A Weekly Compilation of Clinical Laboratory and Related Information
from The Division Of Laboratory Programs, Standards And Services
February 26, 2015
- New Approach to Blocking H.I.V. Raises Hopes for an AIDS Vaccine
- Ebola Containment Strategy Succeeding in Liberia
- We Could Cut the HIV Transmission Rate by More than 90 Percent, CDC Says
- FDA Clears Sale of First Direct-to-consumer Genetic Test
- In NEJM, Lander Lauds Steps at FDA to Build New Regulatory Framework for Genomic Tests
- More-accurate Cancer Tests Based on Computer Math
- Project Sheds Light on What Drives Genes
- Engineered Biomarkers Could ID Cancer Cells
- Small Study Links Lack of Sleep to Type 2 Diabetes Risk
- Long-term Effects of High Cholesterol
- NIH Expands Key Tuberculosis Research Program
- Vaccine that Targets 9 Strains of HPV Boosts Cancer Protection, Study Says
- Progress with Electronic Health Record Adoption among Emergency and Outpatient Departments: United States, 2006–2011
- Hospital to Let Patients Add to Own EHRs
View Previous Issues - Healthcare News Archive
New Approach to Blocking H.I.V. Raises Hopes for an AIDS Vaccine
A new compound has blocked H.I.V. infection so well in monkeys that it may be able to function as a vaccine against AIDS, the scientists who designed it reported. The new method stimulates muscle cells to produce proteins that somewhat resemble normal antibodies, which have Y-shaped heads. These proteins have both a head and a tail, and they use them to simultaneously block two sites on each “spike” that the virus uses to attach itself to a cell. If both sites can be blocked on every spike, the virus becomes helpless and drifts off unattached into eventual oblivion by the immune system. “It’s a twofer,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, which supported the work. “It’s very impressive, and the method is quite promising. But it’s still just in an animal model, so we’ll need to see evidence of whether it works in humans.”
Ebola Containment Strategy Succeeding in Liberia
The Rapid Isolation and Treatment of Ebola (RITE) strategy is helping to end the Ebola epidemic in Liberia, according to new data reported in this week'sMorbidity and Mortality Weekly Report (MMWR). The strategy—a rapid, coordinated response to Ebola cases in remote areas—is now being used in Sierra Leone and Guinea. "Whether it's traveling by air, jeep, canoe, or walking many miles on foot to find every case of Ebola, the RITE teams are helping Liberia get closer to zero cases than ever before," said CDC Director Tom Frieden, M.D., M.P.H. "It's critical that we continue to support these teams – and to expand their work into Sierra Leone and Guinea to help to get the epidemic under control there as well." RITE was developed by the U.S. Centers for Disease Control and Prevention (CDC) and the Liberian Ministry of Health and Social Welfare. The strategy focuses on maintaining investigation- and response-ready health teams (RITE teams) poised to deploy to remote areas as soon as a report of a suspected Ebola case is received. The teams take the lead in coordinating the assistance from the central Ministry and international partners needed to plan, manage, and track a response effort.
We Could Cut the HIV Transmission Rate by More than 90 Percent, CDC Says
More than 700,000 of the 1.1 million people living with HIV in the United States are undiagnosed or not receiving care, a population responsible for 91.5 percent of the transmissions of the infection in 2009, researchers reported. Diagnosing even some of those people, starting them on antiretroviral drugs and keeping them in treatment could have a large and immediate impact on transmission of the virus, according to the paper, published in JAMA Internal Medicine. "If all the people with HIV who either don't know they have the virus or are not receiving HIV clinical services were receiving care and treatment, we could expect a 90 percent reduction in new HIV infections in the United States," Jonathan Mermin, director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention at the Centers for Disease Control and Prevention, and one of the authors of the study, wrote in an e-mail. "That is a goal worth striving for."
Newly Discovered Virus Appears to Have Killed Kan. Man
A newly discovered virus – probably spread by ticks – appears to have killed a Kansas man, federal health officials said. The man became ill last spring after being bitten by ticks while working on his property. Doctors sent his blood to the Centers for Disease Control and Prevention, where sophisticated genetic tests found that he was infected with a previously undiscovered virus never known to cause illness in the U.S. CDC scientists are calling it the Bourbon virus because the man lived in Bourbon, County, Kansas. The Bourbon virus belongs to a family called thogotoviruses; its closest relatives have only been found in Europe, Asia and Africa.
