Model-Based Estimates of the Risk of Human Immunodeficiency Virus and Hepatitis B Virus Transmission through Unsafe Injections

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Abstract
Background. Patient-to-patient transmission through contaminated medical equipment may be the principal roule of nosocomial blood-borne infections globally. Quantifying cross infection risks could facilitate efforts to ensure safe injections in developing countries. Method. A mathematical model was developed to evaluale the risk of cross infection due to unsafe injections. The model was applied to immunization programmes with a fixed number of injections and in which unsterlle needle and synnge reuse rales were speclfied. Risk estimates were generated using a range of human immunodeficiency virus (HIV) and hepatitis B (HBV) prevalences. Results. The risk of cross Infection is zero when properly sterilized equipment is used. With unsafe Injections, the risk of cross infection with HBV is consistently higher than HIV for comparable levels of endemicity. A single reuse of each needle and syringe in areas with an HBeAg prevalence of 4% results in 980 cases of HBV/100 000 Infants; reuse four times results in 3740 cases. When the HIV prevalence is 1% and the reuse rate is 4, 14 to 35 cases of HIV/100 000 women could occur. Contamination of multidose vaccine vials could considerably increase these estimates. Conclusions. Neither HIV nor HBV transmission has been reported with injections administered through the Expanded Programme on Immunization. However, ample evidence exists that reuse of unsterlle needles and synnges is common in developing countries. Ongoing efforts to ensure safe practices and improve injection technologies are required to protect these populations from both medical and traditional skin-piercing procedures.

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