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Unsafe injections in the developing world and transmission of bloodborne pathogens: a review- ...Five studies attributed 20-80% of all new infections to unsafe injections...major mode of transmission of hepatitis C... occur routinely
"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
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
Fast Track to Global Disaster
Tuesday, October 27, 1998
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.
(First Of Three Parts)
Dr. Ciro de Quadros, chief of the campaign that
eradicated polio from the Western Hemisphere, could not
believe the numbers. When the esteemed Brazilian and other
world health leaders arrived in Switzerland last spring,
they expected to discuss the progress of the global
vaccination program -- the most successful public health
campaign in history.
Instead, they got a medical time bomb.
In de Quadros' hand was a chilling internal report: 10
million people a year were contracting lethal diseases such
as hepatitis and AIDS through the reuse of contaminated
De Quadros rose to his feet and implored his colleagues
to keep the findings confidential -- at least until the
numbers could be reviewed once more.
``These figures are so incredible,'' he said, ``that if
they are released, they will make the front pages of
newspapers around the world.''
But an earlier internal WHO study had revealed an even
more alarming figure: Every year as many as 1.8 million
people infected by contaminated syringes, mostly
children, would die -- about one every 20 seconds.
Medical researchers had warned for decades that
hypodermic needles could be deadly. But the WHO reports made
it painfully clear that world health officials had an
international medical crisis on their hands -- and urgent
action was needed.
``We want to avoid creating a panic,'' said WHO's Michel
Zaffran, who helped prepare the still-unreleased infection
numbers. ``But maybe there is a need to create that panic to
solve this problem.''
This is a story, based on hundreds of interviews and
thousands of documents, about a vast, virtually invisible
epidemic, a crisis that could have been defused more than a
It is about soaring disease rates in Egypt and plunging
life expectancies in Brazil; children combing garbage dumps
for syringes to sell in Kenya and India; and
ignorance, poverty and corruption driving medical workers in
Cambodia and Russia to reuse needles dozens -- sometimes
hundreds -- of times.
It is about a promising generation of nonreusable
syringes that got lost in a multibillion-dollar
corporate battle over the global syringe market.
It is about how the world's leading syringe manufacturers
first ignored the problem, then either delayed the new
technology or did little to get it into the hands of health
And it is about how top world health officials --
including several with de Quadros in Conference Room A --
downplayed the mounting death toll for years, fearing that
publicizing it would jeopardize their immunization programs.
The story began more than half a century ago with the
emergence of the hypodermic syringe: an instrument of almost
mystical life-saving power, yet one that can spread disease
with deadly efficiency.
GOLD COAST, AFRICA
In 1920, the tropical disease yaws had been striking down
villagers for as long as anyone could remember. The microbe
invaded the body through broken skin, raising ugly lesions,
inflicting excruciating pain and often totally disabling its
Then, medical workers fanned across the countryside with
hypodermic syringes containing a chemical called
``So spectacular were the results,'' a West African
medical journal later reported, ``that all types of patients
began to clamor for injections, and most of them refused
other forms of orthodox treatment.''
In 1923, Salvarsan shots cured hundreds of
yaws-infected Samoans. Similar results involving other
diseases and medicines were reported from Jamaica, India and
By the 1950s, mass injection campaigns with penicillin
all but eradicated yaws. The image of syringes as
magic was firmly established in the developing world, with
patients often refusing to leave clinics before getting
``Injections and syringes had become the symbol of
modern medicine . . . a metaphor for everything fast and
efficient,'' two medical anthropologists later wrote.
But the talismanic attraction of the syringe began to
fade among health care workers.
Patients in Madagascar, Samoa and the Congo developed
paralysis from polio transmitted through injections. Cases
of hepatitis spread by syringes surfaced in West
Even in the United States, studies showed that syringe
reuse spread malaria, hepatitis and other serious
The ``Injection Age'' had arrived, but it had come with a
Peter Stevens and his colleagues at Roehr Products sat
around a corner table in 1954, picking at pasta and
wondering how to keep the fledgling medical supply company
from going under.
