Are there ethical differences between stopping and not starting blood safety measures?

BACKGROUND AND OBJECTIVES: Concern with the costs of blood safety is growing, which raises the question whether safety measures that reduce risk only marginally should be discontinued. Withdrawing such safety measures would allow reallocating resources to more efficient health care interventions, but it might raise moral objections. MATERIALS AND METHODS: This study evaluates two ethical arguments why discontinuing blood safety measures would be more objectionable than not implementing them. The first argument is that whereas withdrawing protective measures causes harm to patients, not starting protective measures 'merely' omits to prevent harm. The second argument is that patients who benefit from protective measures are historically entitled to the continuation of those protective measures. RESULTS: Both arguments are unconvincing. There is only a weak causal connection between removing blood safety measures and harms that transfusion recipients suffer. Moreover, patients are not entitled to the continuation of protective measures that prove very inefficient, unless applying these protective measures rectifies past injustice towards them. CONCLUSION: Unless stronger ethical objections can be found, blood system operators and regulators should be more willing to withdraw inefficient safety measures.

The estimated future disease burden of hepatitis C virus in the Netherlands with different treatment paradigms.

BACKGROUND & AIMS: Prevalence of hepatitis C virus (HCV) infection in the Netherlands is low (anti-HCV prevalence 0.22%). All-oral treatment with direct-acting antivirals (DAAs) is tolerable and effective but expensive. Our analysis projected the future HCV-related disease burden in the Netherlands by applying different treatment scenarios. METHODS: Using a modelling approach, the size of the HCV-viraemic population in the Netherlands in 2014 was estimated using available data and expert consensus. The base scenario (based on the current Dutch situation) and different treatment scenarios (with increased efficacy, treatment uptake, and diagnoses) were modelled and the future HCV disease burden was predicted for each scenario. RESULTS: The estimated number of individuals with viraemic HCV infection in the Netherlands in 2014 was 19,200 (prevalence 0.12%). By 2030, this number is projected to decrease by 4 5% in the base scenario and by 85% if the number of treated patients increases. Furthermore, the number of individuals with hepatocellular carcinoma and liver-related deaths is estimated to decrease by 19% and 27%, respectively, in the base scenario, but may both be further decreased by 68% when focusing on treatment of HCV patients with a fibrosis stage of ≥ F2. CONCLUSIONS: A substantial reduction in HCV-related disease burden is possible with increases in treatment uptake as the efficacy of current therapies is high. Further reduction of HCV-related disease burden may be achieved through increases in diagnosis and preventative measures. These results might inform the further development of effective disease management strategies in the Netherlands.

[ 'Severe acute respiratory syndrome' (SARS) in perspective]. / 'Severe acute respiratory syndrome' (SARS) in perspectief.

In the Netherlands, the risk of an outbreak of the severe acute respiratory syndrome (SARS) appears to be limited, if people in contact with a possibly imported case observe strict measures to prevent contamination. SARS may well be a zoonosis. Bovine spongiform encephalopathy and outbreaks of virus infections in the bioindustry, such as swine fever, foot-and-mouth disease and classical avian influenza, have led to massive killing of cattle, swine and fowl in the Netherlands. The possibility that the bioindustry constitutes a risky microbiological 'experiment' makes a discussion as to its future in the Netherlands urgent.

Comparison of methods for detection of hepatitis B virus DNA.

We compared the performance of four assays for detection of hepatitis B virus (HBV) DNA: the PCR; the branched DNA hybridization assay (Chiron); and two hybridization assays that use liquid hybridization (Abbott) or direct membrane hybridization (MH). Testing 109 random hepatitis B surface antigen-positive patient samples, the percentages found to be HBV DNA positive among 30 hepatitis B e antigen (HBeAg)-positive samples and 79 HBeAg-negative samples were as follows: PCR, 100 and 90%; Chiron, 73 and 25%; Abbott, 67 and 13%; and MH, 40 and 8%. In six hepatitis B surface antigen-positive, HBeAg-negative samples, all three hybridization assays detected HBV DNA. Testing dilutions prepared from the Eurohep HBV DNA standards, the detection limits of the assays appeared to be the following: PCR, 2.5 x 10(2) HBV genomes per ml; Chiron, 2.5 x 10(6) genomes per ml; and Abbott and MH, 2.5 x 10(7) genomes per ml. HBV DNA levels in the dilution series, as reported by the Chiron and MH assays, were, on average, 2 times higher than calculated; the Abbott results were, on average, 19 times lower than calculated. We concluded that high levels of HBV DNA and the presence of HBeAg do not necessarily coincide, that the application of hybridization assays is limited to the monitoring of relatively high levels of HBV DNA, and that further standardization of quantitative HBV DNA assays is necessary to facilitate comparison of HBV DNA levels.