AMP Issues a Position Statement on Direct-to-consumer Genetic Testing
In a position statement issued earlier this month, the Association for Molecular Pathology (AMP) shared its current views on consumer direct access to genetic tests. The AMP supports direct-to-consumer (DTC) testing when the information is actionable for patients. The AMP Working Group concluded that clinically meaningful tests could benefit patients and consumers and should be made available directly to the public, but only if certain conditions are met. Conversely, AMP opposes direct access to genetic tests that are performed for the purpose of selling additional health-related products or services and do not provide clinically meaningful or actionable information. For recreational or novelty genetic testing, such as ancestry testing, AMP maintains a neutral position as these reports typically do not include health information.
Laboratory Testing / Diagnostics
FDA Clears Sale of First Direct-to-consumer Genetic Test
The US Food and Drug Administration (FDA) announced that they have authorized marketing of a direct-to-consumer genetic test from 23andMe.The test is designed to identify healthy individuals who carry a gene that could cause Bloom Syndrome in their offspring. The agency also noted that it will now classify carrier screening tests, such as this one, as class II products, which means they are subject to general and special controls. Special controls can include performance standards, postmarket surveillance, patient registries, special labeling requirements and guidelines. "The FDA believes that in many circumstances it is not necessary for consumers to go through a licensed practitioner to have direct access to their personal genetic information," said Alberto Gutierrez, PhD, director of the Office of In Vitro Diagnostics and Radiological Health in the FDA's Center for Devices and Radiological Health, in the agency press release. The agency notes that while it is not regulating who can purchase or use the tests, the company is required to provide adequate information in the label such that users will understand what the test means, and, if sold over the counter, how they can reach a board-certified clinical molecular geneticist or equivalent for pre- and post-test counseling.
In NEJM, Lander Lauds Steps at FDA to Build New Regulatory Framework for Genomic Tests
What makes next-generation sequencing-based diagnostic tests alluring also makes them complicated to regulate, but changes to the regulatory framework could ease the adoption of such tests, the Broad Institute's Eric Lander wrote in a Perspective article in the New England Journal of Medicine. Lander said that it would take time to build the necessary regulatory framework at the US Food and Drug Administration to deal with NGS-based tests, but he noted that the agency had "already taken small, but significant steps" when it approved Illumina's MiSeqDx sequencing platform, two associated assays, and a library prep kit in 2013. Lander, who is also the co-chair of the President's Council of Advisors on Science and Technology, called the issue the FDA faces in regulating NGS-based diagnostics a "knotty" one. Others, like Francis Collins, the director of the US National Institutes of Health, and Harold Varmus, the director of the National Cancer Institute, in their own recent NEJM article have also highlighted the need for changes to the regulatory framework to enable the use of new tests and the adoption of personalized medicine.
More-accurate Cancer Tests Based on Computer Math
A more-accurate, less-invasive cancer test now on the market is based not only on genomics but on the same mathematical theories underlying data communication. The test from Guardant Health can detect trace amounts of cancer DNA in the bloodstream. The idea behind it has a common origin with signal processing and other technologies that became "the basis for our digital society," says Professor Abbas El Gamal, chair of the electrical engineering department at Stanford University. Trying to filter and compress digital data over copper wires or wireless systems has something in common with sifting through massive amounts of genomic data looking for cancer, he says.
New Blood Test Marks a Breakthrough in the Diagnosis of Bowel Cancer
The simple check will pick up on antibodies in the blood, produced as the body reacts to the onset of bowel cancer. The collaboration between researchers from the Biomedical Diagnostics Institute at Dublin City University and Irish biotech firm Randox promises that the new test may be a significant breakthrough in the diagnosis of bowel cancer. Studies show that the identification of these very specific biomarkers will allow for a test which is more sensitive and accurate than existing screening. The new blood test may do away with the need for Fecal Occult Blood Test, which has relatively low sensitivity and a high level of patient reluctance, and will prevent unnecessary and costly colonoscopies for people without the disease. The new test will be implemented on Randox’s proprietary Biochip Array Technology detection platform.