By then, it had become clear that a used syringe could
transmit disease. Stevens and his colleagues had an idea: a
plastic syringe so cheap that doctors would discard it after
a single shot.
``We introduced our needle not because of moral
considerations,'' Stevens said, ``but because this is a
litigious country, and everybody was afraid of lawsuits.''
Within a year, Roehr was selling the world's first
disposable syringe, a 5-cent plastic model called Monoject.
But there was little demand for Roehr's new product. Most
doctors insisted that it was safe -- and much cheaper -- to
sterilize and reuse glass syringes. ``We pushed and
pushed,'' said Stevens, but ``people in the health care
field just didn't want to hear about it.''
BECTON DICKINSON FACTORY COLUMBUS, NEB.
Becton Dickinson and Company had heard about the Monoject
and realized that plastic disposable syringes were
In the summer of 1957, the nation's leading maker of
glass syringes sent a small army of executives,
engineers and assembly workers to Columbus, 70 miles west of
Their mission was to create an inexpensive plastic
syringe, and in the company's thermometer factory on the
edge of town, they started work on a disposable version that
would be called Plastipak.
At night, the team would gather at Louie's steak house to
discuss their progress and belt out a theme song:
A million a week in the springtime
A million a week in the fall
A million a week in the springtime
Or we won't get home at all!
OFFICES OF DR. ALBERT L. WEINER
On a late winter day in 1960, Marjorie Atkins visited Dr.
Albert Weiner for anxiety treatment. Weiner, an osteopath
specializing in psychotherapy, injected her with a sedative.
Within six months, the 53-year-old woman was dead of
Fourteen more of Weiner's patients would die of the
disease during the next eight months, and 29 others would
fall gravely ill.
Weiner was eventually convicted of 12 manslaughter counts
for injecting patients with syringes contaminated by
The case made national headlines and sent doctors around
the country scrambling for disposable syringes. It
also secured the fortunes of Becton Dickinson and Roehr
Within a year of Weiner's conviction, sterile disposable
syringes captured a third of the nation's needle
market, and needle manufacturers were producing tens of
millions of disposables annually.
The sudden demand for disposables made Roehr Products an
attractive takeover target, and in 1961 the company was sold
to a firm that would become Sherwood, Davis & Geck, the
nation's second-largest syringe company.
But no company profited more from the soaring demand for
disposables than Becton Dickinson. With cash raised by its
first public stock offering, the company began making
millions of the syringes, promoting them as a
surefire way to stop the spread of disease.
In just three years, sales revenues quadrupled, and
Becton Dickinson was on the road to becoming the most
powerful needle manufacturer in the world.
AMERICAN MEDICAL ASSOCIATION CONVENTION
ATLANTIC CITY, N.J.
It didn't take long for the nation's doctors to realize
that the new disposable syringes presented health
hazards of their own.
As more disposables were manufactured, used and
discarded, more were picked from the trash by drug addicts,
children and others risking deadly infections.
At the American Medical Association's 1967 convention,
Resolution No. 26 called on needle manufacturers to ``adopt
designs to prevent reuse.''
It was the first public warning that the new disposables
could be just as dangerous as the syringes they
The resolution passed unanimously.
Needle manufacturers ignored it. Years later, Becton
Dickinson officials would say they had never heard of it.
FACTORY FIRST AID STATION
STATE OF VICTORIA, AUSTRALIA
On June 27, 1969, more than 200 factory workers lined up
for vaccinations against the ``Hong Kong'' flu.
Four days later, one worker died of septic shock. In a
few more days, the plant's 51-year-old technical manager,
his left upper arm swollen from a massive bacterial
infection, was dead.
