The global burden of disease attributable to contaminated injections given in health care settings

Abstract

As part of the 2000 Global Burden of Disease study, we quantified the death and disability from injection-associated infections with hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). We modelled the fraction of incident infections attributable to health care injections in the year 2000 on the basis of the annual number of injections, the proportion of injections administered with reused equipment, the probability of transmission following percutaneous exposure, the prevalence of active infection, the prevalence of immunity and the total incidence. Infections in 2000 were converted into disability-adjusted life years (DALYs) in 2000-2030 using natural history parameters, background mortality, duration of disease, disability weights, age weights and a 3% discount rate. Four Global Burden of Disease regions where reuse of injection equipment in the absence of sterilization was negligible were excluded from the analysis. In the remaining 10 regions, in 2000, persons received an average of 3.4 injections per year, 39.3% of which were given with reused equipment. In 2000, contaminated injections caused an estimated 21 million HBV infections, two million HCV infections and 260,000 HIV infections, accounting for 32%, 40% and 5%, respectively, of new infections for a burden of 9,177,679 DALYs between 2000 and 2030. Injection overuse and unsafe practices account for a substantial burden of death and disability worldwide. There is a need for policies and plans for the safe and appropriate use of injections in countries where practices are poor.

Assessment of injection safety in Ha Dong General Hospital, Hanoi, in 2012

“…This research showed that on average each patient received 3.1 injections. Compared to the results study in other countries, this rate is lower than result study of HAURI Global 2000 study 15 . However, this result is higher than Tu's study 16, 17 and research by the Vietnam Nurses Association in 2010 13, 18, 19 .…”

Clinical, Biochemical and Virological Profile of Patients with Chronic Hepatitis C Virus Infection - A Study from University Hospital in Nepal

“…2 In developed countries, the most important route of HCV transmission is intra-venous drug use, whereas in resource poor countries, invasive procedures or injection-based therapies with contaminated instruments are predominant source of new infections. 3 Different studies from Nepal showed that the sero-prevalence of HCV ranges from 0.35% to 1.73% in blood donors and healthy population with highest prevalence among injection drug users. [4][5][6][7][8] Six different HCV genotypes and multiple subtypes have been identified on the basis of molecular relatedness.…”

Hepatitis B virus genotype E infection among Egyptian health care workers

“…The declining rate of HBsAg among Egyptian children and general populations was previously reported. [1,2,15] A study conducted in Egypt between 1986 and 1987 found an HBsAg sero-positivity rate of 3.2% among 765 HCWs. [7] More recent data published in 2012 showed a significant decrease of HBsAg (1.5%) among Egyptian HCWs in the Nile delta.…”

“…[1,2] The frequency of HBsAg and anti-HBc positive among Egyptian general populations, with age range of 15-59 years, is 1.5% and 15.7% respectively. [3] HBV genotype D (HBV/D) was reported to be the most prevalent among Egyptians.…”