WHO Approves Breakthrough 15-minute Ebola Test
The World Health Organization has approved the first rapid test for Ebola in a potential breakthrough for ending an epidemic that has killed almost 10,000 people in West Africa, it said on Friday. The test, developed by U.S. firm Corgenix Medical Corp, is less accurate than the standard test but is easy to perform, does not require electricity, and can give results within 15 minutes, WHO spokesman Tarik Jasarevic said.
Seegene Gets FDA Green Light for Herpes Virus Assay
Seegene, a Seoul, Korea-based developer of multiplex polymerase chain reaction technologies, said that it received FDA clearance for its Toce technology-based herpes simplex virus types 1 and 2 assay. This is Seegene’s first product to go through the FDA’s process, and paves the way for other planned submissions of PCR reagents, the company added. The Toce technology enables confirmation of five or more genetic variations and can perform qualitative tests of multiple clinical samples, according to the devicemaker. "
Health Diagnostic Laboratory, Inc., Announces Development and Availability of Lipoprotein(a) Particle Concentration Assay
Researchers at Health Diagnostic Laboratory, Inc., have developed a novel, proprietary method to measure atherogenic lipoprotein(a) particle concentration [Lp(a)-P]. The new method relies on modern immuno-electrophoretic techniques that separate and identify particles based on their charge and size, as opposed to current assays that measure either the amount of cholesterol contained in the Lp(a) fraction or the total mass of the Lp(a) particles in the circulation. The new Lp(a) method is known as lipoprotein immunofixation electrophoresis, or Lipo-IFE.
Project Sheds Light on What Drives Genes
More than 200 scientists working on an ambitious federal project have begun to understand the complicated system of switches that regulates genes, turning some on and others off, making some glow brightly while others dim. They hope these discoveries, described in two dozen papers released on Wednesday, will eventually lead to a deeper understanding of diseases and new ways to treat or cure them. Researchers have long known that genes are only a small part of DNA — the rest contains switches that control genes. And researchers suspect that changes in these switches may have as much to do with diseases and with traits, like height or weight, as changes in genes themselves. Ninety percent of DNA alterations associated with diseases are turning out to be in gene switching areas, not the genes themselves. Scientists say they urgently need a map for understanding those circuits.
Engineered Biomarkers Could ID Cancer Cells
Delivering DNA that results in the production of a tumor cell-specific reporter protein detectable in the blood could be a new method for earlier tumor identification, according to a proof-of-concept study published in PNAS. “Conceptually, this is transformative. There are many studies that put . . . gene-delivery systems into cancer cells and try to kill the cancer cells,” said Shuk-Mei Ho of the University of Cincinnati, who was not involved in the study. “[Instead] we might be able to do a lot of things to kill the cancer cells, including radiation or surgery, if we detect them early enough.” Tumor cells generally release so few cancer-specific biomarker molecules into the bloodstream that these markers cannot be reliably used early disease detection. To circumvent this problem, Sanjiv “Sam” Gambhir and his colleagues at Stanford University designed injectable tumor-detecting DNA “minicircles.” Gambhir and his colleagues are now investigating the use of less leaky or more organ-specific promoters, as well as reporters that could also be used to image the tumor or be expelled in urine or breath for easier detection.
Small Study Links Lack of Sleep to Type 2 Diabetes Risk
A new study helps explain why getting too little sleep might boost diabetes risk. Researchers say lack of sleep can lead to increased levels of substances called free fatty acids in the blood. These substances interfere with the ability of the hormone insulin to regulate blood sugar levels. The researchers said these findings suggest that high rates of obesity and diabetes could be reduced by something as simple as having people get more sleep. "At the population level, multiple studies have reported connections between restricted sleep, weight gain and type 2 diabetes," said study senior author Dr. Esra Tasali in a University of Chicago news release. She is an assistant professor of medicine at the university.
Cambridge Study: Young Fathers More Likely to Pass-on Genetic Flaws
Young fathers are far more likely to pass on genetic flaws to children than men a decade older, a major study by the University of Cambridge study has found. Research on 24,000 parents and their children found that sperm cells of teenage fathers had 30 per cent higher rates of DNA mutation – increasing the risk of birth defects – compared with those of men in their twenties. Until now, it had been assumed that DNA mutation in germ cells increases with age, as more cells divide. Scientists said that the “unexpected” findings would force “textbooks to be rewritten” but said it was not clear why teenage male germ cells are likely to accumulate more DNA errors, which can cause inherited diseases. Mutations - the result of DNA copying errors during cell division - can occur in different cells of the body, and at different stages of life.
