Recycling of medical waste causes deadly virus outbreak

Officials in Gujarat state seize hundreds of tonnes of recycled medical equipment and arrest more than 100 medical scrap dealers and 22 doctors, after an outbreak of hepatitis B.

NEW DELHI // Officials in Gujarat state seized hundreds of tonnes of recycled medical equipment and arrested more than 100 medical scrap dealers and 22 doctors over the past week, after an outbreak of hepatitis B killed at least 70 people and left about 240 others infected with the deadly virus. The virus is usually transmitted through sexual contact or by sharing needles or syringes. Two of the arrested doctors in the town of Modasa in Sabarkantha district, the centre of the epidemic in Gujarat, were charged with culpable homicide after it was learnt that some victims had been treated in their clinic. The doctors - father and son - had used the same syringes and needles on multiple patients, police said. After raiding underground warehouses in Modasa, police and pollution control officials seized the recycled medical waste, most of it packaged and ready for supply to clinics or hospitals. A similar seizure of recycled medical waste took place in other parts of Gujarat, including Ahmedabad. In Modasa, Surat, Rajkot and Ahmedabad, officials discovered makeshift packaging units where recycled needles, syringes, paediatric droppers, intravenous drips and other equipment were being sorted, simply washed and neatly repackaged for sale. Five Ahmedabad-based pharmaceutical companies were also found repackaging used medical waste in the same unsafe manner and the Gujarat pollution control board has issued closure notices against them. Investigators found that medical waste pickers collected used needles and other equipment from hundreds of private hospitals, thousands of doctors and some government hospitals, and then sold them to underground recycling gangs who traded in them. Scientists from Pune's National Institute of Virology identified the killer virus as a "dangerously mutated strain" of hepatitis B that can kill its victims in an unusually short time. Jay Narayan Vyas, Gujarat's health minister, said his department was sure the infection spread fast because of the use of infected syringes or needles by private doctors, and that his government would take stringent action against those responsible. "The situation turned worse because private doctors and hospitals are not under a regulatory mechanism. In the absence of any legal obligation and related punitive measures of dereliction, the private medical practitioners use substandard facilities and equipments," Mr Vyas said. The practice of recycling medical equipment is not a new problem in India. The Indian Clinical Epidemiology Network said that up to 31.6 per cent of the three billion to six billion injections administered in the country annually were done with used equipment and carried the potential risk of spreading such blood-borne viruses as those causing hepatitis and Aids.

The authorities in Gujarat were aware that many clinics in the state were unsafe, but had failed to act sooner because of the "high regard for doctors", said Dr Ramesh Shah, secretary of the Gujarat Pollution Control Board. "This entire saga of medical waste trading is disgusting and we will not spare the offenders. I am aghast that doctors can risk lives like this for the cost of small change." Some experts said that in the absence of a regulatory mechanism, similar outbreaks are bound to occur in the future. "There is no law under which it could be mandatory for Gujarat's 13,000 private medical practitioners to reveal where they bought their equipment. In this situation many culprits - including doctors and infected equipment suppliers - are slipping out of the police dragnet," said one Ahmedabad-based pollution control officer. "We have no idea how many thousands of infected needles or syringes may already be in use in medical clinics across the state. It is impossible to trace them all," he said.