Medical investigators traced the deaths to streptococci
bacteria spread by the vaccinations. Disposable syringes
had been used, but to save money, doctors had filled each
syringe with 20 doses. Although the needles had been changed
between each injection, back pressure from the shots
apparently forced infected blood into the syringe barrel,
contaminating the vaccine.
It was among the earliest documented cases of lethal
infections transmitted through disposable syringes.
WORLD HEALTH ORGANIZATION
In 1974, the World Health Organization launched the most
powerful attack in history on deadly diseases: an ambitious
campaign to vaccinate every child around the globe.
Inspired by the success of mass immunizations against
smallpox, WHO's Expanded Program on Immunization focused on
tuberculosis, diphtheria, tetanus, whooping cough,
polio and measles.
These diseases had killed tens of millions of people in
the early 1970s. But by 1974, only 5 percent of the world's
children had been vaccinated.
Reaching more would take training, vaccines -- and
millions of clean needles and syringes.
At the time, WHO believed that reusable glass syringes,
properly sterilized, were safe enough for the immunization
program. They were also the cheapest option, because one
syringe could administer dozens of shots, whereas the
new disposables were designed to be discarded after a single
injection. So the agency hired armies of health experts to
train immunization workers around the globe on sterilizing
the reusable needles.
From 1974 to 1980, millions of vaccinations were
administered and recorded. Children in virtually every
community of every country were immunized.
But soon after the immunization campaign started, WHO
officials discovered that many of the needles and
syringes used had not been properly sterilized.
They realized that the children were being vaccinated and
exposed to lethal diseases at the same time.
WORLD HEALTH ORGANIZATION
In October 1980, a WHO newsletter published a cover story
on a radical new device -- a syringe containing a simple
mechanism that prevented it from being used more than once.
The story called the device ``the syringe of the
It was the first public notice that world health
officials had found a simple technological solution to the
problem of syringe reuse. And it suggested that the agency
was acutely aware of the underlying social and economic
costs of treating victims.
The story warned that ``the use of contaminated
syringes, especially when they are used over and over
again, can cause infections and even lead to an epidemic. .
. . Such `accidents,' which are not uncommon, can be more
costly . . . than measures to prevent them.''
The new syringe was ``inexpensive'' and would ``shortly
become available,'' the article said.
The syringe was never produced.
CENTERS FOR DISEASE CONTROL
In June 1981, skittish staffers at the national Centers
for Disease Control and Prevention in Atlanta slipped a
disturbing report onto Page 2 of the agency's weekly
newsletter. It described unusual cases of Pneumocystis
pneumonia among homosexual men. The workers feared provoking
panic -- and prejudice -- over a brewing epidemic unlike any
they had seen before.
A year later, at a meeting of national health experts in
Washington, D.C., the fatal immune-system disorder that
could be transmitted by bodily fluids, blood and used
needles was given a name: AIDS.
Researchers would discover that AIDS was not just a
problem within gay communities in the United States and
Europe. It was also rampant among heterosexuals in the
Caribbean and Africa.
AIDS did what no other disease before it could: force
world health experts to pursue a technological solution for
``We'd been concerned about needle reuse since the
1970s,'' said Peter Carrasco, a technical adviser on
immunization at the Pan American Health Organization. ``But
with AIDS in 1982, that's when we really had to start
looking at it.''
WHO FIELD OFFICES
Since John Lloyd joined WHO's childhood immunization
campaign in the late 1970s, his most frustrating task had
been to make vaccination workers properly sterilize reusable
plastic and glass syringes and needles.
The workers would run out of fuel for portable field
sterilizers supplied by WHO. Or they would see people
waiting in line and, feeling rushed, fail to boil or steam
the syringes long enough. Or experienced operators
would move on, leaving the sterilizers in untrained hands.
Often, the workers wouldn't even try to sterilize the
syringes and needles.
