Those who, despite our many warnings, dismiss the risk of Hepatitis C and other BBV infections from needles discarded by IV dug users (IVDUs) tend to ignore the statistics, of high endemicity rates and an approximately up to 30% for Hepatitis B, up to 3% for Hepatitis C and around 0.3% for HIV.

But those statistics are compiled for hospital-based injuries where blood is fresh. Not so for discarded needles, say those who choose to dismiss this particular risk, since any blood will be very old and thus the infectivity of any virus present will be low or non-existent.

Local Authorities know full well that clearing a hotspot area of discarded needles will almost inevitably result in many more fresh needles by the next day. For Local Authorities this creates a constant waste management challenge with obvious safety implications. Not only will many, perhaps most, of the needles be fresh but the incidence of Hepatitis C infection among IVDUs is particularly high, as is co-infection with HIV or Hepatitis B.

Almost every clinical protocol for sharps injury management will rank an injury caused by a needle from an individual who is unknown, and therefore not available for testing (or some pretty good guess), to be the highest risk. Thus, those exposed to discarded sharps found in the community and most probably used by IVDUs, or sharps from clinical wastes managed by ancillary staff and waste handlers who are unlikely every to be able to track wastes back to source with sufficient speed and certainty, will warrant close follow-up and quite probably some intensive anti-viral therapies to prevent development of infection.

Instead of dismissing this risk and assuming blithely that any discarded needle will be old and thus of lesser risk, the risks are in fact magnified beyond those widely quoted risk rations for BBV transmission.

The problems of Hepatitis C infection in a near down-and-out city community is amply described in an excellent piece in The Wall Street Journal. Describing the enormous scale and many facets of the problem in Dundee this makes grim reading indeed.

And for those who would dismiss the risk of infection from discarded IVDU needles, think again. Please.