Newsflash from the World Health Organisation – A call for worldwide use of “smart” syringes

Smart syringes in developing areas
Smart syringes in developing areas

23 FEBRUARY 2015 ¦ GENEVA – Use of the same syringe or needle to give injections to more than one person is driving the spread of a number of deadly infectious diseases worldwide.  Millions of people could be protected from infections acquired through unsafe injections if all healthcare programmes switched to syringes that  cannot be used more than once. For these reasons, the World Health Organization (WHO) is launching a new policy on injection safety to help all countries tackle the pervasive issue of unsafe injections.

A 2014 study sponsored by WHO, which focused on the most recent available data, estimated that in 2010, up to 1.7 million people were infected with hepatitis B virus, up to 315 000 with hepatitis C virus and as many as 33 800 with HIV through an unsafe injection. New WHO injection safety guidelines and policy released today provide detailed recommendations  highlighting the value of safety features for syringes, including devices that protect health workers against accidental needle injury and consequent exposure to infection.

WHO also stresses the need to reduce the number of unnecessary injections as a critical way of reducing risk. There are 16 billion injections administered every year. Around 5% of these injections are for immunizing children and adults, and 5% are for other procedures like blood transfusions and injectable contraceptives.  . The remaining  90% of injections are given into muscle (intramuscular route) or skin (subcutaneous or intradermal route) to administer medicines. In many cases these injections are unnecessary or could be replaced by oral medication.

“We know the reasons why this is happening,” says Dr Edward Kelley, Director of the WHO Service Delivery and Safety Department. One reason is that people in many countries expect to receive injections, believing they represent the most effective treatment. Another is that for many health workers in developing countries, giving injections in private practice supplements salaries that may be inadequate to support their families.”

Transmission of infection through an unsafe injection occurs all over the world. For example, a 2007 hepatitis C  outbreak in the state of Nevada, United States of America, was traced to the practices of a single physician who injected an anaesthetic to a patient who had hepatitis C. The doctor then used the same syringe to withdraw additional doses of the anaesthetic from the same vial – which had become contaminated with hepatitis C virus – and gave injections to a number of other patients.  In Cambodia, a group of more than 200 children and adults living near the country’s second largest city, Battambang, tested positive for HIV in December 2014.  The outbreak has been since been attributed to unsafe injection practices.
“Adoption of safety-engineered syringes is absolutely critical to protecting people worldwide from becoming infected with HIV, hepatitis and other diseases. This should be an urgent priority for all countries,” says Dr Gottfried Hirnschall, Director of the WHO HIV/AIDS Department.

The new “smart” syringes WHO recommends for injections into the muscle or skin have features that prevent re-use. Some models include a weak spot in the plunger that causes it to break if the user attempts to pull back on the plunger after the injection. Others have a metal clip that blocks the plunger so it cannot be moved back, while in others the needle retracts into the syringe barrel at the end of the injection

Syringes are also being engineered with features to protect health workers from “needle stick” injuries and resulting infections. A sheath or hood slides over the needle after the injection is completed to protect the user from being injured accidentally by the needle and potentially exposed to an infection.

WHO is urging countries to transition, by 2020, to the exclusive use of the new “smart” syringes, except in a few circumstances in which a syringe that blocks after a single use would interfere with the procedure. One example is when a person is on an intravenous pump that uses a syringe .

The Organization is also calling for policies and standards for procurement, safe use and safe disposal of syringes that have the potential for re-use in situations where they remain necessary, including in syringe programmes for people who inject drugs. Continued training of health workers on injection safety – which has been supported by WHO for decades – is another key recommended strategy. WHO is calling on  manufacturers to begin or expand production as soon as possible of ”smart” syringes that meet the Organization’s standards for performance, quality and safety.

“The new policy represents a decisive step in a long-term strategy to improve injection safety  by working with countries worldwide.  We have already seen considerable progress,”  Dr Kelley says. Between 2000 and 2010, as injection safety campaigns picked up speed, re-use of injection devices in developing countries decreased by a factor of 7. Over the same period, unnecessary injections also fell:  the average number of injections per person in developing countries decreased from 3.4 to 2.9. In addition, since 1999, when WHO and its partner organizations urged developing countries to vaccinate children only using syringes that are automatically disabled after a single use, the vast majority have switched to this method.