Then, in the mid-1980s, a number of African countries
began using disposable syringes -- a shift that
threatened to undermine the sterilization program
The sterilizers could not adequately clean the plastic
disposables, which also softened and bent at high
temperatures. ``We started getting very worried about the
confusion people were experiencing with two types of
syringes,'' he said.
Lloyd realized that sterilizers alone would not stop
syringes from spreading disease.
UNITED NATIONS CHILDREN'S FUND HEADQUARTERS
NEW YORK CITY
In 1984, Lloyd went to visit his old friend Peter Evans.
Four years earlier, as a UNICEF procurement officer,
Evans was fiddling with a disposable syringe when he noticed
that a few simple changes would make it impossible to use
more than once.
``I thought I was on to something,'' Evans recalled.
So he applied for a U.S. patent, but his
application was rejected.
``I found there were at least four earlier patents along
the same lines going back some 20 years,'' he said.
But Evans' modified syringe caught Lloyd's eye.
``As we were talking,'' Lloyd said, ``I noticed that he
had this intriguing gadget on his desk.
``It was like a revelation.''
PROGRAM FOR APPROPRIATE TECHNOLOGY IN HEALTH
Michael Free and his colleagues at PATH, a nonprofit
developer of health technology for developing countries,
were trying to develop a syringe that could be used only
In 1985, he enlisted his former student, Richard Jaffe,
an anesthesiologist at Stanford University medical school,
to help revamp their design.
``It was too easy to defeat (and reuse),'' said Jaffe. So
he and a partner made several modifications.
Free also consulted Terence Ellard, a Seattle instrument
maker. Ellard said he, too, refined the PATH design, taking
it ``from something that was never going to work to
something that worked well.''
The new device worked well enough to provoke serious
interest from the U.S. Agency for International
Development. Over the next few years, the agency would give
PATH about $250,000 to develop the device further.
WORLD HEALTH ORGANIZATION HEADQUARTERS
In 1986, health experts from WHO, USAID and other
agencies asked inventors and medical manufacturers around
the world to submit designs for nonreusable syringes.
The syringes had to automatically destruct after
one use, include needles that could not be removed, and
contain other features that met the requirements of child
In July 1987, the health experts gathered to review the
There was one from Johns Hopkins University medical
researchers, another from a small Spanish manufacturer and
several from designers in England, Denmark and Switzerland.
A millionaire French inventor proposed an idea he
conceived after contracting hepatitis from a hospital needle
-- the same design touted in the WHO newsletter seven years
No designs were submitted by Becton Dickinson, Sherwood
or any other major syringe manufacturer.
Still, the group of experts adjourned with 35 different
PAN AMERICAN HEALTH ORGANIZATION
On Nov. 16, 1987, the group reconvened in the nation's
capital to discuss the most promising prototypes.
Two stood out, Lloyd recalled, both developed by PATH.
One included a thumbnail-size plastic bubble that could be
squeezed flat to administer a shot. The other was the
syringe that Jaffe and Ellard helped refine.
The need for safer syringes was becoming more
urgent. Sterilization programs were failing. Disposable
needles were creating new problems. And a series of reports
from around the world suggested that the dangers of reusing
syringes were out of control.
In 1984, hepatitis was found in more than 15 percent of
syringes discarded in Florence, Italy. In 1986,
researchers reported from Zaire that syringes
transmitted monkey pox and that people who received more
injections had higher rates of HIV infection.
In 1987, the CDC reported that of nine African countries
surveyed, not one sterilized syringes before
Still, Lloyd and the other health experts were confident.
They believed a powerful, though tragic, force was on their
``We all hoped very much,'' Lloyd said, ``that the AIDS
crisis would provoke manufacturers to pick up the idea of
the autodestruct and that the crisis would help them project
it into the market.
``I can recall a great deal of optimism as I looked
around the table that day. People were very intrigued and
hopeful that we could achieve safety with a device.''
They thought they had reached a new era of safe
injections -- and naively believed they would continue to
immunize children without inflicting deadly disease.
