Transmission of hepatitis B, hepatitis C and human immunodeficiency viruses through unsafe injections in the developing world: model-based regional estimates.

ABSTRACT

PIP: This paper reports global and regional estimates of the prevalence of hepatitis B virus (HBV), hepatitis C virus (HBV), and HIV infections that may occur as a result of unsafe injection practices in the developing countries. The estimates were determined using quantitative information on unsafe injection practices, transmission efficiency of pathogen, and disease burden of hepatitis B and C viruses, as well as HIV and the prevalence of injection usage as observed in the literature reviews. A simple mass-action model was utilized in the study and was applied to world census data to generate the conservative estimates of interest. The model showed that about 8-16 million HBV, 2.3-4.7 million HCV, and 80,000-160,000 HIV infections may result from unsafe injections each year. It was also noted that the estimated range of HBV infection is consistent with a number of epidemiological studies that attribute at least 20% of all new cases of HBV infection to unsafe injections in the developing world. Given that unsafe injections may contribute to a high number of infections with bloodborne pathogens, a major effort is necessitated to improve injection safety and reduce injection overuse in many countries.