Syringes without safety features cost US$ 0.03 to 0.04 when procured by a UN agency for a developing country. The new “smart” syringes cost at least twice that much. WHO is calling on donors to support the transition to these devices, anticipating that prices will decline over time as demand increases.

Molluscum Contagiosum – Can you give me some advice please?

Molluscum Contagiosum
Molluscum Contagiosum

God knows why. Maybe some deeply repressed memory of trying to learn Latin grammar as a spotty teenager.

Anyhow Molluscum Contagiosum came into my life a few days ago when my daughter was diagnosed with it. It turns out that it is “wart bumps” caused by a virus. And usually passes in around 12-18 months.

You can see a picture of it above.

While it is not serious it is not great for a 12 year old.

Does anyone have any advice for me as to how I can help her out.

Please feel free to share in the comments section below if you have any ideas.

Thanks in advance.

Deaths from Malaria dramatically reduced!

Malaria treatment?  Jesuit's Bark
Malaria treatment? Jesuit’s Bark
The number of people dying from malaria has fallen dramatically since 2000 and malaria cases are also steadily declining, according to the World Malaria Report 2014. Between 2000 and 2013, the malaria mortality rate decreased by 47% worldwide and by 54% in the WHO African Region – where about 90% of malaria deaths occur.

New analysis across sub-Saharan Africa reveals that despite a 43% population increase, fewer people are infected or carry asymptomatic malaria infections every year: the number of people infected fell from 173 million in 2000 to 128 million in 2013.

“We can win the fight against malaria,” says Dr Margaret Chan, Director-General, WHO. “We have the right tools and our defences are working. But we still need to get those tools to a lot more people if we are to make these gains sustainable.”

Between 2000 and 2013, access to insecticide-treated bed nets increased substantially. In 2013, almost half of all people at risk of malaria in sub-Saharan Africa had access to an insecticide-treated net, a marked increase from just 3% in 2004. And this trend is set to continue, with a record 214 million bed nets scheduled for delivery to endemic countries in Africa by year-end.

Access to accurate malaria diagnostic testing and effective treatment has significantly improved worldwide. In 2013, the number of rapid diagnostic tests (RDTs) procured globally increased to 319 million, up from 46 million in 2008. Meanwhile, in 2013, 392 million courses of artemisinin-based combination therapies (ACTs), a key intervention to treat malaria, were procured, up from 11 million in 2005.

Moving towards elimination

Globally, an increasing number of countries are moving towards malaria elimination, and many regional groups are setting ambitious elimination targets, the most recent being a declaration at the East Asia Summit to eliminate malaria from the Asia-Pacific region by 2030.

In 2013, two countries reported zero indigenous cases for the first time (Azerbaijan and Sri Lanka), and 11 countries succeeded in maintaining zero cases (Argentina, Armenia, Egypt, Georgia, Iraq, Kyrgyzstan, Morocco, Oman, Paraguay, Uzbekistan and Turkmenistan). Another four countries reported fewer than 10 local cases annually (Algeria, Cabo Verde, Costa Rica and El Salvador).

Fragile gains

But significant challenges remain: “The next few years are going to be critical to show that we can maintain momentum and build on the gains,” notes Dr Pedro L Alonso, Director of WHO’s Global Malaria Programme.

In 2013, one third of households in areas with malaria transmission in sub-Saharan Africa did not have a single insecticide treated net. Indoor residual spraying, another key vector control intervention, has decreased in recent years, and insecticide resistance has been reported in 49 countries around the world.

Even though diagnostic testing and treatment have been strengthened, millions of people continue to lack access to these interventions. Progress has also been slow in scaling up preventive therapies for pregnant women, and in adopting recommended preventive therapies for children under five years of age and infants.

In addition, resistance to artemisinin has been detected in five countries of the Greater Mekong subregion and insufficient data on malaria transmission continues to hamper efforts to reduce the disease burden.

Dr Alonso believes, however, that with sufficient funding and commitment huge strides forward can still be made. “There are biological and technical challenges, but we are working with partners to be proactive in developing the right responses to these. There is a strong pipeline of innovative new products that will soon transform malaria control and elimination. We can go a lot further,” he says.

