Transmission of hepatitis B, hepatitis C and human immunodeficiency viruses through unsafe injections in the developing world: Model-based regional estimates

Trinity College, Duke University, Durham, NC, USA.
Bulletin of the World Health Organisation (Impact Factor: 5.09). 02/1999; 77(10):801-7.
Source: PubMed


Thousands of millions of injections are delivered every year in developing countries, many of them unsafe, and the transmission of certain bloodborne pathogens via this route is thought to be a major public health problem. In this article we report global and regional estimates of the number of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections that may occur from unsafe injections in the developing world. The estimates were determined using quantitative data on unsafe injection practices, transmission efficiency and disease burden of HBV, HCV and HIV and the prevalence of injection use obtained from a review of the literature. A simple mass-action model was used consisting of a generalized linear equation with variables accounting for the prevalence of a pathogen in a population, susceptibility of a population, transmission efficiency of the pathogen, proportion of injections that are unsafe, and the number of injections received. The model was applied to world census data to generate conservative estimates of incidence of transmission of bloodborne pathogens that may be attributable to unsafe injections. The model suggests that approximately 8-16 million HBV, 2.3-4.7 million HCV and 80,000-160,000 HIV infections may result every year from unsafe injections. The estimated range for HBV infections is in accordance with several epidemiological studies that attributed at least 20% of all new HBV infections to unsafe injections in developing countries. Our results suggest that unsafe injections may lead to a high number of infections with bloodborne pathogens. A major initiative is therefore needed to improve injection safety and decrease injection overuse in many countries.

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Available from: Lone Simonsen, Jul 16, 2014
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    • "As the injection is a process that requires supervision by skilled health care providers, its number is regarded very important. The excessive and unnecessary use of injection medications is not only a waste of medical costs, medical staff, time and medical equipment but also increases the risk of infection by viruses, like hepatitis C and AIDS (Beaney & Black, 2011; Kane, Lloyd, Zaffran, Simonsen, & Kane, 1999). "
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    • "HBV is more infectious through blood-borne exposure than both HCV and HIV. Contaminated needles alone are thought to be responsible for 8-16 million HBV infections per year [6]. "
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    ABSTRACT: WHO estimates reveal that the global prevalence of viral hepatitis may be as high as 500 million, with an annual mortality rate of up to 1.3 million individuals. The majority of this global burden of disease is borne by nations of the developing world with high rates of vertical and iatrogenic transmission of HBV and HCV, as well as poor access to healthcare. In 2013, 3.2% of the global population (231 million individuals) migrated into a new host nation. Migrants predominantly originate from the developing countries of the south, into the developed economies of North America and Western Europe. This mass migration of individuals from areas of high prevalence of viral hepatitis poses a unique challenge to the healthcare systems of the host nations. Due to a lack of universal standards for screening, vaccination and treatment of viral hepatitis, the burden of chronic liver disease and hepatocellular carcinoma continues to increase among migrant populations globally. Efforts to increase case identification and treatment among migrants have largely been limited to small outreach programs in urban centers, such that the majority of migrants with viral hepatitis continue to remain unaware of their infection. This review summarizes the data on prevalence of viral hepatitis and burden of chronic liver disease among migrants, current standards for screening and treatment of immigrants and refugees, and efforts to improve the identification and treatment of viral hepatitis among migrants. Copyright © 2015. Published by Elsevier B.V.
    Journal of Hepatology 05/2015; 11(2). DOI:10.1016/j.jhep.2015.04.026 · 11.34 Impact Factor
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    • "HBV is transmitted by body fluids, such as blood and serum, and can exhibit vertical transmission from mother to child. Sexual transmission, vertical transmission, and unsafe injections, including intravenous drug use, are the most common routes of infection for HBV [8] [9] [10] [11] [12]. Household contact and occupational health-care exposure to blood products and hemodialysis are other risk factors [13] [14] [15] [16] [17] [18] [19] [20]. "
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    ABSTRACT: Background. Hepatitis B virus (HBV) is a potentially life-threating infection and a well-recognized occupational hazard for health-care workers including medical students. Methods. A cross-sectional study was conducted at Syrian Private University (SPU), Faculty of Medicine, to assess the knowledge and awareness about hepatitis B, the status of hepatitis B vaccination, and the reasons for not getting vaccinated among the first- and the fifth-year medical students. Results. The present study demonstrates surprising results and raises issues about the high number of medical students that are not vaccinated or not sure about their vaccination status, which puts them at a higher risk of being infected in the future. Another important issue is the medical students’ overall knowledge about this life-threating infection. The students have not been totally educated about the gravity of the situation which requires the need of further HBV education. It is highly recommended that SPU provides the HBV vaccine to all nonvaccinated students attending the faculty of medicine at no cost to encourage them to take the HBV vaccine and to reform some of its educational curriculum to effectively limit the hazardous effects of this disease and elaborate on the serious health consequences of HBV
    Hepatitis research and treatment 11/2014; 2014(2014). DOI:10.1155/2014/131920
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