Tainted Blood Research Articles

Blood Donation and Institutional Trust: Risk, Policy Rhetoric, and the Men Who Have Sex with Men Lifetime Deferral Policy in Canada

This article examines the process of rebuilding institutional trust in the Canadian blood system in the aftermath of the tainted blood scandal. Our focus is the policy of lifetime deferral from donating blood for men who have sex with men. Drawing on findings from interviews with representatives of Health Canada's Expert Advisory Committee on Blood Regulation, the National Liaison Committee, Canadian Blood Services, and blood consumer groups, we demonstrate how claims making about rights, discrimination, science, and risk contribute to policy continuity. We also examine the link between policy continuity and the management of reputational risk.

Evaluating pathogen reduction of Trypanosoma cruzi with riboflavin and ultraviolet light for whole blood

Trypanosoma cruzi, the protozoan parasitic agent of Chagas disease, can be transmitted by blood transfusion. In 2007, most US blood banks started screening blood donations for T. cruzi, but the cost and perceived need of the test have been the subject of ongoing discussion. In this study, we evaluated the ability of the Mirasol System (CaridianBCT), which uses riboflavin (RB) and ultraviolet light to inactivate pathogens, to reduce the levels of infectious T. cruzi in whole blood (WB). WB units were inoculated with 4, 40, 400, and 4000 trypomastigotes/mL. After addition of RB and illumination at various energy levels, the samples were tested for the presence of live parasites by hemoculture. All preillumination samples exhibited T. cruzi growth in hemoculture, while postillumination samples from units containing 4 and 40 trypomastigotes/mL showed no signs of viable parasites after 16 weeks of culture. In contrast, at both 400 and 4000 parasites/mL, two of the three units were positive for viable parasites. The total log reduction observed for T. cruzi was 3.5 log or greater, but less than 4.5 log. This level of reduction is likely to be orders of magnitude higher than what would be expected in a tainted blood donation, indicating that the Mirasol System could be effective at preventing transfusion of the causative agent of Chagas disease.

Dengue Vaccines: Challenge and Confrontation

Dengue has been recognized as one of the most important vector-borne human diseases. The disease is induced by dengue virus infection resulting from the bite of an infected Aedes spp. mosquito after imbibing the tainted blood from animals or patients. Dynamic clinical spectrums ranging from asymptomatic, undifferentiated fever, typical dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) have been well documented. Initially, the disease was mainly restricted in tropical and subtropical zones. However, with factors such as ineffective vector control, frequency of human migration, unplanned urbanization, and changing climate temperature, the disease has been spotted at almost every territory of the earth. Dengue has been associated with human disease for more than two centuries. Although classic DF is viewed as a self-limited illness, subjects normally resolve within two weeks and recover without any noticeable complications or sequelae, some of these infected individuals may progress to life-threatening DHF/DSS, characterized with plasma leakage due to an increase in capillary permeability. The significantly increased public health threat and the burden of morbidity and mortality of dengue globally has caught the attention of public officials and prompted an action to find a way to contain and prevent the disease. The lack of specific dengue therapeutics has led to an emphasis on vaccine development, one of the best and effective strategies to reduce and prevent the illness. Making a dengue vaccine has been attempted more than six decades; although some of these products are in clinical trials, vaccine development for the prevention of dengue disease is still at its infancy. So far no dengue vaccine is available for the public. Dengue vaccine development may be hindered by the complexity of the clinical presentations, which implicates that multiple pathogenic mechanisms are involved in dengue disease. Some of these elements will be discussed in the current review. Opening up discussion on these pros and cons and engaging in more research to understand these features would not only improve the understanding of the pathogenesis of the dengue virus infection but also pave a new tactic to develop a safer and effective dengue vaccine.

More than one and less than many: Materialising hepatitis C and injecting drug use in self-help literature and beyond

Knowledge about disease and illness usually emerges as a result of complex social negotiations among those with a stake in the outcomes of this knowledge. These negotiations can involve a range of agents and discursive avenues, some of which are contradictory and paradoxical. This is especially true for the blood-borne virus hepatitis C, the medical, social and political features of which – associations with injecting drug use, ‘tainted blood’ scandals and HIV – render it a controversial disease involving a range of highly motivated stakeholders. In this paper I analyse one such set of agents in the process of disease knowledge negotiation: self-help books on hepatitis C. In conducting this analysis I offer insights into the content of the books and the way they construct hepatitis C and those who have it. I do this by mapping three key issues helping to shape the way hepatitis C is constituted in these books: HIV, injecting drug use and iatrogenic (medically caused) transmission, and by exploring the implications of the themes of emotion, risk and guilt that arise in the playing out of these issues. In the process I aim to make sense of the complexity of disease, its social constitution and its role in shaping social phenomena such as stigma.

