne Wright, the founders of Autism Speaks. Although she is not a part of Autism Speaks, Ms. Wright said in a 2007 interview that her parents support her view that environmental toxins of some sort trigger autism. She said her father, the former CEO of NBC Universal, "believes there is a place for genetic research, but he realizes the dire need to finance the environmental research because that is what affects our children now." Because of pressure from people like Ms. Wright and groups that believe vaccines are dangerous, officials at Autism Speaks are pulled in two directions, said Kristina Chew, the parent of an autistic son and a blogger on autism issues who does not believe vaccines cause the disorder. "On the one hand," said Dr. Chew, a classics professor in New Jersey, "they do want to promote science. On the other hand, they want to be an organization for families and parents, and I think they're caught there, because what some of the parents see is their children getting vaccines and then becoming autistic overnight." Many other families of autistic children "feel the vaccine issue is overblown," she said, "but they are afraid to articulate that in public because the response from the other side can be very hateful and extreme." While anti-vaccine groups continue to lobby Autism Speaks, the organization may also have been influenced from the opposite direction by the recent resignations of two key people. Dr. Eric London, a New York psychiatrist whose National Alliance for Autism Research merged with Autism Speaks three years ago, resigned from Autism Speaks' scientific affairs committee this year, saying that the group's argument "that there might be 'biologically plausible' vaccine involvement [in autism] is misleading and disingenuous." In an interview last week, he said he thinks Dr. Dawson crafted her new position statement because "the organization was getting a fair amount of pushback from myself and other people and even the press, and this wasn't happening a year or two ago, and so I think they're trying to position themselves as not being too unreasonable." On the other hand, he said, "if they're going to continue to link to the anti-vaccine people [on the Autism Speaks Web site], it's all just spin. They're certainly not delivering a consistent message." Another top official who resigned is Alison Tepper Singer, who was executive vice president of Autism Speaks and is a member of the federal government's Interagency Autism Coordinating Committee, which sets goals for federal research on autism. "When you keep saying more research needs to be done on vaccines it sends the wrong message," said Ms. Tepper Singer. "We have a really good amount of data on vaccines and autism. At some point you have to say we're done and we're going to use our scarce resources elsewhere." She and Dr. London's wife, Karen London, recently established the Autism Science Foundation, a charity that has pledged it will not support any research on vaccines and autism. The biggest fear some experts have is that the controversy is already endangering the health of youngsters and adults whose parents are refusing to vaccinate their children. The immunity children acquire from their mothers starts to wear off at about 6 weeks of age, said Dr. Nancy Minshew, director of the University of Pittsburgh's Center for Excellence in Autism Research. That's one reason the diphtheria-pertussis-tetanus vaccine is given at a young age, she said, because "those illnesses can kill babies." The measles-mumps-rubella vaccine, given at about 1 year of age, is equally important, Dr. Minshew said, and not just for the children themselves. If pregnant women and their fetuses are exposed to rubella, also known as German measles, it can cause deafness, heart and liver problems, retardation and even autism in the children after they are born. If children get mumps and spread it to a man who doesn't have immunity, it can cause sterility. For all these reasons, it's important for parents to follow the recommended vaccination schedule, she said. "There used to be entire classrooms of kids who had become deaf from measles," Dr. Minshew said. "I have male relatives who never could have kids because of mumps. People today don't see the results" of those infections, and that may make them blase about the importance of vaccinations. "When it comes to immunization, who are you going to listen to? I'm going to listen to the researchers who are the best of the best, and what they say is that immunizations do not cause autism, but they do save lives," she said. Read more: http://www.post-gazette.com/pg/09228/991232-114.stm .......................................................................... __________________________________________________________________________ Nasal Vaccine Holds Promise Against Swine Flu Andrew Pollack, New York