- Email: [email protected]
SHOULD LESBIANS GIVE BLOOD?
513
Experience within the Blood Transfusion Service in England indicates that identical kits from the same manufacturer, when used at different laboratories, give widely divergent frequencies of false-positive reactions. A multicentre trial such as the one reported by the SNTS group is only of limited value. Apart from operator variation, batch-to-batch variation produces a wide divergence of results. Although results obtained in carefully controlled trails give a valuable pointer to the suitability of a kit for a particular application, the results obtained in trials are not often reproduced during routine testing.2 All samples found to be reactive during the DuPont and Abbott trials were retested by each of the three kits. None of the sera was found to be reactive by more than one kit, none was reactive by the Wellcome HIV kit, all were negative by fluorescence technique using HIV-infected H9 cells.
Department of Radiation Oncology, Ontano Cancer Institute, Princess Margaret Hospital, Toronto, Canada M4X 1K9
1 Courouce AM. Evaluation of eight ELI SA kits for the detection of anti-LAV/HTLVIII antibodies. Lancet 1986; i: 1152-53. 2. Mortimer PP, Parry JV, Mortimer JY. Which anti-HTLV-III/LAV assays for screening and confirmatory testing? Lancet 1985; ii: 873-77.
SHOULD LESBIANS GIVE BLOOD?
SIR,-We were concerned to see Dr Downton’s letter (Aug 16, p 398), which referred to a letter written by a consultant haematologist working within the National Blood Transfusion Service, on the subject of blood donation and lesbians. Your correspondent is out of date: there was a follow-up to the letter referred to, together with a full explanation and apology by the director of the regional transfusion centre concerned. This was published in the New Statesman on June 27, 1986. The National Blood Transfusion Service has never had a policy excluding lesbians from blood donation. The advice given by the consultant at the Sheffield Regional Transfusion Centre was due to confusion over the term "homosexual". We, in this transfusion centre, have always been at pains to point out that the Department of Health’s advice to homosexuals and bisexuals not to give blood applies to male homosexuals only, and we have made this clear in our literature for prospective donors. Furthermore, for the past year we have not been referring to homosexuals, whether male or female, and we use the phrase "a man who has had sex with another man" to make it clear to donors which group of people is at high risk of transmitting human immunodeficiency virus by blood transfusion. We have already received communications from lesbian groups on this subject and it is disconcerting to see an incident, that happened 2 months ago and was corrected at the time, publicly raised again.
W. DUNCAN
1. Medical Research Council Neutron Therapy Working Party. A comparative review of
the Hammersmith (1971-75) and Edinburgh (1977-82) neutron therapy treatments of certain cancers of the oral cavity, oropharynx, larynx and hypopharynx. Br J Radiol 1986; 59: 429-40.
P. NUTTALL R. PRATT L. NUTTALL C. DALY
Microbiology Laboratory, Regional Transfusion Centre, Sheffield S5 7JN
North London Blood Transfusion Centre, Edgware, Middx HA8 9BD
serious necrosis and other morbidity observed at Hammersmith after neutron therapy. A particular hazard of neutron irradiation, compared with X-rays, is the dissociation of early and late radiation reactions. Its further evaluation, with high-energy machines, requires great caution to avoid the risks of late complications in deep-seated tissues and organs. Neutron therapy remains an interesting experimental treatment, but whether it has any real advantage in cancer management has still to be demonstrated.
