I propose to take Questions Nos. 1, 6, 12, 14, 30, 61, 69, 73, 78, 81, 95, 99, 100, 102, 110, 113, 114 and 139 together.
The hepatitis C virus was first described in 1989. As I have indicated to the House, the question of introducing a screening test for hepatitis C for donations nationally had been considered in 1989 and 1990. During this period, the Blood Transfusion Service Board and the Department of Health examined the possibility of introducing such a test. However, a review of international practices and discussions with medical experts in other countries revealed that there was insufficient scientific information about the test to approve its routine introduction. The position was carefully monitored and, when the test was considered sufficiently reliable for the purposes of screening donations, it was introduced in Ireland. This occurred in 1991 at the same time as the screening was introduced in the UK.
The Blood Transfusion Service Board advised me on 17 February 1994, of a problem with the Anti D product and I immediately authorised the national blood screening programme. I have been informed by the Blood Transfusion Service Board that the number who have been screened for hepatitis C antibodies under their hepatitis C/Anti D Screening programme is 46,269 and that the number who have tested positive is 883 up to and including 12 April 1994. A further confirmatory test is being carried out on the blood samples given by these women and some may yet prove to be negative.
The recipients of Anti-D may have received the product in more than one year. The board has informed me that the recipients testing positive have an average of 3.3 exposures to the product. Because of this it is not possible to say which year they were infected with hepatitis C. I have been informed by the Blood Transfusion Service Board that 587 received Anti D in 1977. Six per cent of those presenting for testing with 1977 exposures are testing positive. However, this does not necessarily mean that these women were infected with hepatitis C in 1977.
The Blood Transfusion Service Board has been investigating the probable year of infection and has informed me that it is clear that while there is a level of infectivity in other years it is much lower than in 1977 and that we cannot be certain at this stage that it has been caused by Anti D and this is being investigated.
In the five year period 1975-79, 90 per cent of those who received Anti D have presented for testing. In the five year periods 1970-74 and 1985-89 75 per cent of those who have received Anti D have presented for testing. In the five year period 1980-84 70 per cent have presented. However, in the four year period 1990-93 only 50 per cent of those who received Anti D have presented for testing. I am concerned with the relatively low uptake of the women who received Anti D during this period and I would urge these people to come forward for testing so that we can get a full picture of the extent of the problem.
The Blood Transfusion Service Board cannot at this stage indicate when the screening programme will be complete. The board estimate that 60,000 women received the Anti D product in the relevant period. The Blood Transfusion Service Board and general practitioners are providing a counselling service to women who have tested positive for hepatitis C antibodies.
Screening of children and/or partners of women who test positive for hepatitis C has commenced. This is being carried out in consultation with the three children's hospitals in Dublin and in paediatric units at Cork and Galway. Women who test positive for hepatitis C and who wish to have their children tested should contact their general practitioners or the Blood Transfusion Service Board and arrangements will be made to have the test carried out free of charge.
Treatment for those who test positive for hepatitis C antibodies is being provided at the following hospitals: St. Vincent's Hospital, Dublin; Beaumont Hospital, Dublin; Mater Hospital, Dublin; St. James's Hospital, Dublin; Cork Regional Hospital and University College Hospital, Galway. Special consultant staffed clinics have been set up in these hospitals.
The treatment initially involves an outpatient visit which may be followed by a short admission for clinical investigation and follow-up treatment, if required. The treatment, including the provision of Interferon, if prescribed by clinicians, will be provided by the public hospital service free of charge. The costs incurred in the screening and treatment programme will be met by the Exchequer.
I am informed by the Blood Transfusion Service Board that there are risks, however remote, of contracting a transmissible disease through transfusion. However, the benefit of blood transfusion must always be weighed against the risk factors involved. The Blood Transfusion Service Board has informed me that the highest possible standards are complied with to ensure that such risks are minimised. The board has informed me that it is not possible to guarantee absolute safety in blood and blood products, but that the standards in place are constantly reviewed, monitored and updated.
All donors are screened and the system of screening used is in accordance with the highest standards in well-developed countries, and take account of guidelines issued by such bodies as the Council of Europe. These standards are also, of course, complied with for blood products provided for haemophiliacs.
I am concerned to ensure that public confidence in the Blood Transfusion Service Board remains high. Since its foundation the board has provided an essential service to thousands of Irish people. Because of the crucial importance of maintaining the highest possible standards for blood and blood products I am determined to take whatever action is necessary to ensure the application of the highest possible safety standards.
In the circumstances, I announced on 4 March 1994, the establishment of an expert group to examine and report to me on: all the circumstances surrounding the infection of the Anti D Immunoglobulin product manufactured by the Blood Transfusion Service Board; the system and standards in place for donor selection, the manufacturing process and use of the Anti-D Immunoglobulin produced by the Blood Transfusion Service Board and to make recommendations to me on the above matters and any other matters relating to the Blood Transfusion Service Board which the group consider necessary.
If the expert group find any cause for concern in respect of any other aspect of the systems and standards in place in the Blood Transfusion Service Board, the expert group are being asked to examine these matters and report to me.
No consideration has been given at this stage to the question of compensation. As I have already indicated I am awaiting the report of the expert group.
It is not the intention to extend the national blood testing programme to all persons who received blood transfusions in the past because the risk of infection is very low. It is known that Irish blood donors have a low incidence of hepatitis C by comparison with other European countries.
I have been informed by the Blood Transfusion Service Board that it is at present considering the necessity of implementing a policy of targeted look back of recipients of previous donations from donors now found antibody positive to hepatitis C.
In general, a person who already has liver disease and develops hepatitis C is more likely to have an accelerated progression of hepatitis C. The problem identified with the Anti D product related to hepatitis C and the present programme was confined therefore to hepatitis C.
With regard to life assurance, I am unable to comment on this issue as it is a matter between the person and the assurance companies involved.
I would once again like to stress the importance of all women who received Anti D at any time between 1970 and 1994 of coming forward for testing. While the programme to date has been very successful, I am, however, concerned that only 50 per cent of the women who got Anti D between 1990 and February 1994 have come forward. I would urge these people to come forward for testing.
The Government and I are determined in so far as is practicable to identify any person who has been put at risk by virtue of exposure to the Anti D product.
