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Post00373 NEW VAX INTRO + ORDER ADS + NEW + NEWS ++ 10 September 2001 CONTENTS 1. A "THINK PIECE" ON INTRODUCTION OF NEW VACCINE 2. REVISED PAGES FOR REVIEW: ORDERING INJECTION EQUIPMENT 3. INAPPROPRIATE DRUG DONATIONS: THE NEED FOR REFORMS 4. INTRODUCING TRAINING FOCAL POINT: THE MANAGEMENT STRENGTHENING PROJECT 5. ZAMBIA PROBLEM-SOLVING WORKSHOPS 6. JOHNS HOPKINS POPLINE DATABASE NOW AVAILABLE ONLINE 7. NEWS Contributions to: [[email protected]][email protected][/email] or use your reply button! ___________________________________________________________________________ Visit TechNet 21 Delhi meeting (updated version available on 10 September) Get the latest Technet21 documents at: access/Vaccines/Vaccine_Cold_Chain/Technet/2001_Delhi_Technet.htm ____________________________________*______________________________________ 1. A "THINK PIECE" ON INTRODUCTION OF NEW VACCINE Robert Steinglass, BASICS, contributed this thought provoking paper. "How to introduce new combination vaccines (tetravalent and pentavalent): some practical and ethical questions" Replies to: [[email protected]][email protected][/email] * or use your reply button! ___________________________________________________________________________ Date: Sun, 02 Sep 2001 From: "Robert Steinglass" To: Technet Moderator Subject: a "think piece" on introduction of new vaccine I have prepared the attached file on a practical dilemma about how to introduce new vaccine combinations. I hope it reaches you as I cannot check the file, as this cybercafe does not have Word Perfect. Your comments are welcome. This might be a topic for the small working group of Technet Forum. Robert ___________________________________________________________________________ How to introduce new combination vaccines (tetravalent and pentavalent): some practical and ethical questions (A paper submitted by Robert Steinglass to TECHNET Forum to encourage some quick discussion.) 3 September 2001 INTRODUCTION: As I have a rather thick skin, I have agreed to offer this paper to stimulate thinking around a difficult topic. No solution is going to be perfect as there are many trade-offs to consider. It is not intended that this paper be sent, as is, to countries. WHO needs to decide first on how best to introduce this topic to its regions and countries. It will be useful for WHO to solicit input rapidly from countries which have already introduced new combination vaccines to see what worked best. BACKGROUND: Many countries will soon begin to receive new vaccines. They will be faced with the challenge of guiding health workers and storeroom managers about how to introduce these vaccines when varying stocks of DPT are already in the field. They will need to communicate clearly with the public about this new vaccine. There is considerable scope for confusion unless partners provide guidance now on factors to consider to permit a smooth introduction. The minutes from the recent partners meeting in Abuja (10-13 July) on main issues for the introduction of new vaccines do not include any discussion on the following choices which must be made on how to introduce new combination vaccines. In most countries, the quantity of tetravalent (DPT + Hep B) or pentavalent (DPT + Hep B + Hib) vaccine has been provided to cover only one full year's birth cohort, including a 25% reserve in the first year. The GAVI guidelines clearly state that countries will be rewarded based on their ability to immunize additional infants over a baseline of past DPT3 coverage. However, in the year of start-up, one cohort 0-11 months of age is already present (a "backlog") and is replaced by a second cohort of babies born during the following 12 months. In effect, the start-up year has a two-year cohort, leading to important implications for vaccine use. This situation is peculiar to the first year only. In subsequent years, only a single birth cohort needs protection. SOME THORNY QUESTIONS: Given limited supplies of new vaccines, several options need to be considered. (This paper assumes that the MOH chooses to introduce the new vaccine nationwide all at once and not to phase in introduction, although in that case similar choices are raised.) The MOH must formulate its introduction policy, design simple information for the public, and provide clear guidance to field staff. Some questions (many of them overlapping) need to be answered by the MOH with corresponding clear messages to be formulated for the public and health staff: - are all infants who are alive at the time of the official start-up of the new combination vaccine eligible to begin the three-dose series? - should immunization with the new vaccine be limited only to babies born after the official start-up? - should immunization