Fostering public engagement

I read with interest the article on public engagement in setting health care priorities.[1][1] As the chief executive officer of Canadian Blood Services, an organization that emerged from the tainted blood tragedy of the 1980s, I can attest to the value of engaging the public in decision-making.

Combining Residual Insecticide Spraying Campaigns with Targeted Detection and Specific Chemotherapy for Trypanosoma cruzi Infection in Children

Combining Residual Insecticide Spraying Campaigns with Targeted Detection and Specific Chemotherapy for Trypanosoma cruzi Infection in Children

The Krever Commission 10 years later

On Nov. 25, 1997, Justice Horace Krever released his landmark report on how Canada's blood system managed the threat of HIV and hepatitis C transmission from blood transfusions.[1][1] The tainted blood tragedy, as it came to be called, was arguably the largest public health catastrophe in this

Doctors not to blame over HIV infection by tainted blood

Doctors not to blame over HIV infection by tainted blood

Shared decision-making in the physician-patient encounter in France: a general overview

In France, patients' claim for information and participation to medical decision-making was initiated in the eighties by AIDS associations, then reinforced by the tainted blood scandal and more recently by demands from cancer patients. The right to patient information was recognised on March 4th 2002 by the law pertaining to patients' rights and the quality of the healthcare system. The present article will explore this background by examining the bases, the current status and the development of shared decision-making in the physician-patient encounter in France. We will describe the evolution of the physician-patient relationship on the basis of legal and administrative documents, then show that patients' information, and more generally healthcare users' information, is a central concern for some national health institutions. Finally, we will demonstrate that even if the literature on shared decision-making is little developed in France as compared to other European countries, Northern America and Australia, some studies have nonetheless been conducted. Their results, combined with a legal context and national health institutions encouraging shared decision-making, should prompt otherwise reluctant healthcare professionals to implement this approach in everyday medical practice.

Tuareg ethnoveterinary treatments of camel diseases in Agadez area (Niger)

For generations, nomadic herders have been learning to manage herd health, particularly in dromedaries because of their great value. Owing to the unavailability of veterinary services, camel herders in remote areas have been developing their own pharmacopoeia and veterinary techniques. The bleeding of sick animals is a common treatment, as Tuareg herders believe that 'tainted blood' (izni) is the cause of many conditions. Several surgical techniques are also used, such as excision of calcified sublingual cord. The remedies mentioned in this survey are derived from Maerua crassifolia, Boscia senegalensis, Acacia raddiana, Cucumis prophetarum, Calotropis procera, Ricinus communis, Citrullus colocynthis, green tea, millet, tobacco and onions. Artificial elements are also used for treatment of animals: Powders collected from batteries, various haircare or skincare creams, crushed glass, insecticides or motor oil belong to their pharmacopoeia. This broadmindedness allows the introduction of modern veterinary medicine. Factors such as the lack of real production objectives constitute limits to this progress, however.

Variant Creutzfeldt–Jakob disease and the Canadian blood system after the tainted blood tragedy

The transfusion transmission of hepatitis C and HIV to thousands of Canadian blood recipients was one of this country's largest public health catastrophes. In response to this crisis, and in an effort to prevent such a tragedy from occurring again, the Canadian blood system has undergone substantial reform. Variant Creutzfeldt–Jakob (vCJD) disease was the first infectious threat faced by the blood system since undergoing reform. The response at the time to this risk provides insights into the Canadian blood system's new approach to infectious threats. Our analysis of the decision-making concerning vCJD identifies two dominant themes characterizing the new blood system's approach to safety: (1) the adoption of a precautionary approach to new risks which involves taking action in advance of definitive evidence, and (2) risk aversion amongst policy makers, which has contributed to the adoption of safety measures with comparatively high cost-effectiveness ratios. Overall the principles governing the new blood system have contributed to the system both providing protection against emerging infectious risks and regaining the confidence of the public and recipients. However, the current set of policy factors will likely contribute to increasingly risk-averse policy making that will contribute to continued increases in the cost of the blood system. The challenge the blood system now faces is to find the appropriate balance between maximizing safety and ensuring the system remains affordable.

