Unsafe injection practices throughout the world result in millions of infections which may lead to serious diseases and death. Each year over-use of injections and re-use of dirty syringes and needles combine to cause an estimated 8-16 million hepatitis B virus infections, 2.3-4.7 million hepatitis C virus infections, and 80 000-160 000 infections with HIV/AIDS worldwide.

An increasing body of evidence — including recent reports in the medical press — suggests that a large proportion of hepatitis C infections in Egypt were caused by unsafe injection practices. In particular, it appears that improperly sterilized needles were used to treat schistosomiasis, a parasitic disease. Approximately 13% of the Egyptian population is infected with hepatitis C virus, leading to a high burden of chronic liver disease, cirrhosis and liver cancer, as well as mortality resulting from these diseases.

As a consequence of these unsafe injections in the last decades, a large reservoir of chronic infection was established that still drives hepatitis C transmission in Egypt today. The use of injections to treat schistosomiasis stopped about 15 years ago; the current treatment for this disease is administered orally.

"Although most injections given in the world follow safe clinical practices, poor injection practices continue to transmit viral hepatitis and other infections on a large scale in many countries. Appropriate measures can and must be taken to avoid this route of transmission of disease," says Dr Yvan Hutin of WHO’s Blood Safety and Clinical Technology Department.

In response to growing concern, WHO and several international partners sharing a common goal in safe and appropriate use of injections worldwide joined forces in October 1999 as a Safe Injection Global Network (SIGN). SIGN is co-ordinated by a secretariat located at the World Health Organization (WHO) headquarters in Geneva, Switzerland.

To prevent injection-associated infections worldwide, SIGN recommends that countries implement a three-element strategy to: (1) change behaviour among patients and healthcare workers to reduce injection over-use and achieve injection safety, (2) ensure sufficient availability of sterile syringes and needles, and (3) appropriately destroy sharps waste after use.

In addition, to ensure the safety of immunization injections, WHO, the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), and the International Federation of the Red Cross and Red Crescent Societies (IFRC) have recently called for the exclusive use of auto-disable (AD) syringes for immunization by the end of 2003.

More information on the prevention of injection-associated infections can be obtained on the WHO web site at www.who.int/inf-fs/en/fact231.html (Fact Sheets 231-234), on the web site of SIGN at www.injectionsafety.org and at the SIGN Secretariat, Department of Blood Safety and Clinical Technology, WHO, Avenue Appia 20, CH-1211 Geneva 27, Switzerland. Telephone: +41 22 791 3680, Facsimile: +41 22 791 4836, E-mail: sign@who.int.

For further information, journalists can contact Ms Melinda Henry, Office of the Spokesperson, WHO, Geneva; Telephone +41 22 791 2535; Facsimile +41 22 791 4858; E-mail henrym@who.int All WHO Press Releases, Fact Sheets and Features as well as other information on this subject can be obtained on Internet on the WHO home page http://www.who.int

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