ABOUT THE SERIES
In April, The Chronicle published ``Deadly Needles,'' a
three-part series about accidental needle injuries. Today,
we begin a new series about deadly viruses transmitted
through syringe reuse -- an epidemic destroying millions of
lives every year. .
-- TODAY: (1920-1987) Researchers warn of an emerging
-- TOMORROW: (1988-1994) Prototypes of nonreusable
syringes promise safer injections.
-- THURSDAY: (1995-1998) After miscalculations by health
officials and resistance by needle makers, turmoil fuels the
RELATED COVERAGE ON TV AND INTERNET
For more about ``Deadly Needles'' watch NewsCenter 4 at 6
p.m. tonight. Or, log onto
www.sfgate.com. for this week's series, as well as The
Chronicle's three-part series on accidental needle sticks
published in April.
ABOUT THE NUMBERS
The statistics and other figures used in this series came
from a number of sources:
The estimated number of worldwide infections and deaths
caused by reuse of contaminated syringes -- 10
million infections and 1.8 million deaths per year -- came
from internal reports of the World Health Organization.
These reports are still under scientific review and have not
been published, but WHO officials say the draft figures are
The estimates of the global prevalance of the diseases
that are most likely to be spread through syringe reuse --
HIV, hepatitis B and hepatitis C -- came from data compiled
by WHO, the U.S. Centers for Disease Control and
Prevention (CDC) and United Nations AIDS.
Figures on the number of nonreusable or ``autodestruct''
syringes produced and distributed were compiled from
syringe manufacturers, United Nations Children's Fund
(UNICEF), WHO and a group of immunization experts called
Technical Network for Logistics in Health (Technet).
The funding figures for development of several
nonreusables syringes were supplied by the U.S.
Agency for International Development (USAID) and Program for
Appropriate Technology in Health (PATH). Pricing data for
the syringes came from UNICEF and individual
U.S. and global estimates of accidental needle
sticks came from the International Health Care Worker Safety
Center, CDC, WHO and from studies in Thailand, Pakistan and
INVISIBLE EPIDEMIC 1920-87
. FIRST SYRINGE 1897: Becton Dickinson and Co. opens for
business and begins selling its first syringe -- made of
glass -- for $2.50.
1920s-'30s: In tropical countries, injections soar in
popularity after shots cure the disfiguring disease
1930: Researchers note an increase in polio following
hypodermic injections in Madagascar.
1933: A medical journal reports that a rare occurrence of
malaria in Omaha, Neb., is the result of a syringe shared by
two drug users.
A report documents that hepatitis can be transmitted by
syringe reuse. The study says the virus is almost impossible
to remove from a needle through accepted disinfection
A study shows that changing needles is not enough to
prevent contamination because blood can back up into the
A hepatitis outbreak is reported among U.S.
soldiers after they receive multiple-dose
tetanus shots from reused syringes.
NEW TYPE OF SYRINGE
Becton Dickinson introduces the Multifit, its first glass
syringe with interchangeable needles.
TUBERCULOSIS A study shows that tuberculosis can be
transmitted by syringe reuse.
FIRST DISPOSABLE Roehr Products introduces the first
plastic disposable hypodermic syringe, called the Monoject.
The company is soon sold to a firm that will become
Sherwood, Davis & Geck, the nation's second-largest syringe
DEATH LINK Outbreak of hepatitis is traced to a New
Jersey doctor who used contaminated reusable syringes.
Fifteen deaths result, propelling national sales of
PLASTIPAK Becton Dickinson introduces its first plastic
disposable syringe, called the Plastipak. The company goes
public the following year and sells its shares on the stock
DOCTORS' PLEA American Medical Association unanimously
adopts resolution asking manufacturers to market syringe
designs that would prevent reuse. Manufacturers ignore the
ROYALTIES WAIVED Wyeth Laboratories, a subsidiary of
American Home Products, waives patent royalties to its
special smallpox needle, used to deliver 200 million
vaccinations a year worldwide.
