OK, I was hoping not to get up on my soapbox about this but Phil's statement regarding the lack of reports of sorter operators becoming infected as evidence that it has not happened has hit a raw nerve. That's the justification I hear from people who think I am being overly cautious in deciding what I will and will not sort without BSL3 containment. We should all be careful about making deductions based on the lack of data, i.e. ignorance is bliss. Just because there are no reports of something does not mean it does not exist. I am sure 30 years ago there were no reports of smoking related lung cancer either. We also need to differentiate between "disease" and "infection". And how many sorter operators are screened on a regular basis for evidence of "infection"? And I don't mean serological evidence, as we all know lack of serological evidence does not necessarily indicate lack of infection. It's funny how we so quickly use that argument to support the notion that testing the samples to be sorted is not a good idea, but when we talk about whether a sorter operator has become infected we use the fact that there is no evidence of disease or serological conversion, hmmmm. The other thing to consider is that perhaps infectious disease may not be the only risk, what about the potential of exposure to these pathogens being pro-oncogenic in the absence of obvious infection? Marusawa - Gut 1999 abstract / Pub Med High prevalence of infection with hepatitis B and C viruses in patients with hepatocellular carcinoma in Japan. S Kubo, S Nishiguchi, K Hirohashi, H Tanaka, T Tsukamoto, H Hamba, T Shuto, T Okuda, A Tamori, T Kuroki, H Kinoshita. Hepatogastroenterology 1999 Jan-Feb;46(25):357-359. "Hepatitis B virus genes were detected in 13 patients with anti-surface antibody, in 21 of 30 patients with anti-core antibody, and in 9 of 22 patients without hepatitis B antibodies. Viral genes were detected in tumor tissue in 5 of 11 patients with neither B nor C virus markers in their sera; viral markers were found in either serum or tumor tissue in 324 of 330 patients (98.2%)." Kubo <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&li st_uids=10228821&dopt=Abstract> - Hepatogastroenterology 1999 abstract / Pub Med Impact of HBV, HCV and GBV-C/HGV on hepatocellular carcinomas in Europe: results of a European concerted action. C Brechot, F Jaffredo, D Lagorce, G Gerken, K Meyer zum Buschenfelde, A Papakonstontinou, S Hadziyannis, R Romeo, M Colombo, J Rodes, J Bruix, R Williams, N Naoumov. J Hepatol 1998 Aug;29(2):173-183. HBV DNA was detected in the serum and liver of 33% and 47% of HBsAg negative patients, and in the serum of 25.1% who were "without any HBV marker." They also found HCV RNA by R-PCR in 7% of anti-HCV negatives. "It also stresses the need to use genome detection in epidemiological studies when serological tests are negative." I don't believe anyone has studied the sorter operator population to determine if there is an increased incidence of certain types of cancer, have they?? What we don't know may be our greatest risk. We are creating the potential of a new mode of transmission of certain pathogens that does not exist in nature. I would hate to find out the hard way that what we "believed to be true" was in fact a careless assumption due to the lack of evidence of "disease". Since there is no realistic way to test operators for the presence of viral DNA/RNA on a regular basis we have to assume that the potential exists just as we make this assumption on untested samples to be sorted. I think it would be foolish to find comfort in the fact that there are no documented cases of sorting related transmission of infection, perhaps we haven't found anything because we really haven't looked. That's my 2 cents (or maybe 25 cents) Joanne Lannigan, MS Director, Flow Cytometry Core Facility University of Virginia Jordan Hall, Room 7067 P.O. Box 800734 Charlottesville, VA 22908-0734 Office: 434-924-0274 Lab: 434-243-2695 Fax: 434-982-1071 email: joannelannigan@virginia.edu > -----Original Message----- > From: McCoy, J. Philip (NIH/NHLBI) [mailto:mccoyj@nhlbi.nih.gov] > Sent: Tuesday, April 13, 2004 2:59 PM > To: Cytometry Mailing List > Subject: RE: Biosafety of sorting revisited > > I think this point brought out by Dr Rizzo is a major concern to all > sorting jocks. I have been involved in cytometry for nearly 30 years and I > am not aware of a single documented case of anyone becoming infected with > anything because of cytometric cell sorting. While I fully endorse using > universal precautions, and even more precautions than outlined in certain > regulations, inevitably, when one discusses safety/precautions versus > costs > (a reality in modern medicine), the risk assessment folks will demand > knowing what documented risks there are associated with sorting. And there > you sit....ranting about the great risks, but unable to produce a single > case report associating sorting with infection. Nada...zip...none. > > So I would take a different approach. Do not ask about the precautions > needed when sorting...ask about precautions need when handling potentially > infectious human material. After all....the specimens are handled before, > during, and after sorting. There are certainly numerous reports of lab > workers infected by various agents in human (and animal) tissues. Also ask > about modes of transmission of various agents - direct contact aerosol, > etc > without any regard to sorting. These lines of reasoning have much more > documentation that you will find if you ask about infectious agents and > sorting. These will likely get a better reception than our undocumented, > but > undoubtedly valid, concerns limited to cytometric sorting per se. > > Phil > > J. Philip McCoy, Jr., Ph.D. > Director of the Flow Cytometry Core Facility > NHLBI - NIH > Bldg 10, Rm 4A07 > 10 Center Dr., MSC 1357 > Bethesda, MD 20892 > > > > -----Original Message----- > > From: Sian Rizzo [mailto:Sian.Rizzo@icr.ac.uk] > > Sent: Tuesday, April 13, 2004 6:24 AM > > To: Cytometry Mailing List > > Subject: Re: Biosafety of sorting revisited > > > > > > Hello Flow-ers, although I appreciate that prevention is the prime aim > > of the directives and guidelines discussed here and set out by the > > appropriate health and safety regulatory bodies, have there been any > > irrefutably documented cases of flow sort operators contracting an > > infection while sorting biohazardous material? > > > > Sian. > > > > Dr.Sian Rizzo > > Prostate Stem Cell Laboratory > > Male Urological Cancer Research Centre > > Institute of Cancer Research > > 15 Cotswold Road > > Sutton > > Surrey SM2 5NG > > > > TEL: +44(0)20 8722 4178 > > FAX: +44(0)20 8722 4278 > > email: Sian.Rizzo@icr.ac.uk > >Received on Fri Apr 16 17:58:00 2004
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