Unsafe injections lead to diseases

American philosopher William James (1842-1910) was bang on target when he quipped: “Is life worth living?

It all depends on the liver.” In an age when heart ailments hog print space, people overlook the fact that liver diseases can be equally dangerous and deadly. It comes as no surprise then that in February 2012 more than 1,600 confirmed cases of Hepatitis C were reported from Ratia town, Fatehabad district, Haryana – an outbreak blamed primarily on the reuse of syringes and needles by doctors and dentists.1 Following this incident, the Haryana government launched a massive awareness drive to educate the public as well as medical practitioners about the dangers of unsafe injections.

Earlier in February 2009, India witnessed one of its deadliest outbreaks of Hepatitis B at Modasa in Gujarat’s Sabarkantha district. Within months, there were 593 confirmed cases and 94 deaths in the talukas of Modasa, Idar and Meghraj. In this incident, Hepatitis B had broken out because some private practitioners were reusing infected syringes.

Like Hepatitis A, Hepatitis B (HBV) and Hepatitis C (HBC) are both distinct diseases caused by a virus that infects the liver. Each infection, however, displays different causes and symptoms. Accordingly, the treatment for each disorder is contingent upon the type of the virus, which can be determined through laboratory tests.  
Long-term infection
Since persons with HBV may display no overt symptoms, they could remain unaware of their ailment. Most adults may have HBV for a short period only and then recover. Termed acute Hepatitis B, this can be transmitted to others as long as the virus resides in a patient’s body. Sometimes, the virus can cause long-term infection and damage the liver over time; this is called chronic Hepatitis B. Infants and young children infected with the virus are likely to contract chronic HBV.
While HBV is caused by the Hepatitis B virus and HBC by the Hepatitis C virus, both are spread via contact with an infected person’s blood and body fluids. Hepatitis B can be contracted if a person has sex with an infected person without using a condom; shares needles with an infected person (as drug addicts do); has a tattoo or piercing with infected tools; and shares razors or toothbrushes with an infected person. An infected pregnant mother could also pass the virus to her baby during delivery.

Similarly, Hepatitis C can be contracted through the sharing of needles during drug use; via reuse of infected syringes; through blood transfusion, if the blood was not properly screened; and during a tattoo or piercing done with infected tools. In rare cases, an infected pregnant woman could spread the virus to her baby at birth.

Both Hepatitis B and C cannot be contracted through casual contact such as hugging, kissing, sneezing and coughing, or by sharing food and drinks.

In India, however, as repeated outbreaks of Hepatitis B and C have shown, a major danger arises from unsafe injection practices and the reuse of needles. The World Health Organization estimates that between 12 and 16 billion injections are administered annually worldwide.

But in most developing nations, almost half of these may be unsafe because of inadequate sterilization practices; reuse of single-use syringes and needles; faulty techniques; and poor disposal methods. Such unsafe practices expose patients, physicians and the public to deadly risks via transmission of infections.

In fact, reuse of syringes and needles accounted for 32 per cent of HBV cases, 40 per cent of HBC and 5 per cent of HIV infections in 10 sub-regions in 2000.2 Wary of the risk to children during immunisations, in 2001 the Indian government mandated the use of auto-disable syringes for immunisation to ensure these were not reused. But because less than 5 per cent of all injections are used for preventive purposes, the real danger arises from the reuse of syringes through the remainder 95 per cent administered for therapeutic reasons. That is how repeated outbreaks of Hepatitis B and C in India have occurred due to unsafe injection practices.

Given India’s endemic risk factors, it is imperative to spread awareness among medical practitioners, patients and the public at large about the dangers of unsafe injection practices in spreading deadly diseases such as Hepatitis. Such awareness needs to be backed by strict enforcement of norms to make certain that accidental transmission of disease is prevented altogether or reduced to the minimum.

Only widespread awareness and stringent enforcement will finally ensure that deadly periodic outbreaks of Hepatitis B and Hepatitis C soon become a thing of the past.

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