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WHO promotes safe injections, but continues to underestimate bloodborne risks


On 23 February, WHO announced its intention to promote auto-disable syringes for curative injections[1]. This is a hugely encouraging response to an HIV outbreak discovered in Roka village, Cambodia, in December 2014 – hundreds of villagers infected through unsafe healthcare.

Unfortunately, WHO’s press release announcing its commitment to promote auto-disable syringes low-balled the risk to get HIV from unsafe health care. The press release cited a recent WHO-sponsored study[2] that estimated unsafe medical injections accounted for less than 1.3% of HIV transmissions in the world in 2010. The authors of that WHO-sponsored study calculated their estimates using a model that depends crucially on an assumed low rate of HIV transmission through contaminated syringes and needles. The authors assumed that if a doctor or nurse injects someone with HIV and then reuses the same syringe and needle – without boiling them – to give you an injection, your risk to get HIV is only 0.32%-0.64%. To support such an assumed low risk, the authors cited similar assumptions from other papers and authors – all of which ignored and/or rejected evidence of transmission during actual outbreaks where medical injections transmitted HIV.

The outbreak in Roka, Cambodia, gives us a chance to test these low-ball assumptions. If the risk to transmit HIV from an HIV-infected patient to a later patient through reused, unsterilized syringes and needles was 0.32%-0.64% only, someone infected with HIV would have to have, on average, 156 (=1/0.0064) to 313 (=1/0.0032) injections after which equipment was reused without sterilization to infect one other person. If the average person living with HIV got 15 injections per year (an absurdly large figure) it would take an average of 10 to 20 years for him or her to transmit HIV to one other person through unsafe injections. People living with HIV would, on average, die before infecting someone through an unsafe injection.

In short, with the transmission efficiencies Pepin and colleagues assumed (in the study cited by WHO’s press release), the outbreak in Roka, Cambodia, was impossible.

For decades, health care authorities who could stop transmission of HIV in health care have chosen not to do so. They have chosen to stick their heads in the sand, to accept ridiculously low assumptions about HIV transmission efficiencies through contaminated instruments, not to warn patients at risk, to give deceitful assurances, etc.

WHO’s endorsement of auto-disable syringes is a step in the right direction. Much more is required to change the trajectory of largely unnecessary and easily preventable HIV epidemics in Africa – eg, outbreak investigations, acknowledging common risks in formal as well as informal health care settings, etc.

1. WHO. WHO calls for worldwide use of “smart” syringes. Press release 23 February 2015. Available at: http://www.who.int/mediacentre/news/releases/2015/injection-safety/en/ (accessed 24 February 2015).

2. Pepin J, Abou Chakra CN, Pepin E, Nault V, Valiquette L (2014) Evolution of the Global Burden of Viral Infections from Unsafe Medical Injections, 2000–2010. PLoS ONE 9(6): e99677. doi:10.1371/journal.pone.0099677. Available at: http://www.plosone.org/article/fetchObject.action?uri=info:doi/10.1371/journal.pone.0099677&representation=PDF (accessed 24 February 2015).

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