Education on the risks and absolute unacceptability of re-using needles and syringes and of

inadequate hospital sterilization measures will be very important, preferably combined with governmental initiatives and mandates against these vectors of infection. In addition, clear guidelines on universal precautions can reduce risks for health-care workers, while guidelines regarding the management of health-care AG-014699 supplier workers who are infected with HBV, HCV, and/or HIV can protect patients.27 Screening for HIV, HBV, HCV, malaria and syphilis is compulsory for all blood donations. According to the World Health Organization (WHO), Viet Nam has made www.selleckchem.com/products/Staurosporine.html substantial progress on transmission of HBV or HCV via blood transfusions and other blood products, increasing the rate of voluntary blood donations, the safest source of blood, from less than 15% in 1994 to more than 65% currently.28 To further reduce risks, WHO recommends developing quality assurance systems in blood centers and blood banks nationwide and creating a national blood service and a national blood policy in Viet Nam.

Re-use of contaminated needles and syringes by injecting drug users (IDU) is another substantial risk factor, with the prevalence of HCV shown to be extremely high (87%) in IDU in Ho Chi Minh2 Cepharanthine and northern Viet Nam (74.1%).18 The prevalence of HBV among IDU in northern Viet Nam is also extremely high

(80.9%).18 Researchers have strongly recommended interventions that target new heroin users.29 A 1998 study indicated the feasibility of establishing needle/syringe exchange programs in Viet Nam.30 The Vietnamese government has supported harm-reduction through needle/syringe exchange,31 and a recent study has shown that it contributes to safe injecting practices as well as safe disposal of used needles/syringes.32 Alas, despite the government’s support, the overall access to clean syringes/needles nationwide remains quite limited, with one recent study showing that 90% of IDU in seven provinces had no access to sterile injection equipment,33 so substantial expansion of harm-reduction programs is needed. It is not uncommon for needles and knives to be re-used in tattoo shops. In one study, tattoos were one of the two main risk factors for HCV.21 Since household sharing of razors is a risk factor for HBV,4 the same risk would apply to commercial re-use. Educating barbers and tattoo shop personnel about such risks is very important. This is a developing country with a relatively low annual per capita income (approximately $US1024)34 and very limited annual per capita spending on health care (according to WHO, approximately 264 international dollars, 2006).