with the new vaccine also be offered to infants who have already begun their DPT series? - should immunization with the new vaccine be given to children over 12 months of age who have already begun, or not even begun, their DPT series? - is there enough new vaccine for catch-up immunization of the partially immunized or unimmunized infants and older children? is it ethical to use the limited supply of vaccine to cover older children or children who have started their series when there is insufficient vaccine to fully immunize more than a single birth cohort over the coming 12 months? - is it ethical to deny any child protection with the new vaccine? Does the answer depend on whether the child is less than 12 months old, or whether the child has already started their DPT series, or when the child is born relative to the introduction of the new vaccine? - is it practical or ethical to introduce the new vaccine starting from a specific date with infants receiving it as either their first, second or third dose -- but without ensuring that infants who were partially immunized previously with DPT continue to complete all three doses of the new vaccine? - is it acceptable and practical to offer one child one type of vaccine and another child a different type of vaccine at the same immunization session? - is it safe to complete the series with new vaccine if this means that the child will receive a total of up to 5 doses of DPT? - do the recommendations depend on the size of the stock of DTP in the country at the time of the start-up? Whatever policy is formulated, immunization staff will need the support or their supervisors to apply the selected criterion consistently. OTHER CONSIDERATIONS: From an epidemiological and cost-effective perspective, it is important that the maximum number of children receive the full series of three hepatitis B doses. I am not sure about the relative efficacy of 1 or 2 doses of Hib. Hepatitis B and hib vaccines are most effective the earlier in life they are given. While wasteful of DPT, it is assumed that 5 doses of DPT (2 DPT followed by three of the new combination vaccine) are not harmful, when given with shorter intervals than is usually the case with booster doses. It is important to set the program on the right footing from the outset in terms of emphasizing that immunization should begin and be completed at as early an age as possible. If immunization is limited to babies born after the official start-up of the new vaccine, it may be difficult for immunization staff to refuse to vaccinate older unvaccinated infants or those infants who have already started their DPT series. There will seem to be an excess of new vaccine in the first few months after the start-up. This apparent excess is due to the fact that the health facility will receive their customary 1-3 months of supply with only a very narrow age target to vaccinate, consisting exclusively of babies born after the official start-up. The apparent surplus of vaccine at the beginning of the program, combined with pressure from parents, may cause considerable difficulty for health staff offering different vaccines on the same day to different children. ONE PROPOSAL (A "STRAW MAN"): The best solution in each country may very much depend on the amount of DPT vaccine already in stock in the country. The following assumes that there is a sizeable quantity of DPT in the country at the time of start-up with the new vaccine. - Offer the new combination vaccine only to babies born after the well- publicized official start-up date. (One compromise might be to offer new entrants presenting themselves for immunization who are less than 3 months of age at the time of the start-up.) - Supply less than the standard amount of new vaccine in the first shipment, plus 25% reserve, to each level after the start-up, as initial uptake will be slow if the target is only babies born after the start-up. - Maintain dual stocks of DPT and new vaccine at each level for at least six months after the start-up. - Immunize new entrants born before the official start-up with three doses of DPT vaccine. - If infants or older children over 12 months of age have already begun their DPT series, continue the three-dose series with DPT. - Vaccinate unimmunized children over 12 months of age with three doses of DPT. The simple message which corresponds to the above proposal would be that "new combination vaccine is offered only to babies born after (date or special national/religious occasion). All other infants and children complete their series with DPT." Robert ____________________________________*______________________________________ 2. REVISED PAGES FOR REVIEW: ORDERING INJECTION EQUIPMENT Debbie Kristensen, PATH, posts 3 pages of the draft document "Giving Safe Injections: Introducing Auto-disable Syringes" manual on ordering injection equipment. Download the file SupplySection.pdf Go to the website and click on the file: SupplySection.pdf or send an email to: [[email protected]][email protected][/email] with the message: get technet SupplySection.pdf *Comments and suggestions to Debbie at: [[email protected]][email protected][/email], [email protected] ___________________________________________________________________________ From: "Kristensen, Debra" To: Technet Moderator Subject: Ordering Injection Equipment Date: Thu, 6 Sep 2001 Dear Allan: I am enclosing 3 revised pages from the "Giving Safe Injections: Introducing Auto-disable Syringes" manual. The section is entitled "Ensuring Adequate Supplies of Injection Equipment". We have updated these pages to reflect GAVI guidelines for ordering equipment. I submit this in hope that Technet members familiar with this topic might provide some quick feedback. Please note that the "Key Points" section can be ignored as it covers the key points from the entire chapter. Thank you. Best regards, Debbie Kristensen Technical Officer Program for Appropriate Technology in Health (PATH) 4 Nickerson Street, Seattle, WA 98109-1699 USA Telephone: (206) 285-3500; Fax (206) 285-6619 E-Mail: [[email protected]][email protected][/email]; PATH Web Site: ___________________________________________________________________________ EXTRACT! EXTRACT! EXTRACT! EXTRACT! EXTRACT! EXTRACT! EXTRACT! EXTRACT! ___________________________________________________________________________ Chapter 5: Using Auto-Disable Syringes ENSURING ADEQUATE SUPPLIES OF INJECTION EQUIPMENT If you need to order injection equipment, the following pages will help you calculate the number of syringes and sharps disposal containers to order for routine immunization or campaigns. The formulas presented are consistent with current WHO, UNICEF, and GAVI guidelines, but adjustments should be made to reflect the needs and wastage rates of individual sites. Order quantities must also be rounded up to match the case or box size available from the supplier. ORDERING AUTO-DISABLE SYRINGES It is essential that each injection is delivered with a sterile syringe and needle. Managers must therefore ensure that they order and distribute adequate quantities of syringes for the target population to be immunized, including an allowance for wastage. Wastage can occur when auto-disable syringes get disabled prematurely, break, or become contaminated. Managers can measure their site?s wastage rate using the first formula in Figure 25. If this is not possible, then a 10% syringe wastage rate should be used. The syringe wastage rate is converted into a wastage factor in order to calculate the quantity of syringes to order. The second formula in Figure 25 shows how to calculate the wastage factor, which is 1.11 for a wastage rate of 10%. If managers are ordering auto-disable syringes for the first time, they should establish an additional reserve stock to ensure that when demand varies or supplies arrive late, syringes will still be available for immunization. UNICEF and WHO estimate that a 25% reserve stock should be ordered, in addition to the syringes to be used and those that will be wasted. The third formula in Figure 25 shows the calculation of syringes to be ordered for the first time, including use of the 1.25 factor for reserve stock. If managers are re-ordering auto-disable syringes, then the quantity of remaining syringes in stock should be subtracted from the total quantity of syringes needed, taking into account the target population, the wastage and the reserve stock. The fourth formula in Figure 25 shows how to calculate the quantity of syringes to be re-ordered. ____________________________________*______________________________________ 3. INAPPROPRIATE DRUG DONATIONS: THE NEED FOR REFORMS [Crossposted from E-Drug with thanks] Selected news items reprinted under the fair use doctrine of international copyright law: ___________________________________________________________________________ From: E-drug Subject: [e-drug] Inappropriate drug donations: the need for reforms From section 'Health and human rights', The Lancet. The Lancet. Volume 358, Number 9281, 18 August 2001 Inappropriate drug donations: the need for reforms Individuals and organisations tend to respond to humanitarian emergencies with an urgent desire to help those in need. The media often highlight shortages of medicines, and donating medicines can seem a tangible way to express concern and solidarity. Drug donations do play an important part in humanitarian relief efforts, but they are not always the most effective way to help. After an earthquake, the first needs are usually shelter and earth- moving equipment. In refugee settings, priorities