FLU SHOTS Two factory workers die in Australia
from bacterial infection traced to flu shots. The
shots were given with the same disposable syringe, but
with new sterile needles after each injection.
GLOBAL VACCINATIONS World Health Organization launches
Expanded Program on Immunization to vaccinate all children
worldwide against diphtheria, tetanus, whooping
cough, polio, measles and tuberculosis.
EBOLA OUTBREAK In Zaire, the Ebola virus kills 280
people, most of whom were infected by reused
syringes and needles.
SINGAPORE OUTBREAK Outbreak of fatal hepatitis B cases in
Singapore traced to contaminated syringes.
SMALLPOX Smallpox eradicated globally making the disease
the first victim of worldwide immunization programs.
FIRST AUTODESTRUCT NEEDLE Prototype of one of the first
nonreusable or autodestruct syringes, called the
``syringe of the future,'' is described in a World Health
STERILIZERS World Health Organization orders hundreds of
thousands of portable steam sterilizers for developing
countries to prevent cross-infection from reused
AIDS Virus that causes AIDS is isolated in U.S.
and French laboratories. U.S. Agency for
International Development agrees to fund development of an
autodestruct syringe with nonprofit Seattle group called
RECOMMENDATIONS WHO and UNICEF issue policy statement
requiring use of a sterile needle and syringe for each
vaccination and recommend steam sterilization.
Studies of children in Zaire and Haiti show those who
receive more injections have higher rates of HIV.
NEW SYRINGE DESIGNS
USAID sponsors meetings in Geneva and Washington D.C.,
with WHO, UNICEF, PATH and a panel of experts to review 35
designs for autodestruct syringes. Among the most
promising is a laminated blister model and a syringe with a
metal clip that renders it nonreusable, both developed by
-- In 1974, only 5 percent of the world's children were
immunized against the most serious childhood diseases. World
OLD AND NEW SYRINGES COMPARED
Developed in the late 1950s for one-time use, the plastic
disposable syringe is still often reused in poor
-- Conventional syringe Includes a plunger and hollow
needle for injecting or drawing fluids. Can be used multiple
Costs about 5 cents each.
-- UniJect single-use syringe.
Prefilled plastic bubble attached to a needle with a
one-way valve. Can give only one injection. Not yet
available, but expected to cost relief agencies about 10
cents each. Contaminated barrel can spread disease even when
needle is sterile .
INFECTIONS TRANSMITTED BY SYRINGE REUSE
Hepatitis B virus
-- Hepatitis B infection can cause cirrhosis and is the
leading cause of liver cancer in the world. The virus is
extremely infectious and can stay alive in dried blood for
up to a year. Only 10 percent of infected adults become
chronic carriers, but 60 percent to 90 percent of infected
children under 1 year old end up with a chronic condition.
One-fourth of chronic carriers eventually die of liver
cancer or cirrhosis. A three-shot vaccine has been available
since 1982, but it is still too costly for widespread use in
-- Chance of getting hepatitis B from a syringe infected
with the hepatitis B virus: 30%
Hepatitis C virus
-- The hepatitis C virus also attacks the liver. More
than 80 percent of those infected become chronic carriers,
and one-fifth of those will develop cirrhosis within 10 to
40 years. A smaller percentage develop liver cancer. The
first test for the virus became available in 1989, so much
is still unknown about the disease. There is no vaccine.
Treatment with interferon is expensive, limited to adults
and effective in less than 20 percent of cases.
-- Chance of getting hepatitis C from a syringe infected
with the hepatitis C virus: 3%-5%
HIV, also known as the AIDS virus
-- The AIDS virus attacks the immune system, allowing
other diseases to develop. AIDS was considered fatal until a
recent combination of new drugs led to a dramatic drop in
the death rate in the United States. But few people in
developing regions can afford the new drugs. HIV is
transmitted primarily through sexual contact. Transmission
risk from a needle is low. But because the underlying
prevalence of the disease is increasing at a rapid rate,
particularly in Africa, where unsterile injections are
common, the overall risk is rising rapidly.