Gut Microflora in Cutting-edge Allergy and Asthma Care
Technological advances are transforming how many physicians think about allergy and asthma. Delegates attending this year's American Academy of Allergy, Asthma & Immunology (AAAAI) conference will hear how the microbiome could change disease management. "They're now using DNA techniques, measuring certain types of RNA that only occur in bacterial or viral species," meeting program chair Paul Williams, MD, from the Northwest Allergy & Asthma Center in Mount Vernon, Washington, told Medscape Medical News. "There are millions of organisms inhabiting the gastrointestinal tract that we didn't know about," he explained. "It's not only the species that is important; even the strain of bacteria and the collection are important because they interact with each other and they interact with diet. All of that plays a role in inflammation and immune response."
Feeding Infants Peanut Products Could Prevent Allergies, Study Suggests
Turning what was once conventional wisdom on its head, a new study suggests that many, if not most peanut allergies can be prevented by feeding young children food containing peanuts beginning in infancy, rather than avoiding such foods. About 2 percent of American children are allergic to peanuts, a figure that has more than quadrupled since 1997 for reasons that are not entirely clear. There have also been big increases in other Western countries. For some people, even traces of peanuts can be life-threatening. An editorial published in The New England Journal of Medicine, along with the study, called the results “so compelling” and the rise of peanut allergies “so alarming” that guidelines for how to feed infants at risk of peanut allergies should be revised soon. The study “clearly indicates that the early introduction of peanut dramatically decreases the risk of development of peanut allergy,” said the editorial, by Dr. Rebecca S. Gruchalla of the University of Texas Southwestern Medical Center and Dr. Hugh A. Sampson of the Icahn School of Medicine at Mount Sinai in New York City. It also “makes it clear that we can do something now to reverse the increasing prevalence of peanut allergy.”
Long-Term Effects of High Cholesterol
Even slightly elevated cholesterol levels in otherwise healthy adults ages 35 to 55 can affect long-term heart health, according to a recent study, published in Circulation. In fact, every decade spent with high cholesterol increases a person’s chance of eventual heart disease by 39%, reported the study’s authors, who are from the Duke Clinical Research Institute. “The number of years with elevated cholesterol, or 'lipid years,' can affect you in a similar way to the number of 'pack years' you have had as a smoker,” said lead study author Ann Marie Navar-Boggan, MD, PhD, in a prepared statement. “It shows that what we're doing to our blood vessels in our 20s, 30s and 40s is laying the foundation for disease that will present itself later in our lives. If we wait until our 50s or 60s to think about cardiovascular disease prevention, the cat's already out of the bag.” The researchers looked at data from the Framingham Heart Study, focusing on 1,478 adults who did not have heart disease at age 55. They calculated how long each study participant had high cholesterol by that age, and then they followed them for up to 20 years to assess how their cholesterol levels affected their risk of one day developing heart disease. For the purpose of the study, elevated cholesterol was defined as non-HDL cholesterol of 160 mg/dL or higher. The researchers also said they found similar results for patients with LDL cholesterol of 130 mg/dL or higher.
NIH Expands Key Tuberculosis Research Program
The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, is expanding its Tuberculosis Research Units (TBRU) program in an effort to drive innovation in tuberculosis (TB) research. NIAID is awarding up to $15.2 million in fiscal year 2015 and as much as $105.3 million over seven years to fund four institutions that will act as a collaborative TBRU network. A critical component of NIAID’s tuberculosis research, the TBRU program was established in 1994 with the aim of integrating basic and clinical research to study TB in countries where the disease is endemic. For the past 20 years, one TBRU operated under a contract with Case Western Reserve University with study sites in Uganda, Brazil, the Philippines and South Africa and active research collaborations worldwide. This TBRU has helped to identify biomarkers that define the various stages of infection and disease, contributed to best practices for TB clinical trials, and examined factors to help understand why some people infected with the disease-causing Mycobacterium tuberculosis do not develop TB.