While funding to combat malaria has increased threefold since 2005, it is still only around half of the USD 5.1 billion that is needed if global targets are to be achieved.

“Against a backdrop of continued insufficient funding the fight against malaria needs a renewed focus to ensure maximum value for money,” says Fatoumata Nafo-Traoré, Executive Director of the Roll Back Malaria Partnership. “We must work together to strengthen country ownership, empower communities, increase efficiencies, and engage multiple sectors outside health. We need to explore ways to do things better at all levels.”

Ray Chambers, who has served as the UN Secretary-General’s Special Envoy for Malaria since 2007, highlights the remarkable progress made in recent years. “While staying focused on the work ahead, we should note that the number of children dying from malaria today is markedly less than 8 years ago. The world can expect even greater reductions in malaria cases and mortality by the end of 2015, but any death from malaria remains simply unacceptable,” he says.

Gains at risk in Ebola-affected countries

At particular risk is progress on malaria in countries affected by the Ebola virus. The outbreak in West Africa has had a devastating impact on malaria treatment and the roll-out of malaria interventions. In Guinea, Sierra Leone and Liberia, the three countries most severely affected by the epidemic, the majority of inpatient health facilities remain closed, while attendance at outpatient facilities is down to a small fraction of rates seen prior to the outbreak.

Given the intense malaria transmission in these three countries, which together saw an estimated 6.6 million malaria cases and 20 000 malaria deaths in 2013, WHO has issued new guidance on temporary measures to control the disease during the Ebola outbreak: to provide ACTs to all fever patients, even when they have not been tested for malaria, and to carry out mass anti-malaria drug administration with ACTs in areas that are heavily affected by the Ebola virus and where malaria transmission is high. In addition, international donor financing is being stepped up to meet the further recommendation that bednets be distributed to all affected areas.

Note to editors

Globally, 3.2 billion people in 97 countries and territories are at risk of being infected with malaria. In 2013, there were an estimated 198 million malaria cases worldwide (range 124-283 million), 82% of which were in the WHO African region. Malaria was responsible for an estimated 584 000 deaths worldwide in 2013 (range: 367 000 – 755 000), killing an estimated 453 000 children under five years of age.

Based on an assessment of trends in reported malaria cases, a total of 64 countries are on track to meet the Millennium Development Goal target of reversing the incidence of malaria. Of these, 55 are on track to meet Roll Back Malaria and World Health Assembly targets of reducing malaria case incidence rates by 75% by 2015.

The World Malaria Report 2014 will be launched on 9 December 2014 in the United Kingdom Houses of Parliament. The event will be co-hosted by the All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases (APPMG) and Malaria No More UK.

Are you at risk from the ‘flu this winter? Read our interview with Dr Jonathan Pittard

Do you need a flu jab?
Do you need a flu jab?
More than half of Doctors think the main reason at-risk patients do not take up flu vaccination is because they are concerned the vaccine itself could give them flu-like symptoms, according to results of a recent survey.

53 per cent of professionals polled rated this as the top reason why they think at-risk patients – including over 65s, pregnant women and those with weakened immune systems because of other diseases – miss out on vaccination. It ranked in the top five reasons among 94 per cent of respondents.

The next biggest concern for HCPs was that patients who have not previously had flu do not consider themselves at risk, with 86 per cent placing this in the top five reasons patients miss the jab. And 76 per cent said patients being unaware of the increased risk of complications from flu were among the top five reasons.

Flu is an infectious viral illness spread by coughs and sneezes. It is different from the common cold because it is caused by different viruses and tends to result in more severe and long-lasting symptoms. Flu can be prevented through good hygiene, vaccination and, in some cases, antiviral medication.

During the last flu season, uptake of the flu vaccine varied in at risk groups with just around 40% of pregnant women and 73% of over 65s being immunised across England.

To find out more we contacted an interview with Dr Jonathan Pittard, a UK based family doctor.

PATENTTALK.ORG: Thanks for taking time to talk us Dr Pittard, can you start by telling us what influenza is?