are clean water, sanitation, shelter, food, and vaccines. The requirement for drugs is determined with a comprehensive assessment of health problems. Surplus drugs from hospitals and pharmacies in donor countries are rarely what is most needed in emergency settings. If the medical needs of the affected population are not clearly specified, responses from hospitals and pharmacies are unlikely to be helpful. Surplus drugs often include free samples or drugs returned by patients or health professionals, such as cardiovascular drugs, gastrointestinal drugs, hormones, and anti-rheumatic remedies. Some drugs have reached or are near their expiry date. Antimalarials and vitamin A are commonly needed in an emergency, but are unlikely to be among the medicines donated by western hospitals. In 1991, Pharmaciens Sans Frontiè²¥s found that only 20% of 4 million kg of drugs collected from 4000 pharmacies in France for international aid programmes could be used--the rest had to be burnt. Guidelines for drug donations were produced by several organisations during the 1980s in response to inappropriate donations in emergency situations. They formed the basis for internationally endorsed drug donation guidelines.1 The 12 articles of these guidelines are based on a set of core principles. First, there should be maximum benefit for the recipient. Second, there should be respect for the wishes and authority of the recipient, and support for existing government policies. Third, there should be no double standards in quality--if the quality of an item is unacceptable in the donor country, it is also unacceptable as a donation. Fourth, there should be effective communication between the donor and the recipient. After arrival in the recipient country all donated drugs should have a shelf-life of at least 1 year. Drugs may lose their active properties after their expiry date, and distribution through different storage levels (eg, central store to provincial store to district facilities) can take 6-9 months. Although some drugs may continue to be safe and effective after the expiry date, their use would not be allowed in the donor country and so they should not be donated. Many countries have developed a national standard drug list based on treatment guidelines for the most common diseases, to ensure safe and reliable treatment and optimal use of resources. The criteria for selection of drugs are appropriateness, efficacy, safety, and cost-effectiveness. Donations of drugs on the standard list, in consultation with recipients, can be helpful. Donations of products not on the list should be made only if there is a strong rationale, and after consultation with the recipient country. At the community level, donation of inappropriate drugs can interfere with management of common problems and can undermine a system based on rational prescribing from standard drug lists, treatment protocols, and trained national health workers. Governments can buy essential generic drugs from reputable non-profit procuring agencies at lower prices than brand-name drugs from large multinational companies. Furthermore, medicines identified by international non-proprietary names make training easier by overcoming the confusion caused by different brand names. The use of non-proprietary names also facilitates ordering and storage of drugs. Despite the existence of published guidelines since the 1980s, every emergency produces new examples of inappropriate donations. In eastern Zaire in 1994, for example, one relief organisation chartered an aeroplane to deliver a huge shipment of a commercial soft drink used by athletes, in the false belief that it could be used to treat people with cholera. In fact, this product can be dangerous if given to infants. In addition, the product was not only bulky and difficult to store, but caused considerable waste and was not cost-effective when compared with standard oral rehydration therapies used to treat diarrhoea. There are many documented cases1,2 of relief organisations, private companies, governments, and individuals providing culturally unacceptable and nutritionally inadequate foods; inappropriate, expired, poorly packaged, and even dangerous drugs; and other useless relief supplies. Donations by pharmaceutical companies can be used to obtain tax deductions on unused stock or to stimulate a market for certain products. In April, 1999, growing concern about the appropriateness and the quality of the drugs donated to Albania during the Kosovo refugee crisis caused the WHO to voice its concern. Albania was assisted by a WHO consultant to develop national guidelines for drug donations and a standardised list of drugs. The WHO audit of Albania during May, 1999, noted that about 50% of the donated drugs were inappropriate or useless and would have to be destroyed. 