Vaccine that Targets 9 Strains of HPV Boosts Cancer Protection, Study Says
When it comes to HPV vaccines, more protection is better. A new version of the vaccine that fights nine strains of human papillomavirus offered greater cancer protection for women than the earlier one that targets only four, researchers reported. A multinational study involving thousands of women found that Merck’s Gardasil 9 worked as well as the original Gardasil at preventing infections caused by HPV-16 and HPV-18. Together, these strains are responsible for 70% of all cases of cervical cancer. Gardasil 9 also prevented infections due to HPV strains 31, 33, 45, 52 and 58. That translates into protection against 85% to 90% of HPV-related cancers, according to the study. Both versions of Gardasil block HPV-6 and HPV-11, the strains that cause 90% of cases of genital warts.
Seasonal Flu Vaccine May Protect against Deadly Bird Flu
Seasonal flu vaccines trigger immune system protection against the deadly H7N9 bird flu virus, a new study reveals. This strain of bird flu, which emerged in China in 2013, kills nearly one-third of people infected with it, the researchers noted. "We have clear evidence that a normal immune response to flu vaccination offers protection against dangerous and highly unique strains of influenza such as H7N9," study co-senior author Patrick Wilson, an associate professor of medicine at the University of Chicago, said in a university news release. "We now need to develop ways of amplifying this response," he added.
How the Sun Can Damage Your Skin Even in the Dark
The damage the sun inflicts on your skin may be even more insidious than was previously thought, according to new research. A study published in Science finds that the effects of sun exposure can continue to wreak havoc on your DNA -- even in the dark. The researchers say that as much as half the harm the sun does to the DNA in skin cells occurs up to three hours after exposure via a chemical process they call the "dark pathway." "The main lesson of our research is that your skin doesn't stop getting damaged when you get out of the sun," said Douglas Brash, professor of therapeutic radiology and dermatology at Yale School of Medicine and the senior author of the paper.
U.S. Cancer Survival Rates Improving
The proportion of people surviving years after a cancer diagnosis is improving, according to a new analysis. Men and women ages 50 to 64, who were diagnosed in 2005 to 2009 with a variety of cancer types, were 39 to 68 percent more likely to be alive five years later, compared to people of the same age diagnosed in 1990 to 1994, researchers found. “Pretty much all populations improved their cancer survival over time,” said Dr. Wei Zheng, the study’s senior author from Vanderbilt University in Nashville.
Progress with Electronic Health Record Adoption among Emergency and Outpatient Departments: United States, 2006–2011
Data from the 2006–2011 National Hospital Ambulatory Medical Care Survey
- In 2011, 84% of hospital emergency departments (EDs) used an electronic health record (EHR) system.
- Adoption of a basic EHR system with a specific set of functionalities by EDs increased from 19% in 2007 to 54% in 2011.
- In 2011, 73% of hospital outpatient departments (OPDs) used an EHR system, up from 29% in 2006.
- Adoption of a basic EHR system with a specific set of functionalities by OPDs increased from 9% in 2007 to 57% in 2011.
- From 2007 through 2011, adoption of Stage 1 Meaningful Use objectives by EDs and OPDs increased.
- In 2011, 14% of EDs and 16% of OPDs had EHR technology able to support nine Stage 1 Meaningful Use objectives.
The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 provides incentive payments to eligible hospitals and providers that demonstrate the meaningful use of a certified electronic health record (EHR) system. This report describes the adoption of EHRs in hospital emergency departments (EDs) and outpatient departments (OPDs) from 2006 through 2011 using the National Hospital Ambulatory Medical Care Survey (NHAMCS).
Hospital to Let Patients Add to Own EHRs
Beth Israel Deaconess Medical Center is launching a pilot that gives patients unprecedented input to their electronic health records. "We believe that OurNotes, which will enable patients to contribute to their own medical records, has the potential to further enhance communication and engage patients in managing illness more effectively and efficiently, leading to improved patient safety and quality of care and potentially, to lower healthcare costs," said Jan Walker, RN, a member of the research faculty of BIDMC's division of general medicine and a co-director of the OpenNotes project, in a press statement.
Med Identity Theft Continues to Rise
Medical identity theft incidents rose more than 20 percent in fiscal year 2014 compared to the year prior, according to a recently released survey by the Ponemon Institute. The researchers found that data theft is costly for consumers, complicated and time-consuming to resolve and--of course--can negatively impact a patient's reputation. Ponemon surveyed more than 49,000 adults across the U.S. for the study.
