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26th July 2016

Hepatitis C: Stopping a killer’s spread for pennies

The nurse already had given dozens of free flu vaccinations at a small New Jersey office one day last fall when an alert employee noticed that she was using the same syringe over and over.

State health officials urged the 67 employees who had received shots to undergo hepatitis and HIV testing. The nurse, who was ordered to surrender her license, later explained that she had received only two syringes in the supply pack from the company that gave her the contract.

As of July, none of the vaccinated employees had tested positive for hepatitis or HIV.

Others haven’t been so lucky. Worldwide, victims of unsafe injections are still counted in the hundreds of thousands every year.

-An 82-year-old monk and a number of children were among 272 who contracted hepatitis C or HIV in Cambodia after receiving injections from syringes reused by a local health care practitioner.

-In the US, 45 patients contracted hepatitis C because an infected contract health worker regularly stole syringes of painkillers and refilled them with saline, continuing to do so even after learning he had the disease. He was sentenced to 39 years in prison.

-Also in the US, 99 hepatitis C cases were linked to a Nebraska clinic that reused syringes to administer chemotherapy to cancer patients.

-In Egypt, 22 percent of the population has hepatitis C, partly because of unsafe injections used in a mass public health campaign.

The wonder is that reusable syringes are still legal and widely distributed, for syringes with mechanical auto-disable features have been available since the 1990s.

In 2010 alone, unsafe injections caused a staggering 315,000 cases of hepatitis C, according to a 2014 estimate by the World Health Organization. In fact, no one really knows the scope of the problem because hepatitis C destroys the liver slowly, with symptoms appearing many years later.

The hepatitis C virus cannot be killed by bleaching, boiling, cleaning fluids, alcohol or peroxide. Plastic syringes, in use since the 1960s, cannot be adequately sterilized for reuse.  No vaccine for hepatitis C exists; treatment takes 12 weeks and costs tens of thousands of dollars.

“It’s a huge issue. It makes us crazy,” Michael Bell associate director for infection control at the US Centers for Disease Control, told USA today in a 2013 interview. The problem exploded with the advent of injectable medicines and drugs after the syringe was invented in 1853. Today, 16 billion injections are administered worldwide every year. It’s anyone’s guess how many of those injections involve reused syringes.

In China and Pakistan syringes are routinely recycled for resale. Healthcare practitioners in developing countries often give superfluous injections to supplement their salaries, world officials say. In developed countries, unsafe practices are found at outpatient services such as endoscopies, cardiology care, plastic surgery, oral surgery, pain management, and vitamin injections, which may fall in regulatory gray areas. Last year, WHO acted, urging that safe syringes be adopted worldwide by 2020 to prevent millions of bloodborne infections.

The safe syringes cost 4-6 cents apiece, compared with 3-4 cents for reusable ones, but the added cost is dwarfed by the devastating price of bloodborne hepatitis and HIV. Safety-engineered syringes could also help prevent most of the estimated 3 million needle stick injuries that occur each year, WHO said. For the millions of people receiving injections, safe injection technology can’t arrive too soon.

“When the trust that the patient places in his or her physician is betrayed, I don’t think there is a greater betrayal  in our society,” Judge Valerie Adair said in sentencing Dr. Dipak Desai to life in prison for infecting nine patients with hepatitis C at his Las Vegas endoscopy clinics.

Prosecutors said the doctor was reusing syringes to save money.

Photo Source: WHO