According to the report, of the 33-36 million people estimated to be HIV positive worldwide, 5 – 10 percent were infected by a contaminated blood transfusion. Direct blood stream exposure to HIV is the most efficient means of transmission – more than 92 percent of HIV-contaminated transfusions result in infection, while less than 1 percent of intravenous drug injections with a contaminated syringe do.

Blood transfusion services, coupled with safe medical procedures, are vital to health systems, helping to save people’s lives every day. Until recently, according to the study, little was known about blood transfusion systems in Central Asia and their contribution to disease transmission. The report found that the current screening of donated blood in Central Asian health systems may not be fully effective, and leaves some real risk of transfusion of infected blood by unsuspecting doctors to unsuspecting patients. Even more alarming is the finding that some health facilities in Central Asia do not test blood donations at all.

Countries covered by the study were Kazakhstan, Kyrgyz Republic, Tajikistan, and Uzbekistan, in which blood samples from 7,500 blood donors were re-tested at national reference laboratories. The re-screened blood samples were screened for HIV, syphilis, and hepatitis B and C. The blood sample re-testing identified cases of HIV that had been undetected by the blood center laboratories that originally tested the samples. These cases included HIV-infected blood unitsthat reached health facilities. The re-testing found a prevalence of communicable diseases in the blood samples to be 0.20 percent for HIV, 2.7 percent for hepatitis B, 3.0 percent for hepatitis C, and 3.6 percent for syphilis. The restesting also found a prevalence of 8.6 percent for ALT elevation, signaling the potential residual risk of transmission of viral diseases during the "window" period "when markers for these diseases are still not detectable in blood donations.

"Indeed patchy testing of donated blood is creating a false sense of security in the Central Asian health systems," said Patricio Marquez, World Bank Lead Health Specialist and author of the report. "These findings underscore the need to strengthen screening of blood donors for each donation and strengthen other prevention and control measures to guarantee the safety of the blood supply in the health systems of the Central Asia countries. Such improvements would reduce the potential risk of involuntary infection to the unsuspecting population."

Although blood transfusions are a small contributor to infectious disease transmission compared to other well-reported modes, the report emphasizes that national governments have a responsibility to their populations to ensure the safety of the blood supply in their countries’ health systems.

"Numerous parts of these countries’ blood transfusion systems," said Marquez, "are in serious need of restructuring, of new investments, and of increased budgetary support for operation and maintenance. And the low level of blood supplies in Central Asia is driven by a culture that places little value on donating blood, fear by people of getting infected by donating blood, and the near non-existence of campaigns to promote blood donations among low-risk populations. These trends need to be reversed."

The report recommends measures to Central Asian governments to improve blood services, including optimizing the laws and regulations, putting in place nationally coordinated blood transfusion systems, universal unpaid blood donor systems, and regular donor promotion campaigns. Special attention is also placed on effective donor screening strategies, training of medical personnel, and promoting justified and rational use of blood and blood products, among others.

Ensuring blood supply safety, however, is a difficult challenge for poor countries with weak and underfunded health care systems. Therefore, the support of the international community is critical to helping countries in the region block this source of communicable disease transmission as part of the broader efforts to restructure health systems.

The report draws on results of assessments carried out in collaboration with the US Centers for Disease Control and Prevention and the World Health Organization Regional Office for Europe, and with the Central Asian countries’ Ministries of Health.