Subhas Chandra Pattanayak
The National Blood Policy makes it a must for the State “ to provide safe and adequate quantity of blood, blood components and blood products” (Objective 1) and “to make latest technology available” (Objective 3) to the blood banks for correct screening so that patients needing urgent transfusion would get safe blood.
But the State government run by Naveen Patnaik has failed to adopt “latest technology” as a result of which AIDS is spreading through blood transfusion in Orissa. Dependents on frequent transfusion such as thalassemia patients are more vulnerable to Virus 1 (HIV-!), Hepatitis C Virus (HCV) and Hepatitis B Virus (HBV).
After we exposed this phenomenon in these pages, various news media organizations have been harping on about the urgency of adoption of latest technology in screening of blood.
In a case of a 17 month old child who is infected with AIDS after taking blood transfusion, the Orissa High Court, a year ago, had not only awarded a cash compensation worth Rs. 3 lakhs to the infected boy, but also had made it a “must” for the Government to adopt advance technology, i.e. NAT PCR method in “all the Blood Banks” for blood screening, in order to ensure supply of “safe blood” to patients. Its mandate is in these words: “Therefore, the Government must ensure that in all blood Banks the Polymer Chain Reaction (PCR) method is available to identify the virus of HIV during window period”.
Steps to Implement the Court Order
This judgment had forced the State government to review its blood screening scenario in a high level committee constituted for the purpose under the chairmanship of Dr. Pramod Meherda, IAS, M.D., NRHM & Project Director, Orissa State AIDS Control Society.
The Professors & Heads of Departments of Microbiology in VSS Medical College, Burla Dr. Sudhir Kumar Ghosh, the Professors & Heads of Departments of Microbiology in MKCG Medical College, Berhampur Dr. Binojini Parida, the Associate Professors in Microbiology department of MKCG Medical College, Berhampur, the Associate Professors in Microbiology department of SCB Medical College, Cuttack Dr. Bimoch Prajna Pati, the Drug Controller of Orissa, Ex-Director of SBTC Dr. L.N.Hati, Dr. Mangala Pr. Mohanty, Hon. Secretary, IRCS-OSB, Director of Central Red Cross Blood Bank at Cuttack Dr. Benudhar Satpathy and seven other top functionaries were members in this committee.
Unanimous Recommendation for NAT
The Committee met on 25 Feb.2012 at the Conference hall of OSCAS. Its minutes disclose, “After thorough discussion on NAT PCR technology, the Committee unanimously recommended that the NAT PCR technology which is the latest testing facility need to be introduced for screening of the blood units to reduce the gray zone period of Transfusion Transmissible Infections like HIV-I, HIV-II, Hepatitis-B and HCV, as it is the latest and foremost technology available in India”.
The Sleeping State
Despite this “unanimous” recommendation submitted “after thorough discussion” by all the above noted illustrious microbiologists, serologists and other specialists in the Committee, the State Government did not wake up to the occasion.TTI continued to affect lives in Orissa.
We had to expose this monstrous negligence of the state to the most urgent need of the moment in these pages on 8 July 2012.
Thereafter, on 24 July 2012, the Secretary of Health P.K.Mohapatra took a “meeting on implementation of NAT PCR in Blood Banks”.
To our surprise and shock, we found that all the super-specialists, serologists and microbiology Professors who, “after thorough discussion” in the previous meeting of 25 February 2012 had “unanimously” recommended that “the NAT PCR technology which is the latest testing facility need to be introduced for screening of the blood units to reduce the gray zone period of Transfusion Transmissible Infections” were kept out of this meeting and a Director of Medical Education and Training (DMET) having no role under the rules of business in the concerned matter, who was to retire from service the same month, was encouraged to lobby for the old ELISA method and to raise a bogus allegation that the High Court had delivered its verdict directing for adoption of NAT PCR for blood screening without being “apprised properly on the issue under reference”. And, it seems, such aspersions against the High Court was approved in the meeting, as is evidenced in its 1st resolution that reads, “ Special Secretary (Technical) H&FW Department, Govt. of Orissa will move file for filing a review petition against the judgement”.