The Pocahontas Exception: The Exemption of American Indian Ancestry from Racial Purity Law

This article addresses the treatment of Native American ancestry as a curious exception to the threat of racial impurity. Virginia's Racial Integrity Act of 1924 aimed to prevent all interracial marriages in the state between white and nonwhite persons. This antimiscegenation statute sought to eradicate stealth intrusions of tainted blood into the white race, which proponents believed to be threatened by the quagmire of mongrelization. Exempted from this racial policing regime were those influential whites, the First Families of Virginia, who proudly claimed Native American ancestry from Pocahontas. For a statue with racial purity as its obsession and mantra, how does this exceptionalism hold? Why would Native American ancestry, as opposed to others, pass as acceptable nonwhite blood and good law? Even in our contemporary era, why do claims of the Cherokee Princess Grandmother not invoke multiraciality? This disparity calls for a critical inquiry of the miscegenistic exceptionalism accorded to American Indians. With increasing numbers of Americans freely and lately claiming Native ancestry, we may ask why such affirmations do not meet the triumvirate of resistance, shame, and secrecy that regularly accompanies findings of partial African ancestry. This paper contends that antimiscegenation laws relegate Indians to existence only in a distant past, creating a temporal disjuncture to free Indians from a contemporary discourse of racial politics. I argue that such exemptions assess Indians as abstractions rather than practicalities. These practices bifurcate treatments of Indian blood, either essentializing a pre-modern and ahistorical culture, or trivializing this ancestry as inconsequential ethnicity.

Tainted Blood and Vengeful Spirits: The Legacy of Japan’s Yakugai Eizu (AIDS) Trial

Medical anthropologists often point to the importance of "illness narratives" as emergent or incipient forms in which patients attempt to make sense of the moral dimensions of illness and suffering (Kleinman 1988; Mattingly 1998). In this article I draw upon published accounts, newspapers, and legal documents, supplemented by ethnographic interviews carried out from 1999 to 2001, to show how plaintiffs in the yakugai AIDS trials brought by HIV-infected hemophiliacs against the Japanese government and the pharmaceutical industries that sold them tainted blood products appropriated powerful cultural themes in producing narrative accounts of their suffering. These narratives resonate with themes of lost trust, filial piety, and the desire for a "good death." In contrast, I show how the neat and tidy narrative that emerged in the course of the yakugai AIDS trial served to impose meaning upon the plaintiffs' unruly experiences such that, when it was over, the Japanese public was convinced that the "AIDS problem" had been "solved."

Richard Darling, President and CEO of the FAIR Foundation

Richard Darling, President and CEO of the FAIR Foundation

The World Federation of Hemophilia: 40 years of improving haemophilia care worldwide.

In 2003, the World Federation of Hemophilia marks its 40th anniversary. Established in 1963 by Frank Schnabel, a person with hemophilia from Montreal, Canada, the WFH has grown into its role as an independent, not-for-profit representative of the global haemophilia community. Since then, its biannual world congresses have provided an opportunity to exchange information on research and treatment. Today, more than 3,000 delegates attend these congresses. Until the early 1990s, the WFH's other major function was the International Hemophilia Training Centre programme, offering training fellowships and workshops to medical and paramedical staff from developing countries. In 1982, AIDS was reported in people with haemophilia who had received tainted blood products. The WFH developed task forces and committees to monitor safety and supply issues and set up the Global Forum on the Safety and Supply of Treatment Products. In the mid-1990s, twinning programmes were established for treatment centres and national haemophilia organizations. Twinning facilitates the exchange of training, coaching, and expertise. In the late 1990s, the WFH expanded and began working with local organizations and health authorities in a number of countries to improve the diagnosis and care of persons with hemophilia. The federation currently has ongoing projects in 25 developing countries. On World Hemophilia Day, April 17, 2003, the WFH launched the Global Alliance for Progress (GAP) in haemophilia which aims to double the number of people with haemophilia diagnosed and receiving treatment in up to 40 developing countries over a 10-year period.

The Politics of Naming, Blaming and Claiming: HIV, Hepatitis C and the Emergence of Blood Activism in Canada

The term ''blood activism'' describes the range of collective challenges that arose among victims of Canada's tainted-blood scandal in the 1990s. This article examines the emergence of blood activism in Canada from the perspective of social movement theory, paying particular attention to the tensions between victims who contracted HIV through tainted blood and those who contracted Hepatitis C, the so-called ''forgotten victims'' of the tragedy. This study discusses how changes in the ''political opportunity structure''—loosely defined in the literature as aspects of the movement's external environment—influenced the nature of political action pursued by victims of tainted blood, the negotiation of the movement's collective identity and policy outcomes.

Safety of blood supply for infectious diseases in Latin American countries, 1994-1997.