DR PITTARD: Well influenza is a viral illness of several different strengths but you only get one at a time. Essentially it gives you a very high fever, and a very bad headache and a very bad muscle ache. So essentially for 4 or 5 days you are sneezing and snuffling a bit, you can hardly stand up, you can get to the bathroom and back to your bed and you feel pretty dreadful. It is a bit like having malaria so it is way worse than a cold.

PATENTTALK.ORG: And, what are the different types of flu and how do they infect people?

DR PITTARD: There are two classifications; there is A influenza and B influenza.  B has by reputation to be slightly more severe. The most recent A one that people will be familiar with would be swine flu, which came out in 2009-10.  We vaccinated a lot of pregnant women then because it was worst in pregnancy.  The actual illness I had in April of that year and happily it was just for the Friday, Saturday, Sunday so I didn’t miss any work but the current vaccine has a 2009 strain in and two from 2012.  One of A vaccine and one of B virus and they were identified in the States. In the case of Swine flu it came up from Mexico from pigs to humans and that’s how it has picked up.  So the World Health Organisation keeps an eye out for this like Sherlock Holmes and spots what the trends would be; the virus strains that we haven’t had in Europe and it will put the manufacturers on advice to make the vaccine to anticipate the ones we haven’t had.

PATENTTALK.ORG: Could you just tell us a little bit about the particular danger posed by the different strains of flu,  such as bird flu.

DR PITTARD: Well the biology of it seems that these viruses, similar with the Ebola virus, they seem to get into animal systems and seem to mutate there. And then there are places in China in case of bird flu there are a lot of poorer Chinese who will live with chickens in their house and because chickens are kind of valuable they keep them under their beds, you can well imagine if you stay with a chicken long enough it may share one of its viruses with you, and when the jump is made from avian bird flu to a human often the human system reacts very badly to it, and there have been one or two deaths.  So it is quite interesting biology.  In the case of the Ebola virus, it was bush meat and people were eating these animals and getting these animal viruses.

PATENTTALK.ORG: Can you just briefly outline how the flu jab works?

DR PITTARD: What happens is the myth that the survey shows, people object to the flu vaccine on the one ground is maybe that they think it will give them the flu.  Some viruses are actively vaccinated into us.  Polio used like that – it was audited in a way that it didn’t make you ill but it gave you immunity for life.  With the flu vaccine they extract the infectious part and they just give you the virus ‘skin’, to give it to you in simpler terms and it then prompts your immune system to look out for that virus when you meet it live in the future. So after about ten days you meet the live virus your immune system won’t take a hold because it will recognise the skin, the armour if you like, and will destroy it before it starts with the  Interferon that is the body’s anti-viral.  So it is a dead vaccine, it won’t give you the flu.

PATENTTALK.ORG: So is it a myth, then – that you may develop symptoms of flu by having the jab?

DR PITTARD: Yes, I think what happens is when people go to the doctors they pick up a virus in winter, they are incubating it they get hit in the waiting room or the supermarket on the way home, and it coincides with the flu vaccine and for a few patients they say “Oh, well that is what has given me the flu, I should not have had the flu vaccine”, and so they become adverse to it.  Most of our patients don’t subscribe to that but that is what the survey, Ipsos Moray GSK Survey showed.  And so we are really keen to expose that as a myth.

PATENTTALK.ORG: Are there any possible complications from having the flu vaccine?

DR PITTARD: Well the headline objection that’s very rare is that if a patient has true intolerance to eggs, and you might not like eggs, you might not like egg soufflé or egg fried rice or omelettes but that is not an allergy an allergy is where your tongue swells up, your eyes close, you need adrenalin, and you get very asthmatic I mean that is very rare to eggs it is probably as rare as being allergic to milk but because the vaccine is prepared using live hens eggs which is un-purified there is a theoretical objection to that, but that is the only headline issue. If for example you are very allergic to rare ingredients in the flu vaccine, the preservatives in the other vaccines you have had a reaction to tetanus, you have had a reaction to pneumonia vaccine, then possibly your doctor will know that.  These are very rare 1 in 10,000 or 1 in 1,000,000 cases.  For the bulk of us, none of that applies. If you can tolerate eggs, you can tolerate the flu vaccine.

PATENTTALK.ORG: Who is particularly at risk from believing in these myths?