65% of drugs were due to expire within 1 year, and 32% were identified only by brand-names that were unfamiliar to Albanian health professionals. None of the short shelf-life donations were requested, and aid workers reported that they could not be distributed and used before the expiry date. Donations need to be properly thought out before they leave the donor. Transport to the recipient country can cost more than the value of the drugs. Packages must be clearly labelled in a language that can be read in the region and units of drugs, such as blister packs, should not have been opened or used. Sometimes consignments remain at the point of entry for months because arrangements were not made for distribution on arrival. Storage costs and taxes may also be demanded. If drugs are not appropriate then the recipient has to ensure their safe disposal, which also poses difficulties. Between 1992 and mid-1996 in Bosnia and Herzegovina, about 17 000 tonnes of inappropriate donations cost US$34 million to destroy. There were neither high temperature incinerators nor specialist chemical waste treatment centres necessary for safe drug disposal.2 An incinerator supplied to Macedonia by the UK at the time of the Kosovo refugee crisis did not comply with British or EU emission standards. In response to such difficulties WHO have developed and published guidelines for the disposal of drugs.3 In most humanitarian energencies, a financial contribution is more appropriate than donation of medicines. Such aid allows purchase and transport from specialist procuring agencies, at a fraction of the cost of supplying products from another country. The frustration of waiting for consignments of donated medicines, only to find that most were useless, led the Eritreans to develop their own manufacturing plant for commonly used medicines during their war for independence. By the end of 1987, this plant was able to prepare all intravenous fluids and 40% of the tablets and capsules needed in Eritrea. The plant formed the basis of the national manufacturing programme which has developed since independence. Inappropriate donations need to be prevented and recipients must be able to refuse unwanted gifts. Ideally, the government of a disaster-affected country should monitor the quality of the assistance and ensure that inappropriate aid is rejected. Without government controls, the lead aid agency in a relief programme should exert its authority on monitoring the quality of donations. Well-informed media could play a part in exposing agencies, companies, and governments that persist in sending useless drugs to countries facing humanitarian crises. In the long-term, the problem of inappropriate drug donations needs to be resolved by relief agencies through education of the public and by maintaininng a commitment to high standards through consultation with the media, policy makers, and the drug industry. On a positive note, the world's newest nation, East Timor, has already developed a national standard drug list to cover all health facilities, and procurement policies that preclude drug donations. Beverley Snell International Health Unit Macfarlane Burnet Centre for Medical Research PO Box 254, Fairfield, Victoria 3078, Australia 1. WHO. Guidelines for drug donations. Geneva: WHO, 1999. 2. Forte G, Alderslade B. Inappropriate drug-donation practices in Bosnia and herzegovina. N Engl J Med 1998; 338: 1473. 3. WHO. Guidelines for safe disposal of unwanted pharmaceuticals in and after emergencies. Geneva: WHO, 1999. ____________________________________*______________________________________ 4. INTRODUCING TRAINING FOCAL POINT: THE MANAGEMENT STRENGTHENING PROJECT Crossposted from 'HIF-net at WHO with thanks: ['HIF-net at WHO' profile: Tom O'Connell works in WHO's Vaccines & Biologicals/EPI (Expanded Programme on Immunization) to coordinate a management strengthening project for EPI managers at national and subnational levels. This project will: 1). produce a comprehensive set of management tools & resources; 2) develop a continuous training component to build national managerial capacity; and 3) develop national electronic capacity through creation of a web-based interactive resource center and electronic managerial discussion forums open to all EPI managers. He is especially interested in hearing of successful electronic support services for managers of immunization programmes and other related health services delivery programmes. ] ___________________________________________________________________________ From: [[email protected]][email protected][/email] To: Technet Moderator Subject: Introducing the training focal point for the Management Strengthening Project Date: Wed, 5 Sep 2001 1 Dear All, I would like to introduce a new member of the V&B