Unsafe injections in the developing
world and transmission of bloodborne
pathogens: a review.
World Health
Organization, Geneva, Switzerland.
Unsafe injections
are suspected to occur routinely in
developing countries. We carried out a
literature review to quantify the
prevalence of unsafe injections and to
assess the disease burden of bloodborne
infections attributable to this
practice.
Quantitative information on
injection use and unsafe injections
(defined as the reuse of syringe or
needle between patients without
sterilization) was obtained by
reviewing the published literature and
unpublished WHO reports. The
transmissibility of hepatitis B and C
viruses and human immunodeficiency virus
(HIV) was estimated using data from
studies of needle-stick injuries.
Finally, all epidemiological studies
that linked unsafe injections and
bloodborne infections were evaluated to
assess the attributable burden of
bloodborne infections.
It was estimated
that each person in the developing world
receives 1.5 injections per year on
average. However, institutionalized
children, and children and adults who
are ill or hospitalized, including those
infected with HIV, are often exposed to
10-100 times as many injections. An
average of 95% of all injections are
therapeutic, the majority of which were
judged to be unnecessary. At least 50%
of injections were unsafe in 14 of 19
countries (representing five developing
world regions) for which data were
available.
Eighteen studies reported a
convincing link between unsafe
injections and the transmission of
hepatitis B and C, HIV, Ebola and Lassa
virus infections and malaria. Five
studies attributed 20-80% of all new
hepatitis B infections to unsafe
injections, while three implicated
unsafe injections as a major mode of
transmission of hepatitis C. In
conclusion, unsafe injections occur
routinely in most developing world
regions, implying a significant
potential for the transmission of any bloodborne pathogen.
Unsafe injections
currently account for a significant
proportion of all new hepatitis B and C
infections. This situation needs to
be addressed immediately, as a political
and policy issue, with responsibilities
clearly defined at the global, country
and community levels.
PIP: Unsafe
injections and the consequent
transmission of bloodborne pathogens are
suspected to occur routinely in the
developing world. This paper presents a
review of the literature to determine
the prevalence of unsafe injection
practices and assess the disease burden
of bloodborne infections. Quantitative
data on injection usage and unsafe
injection practices, such as the reuse
of unsterilized syringe or needles
between patients, is obtained by
reviewing published articles and
unpublished reports of the WHO. In
addition, the transmissibility of
hepatitis B and C viruses and HIV was
determined using information from
studies of needle-stick injuries. All
epidemiological researches that
associate injections with bloodborne
diseases were examined to assess the
attributable burden of bloodborne
infections. It was estimated that each
person in developing countries receives
an average of 1.5 injections per annum.
However, institutionalized children,
children and adults who are sick or
confined in hospitals, often receive
10-100 times as many injections. Of
these injections, 95% are therapeutic, a
majority of which are unnecessary. At
least 50% of injections in 14 of 19
countries were unsafe. Furthermore, 18
studies present convincing evidence on
the association of unsafe injection
practices and the transmission of
bloodborne viruses such as hepatitis B
and C, Ebola, Lassa virus infections and
malaria. Such practices account for a
significant number of hepatitis B and C
infections.
PMID: 10593026 [PubMed -
indexed for MEDLINE]
October 27, 1998 SFGate DEADLY NEEDLES Fast Track to Global Disaster Reynolds Holding, William Carlsen, Chronicle Staff Writers- For decades, researchers warned that contaminated syringes could transmit deadly viruses with cruel efficiency. But efforts to defuse the crisis were failed, and today, it has become an insidious global epidemic, destroying millions of lives every year.
"Dear Colleague" letter from the Centers for Disease Control and Prevention (CDC) Federal heads in the sand:( written by Acting Deputy Director, Epidemiology and Surveillance Division, National Immunization Program, CDC; in response to San Francisco Chronicle
Two
3-part
series
of
articles
on
needle
safety
published
in
1998.
The
first
series,
"Deadly
Needles," caught the attention of readers by claiming that "one million health care workers each year are injured by needle sticks - more than 100,000 of them in California." The second series, "The Invisible Epidemic, 1920-87," began with an article on health risks associated with the use of contaminated needles and resulted in the publication of a "Dear Colleague" letter from the Centers for Disease Control and Prevention (CDC)
