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HEPATITIS B VIRUS - INDIA (08): (GUJARAT), RECYCLED MEDICAL WASTE
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International Society for Infectious Diseases
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Date: Thu 12 Mar 2009
Source: The National Newspaper online [edited]
http://www.thenational.ae/article/20090312/FOREIGN/97643596/1103/NEWS

Officials in Gujarat state seized hundreds of tons of recycled
medical equipment and arrested more than 100 medical scrap dealers
and 22 doctors over the past week, after an outbreak of hepatitis B
killed at least 70 people and left about 240 others infected with the
deadly virus.

[Hepatitis B] virus is usually transmitted through sexual contact or
by sharing needles or syringes.

Two of the arrested doctors in the town of Modasa in Sabarkantha
district, the centre of the epidemic in Gujarat, were charged with
culpable homicide after it was learnt that some victims had been
treated in their clinic. The doctors — father and son — had used
the same syringes and needles on multiple patients, police said.

After raiding underground warehouses in Modasa, police and pollution
control officials seized recycled medical waste, most of it packaged
and ready for supply to clinics or hospitals. A similar seizure of
recycled medical waste took place in other parts of Gujarat,
including Ahmedabad. In Modasa, Surat, Rajkot and Ahmedabad,
officials discovered makeshift packaging units where recycled
needles, syringes, pediatric droppers, intravenous drips and other
equipment were being sorted, simply washed and neatly repackaged for sale.

Five Ahmedabad-based pharmaceutical companies were also found
repackaging used medical waste in the same unsafe manner, and the
Gujarat pollution control board has issued closure notices against
them. Investigators found that medical waste pickers collected used
needles and other equipment from hundreds of private hospitals,
thousands of doctors and some government hospitals and then sold them
to underground recycling gangs who traded in them.

Scientists from Pune’s National Institute of Virology identified the
killer virus as a “dangerously mutated strain” of hepatitis B [virus]
that can kill its victims in an unusually short time. Jay Narayan
Vyas, Gujarat’s health minister, said his department was sure the
infection spread fast because of the use of infected syringes or
needles by private doctors and that his government would take
stringent action against those responsible. “The situation turned
worse because private doctors and hospitals are not under a
regulatory mechanism. In the absence of any legal obligation and
related punitive measures of dereliction, the private medical
practitioners use substandard facilities and equipment,” Mr Vyas said.

The practice of recycling medical equipment is not a new problem in
India. The Indian Clinical Epidemiology Network said that up to 31.6
per cent of the 3 billion to 6 billion injections administered in the
country annually were done with used equipment and carried the
potential risk of spreading such blood-borne viruses as those causing
hepatitis and AIDS. The authorities in Gujarat were aware that many
clinics in the state were unsafe but had failed to act sooner because
of the “high regard for doctors,” said Dr Ramesh Shah, secretary of
the Gujarat Pollution Control Board.

“This entire saga of medical waste trading is disgusting, and we will
not spare the offenders. I am aghast that doctors can risk lives like
this for the cost of small change.” Some experts said that in the
absence of a regulatory mechanism, similar outbreaks are bound to
occur in the future.

“There is no law under which it could be mandatory for Gujarat’s 13
000 private medical practitioners to reveal where they bought their
equipment. In this situation, many culprits — including doctors and
infected equipment suppliers — are slipping out of the police
dragnet,” said one Ahmedabad-based pollution control officer. “We
have no idea how many thousands of infected needles or syringes may
already be in use in medical clinics across the state. It is
impossible to trace them all,” he said.

[Byline: Shaikh Azizur Rahman]

—
Communicated by:
HealthMap Alerts via
ProMED-mail promed@promedmail.org

[This is an appalling revelation. In these circumstances, it seems
unnecessary to attribute the outbreak to a “dangerously mutated
strain” of hepatitis B virus that can kill its victims in an
unusually short period. The exposure of patients to non-sterile
recycled medical equipment would be likely to enhance the severity of
any disease condition. - Mod.CP]

[see also:
Hepatitis B virus - India (07): (GJ) 20090225.0774
Hepatitis B virus - India (06): (GJ) 20090224.0768
Hepatitis B virus - India (05): (GJ), hepatitis D, RFI 20090223.0756
Hepatitis B virus - India (04): (GJ), hepatitis D, RFI 20090221.0727
Hepatitis B virus - India (03): (GJ), hepatitis D, RFI 20090220.0717
Hepatitis B virus - India (02): (GJ), hepatitis D, RFI 20090217.0660
Hepatitis B virus - India: (GJ), hepatitis D, RFI 20090216.0651
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