team. Ms. Jhilmil Bahl is a Technical Officer who has been hired as the training focal point for the UNF-funded project to strengthen the management of immunization services. She will help in the design and development of a training resource centre, which will organise all V&B training materials, including the creation off a databank of training aids, questions, case studies, etc that will be made available to national programmes. She will also help design & develop project training materials (e.g. facilitator's guide) as well as the design of a reference CD-ROM and website for managers of immunization programmes. I have enclosed a brief bio on Jhilmil below. Cheers, Tom Thomas O'Connell Technical Officer, Office M323 Expanded Programme on Immunization World Health Organization Avenue Appia 20 CH-1211 Geneva 27 Switzerland Telephone: 41 22 791 4957 Fax: 41 22 791 4193 E-mail: [[email protected]][email protected][/email] ___________________________________________________________________________ Jhilmil has a masters degree in Instructional design from Syracuse University, New York and varied experience in diverse training environments. Her skills include: * Designing training programs and training materials- information gathering, content structuring, technical writing & editing, workbook design & layout, creating graphics, standardizing training materials. She also has experience with conducting training needs assessment and quality assurance. Recently she worked with the Mental Health Program to design their training materials. She also created workbook for a workshop commissioned by United States Information Agency, and created several other training materials. * She has experience in designing and producing interactive CD-ROMs- storyboarding, converting web pages, building search features and interactivity, programming and developing, testing. Recently, she created a CD-ROM to teach effective web searching skills. Her history includes working in a company developing commercial computer based training CD-ROMs. * Other skills include designing and maintaining Websites - consulting with people in regions to design their web site and training them on web design software, creating website for training follow-up activities As a project Manager, Multimedia in her previous job, she worked on several web projects - , (others listed in my CV) She also designed WHO's IT training website * Delivering training - she has conducted stand up training, workshops, presentations in WHO for the past 4 years. * Train the trainer effort- designing trainer/facilitator manuals as well as co-ordinating and participating in several train the trainer workshops. * She will provide IT support to the project, being proficient in many computer applications. ____________________________________*______________________________________ 5. ZAMBIA PROBLEM-SOLVING WORKSHOPS Tom O'Connell, WHO/V&B/EPI, kindly post the program of management training course in Zambia in November 2001. * For more information contact: Tom O'Connell, WHO/V&B/EPI; e-mail [[email protected]][email protected][/email] Tel. (+44-22) 791-4957 ___________________________________________________________________________ To: Technet Moderator Subject: CORRECTED dates for Management Training for Tanzania & Zambia Dear All, Tanzania: Training of trainers Oct 25-26, 5-day workshop: Oct 29 to Nov 2 (these dates have been confirmed) For Zambia, the dates are still TENTATIVE: Training of Trainers: Nov 22-23, 5-day workshop: Nov 26 to Nov 30 The Agenda for Zambia is attached, with the correct dates. The agenda for Tanzania will be sent out shortly. Regards, Tom ___________________________________________________________________________ ZAMBIA PROBLEM-SOLVING WORKSHOPS WEEK 1: TRAINING OF TRAINERS PROGRAM November 22 - 23 Day 1 * Opening ceremony * Goals of the week and goals of the day * Presentation on "The Multi-Year Plan for Zambia: Priority Goals" * Presentation on "Problem Solving: workshop process & training methods" * Presentation on "Problem Identification" * Small groups work: "Problem identification" * Plenary session: "Consensus on priority training problem" * Presentation on "Problem analysis: tracing the causes" * Plenary: What essential information is needed to determine causes of problem? * Presentation on "methods to develop alternative solutions" * Small groups work: Brainstorming. * Presentation on "Planning for action" Day 2 * General comments and "Goals of the Day" * Presentation on "Development of a Plan of Implementation" * Exercise on "Development of a Plan of Action & Implementation" * Plenary: "Plan of Action and Implementations" by each group * Discussion on "Participant workshop manual" * Discussion on "Facilitators roles and responsibilities during the workshop" * Presentation