Countries struggle with hepatitis C contamination.
Source: BMJ: British Medical Journal; 2/18/95, Vol. 310 Issue
6977, p417, 2p, 2bw
Document Type: Article
Subject(s): HEPATITIS C -- Transmission
BLOOD -- Transfusion -- Complications
Abstract: Examines how France, Germany, Australia, the United
States and Great Britain are tackling hepatitis C contamination through
blood and blood products. Screening of blood donations; Recipients of
blood transfusions; Questions on legal responsibility; Compensation for
patients; Intravenous drug use.
Full Text Word Count: 1392
Accession Number: 9510256662
Database: Health Source: Nursing/Academic Edition
COUNTRIES STRUGGLE WITH HEPATITIS C CONTAMINATION
In France a worker infected with the hepatitis C virus more than 10
years ago has won a lawsuit against a blood transfusion centre in
Marseilles. He was awarded an immediate sum of Fr 80 000 (£10 000) while
the full amount of compensation is decided. In France, only about 20
people have been compensated out of more than 100000 people estimated to
have acquired the infection from transfusions.
Compensation for patients infected by blood or blood products has become
a hot political topic in many countries. Approaches to the problem vary,
though the compulsory screening of donated blood is now widespread. Here
we examined how five countries--France, Germany, Australia, the US and
Britain--are tackling the problem.
In all five countries screening of blood donations for hepatitis C has
been compulsory since 1990-1. But many people who received blood
donations before that time could have been infected.
In Britain the Department of Health estimates that 6000 people have been
infected with the virus by the use of blood products, some 3000 of whom
have haemophilia. In Australia official estimates suggest that up to
200000 out of a population of 18 million are infected with hepatitis C
virus, though figures are not available for the numbers of infections
linked to blood transfusions. In Germany no estimates are available of
the number of people infected through blood transfusions, but before
compulsory screening was introduced in 1990 the risk was thought to have
been 1 in 5000.
Recipients of blood transfusions in Germany are offered free testing for
hepatitis C virus if their doctor considers it necessary. Free testing
is also available in Australia, Britain, and France.
The question of who is legally responsible when someone is found to have
been infected through blood transfusion is difficult. The Frenchman who
has just won his lawsuit sued the blood transfusion centre in
Marseilles. He had an accident and received blood during an operation in
July 1984. Eighteen months later he was diagnosed as having non-A, non-B
hepatitis, which was identified as hepatitis C in 1989.
Two years ago, a judgment made in MarseRies ruled that the man's disease
was attributable to the transfusion but excluded the blood centre's
responsibility on the grounds that at the time of the
transfusionscientific knowledge was not sufficient to guarantee blood
not contaminated by the virus, which had not yet been identified. The
regional court of appeals in Aix-en-Provence rejected the argument,
stating that the virus had been "spotted" in 1982, and that it Was known
that it could be transmitted through blood. To receive compensation
French patients must sue the blood centre that supplied the blood and
prove that it was the site of the contamination.
Cases could run into thousands
In Australia experts say that no court cases have yet progressed through
the legal system, But in New South Wales one elderly man, who was
infected in the 18 months after screening of the blood supply for the
virus began, is suing a large public hospital; and in the state of
Victoria five adults are seeking damages from the Red Cross blood bank
after allegedly acquiring the virus through contaminated transfusions.
The legal firm representing the five says that the number of cases could
run into thousands.
In Britain the government has just reiterated its position that there
will be no compensation for people infected with the hepatitis C virus
through blood transfusions. The Haemophilia Society, however, is
continuing its fight on behalf of the estimated 2000 haemophilic
patients who have been infected with the virus through the use of blood
products. In addition, about 100 people infected through transfusion
plan to sue the health department for negligence. They will argue that
screening of donations was introduced too late (September 1991) and that
earlier promises to improve the blood supply were not kept.
In the US legal liability has not been a big problem, according to a
spokesman for the American Association of Blood Banks. A few suits have
been pressed by people infected through transfusions, but none has gone
to trial. The plaintiffs' claims fall under "negligence," and because
the risk of infection cannot be completely removed, negligence would be
difficult to show. The lack of a national health service in the US means
that there is no universal mechanism to reimburse victims of standard
medical practice when it has later been shown to be harmful in some way.
In Germany virologist Professor Johannes Lower, who works at the Paul
Ehrlich Institute for Sera and Vaccines, says that he knows of no
patients seeking compensation for contracting hepatitis C from
tranfusions. But he points out that the risk of infection was known
before compulsory screening of blood donations was introduced and that
recipients of blood were informed of it.
The most common source of hepatitis C infection is probably intravenous
drug use. In France the Ministry of Social Affairs and Health estimates
that between 500 000 and one million people (about 1-2% of the
population) are hepatitis C carriers. The mode and origin of infection
are unknown for about half of them. For the other half, syringes shared
by drug addicts and blood transfusion are believed to be the main
methods of transmission.
Needle sharing by intravenous drug users is also the main source of
infection in Britain; it accounts for one in four cases in the US. About
half of the cases in the US are from unknown sources, according to the
Centers for Disease Control and Prevention, which also estimate that
about 18% of cases are due to sexual and household contact and less than
5% to blood transfusions. Germany and Australia also name needle sharing
by intravenous drug users as the main source of hepatitis C infection.
Australian authorities say that tattooing and the arrival of migrants
from areas with a greater prevalence of the disease, including South
East Asia, are also factors.
Most governments are now trying to help those infected through
transfusion. In Britain the health department has begun a project to
trace those who may have been infected. The deputy chief medical
officer, Dr Jeremy Metters, said: "Until recently there was no treatment
to offer those who might be infected and it was believed that this
experiment would have been technically very difficult. However, certain
drugs have recently been licensed which may be suit-able for the
treatment of some of those involved." The department is particularly
interested in the possibilities of using inter-feron alfa.
According to the French Blood Agency, 95% of patients infected with
hepatitis C virus remain symptom free, and in most cases
aminotransferase concentrations return to normal and antibodies
disappear. Acute hepatitis is rare. Chronic hepatitis is treated with
interferon alfa, and treatment is paid for by national health insurance.
In Germany health insurers pay for all treatments but are entitled to
challenge doctors if an expensive drug was unnecessary. Dr Nick Crofts,
head of epidemiology and social research at Melbourne's Burner Centre
for Medical Research, says that in Australia treatment with interferon
is available under Medicare.
Similarities between the infection of patients with HIV through blood
transfusions in the early 1980s and those infected more recently with
hepatitis C virus have led campaigners to demand similar compensation.
Clearly this could be expensive, and in France lawyers are working to
separate the two groups. French legal experts have argued that two of
the fundamental components of the prejudice caused by AIDS do not exist
in the case of hepatitis C: social isolation and the risk of death
(which is said to be very remote). Compensations awarded have therefore
been low, but in at least two cases they have reached Fr 1m (£120 000).
One award was made to a patient contaminated with hepatitis C virus who
received an additional Fr 2m (£240 000) for contamination with HIV;
another was to a 46 year old woman infected with the hepatitis C virus
PHOTO (BLACK & WHITE): Processing blood.Until recently no one looked for
PHOTO (BLACK & WHITE): The ELISA test for hepatitis G: trays of blood
laid out for testing for antibodies to the virus
By CHRISTOPHER ZINN in Australia; OWEN DYER in Britain; ALEXANDER
DOROZYNSKI in France; HELMUT KARCHER in Germany; and JOHN ROBERTS in the
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Source: British Medical Journal, 2/18/95, Vol. 310 Issue 6977, p417, 2p