New Tricks of subterfuge
It is seen from the meeting taken by the Health Secretary, that ,the Special Secretary of the Department who hails from the pool of Doctors, collaborated with the said DMET in confusing the issue with a downloaded document of Canadian Blood Banking Association “where it is mentioned that the HIV positive scenario is 1 in 2.7 million than ELISA”. The quoted observation is a conundrum and the Health secretary, before signing the minutes, has failed to notice this confusing expression. However, one is at a loss to understand when the Special Secretary with a downloaded version of Canadian Blood Banking Association was allowed to mislead the meeting, why had the Health secretary not wanted to know how the scenario is seen by Indian authorities on blood screening by NAT, specifically as India has a high prevalence of the killing viruses when Canada is almost free of these killers.
The Chilling Scenario in India
A research reported in Indian Journal of Medical Research (127, February 2008, pp 140-147) is captioned “Multicenter evaluation of individual donor nucleic acid testing (NAT) for simultaneous detection of human immunodeficiency virus-I & hepatitis B & C viruses in Indian blood donors”.
The research was based on the ground that “India has a high prevalence of HIV-I, hapatitis C & B viruses (HCV and HVB) in the blood donors but has yet to implement nucleic acid testing (NAT) in blood screening”. It had tested 12,224 samples along with their serological results obtained from representative eight blood banks in India and had submitted its findings to the Journal on 26 September 2006.
Luminaries in the field namely R.N.Makroo, N. Choudhury, L. Jagannathan, M. Parihar-Malhotra, V. Raina, R. K. Chaudhary, N. Marwaha, N. K. Bhatia, and A. K. Ganguli had conducted the research that the Department of Transfusion Medicine, Indraprastha Apollo Hospital, New Delhi, had patronized.
They reported, “Data from our study suggested that the NAT yield for all three viruses (HIV, HCV and HVB) in India could be 29 times higher than that observed in Japan, and higher for HIV-I alone. Our observed HIV-I yield was over 515 times that observed in the US and Canada, 89 times that observed in Italy”.
So, citing a report of Canada where the prevalence of HIV-I is 515 times less than India, to frustrate the “unanimous recommendation” of the earlier committee, is not only low on merit but also is a mischievous attempt to mislead the Government.
The study cited above has concluded that its “observed NAT yield for all three viruses was 1 in 1528. This study was conducted in 2006. Now the 1 has become 3 inasmuch as every blood unit is becoming 3 units of blood products viz. platelet, plasma and pack cell. This means, if the virus was escaping EISA test in one out of 1528 samples, it would be read as three escapes in 1528 samples. This estimation relates to 2006 when HIV-I was not as wide spread as it is today. So, in every 1528 cases, it can be safely said that multiples of three cases of HIV-I infection are not being detected through screening in ELISA method.
In Orissa, blood collection has reached 3 lakh units per year. Divided into the three categories, i.e. platelet, plasma and pack cell, the total collection becomes 9 lakh units. If the 2006 study is applied to this volume of 9 lakh units, at least 1767 transfusion takers are possibly getting AIDS infected with the virus escaping detection, as ELISA is not efficient to detect the virus during the “window period”.
Orissa has 81 blood banks out of which 56 are running under joint banner of the state government and Red Cross whereas only one blood bank functions directly under the Government. rest are privately managed. Out of all these 81 blood banks the ELISA facility is also not available in 23 blood banks. After we exposed the malady, the government has ascertained through review that these blood banks having no ELISA facility are using rapid test kits to detect AIDS virus! The meeting held on 24 July under chairmanship of the Health Secretary (where he was in fact not even present) has noted this in its resolution No.2 and suggested that “No blood bank should procure any rapid test kit for hepatitis B & hepatitis C and HIV at their level”. The rapid test is a method through which the viruses escape detection. Taken into consideration, this makes it clear that non-detection of AIDS virus is alarmingly rampant in Orissa.
Yet, the mandarines in the health department have kept the High Court oder for adoption of NAT PCR method inoperative and are conniving to go in litigation against the said order.
Just imagine, how unsafe is Orissa .