“CDC Classification Promotes Epidemics” – Dr. David Lewis

“CDC Classification Promotes Epidemics” – Dr. David Lewis

By TLB Science Advisor: Dr. David Lewis

Swiss scientists reported recently that human papillomavirus, HPV, remains in nooks and crannies of gynecological instruments. This may place women who undergo routine gynecological examinations at risk of becoming infected. HPV is the leading cause of anal and cervical cancers. I first became aware of this problem in the 1990s when someone familiar with my research on HIV transmission in dentistry told me one of his patients developed a sexually transmitted disease following a gynecological exam. I also personally know a woman diagnosed with HPV-related anal cancer linked to colonoscopy.

The CDC’s infectious disease surveillance system mainly detects large outbreaks. Physicians, for example, have been criminally prosecuted for cross-infecting hundreds or possibly even thousands of patients by reusing hypodermic syringes. The CDC classifies medical devices that enter sterile areas of the body as “critical” devices. When not sterilized, they are very efficient at spreading infections.

Gynecological instruments, flexible endoscopes, dental drills and other devices that contact mucus membranes, but don’t normally enter sterile areas, are classified as “semi-critical” devices. So far as the FDA and CDC are concerned, it’s perfectly acceptable for these devices to be only partially cleaned, briefly subjected to germicides that cannot penetrate residual patient materials, and then reused. Semi-critical devices typically generate sporadic infections involving only a few patients, which usually go undetected. Their routine use on millions of patients causes innumerable sporadic infections under the CDC’s radar.

Research my coauthors and I published in Lancet and Nature Medicine suggests that non-sterilized semi-critical devices have created an invisible tunnel through which infectious agents are widely shared among the general population, including with high-risk groups. The impact this invisible tunnel of widespread sporadic infections is having on public health is indicated by epidemics of hepatitis B and C viruses, HBV and HCV.

HBV is mainly transmitted through blood-contaminated medical devices and sexual intercourse. High-risk groups include, for example, injection drug users and prostitutes. From 1986-94, the number of cases annually reported in the United States dropped 50%, mainly among injection drug users. The CDC took credit for this achievement, citing its guidelines for HBV vaccinations and efforts to educate drug addicts. HCV, which is primarily spread by sharing dirty needles, dramatically declined beginning in 1989. Although the CDC attributes much of this decline to eliminating HCV from the nation’s blood supply, that effort didn’t begin until 1991.

The plummeting of HCV and HBV in the United States was more likely due to improvements in dental infection control beginning in 1989, including heat-sterilization of semi-critical devices. They began when dental-related HIV cases surfaced. The CDC ruled out this possibility, but failed to consider how these improvements reduced the widespread sporadic introduction of blood-borne viruses to injection drug users and other high-risk groups throughout the country.

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