The potential risk of acquiring a transfusion-transmitted infection by the human immunodeficiency virus (HIV), hepatitis B (HBV) virus, hepatitis C (HCV) virus, or Trypanosoma cruzi was estimated for seven South American and five Central American countries during the period 1994-1997. The estimates were based on official national reports of the number of donors, blood screening coverage, and prevalence of serologic markers for infectious diseases. Coverage of screening in 1997 was 100% in 12 and 11 countries for HIV and HBV respectively. Complete screening for HCV was reported by only one country in 1994 and by six in 1997. For T. cruzi, the number of countries with 100% screening coverage increased from two in 1994 to four in 1997. In 1994, three countries showed risk of transfusion-transmitted infections for HIV, seven for HBV, eight for HCV, and seven for T. cruzi. The risk of receiving an infected blood unit and acquiring a transfusion-transmitted infection has been reduced with time in 10 of the 12 countries due to improvements in screening coverage. In Uruguay, the risk was theoretically nil from 1994-1997 because at the beginning of the study period they already had 100% blood donor screening for all infectious diseases transmitted by blood. In 1994, Colombia and Venezuela had the highest health risk associated with blood transfusion (spreading index of 101 and 62, respectively); during the period 1996-1997, Costa Rica presented the highest figures (spreading index of 53 and 83, respectively). The analysis of the potential risk associated with transfusion of tainted blood highlights the need for continuous monitoring of the safety of blood supply.

Preventing the spread of hepatitis B and C viruses: Where are germicides relevant?

Hepatitis B virus (HBV) and hepatitis C virus (HCV) are the most prevalent bloodborne pathogens. Infections caused by these organisms can become chronic and may lead to liver cirrhosis and carcinoma. Limited chemotherapy is now available, but only HBV can be prevented through vaccination. Both viruses are enveloped and relatively sensitive to many physical and chemical agents; their ability to survive in the environment may not be as high as often believed. As a result, their spread occurs mainly through direct parenteral or percutaneous exposure to tainted body fluids and tissues. Careful screening of and avoiding contact with such materials remain the most effective means of protection. Nevertheless, the indirect spread of these viruses, although much less common, can occur when objects that are freshly contaminated with tainted blood enter the body or contact damaged skin. Germicidal chemicals are important in the prevention of HBV and HCV spread through shared injection devices, sharps used in personal services (such as tattooing and body piercing), and heat-sensitive medical/dental devices (such as flexible endoscopes) and in the cleanup of blood spills. Microbicides in vaginal gels may also interrupt their transmission. General-purpose environmental disinfection is unlikely to play a significant role in the prevention of the transmission of these viruses. Testing of low-level disinfectants and label claims for such products against HBV and HCV should be discouraged. Both viruses remain difficult to work with in the laboratory, but closely related animal viruses (such as the duck HBV) and the bovine viral diarrhea virus show considerable promise as surrogates for HBV and HCV, respectively. Although progress in the culturing of HBV and HCV is still underway, critical issues on virus survival and inactivation should be addressed with the use of these surrogates. (Am J Infect Control 2001;29:187-97)

Cruel and Unusual: Parsing the Meaning of Punishment

If Foucault's metropolitan world of public torture--"the great spectacle of physical punishment,"--died out by the beginning of the nineteenth century, the punitive spectacle and its requisite bodies were resurrected in the colonies. Given the lack of precedents in English law, the speed with which the institution of slavery took shape in the United States and the severity of the laws that effected it are exceptional. Although strategies of divestment were already present in the rights of property and privilege at common law, and later tied to the definition of property in persons; black slaves, regarded as outside the social order, gave new genetic capital to the principles of tainted blood, bondage, and servility.

Hemophilia: A Story of Success—Disaster and the Perseverance of the Human Spirit. Part 1: Background and Overview

Until the 1980s, persons with hemophilia were a small, insular, and relatively unknown population within the United States. They generally lived quiet lives, attempted to blend in with the general population, and went about their lives while coping with a physically devastating illness in relative anonymity. Through the first eight decades of this century, hemophilia was an obscure, misunderstood, and basically unknown disease to the society at large. This situation remained true until the outbreak of the AIDS epidemic and of the mass infection of persons with hemophilia through the infusion of HIV-tainted blood products. It is estimated that 50% of persons with hemophilia are currently infected with HIV, and among those with the most severe form of hemophilia, more than 90% are HIV infected. Also, as a result of infusion of tainted blood products, more than 90% of all persons with hemophilia are infected with hepatitis C. This makes the hemophilia community the largest HIV/HCV coinfected group in the United States. There are two types of hemophilia. Of those with hemophilia, 80% have classic hemophilia (type A), in which the eighth factor in the clotting cascade is deficient or virtually nonexistent. The remaining 20% of persons with hemophilia have type B, in which the ninth factor in the clotting cascade is deficient. Within these two types of hemophilia, persons are classified as having severe hemophilia (60% of cases), moderate hemophilia (15% of cases), or mild hemophilia (25% of cases). These classifications are based on the severity of the factor VIII or factor IX deficiency that exists. The latest data from the Centers for Disease Control and Prevention report the incidence of hemophilia at 1 per 5,032 male births in the United States. Worldwide, the incidence of hemophilia is estimated to be 15 to 20 per 100,000 male births. Statistics from the hemophilia treatment centers indicate that there are currently 13,321 persons with hemophilia A and 3,638 persons with hemophilia B in the United States.