Improper strerilsation and use of recycled syringes was the cause of the recent outbreak of hepatitis B in some parts of Gujarat region of India. Hepatitis B unlike hepatitis A is a very serious infection and can result in considerable morbidity and moratlity.It has some peculiar features. One is that it can only be transmitted by contaminated blood and blood products. That is if you swallow a sample containing this virus, unless you have an ulcer or abrasion in your gastrointestinal tract you will not get it. But having sex with a partner who is a carrier of this virus, or coming into body contact [contact sports] can be risky. So also those who deal constantly with blood and blood products [surgeons, dentists, blood transfusion workers, hemodialysis workers]. Effective immunization is available and it is important to immunize children more than adults, though vaccine manufacturers don’t say it. The percentage of children becoming carriers is very high in contrast to adults. Carrier state involves the risk of the carrier developing cancer liver and Cirrhosis of liver after a lapse of ten to twenty years [both are deadly] makes it necessary that all children must be immunized. This is not so in low risk adults. Nevertheless, to eradicate this illness from our country universal immunization has been advocated.
Now coming back to the epidemic. When plastic disposables came to be used in preference to the old steel and glass reusable [after heat sterilization], I had wondered when this epidemic would arrive, given our mania for injections and the unscrupulous elements who would wash these repack and sell again as new syringes. This has now happened. Adulteration is rampant and reuse of plastic contaminated syringes must have been going on for a long time and quite a few of the unexplained cases of hepatitis B we see must be due to this. Hepatitis B virus unlike the AIDS virus is robust and survives outside the body for years and washing the syringe with detergents will not kill it.
Then what is the solution? No doctor or institution should discard the syringe where it can be accessed. They have to be destroyed and then discarded preferably incinerated [equipment to do this is available] Patients should not demand injections and most illnesses don’t need drugs in the injection form. What about quacks? [Qualified and unqualified] I have no answer. Quackery exists as long as the society remains ignorant and uneducated [love for injections is an Asian and African phenomenon].
So next time you visit the doctor, don’t insist on injection. The drug given by injection takes 15 minutes to reach the blood and that given by mouth takes one hour. Therefore there is really no advantage. It is all in the mind.