DR PITTARD: The best way to answer that is the “at risk” population. Most GPs are concerned with the over 65’s because you tolerate flu worse and worse as you get older.  The rest of your biology is compromised by aging; heart, lungs and so on.  You are more likely to get pneumonia and you are less likely to be able to look after yourself.  Younger patients that battle on are a bit stronger I guess.  So the national policy is to vaccinate the over 65’s and also vaccinate people with pneumonia and bronchitis risks, diabetic risks, heart disease risks and one of the two groups like care workers and ambulance drivers.  These are the people that need the vaccine and they are the ones that are likely to object for grounds of getting the flu from the flu vaccine, which is not true.  The other objections that the survey showed is they thought that they never got the flu so they didn’t need it. Of course eventually, it is like Russian roulette, they will get it.

PATENTTALK.ORG: Final question, what is your advice to anyone who might be worried about getting the flu?

DR PITTARD: Well, the national policy which had thousands of patients seeing their GP’s in October / November and the GP’s keep the flu vaccine in their surgery, their special clinics, and kept in touch with their practice, if you have moved area just talk to the reception staff and they will make it very easy for you to get your vaccine.  If you are concerned that you may have a particular risk then you can have a consultation with your GP by phone for example, and they can often phone you back, book an appointment to talk about it or if you are outside of the risk group that the NHS will vaccinate you then you can still go to pharmacy chains and buy the vaccine for about £10, maybe less, and have it yourself. There are very few contraindications of having this, it is a very safe procedure.


Healthcare Associated Infections – Britons will go a long way to avoid them – A guest post from MindMetre Research

As regular readers of the blog will know we has been covering the topics of superbugs and the related issue of MRSA here at PatientTalk.Org.

So we are delighted to share this guest post from MindMetre Research which tells us more about a recent study the contacted in the UK looking at attitudes toward hospital provision and infection.

They share “How far would you go to avoid being treated in a hospital with a poor record for antibiotic-resistant Healthcare Associated Infections (HCAIs), or ‘superbugs’? The answer – “up to a hundred miles” – according to almost half of British citizens.

Latest research on the subject from MindMetre seeks to calibrate the likelihood of British citizens to insist on treatment at an alternative hospital if their local provider had a below average record of HCAI reduction, along with the distance they would be prepared to go to get treatment in a safer environment.

The findings from the MindMetre study were definitive and clear:
· 76% of citizens say that if they learned that their hospital was a low performer on HCAI reduction, they would insist their GP referred them to a hospital with a better record;
· 83% would be happy to travel 20 miles to be treated in a hospital with a better HCAI reduction record than their local hospital;
· 62% would be happy to travel 50 miles for treatment;
· And 48% would be happy to travel 100 miles in the same situation.

Paul Lindsell, Managing Director at MindMetre Research, comments, “In the new structure of the NHS, with acute clinical services commissioned by GP-managed Clinical Commissioning Groups (CCG), patient mobility has become a clear and present reality. Patients, in partnership with their GP, can choose to be treated at an Acute Trust of their choice, with the associated funds following the patient. CCGs are clearly charged with the mandate to improve patient outcomes, and so offering this level of patient choice is systemically built in to the new NHS structure.”

“Acute Trusts have done a great job addressing very specific HCAIs, notably MRSA and C.difficile, but there is a rising tide of other infections, and the problem needs to be addressed holistically.”

“This research note clearly demonstrates that Acute Trusts need to take their initiatives to reduce HCAIs even more seriously if they are to avoid patients opting to be treated at a hospital with a better record, with funds following the patient.” ”

Research Methodology
Fieldwork was conducted by MindMetre Research between May and July 2014, in person and via online questionnaires, amongst a nationally representative sample of 2,003 British citizens (age, gender, region, social class). Margin of error: – +/- 1.78%

About MindMetre
MindMetre, part of the Lindsell Marketing Group, is a leading consumer and business analyst. The organisation has been investigating trends in a number of fields and sectors since the late-1990s, including health & medicine, finance, central & local government and internet technology. Research programmes are regularly conducted across the globe, embracing geographies from the Americas to the Far East. In the healthcare sector, MindMetre is particularly known for its series on healthcare financing, beginning in the early 2000s. All MindMetre research activity strictly protects the privacy and confidentiality of respondents.