WATERBORNE GIARDIASIS IN THE UNITED STATES 1965-84
SiR,—Jephcott et all have reported the first recognised waterborne outbreak of giardiasis in the UK. The water supply was thought to have been contaminated downstream of the storage reservoir; contamination may have entered the main during the repair or through back siphonage from pressure changes associated with the repair. Water samples collected in this area during the outbreak investigation were negative for faecal coliforms and , giardia, however. Jephcott et al cited my review2 of causes of waterborne giardiasis outbreaks in the United States, and I would like to take this opportunity to update that information, emphasising the aspects most relevant to Jephcott’s paper. An additional seven years of information are now available. Ninety outbreaks and 23 776 cases of giardiasis had been reported in the United States by the end of 1984. 69% of outbreaks and 74°,of cases related to community water systems with at least 25 year-round residents or 15 service connections. Most outbreaks were in the northeastern, northwestern, and Rocky Mountain states and most resulted from the use of contaminated surface water which either had not been treated or had been treated by simple chlorination only (table I). 15’B,of the US cases resulted from outbreaks caused by contamination of water mains through cross-connections, or damage and repair of mains. 2000 cases at a camp in Arizona occurred when sewage-contaminated water entered the drinking water through a direct cross-connection between the potable water system and a pipe carrying sewage effluent. Routine water sampling ,
TABLE I-WATERBORNE OUTBREAKS OF GIARDIASIS CLASSIFIED BY TYPE OF WATER TREATMENT OR WATER SYSTEM DEFICIENCY,
1965-84
MARCELA CONTRERAS PATRICIA E. HEWITT
FAST NEUTRON THERAPY
SiR,—Dr Catterall (June 21, p 1437), responding to your excellent editorial on fast neutron therapy (May 24, p 1189), says that "the reasons for the less good neutron results in Edinburgh were the lower neutron doses and suboptimal fractionation". There is no evidence that the fractionation used in Edinburgh was "suboptimal", and this point is made clear in the detailed review1 which stimulated your editorial. The lower dose in Edinburgh was deliberately chosen in the knowledge that the Hammersmith Hospital’s neutron therapy had produced levels of radiation-related morbidity and mortality which I felt to be unacceptable. There was no clear advantage to neutrons either at Hammersmith or Edinburgh when late radiation mortality and recurrence of local disease were together regarded as treatment failure. The low recurrence rate observed at Hammersmith and associated with higher neutron doses was at the cost of high radiation-related mortality. Mr McGregor (July 12, p 100) has drawn attention to the
*Includes 3 outbreaks and 76 cases of illness where filtration was available but not used. In 1 outbreak filtration facilities were used Interrmttently and m 2 outbreaks filtration facilities were
bypassed
Experience within the Blood Transfusion Service in England indicates that identical kits from the same manufacturer, when used at different laboratories, give widely divergent frequencies of false-positive reactions. A multicentre trial such as the one reported by the SNTS group is only of limited value. Apart from operator variation, batch-to-batch variation produces a wide divergence of results. Although results obtained in carefully controlled trails give a valuable pointer to the suitability of a kit for a particular application, the results obtained in trials are not often reproduced during routine testing.2 All samples found to be reactive during the DuPont and Abbott trials were retested by each of the three kits. None of the sera was found to be reactive by more than one kit, none was reactive by the Wellcome HIV kit, all were negative by fluorescence technique using HIV-infected H9 cells.
Department of Radiation Oncology, Ontano Cancer Institute, Princess Margaret Hospital, Toronto, Canada M4X 1K9
1 Courouce AM. Evaluation of eight ELI SA kits for the detection of anti-LAV/HTLVIII antibodies. Lancet 1986; i: 1152-53. 2. Mortimer PP, Parry JV, Mortimer JY. Which anti-HTLV-III/LAV assays for screening and confirmatory testing? Lancet 1985; ii: 873-77.
SHOULD LESBIANS GIVE BLOOD?
SIR,-We were concerned to see Dr Downton’s letter (Aug 16, p 398), which referred to a letter written by a consultant haematologist working within the National Blood Transfusion Service, on the subject of blood donation and lesbians. Your correspondent is out of date: there was a follow-up to the letter referred to, together with a full explanation and apology by the director of the regional transfusion centre concerned. This was published in the New Statesman on June 27, 1986. The National Blood Transfusion Service has never had a policy excluding lesbians from blood donation. The advice given by the consultant at the Sheffield Regional Transfusion Centre was due to confusion over the term "homosexual". We, in this transfusion centre, have always been at pains to point out that the Department of Health’s advice to homosexuals and bisexuals not to give blood applies to male homosexuals only, and we have made this clear in our literature for prospective donors. Furthermore, for the past year we have not been referring to homosexuals, whether male or female, and we use the phrase "a man who has had sex with another man" to make it clear to donors which group of people is at high risk of transmitting human immunodeficiency virus by blood transfusion. We have already received communications from lesbian groups on this subject and it is disconcerting to see an incident, that happened 2 months ago and was corrected at the time, publicly raised again.
