Problem: Unsafe Injections



  Each year, syringe

  re-use in developing

  nations results in

  about 25 million

  new infections —

  HIV, hepatitis B,

  hepatitis C and viral

  hemorrhagic fevers

  such as Ebola —

  leading to thousands

  of deaths.

Injections are the most common health procedure worldwide. In developing countries alone, some 16 billion injections are administered each year. Most injections (more than 90 percent) are given for curative purposes, while 5 to 10 percent are given for preventive purposes such as immunization. Yet according to the World Health Organization (WHO), up to 50 percent of those injections — including in Sub-Saharan Africa and Nigeria specifically — are unsafe.

About half the syringes used in Africa are also re-used. According to Dr. Edward Hoekstra, a senior health advisor to UNICEF, “The steel needles could be re-used as many as 100 times.”

Re-usable syringes may simply be rinsed in tepid water (not sterilized) between injections.

A syringe-full of medicine or vaccine may be partly injected into one patient, partly into the next and then into another, picking up pathogens and passing them down the line.

Any blood-borne pathogen can spread in those ways. Each year, syringe re-use in developing nations results in about 25 million new infections, leading to thousands of deaths. WHO considers these to be the most devastating needle-transmitted viruses:


HIV: 5 percent of new cases are transmitted via syringe re-use.

HEPATITIS B: One-third of new cases are transmitted via syringe re-use. “Hepatitis B is one of the major diseases of mankind and is a serious global public health problem. ... Of the 2 billion people who have been infected with HBV [hepatitis B virus], more than 350 million have chronic (lifelong) infections. These chronically infected persons are at high risk of death from cirrhosis of the liver and liver cancer, diseases that kill about one million persons a year. ... In many developing countries, almost all children become infected with the virus.” (WHO)

HEPATITIS C: 40 percent of new cases are transmitted via syringe re-use. “Hepatitis C has been compared to a ‘viral time bomb’. WHO estimates that about 180 million people ... are infected with hepatitis C virus (HCV), 130 million of whom are chronic HCV carriers at risk of developing liver cirrhosis and/or liver cancer. It is estimated that three to four million persons are newly infected each year .... Disease prevalence is ... high (>2%) in many countries in Africa .... In these countries, prevalence figures between 5% and 10% are frequently reported.” (WHO)

SOME OF THE VIRAL HEMORRHAGIC FEVERS, such as Ebola and Lassa: Syringe re-use is a major cause of transmission of those diseases, although percentages vary by locale.


A December 1999 statement, jointly produced by WHO, UNICEF and UNFPA (the U.N. Population Fund) and entitled Safety of injections (WHO/V&B/99.25), warns of the dangers of syringe re-use and identifies auto-disable (AD) syringes as the “equipment of choice” to prevent re-use — and therefore, infection. The statement reads in part:


“1. The reuse of standard single-use disposable syringes and needles places the general public at high risk of disease and death.

“2. The auto-disable syringe, which is now widely available at low cost, presents the lowest risk of person-to-person transmission of blood-borne pathogens (such as hepatitis B or HIV) because it cannot be reused. The auto-disable syringe is the equipment of choice for administering vaccines, both in routine immunization and mass campaigns. ...

“4. ... WHO, UNICEF and UNFPA urge that, by the end of 2003, all countries should use only auto-disable syringes for immunization.”


The year 2003 has come and gone; and still, AD syringes are not in universal use. Most often cited as the reasons are issues of affordability and availability.

AD syringes cost a few cents more, per syringe, than re-usable glass syringes; and the glass syringes offer the further “economy” of re-usability. Those are false economies, however. WHO estimates that each unsafe injection ends up costing governments three to five times the difference in the price of AD syringes — costs ranging from the treatment of illness, to lost productivity, to the impact of diseases and premature death upon families and communities as a whole. The individual human suffering is incalculable.

Availability has been an issue, because almost all AD syringes for use in developing countries have had to be imported and, at times, the quantities have been scarce.

Until recent years, poor clinics essentially have had no choice. They could not afford, or could not gain access to, AD syringes.

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Updated: November 21, 2008.

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