Times (31.07.09) As the nation girds for a possible swine flu pandemic, one of the big weapons may come from an unexpected source - a vaccine squirted or dropped into the nose. MedImmune, which already makes the nasal spray vaccine FluMist for seasonal flu viruses, says it is on track to produce about five times as much swine flu vaccine as it had expected - so much, in fact, that it will run out of nasal spray devices and is looking to administer the vaccines with droppers instead. A nasal spray vaccine could be a strong weapon against swine flu because makers of conventional flu shots have reported problems producing their vaccines. If nasal spray vaccines emerge as a central player against swine flu, it would represent a reversal of fortune for MedImmune’s efforts in the field. As a vaccine for seasonal influenza, its FluMist has been a flop from a marketing standpoint, accounting for only a few percent of the inoculations Americans receive each year. But it appears to have a manufacturing edge. Because its vaccine uses a live but weakened virus, MedImmune uses a different viral strain than the makers of flu shots, which contain an inactivated virus. Each approach uses chicken eggs as the culture for growing its virus strain, but flu shot makers say the strain of swine flu virus they are using is growing more slowly than expected. MedImmune’s strain, meanwhile, is growing faster than expected. As a result, MedImmune, a subsidiary of AstraZeneca, says it can make 200 million doses by next March, about five times what it had expected. Robin Robinson, who heads procurement of the pandemic vaccine for the Department of Health and Human Services, said MedImmune alone accounted for 12 million of the 20 million doses already produced by the five companies under contract to the government. Dr. Robinson said that the other drug makers were resolving their production problems and would catch up. He said 120 million doses should be available by October, without counting on any extra production from MedImmune. But if the extra nasal spray doses can be used, Dr. Robinson said, "our supply could possibly increase by a very large amount." The problem for MedImmune is that the unexpected production surge left the company short of the sprayers used to squirt the vaccine into the nose. It can supply only about 40 million doses in sprayers by March. "We now are sitting on a surplus of potentially 150 million bulk doses," Bernardus N. M. Machielse, executive vice president for operations, said in an interview. BD, supplier of the sprayers, said Thursday that it was running its sprayer factory in Columbus, Neb., round the clock to increase annual capacity to 70 million sprayers - up from 20 million. But even that will not be enough. So MedImmune wants to use droppers in addition to sprayers. Some early clinical trials of the vaccine were conducted with droppers, so the company hopes to win approval from the Food and Drug Administration to use them. Pandemic vaccines could bolster the total sales of AstraZeneca, the pharmaceutical giant based in London that acquired MedImmune, a Maryland biotechnology company, for $15.6 billion in 2007. The government has ordered 12.8 million doses of pandemic vaccine from MedImmune for $151 million, Dr. Robinson said. AstraZeneca might get many hundreds of millions more in sales if the government buys the rest of the 40 million or so doses in sprayers and potentially the some 150 million doses in droppers. Simon Lowth, AstraZeneca’s chief financial officer, told analysts on Thursday that FluMist had a lower-than-average profit margin and that the pandemic vaccine, being sold under government contract, had margins that are "lower still." The pandemic might also allow AstraZeneca to achieve a foothold outside the United States, the only country that has approved FluMist. The company is applying for approval in other countries and is talking to the World Health Organization about supplying some pandemic vaccine to poorer countries, David Brennan, its chief executive, said Thursday. When MedImmune agreed to buy Aviron, the developer of FluMist, in 2001, executives predicted sales would grow to more than $1 billion a year. But in 2008, the best year yet for FluMist, sales reached only $104 million. Several missteps nullified any appeal a needle-less vaccine might have. When it was initially sold in 2003, FluMist was priced at about $50, two to six times as much as a flu shot. And FluMist had to be frozen, a problem for some doctors’ offices. Because of safety concerns FluMist was approved only for healthy people 5 to 49 years old. But those are not typically the people who get flu vaccines. FluMist is now approved for children as young as 2, it can be refrigerated instead of frozen and the wholesale price is down to $18.95. 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