W. DUNCAN
1. Medical Research Council Neutron Therapy Working Party. A comparative review of
the Hammersmith (1971-75) and Edinburgh (1977-82) neutron therapy treatments of certain cancers of the oral cavity, oropharynx, larynx and hypopharynx. Br J Radiol 1986; 59: 429-40.
P. NUTTALL R. PRATT L. NUTTALL C. DALY
Microbiology Laboratory, Regional Transfusion Centre, Sheffield S5 7JN
North London Blood Transfusion Centre, Edgware, Middx HA8 9BD
serious necrosis and other morbidity observed at Hammersmith after neutron therapy. A particular hazard of neutron irradiation, compared with X-rays, is the dissociation of early and late radiation reactions. Its further evaluation, with high-energy machines, requires great caution to avoid the risks of late complications in deep-seated tissues and organs. Neutron therapy remains an interesting experimental treatment, but whether it has any real advantage in cancer management has still to be demonstrated.
WATERBORNE GIARDIASIS IN THE UNITED STATES 1965-84
SiR,—Jephcott et all have reported the first recognised waterborne outbreak of giardiasis in the UK. The water supply was thought to have been contaminated downstream of the storage reservoir; contamination may have entered the main during the repair or through back siphonage from pressure changes associated with the repair. Water samples collected in this area during the outbreak investigation were negative for faecal coliforms and , giardia, however. Jephcott et al cited my review2 of causes of waterborne giardiasis outbreaks in the United States, and I would like to take this opportunity to update that information, emphasising the aspects most relevant to Jephcott’s paper. An additional seven years of information are now available. Ninety outbreaks and 23 776 cases of giardiasis had been reported in the United States by the end of 1984. 69% of outbreaks and 74°,of cases related to community water systems with at least 25 year-round residents or 15 service connections. Most outbreaks were in the northeastern, northwestern, and Rocky Mountain states and most resulted from the use of contaminated surface water which either had not been treated or had been treated by simple chlorination only (table I). 15’B,of the US cases resulted from outbreaks caused by contamination of water mains through cross-connections, or damage and repair of mains. 2000 cases at a camp in Arizona occurred when sewage-contaminated water entered the drinking water through a direct cross-connection between the potable water system and a pipe carrying sewage effluent. Routine water sampling ,
TABLE I-WATERBORNE OUTBREAKS OF GIARDIASIS CLASSIFIED BY TYPE OF WATER TREATMENT OR WATER SYSTEM DEFICIENCY,
1965-84
MARCELA CONTRERAS PATRICIA E. HEWITT
FAST NEUTRON THERAPY
SiR,—Dr Catterall (June 21, p 1437), responding to your excellent editorial on fast neutron therapy (May 24, p 1189), says that "the reasons for the less good neutron results in Edinburgh were the lower neutron doses and suboptimal fractionation". There is no evidence that the fractionation used in Edinburgh was "suboptimal", and this point is made clear in the detailed review1 which stimulated your editorial. The lower dose in Edinburgh was deliberately chosen in the knowledge that the Hammersmith Hospital’s neutron therapy had produced levels of radiation-related morbidity and mortality which I felt to be unacceptable. There was no clear advantage to neutrons either at Hammersmith or Edinburgh when late radiation mortality and recurrence of local disease were together regarded as treatment failure. The low recurrence rate observed at Hammersmith and associated with higher neutron doses was at the cost of high radiation-related mortality. Mr McGregor (July 12, p 100) has drawn attention to the
*Includes 3 outbreaks and 76 cases of illness where filtration was available but not used. In 1 outbreak filtration facilities were used Interrmttently and m 2 outbreaks filtration facilities were
bypassed