12 Tips for Better EHR Usability
'Developers need to optimize EHR systems to facilitate longitudinal care delivery'
"Although computers and EHRs can facilitate and even improve clinical documentation, their use can also add complexities," according to a new paper from the American College of Physicians, which offers its take on usage strategies and better system design. "In the past decade, medical records have become increasingly synonymous with electronic health records," write the authors of the new report, "Clinical Documentation in the 21st Century," published in the Annals of Internal Medicine. In the not-too-distant future, EHRs – and the clinical notes contained therein – will evolve: "Existing technology, such as registries, portals, connected home monitoring devices and provider- and patient-controlled mobile devices, as well as technology not yet in use or even built, is likely to integrate with or possibly even replace the EHR (as currently conceptualized) as a primary vehicle for viewing and recording clinical documentation," they write.
HIPAA Crackdown Coming: How to Prep for Audits
When HIPAA was enacted in 1996, privacy was not the principal focus of the legislation. Indeed, it took HHS eight years to publish the initial HIPAA Privacy Rule. It took several more years for HHS to publish the initial Security Rule. The Security Rule directed “covered entities” (e.g., providers, hospitals, health insurers) to perform a risk assessment, understand where their vulnerabilities were, and to adopt reasonable safeguards to fix them. There are three categories of HIPAA safeguards:
These involve designating personnel, creating and adopting HIPAA policies and procedures, and training your workforce to understand the policies and procedures, including how to document compliance.
How your practice manages the physical devices and media where patient information is stored and can be accessed is vitally important. Locks and alarms for facility access remain important, but address a limited aspect of physical safeguarding.
This may be the one area in which it is reasonable to believe that HIPAA compliance is a headache only for the CIO, CTO, and the IT department. Technical safeguards focus on things like access controls, the integrity of PHI (i.e., making sure it can’t get corrupted), authentication (making sure the person trying to access PHI is who she says she is), and transmission security (is there a risk that PHI can be “grabbed” while it’s in transit
Are IT Shops Ready for Value-based Reimbursement?
Value-based reimbursement (VBR) is becoming an imperative for the healthcare industry, but the large-scale adoption of VBR will create serious challenges for IT organizations dealing with so many other changes. Efforts to move past volume-based payments (embodied by the existing fee-for-service payment methods) into new value-based payments have been occurring for decades. The creation of capitated risk for providers and the large scale adoption of DRG- or APC-based facility payments are two historical examples of modifications to fee-for-service that have increased value. However, each of these changes created huge challenges for IT systems; failed efforts to shift from fee-for-service to these methods caused whole organizations to fail.
ECRI Institute Issues Proceedings, Convenes Multi-stakeholder Workgroup on Health IT Safety
The Partnership for Health IT Patient Safety, an innovative and collaborative multi-stakeholder effort, took important steps in improving health IT safety at its first in-person meeting held in September at ECRI Institute's U.S. headquarters outside Philadelphia. Proceedings from this event are now available for free public access at www.ecri.org/HIT.The Partnering for Success meeting provided a forum for addressing health IT safety and innovation as a shared responsibility among stakeholders including: providers, health IT vendors, associations, patient safety organizations, and researchers. An initial outcome from the meeting was the formation of workgroups to study why specific safety problems are occurring and identify best practices for preventing recurrence. The first workgroup is focusing on the unsafe aspects of copy-paste in the electronic health record. This workgroup, chaired by Tejal Gandhi, MD, MPH, CPPS, president and chief executive officer of the National Patient Safety Foundation, comprises 20 individuals representing all of the different stakeholders participating in the partnership. The workgroup will be meeting through the summer of 2015 and releasing recommendations and best practices.
WHO Urges Shift to Single-use Smart Syringes
Smart syringes that break after one use should be used for injections by 2020, the World Health Organization has announced. Reusing syringes leads to more than two million people being infected with diseases including HIV and hepatitis each year. The new needles are more expensive, but the WHO says the switch would be cheaper than treating the diseases. More than 16 billion injections are administered annually. Normal syringes can be used again and again. But the smart ones prevent the plunger being pulled back after an injection or retract the needle so it cannot be used again.
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