on " The follow-up workshop" * Discussion on "Facilitators' roles and responsibilities after the workshop" * Closing ceremony ZAMBIA PROBLEM-SOLVING WORKSHOPS WEEK 2: IMMUNISATION PROGRAMME MANGERS November 26 - 30 Day 1 * Opening ceremony * Presentation on "The EPI program in Zambia" * Presentation on "Problem Solving for Better Immunization Programs" * Goals of the week and goals of the day * Assigning of participants in to small groups, each with a national facilitator * Presentation on "Problem identification" * Development of problem list by small groups Day 2 * General comments and "Goals of the Day" * Presentation of "List of problems" developed by the groups * Presentation: Problem Analysis * Small groups work: Defining data needed and objective to be achieved * Plenary: The need for a management information system * Presentation: Developing alternative solutions * Presentation: Priority setting Day 3 * General comments and "Goals of the Day" * Small groups work: brainstorming alternatives * Presentation: Choosing the best solution: what is realistic? * Plenary: Debate on list of "alternatives" developed by each group * Presentation: "The Plan of Action": * Small groups work: Development of "Plan of Action" Day 4 * General comments and "Goals of the Day" * Small groups work: Continue on "Development of Plan of Action" * Plenary: Debate on Plan of Action developed by each group * Presentation on "Implementing a Plan of Action" * Small groups work: "Implementing a Plan of Action" Day 5 * General comments and "Goals of the Day" * Plenary: Debate on implementation actions recommended by each group * Presentation on "Monitoring and Evaluating" * Small groups work: "Ensuring monitoring and evaluation of the PoA" * Presentation & discussion: follow-up workshop and expectations for participants * Closing ceremony ____________________________________*______________________________________ 6. JOHNS HOPKINS POPLINE DATABASE NOW AVAILABLE ONLINE ___________________________________________________________________________ [Forwarded from AFRO-Nets] Johns Hopkins POPLINE Database Now Available Online Looking for the latest information on female genital mutilation? Need a journal article on adolescent reproductive health and HIV/AIDS? Trying to track down an article on population and the environment? The answers to these questions and much more are now just a few mouse clicks away on the new Internet POPLINE database. POPLINE, the world's largest bibliographic database on population, family planning, and related issues, is now available free of charge on the Internet. All 280,000 citations, representing published and unpublished literature, can be accessed for no charge at: Maintained by the Johns Hopkins Population Information Program, Internet POPLINE is updated every two weeks and offers the only com- plete, up-to- date Internet location for POPLINE records. Approximately 10,000 records are added annually. (POPLINE records are no longer available through the U.S. National Library of Medicine's IGM or PubMed systems.) The new Internet POPLINE's current awareness search allows users to save time by easily limiting their searches to the most current en- tries. Plans are underway to offer "relevance" scores to search re- sults and a "shopping cart" feature for document delivery is under development. For those in developing countries who may have limited access to the Internet, POPLINE will continue to distribute POPLINE on CD-ROM to over 950 sites twice a year. For more details about this service go to: POPLINE Digital Services also provides full text documents of many of its abstracts in the database at no charge for readers in developing countries. Full-text documents are only available if the information is not available locally, is not a commercially published book, and is less than 100 pages in length. POPLINE sends full-text documents as an e-mail attachment in Adobe Acrobat format or by mail. More in- formation is available at: or by contacting: POPLINE Digital Services 111 Market Place, Suite 310 Baltimore, MD 21202, USA Tel: +1-410-659-6300 Fax: +1-410-659-6266 mailto:[email protected] The Population Information Program is funded by the United States Agency for International Development (USAID) and the United Nations Population Fund (UNFPA). For more information, log on to or send an e-mail to Anne Compton Deputy Director PIP, and Chief POPLINE Digital Services mailto:[email protected] or contact the Johns Hopkins Center for Communication Programs at 111 Market Place Suite 310 Baltimore, Maryland 21202, USA ____________________________________*______________________________________ 7. NEWS Selected news items reprinted under the fair use doctrine of international copyright law: ___________________________________________________________________________ "Polio Cases Drop Sharply in Pakistan" Associated Press ( (09/06/01) According to World Health Organization Eastern Mediterranean Regional Director Hussein Gezairy, the polio eradication effort in Pakistan has reduced the number of polio cases from 199 at this time last year to just 35 cases so far in 2001. As part of the global effort to eradicate polio by 2005, health officials routinely go door-to-door in Pakistan for polio vaccination campaigns. The next round of the national immunization program in the country will start on Sept. 25, with another set for early November. --- "Yellow Fever Strikes Ivory Coast, UN Seeks Help" Reuters ( (09/05/01) The World Health Organization (WHO) has identified an outbreak of 20 cases of yellow fever in Abidjan, the commercial capital of Ivory Coast. In response to Ivory Coast's request for assistance, the health organization sent a team of medical experts to assess the situation and to assist in the administration of 3 million doses of yellow fever vaccine. On Wednesday, the WHO made an urgent appeal for $2.9 million to help fund the emergency vaccination effort. The mosquito-borne viral disease causes hepatitis, jaundice, and kidney failure. --- "Post-Polio Syndrome Hits Hundreds in Metro Area" Detroit News ( (08/26/01) P. 5; Schabath, Gene Although the polio virus has been eradicated from the United States, patients who got polio in their childhood and recovered are now experiencing post-polio syndrome, which has symptoms of weakening muscles, difficulty breathing and swallowing, fatigue, and unusual strain. Michigan's St. John Hospital Health System has established in Shelby Township a post-polio clinic that helps post-polio syndrome patients with their unique problems. The problems are caused by the combination of polio and the natural progression of aging, says Daniel Ryan, the clinic's medical director. Ryan believes the clinic will be obsolete in about 20 years, because most of the people who got polio in their childhood are in their 50s and 60s, and the next generation will not have post-polio syndrome thanks to the availability of the polio vaccine. --- "Doctor's Hepatitis B Infection Kills Patient" Glasgow Herald (Scotland) ( (08/23/01) P. 1; Montgomery, David In Dunfermline, Scotland, an elderly patient at Queen Margaret Hospital has died after being accidentally infected by a doctor with hepatitis B. A second elderly patient also contracted the disease. The Fife Health Board is now contacting the approximately 350 patients who were exposed to the doctor. An investigation has now been set up to find out how the patients were infected and how the doctor's condition went undetected, a spokeswoman for the Fife Health Board said. Dr. Charles Saunders, acting director of public health at Fife Health Board, says it is not clear at the moment how the doctor had contracted the virus, because the doctor involved had followed Scottish Executive guidelines on health care workers and hepatitis B. Saunders added that the board is currently working closely with experts in blood-borne infection and virology from Edinburgh and the Scottish Centre for Infection and Environmental Health in Glasgow. --- "Improving Vaccines Are Helping in Fight Against Hepatitis B" Glasgow Herald (Scotland) ( (08/23/01) P. 2; Macdermid, Alan Hepatitis B virus infection is transmitted via tainted blood or blood products, contaminated needles, sexual contact, and from infected mothers to their infants. Symptoms of hepatitis B infection include skin rashes, joint pains, fever, loss of appetite and energy, inflammation of the liver, and jaundice. Patients with chronic hepatitis B infection may experience cirrhosis, liver cancer, and even death. In the last couple of decades, vaccines against the disease have improved greatly, and they are now routinely given to health workers and other people who may be at risk. --- "Hepatitis Rate Spikes in China" Associated Press ( (08/22/01); Fackler, Martin The Chinese province of Guangdong has one of the world's highest rates of hepatitis B infection, with studies indicating that 75 percent of the population, or about 10 million people, has been infected with the virus. Early reports, according to Luo Huiming of the Guangdong Diseases Control and Prevention Center, suggest that two-thirds of China's people have been infected with hepatitis B. A researcher at the China Academy of Medical Prevention noted that the most common means of hepatitis B virus transmission in China is dirty needles, which are often reused in poor areas. There are effective shots to prevent hepatitis B virus infection; however, the vaccines are too costly for most Chinese and national health insurance does not cover the price.
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