DIRTY needles are causing an epidemic of liver disease in the developing
world. Up to 20 million people a year around the world contract hepatitis from
injections that are often unnecessary. This weekend, politicians and public
health officials will meet in the Egyptian capital, Cairo, to discuss strategies
for fighting the epidemic.
Egypt is one of the world’s worst-hit nations. Eight million of its people
have hepatitis C. And of those who have advanced liver disease because of this
virus, nearly half can blame it on unsafe injections 20 or so years ago. “In
Egypt and other places such as the Indian subcontinent there’s astronomical
injection overuse,” says Yvan Hutin, head of the Safe Injection Global Network
based at the WHO in Geneva. SIGN is organising the Cairo conference, at which
doctors hope to swap ideas on how to persuade people to avoid unnecessary
injections.
In the Far East, South Asia, Africa and parts of Eastern Europe, unsafe
injections cause between 10 and 20 million hepatitis B and C infections every
year. The 20-year time lag between infection and terminal liver disease means
that the true cost of dirty needles is only emerging now. Children are
particularly vulnerable: around 80 per cent infected with hepatitis B can’t
shake off the virus, and 20 per cent will eventually die from liver disease.
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In the Pakistani city of Karachi, dozens of unqualified health workers sell
sick people “curative” injections. “These places have to be seen to be
believed,” says Hutin. The injections are usually worthless as well as passing
on viral infections, says epidemiologist Arshad Altaf of the Aga Khan University
in Karachi. “Formal and informal healthcare advisers are in the habit of
providing unnecessary injections. Usually they’re just water and vitamins.
Sometimes they contain antibiotics.”
“If we don’t control this, I think the problem will increase tenfold in the
next 10 years. There’s a dearth of data, but what we have suggests that between
2.5 to 10 per cent of the population have hepatitis B or C. The situation will
be horrendous. Hospitals are already seeing a big rise in people with liver
徱.”
“If you look at hospitals in Europe and, I suspect, around the world, more
and more people are coming down with end-stage liver disease,” says Steve Luby,
of the US Centers for Disease Control and Prevention in Atlanta, who spent five
years in Pakistan studying the problem.
In addition, the WHO estimates that up to 150,000 people a year catch HIV,
the same way. Last month, 91av
(30 September, p 16) revealed
that the widespread use of non-sterile penicillin injections in Africa in the
1950s may have triggered the AIDS pandemic.
Fortunately, the fear of HIV may be prompting an improvement. The Cairo
conference will be told that in sub-Saharan Africa the sterility of injections
has improved dramatically. Five years ago 90 per cent of injections in Burkina
Faso were not sterile. Now only 5 per cent are unsafe. “This is a spectacular
fall,” says Hutin.
“Changing behaviour in Africa suggests there are grounds for optimism,” says
Luby.
