World Bank: Urgent action needed to prevent the spread of HIV/AIDS and other infectious diseases in Central Asia through tainted blood transfusions
WASHINGTON, June 12, 2008 —Unsafe blood transfusions and medical practices in Central Asia may contribute, and in some cases have already contributed, to the spread of communicable diseases in the region, particularly HIV, according to the new World Bank report entitled Blood Services in Central Asian Health Systems: A Clear and Present Danger of Spreading HIV/AIDS and Other Infectious Diseases.
According to the report, of the 33-36 million people estimated to be HIV positive worldwide, 5 – 10 percent were infected by a contaminated blood transfusion. Direct blood stream exposure to HIV is the most efficient means of transmission – more than 92 percent of HIV-contaminated transfusions result in infection, while less than 1 percent of intravenous drug injections with a contaminated syringe do.
Blood transfusion services, coupled with safe medical procedures, are vital to health systems, helping to save people’s lives every day. Until recently, according to the study, little was known about blood transfusion systems in Central Asia and their contribution to disease transmission. The report found that the current screening of donated blood in Central Asian health systems may not be fully effective, and leaves some real risk of transfusion of infected blood by unsuspecting doctors to unsuspecting patients. Even more alarming is the finding that some health facilities in Central Asia do not test blood donations at all.
Countries covered by the study were Kazakhstan , Kyrgyz Republic , Tajikistan , and Uzbekistan , in which blood samples from 7,500 blood donors were re-tested at national reference laboratories. The re-screened blood samples were screened for HIV, syphilis, and hepatitis B and C. The blood sample re-testing identified cases of HIV that had been undetected by the blood center laboratories that originally tested the samples. These cases included HIV-infected blood units that reached health facilities. The re-testing found a prevalence of communicable diseases in the blood samples to be 0.20 percent for HIV, 2.7 percent for hepatitis B, 3.0 percent for hepatitis C, and 3.6 percent for syphilis.
The study’s tests included an ALT test, which detects liver injury. An increased level of ALT in the blood is caused by liver damage due to all types of hepatitis--viral, alcoholic, drug-induced. The assessment found a prevalence of 8.6 percent for ALT elevation, signaling the potential residual risk of transmission of viral diseases during the "window" period--when the infection could not be detected.
“Indeed patchy testing of donated blood is creating a false sense of security in the Central Asian health systems,” said Patricio Marquez, World Bank Lead Health Specialist and author of the report. “These findings underscore the need to strengthen screening of blood donors for each donation and strengthen other prevention and control measures to guarantee the safety of the blood supply in the health systems of the Central Asia countries. Such improvements would reduce the potential risk of involuntary infection to the unsuspecting population.”
Although blood transfusions are a small contributor to infectious disease transmission compared to other well-reported modes, the report emphasizes that national governments have a responsibility to their populations to ensure the safety of the blood supply in their countries’ health systems.
“Numerous parts of these countries’ blood transfusion systems,” said Marquez, “are in serious need of restructuring, of new investments, and of increased budgetary support for operation and maintenance. And the low level of blood supplies in Central Asia is driven by a culture that places little value on donating blood, fear by people of getting infected by donating blood, and the near non-existence of campaigns to promote blood donations among low-risk populations. These trends need to be reversed.”
The report recommends measures to Central Asian governments to improve blood services, including optimizing the laws and regulations, putting in place nationally coordinated blood transfusion systems, universal unpaid blood donor systems, and regular donor promotion campaigns. Special attention is also placed on effective donor screening strategies, training of medical personnel, and promoting justified and rational use of blood and blood products, among others.
Ensuring blood supply safety, however, is a difficult challenge for poor countries with weak and underfunded health care systems. Therefore, the support of the international community is critical to helping countries in the region block this source of communicable disease transmission as part of the broader efforts to restructure health systems.
The report draws on results of assessments carried out in collaboration with the US Centers for Disease Control and Prevention and the World Health Organization Regional Office for Europe , and with the Central Asian countries’ Ministries of Health.
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To get more information and download the full report in English and in Russian,
please go here.
For more information on the World Bank’s work in Europe and Central Asia ,
please visit: www.worldbank.org/eca