More than 20 other infections can be transmitted through
contaminated needles, including: -- Syphilis, malaria,
tuberculosis, streptococcal and staphylococcal sepsis,
Dengue fever, Rocky Mountain spotted fever, herpes,
hepatitis D and G, babesiosis, brucellosis, leptospirosis,
arboviral infections, relapsing fever, Creutzfeldt-Jakob
disease and viral fevers caused by Ebola. -- Chance of
getting HIV from a syringe infected with the HIV virus 0.3%
STEVE KEARSLEY/THE CHRONICLE
Becton Dickinson's sales revenues took off after it
started marketing its first plastic disposable needle.
Becton dickinson annual sales: 1947 $20 million 1981 $1
billion Source: Becton dickinson
SYRINGE REUSE AND THE SPREAD OF DISEASE
Deadly viruses like hepatitis B, hepatitis C and HIV have
spread rapidly over the past few decades and experts say
contaminated syringes play a major role in their
Estimated total annual infections from syringe reuse:
Hepatitis B: 8.3 mil.
Hepatitis C: 1.3 mil.
Estimated annual death rate:
1.4 mil. to 1.8 mil.
-- Sub-Saharan Africa Kenya: Rural doctors are supplied
with limited numbers of syringes, forcing them to
decide between not providing medical care or reusing the few
syringes that they have.
Infections from syringe reuse:
Hepatitis B: 1.25 mil.
Hepatitis C: 204,000
-- Middle Eastern crescent Egypt: Mass injections to
treat a water-borne disease in the 1960s and 1970s have
resulted in the world's highest incidence of hepatitis C.
Investigators say syringe reuse was the cause.
Infections from syringe reuse:
Hepatitis B: 693,700
Hepatitis C: 94,400
-- Latin America and the Caribbean Brazil: Prompted by a
soaring number of AIDS cases, Brazil passed a law in 1996
mandating the use of non-reusable syringes. But the
law has never been implemented.
Infections from syringe reuse:
Hepatitis B: 24,700
Hepatitis C: 89,600
-- Former Soviet Union and Eastern bloc countries Russia:
In 1988 and 1989, 246 children in six southern Russian towns
are infected with HIV from reused needles and
Infections from syringe reuse:
Hepatitis B: 446,500
Hepatitis C: 60,800
A study of 294 village doctors indicates widespread
inadequacy of sterilization of syringes and
Infections from syringe reuse:
Hepatitis B: 2.51 mil.
Hepatitis C: 339,800
Other Asian/Pacific Island
Cambodia: More than half of the government's outlay for
public health care is swallowed up by graft, resulting in
limited availability of syringes and rampant reuse.
Infections from syringe reuse:
Hepatitis B: 1.51 mil.
Hepatitis C: 246,200
World prevalence of the hepatitis B virus More than 350
million people are now chronic carriers of the hepatitis B
virus. Recent estimates of infections from syringe reuse
generally track the prevalence of the disease globally.
World prevalence of the hepatitis C virus Hepatitis C
infections from syringe reuse follow the global prevalence
of the virus, now carried by more than 170 million people.
World prevalence of the HIV HIV infections from syringe
reuse track the worldwide prevalence of the virus, which now
infects more than 30 million people.
Source: World Health Organization and Chronicle research
STEVE KEARSLEY/THE CHRONICLE
Chronicle foreign correspondents Sandy Barron in
Cambodia, Jack Epstein in Brazil, Steve Fennessy in Egypt,
Brian Humphreys in Russia and Andrea Useem in Kenya
contributed to this report.
This article appeared on page A - 1 of the
San Francisco Chronicle
Colleague" letter from the Centers for
Disease Control and Prevention (CDC).