Dear Student,

I am writing to you on behalf of the University of Toronto to provide you with some health information that may be relevant to you. The information pertains to some of the participants in the following courses: PHE 325Y and PHE 225S from 2006 until 2012, PSL 372H from 2005 until 2011, and the Youth Summer Program (YSP) from 2008 until 2011.

This issue applies only to those students who agreed to have their blood tested with a finger-stick device during the lab portion of these courses. If you did not volunteer to have your blood tested, this notice does not pertain to you.

During the laboratory portion of these courses, a finger-stick device was used by some students to take a drop of blood for determining blood type or testing for glucose or lactate levels. The lancet tip, the part of the device that punctures the finger, was replaced after each use but the finger-stick device itself was sometimes re-used during the same lab. Health Canada recommends that this type of finger-stick device should only be used by one person, even if the lancet tip is changed.

The Health Canada guidelines are based on concerns about possible transmission of Hepatitis B virus (Hep B) from re-use of these devices. These finger-stick devices have been used safely for many years in many settings. However, some reports show that, in clinics and long-term care settings where these devices are used very differently than during our labs, use of these devices on more than one person can lead to transmission of Hep B. We emphasize that there are no published reports whatsoever of transmission of Hep B with settings and patterns of uses such as the labs in which you participated. There has also never been any published association of Hepatitis C (Hep C) or HIV with the use of such a device on multiple individuals in any setting.

We have reviewed the circumstances of the use of these finger-stick devices at the U of T and consulted with Toronto Public Health. We have determined that your risk of being exposed to Hep B through use of the finger-stick device is exceedingly low. We know that these devices have been widely used in non-clinical settings. Departures from best practice have occurred, as already indicated by similar notices to students at Wilfred Laurier University and the University of Prince Edward Island. However, no reports whatsoever of Hep B have occurred outside of healthcare settings where the devices were used in a more intensive fashion on patients who received multiple tests over time.

Notwithstanding the very low risks, we feel strongly that the right way forward is to notify students who volunteered to have their blood taken using finger-stick devices during these labs. Our firm expectation is that any medical devices should be used only in exact accordance with guidelines, and we regret the fact that staff did not always meet those expectations. The University has since made it clear that only single-use, disposable lancet devices should be purchased and deployed for such tests.
Students who used the finger-stick devices, and received Hepatitis B vaccination prior to their participation in this lab, are likely protected against being infected with Hep B and no further action is recommended. Ontario began a school-based immunization program to prevent Hep B in 1994.

For students who have not been vaccinated against Hep B, the risk of being infected is slightly higher. We estimate that it could take many years of similar usage of the finger-stick devices across all universities in Canada for there to be one single occurrence of Hep B. It is therefore very unlikely that even one unvaccinated student would have been infected with Hep B by the tests you underwent. However, in this situation, you may wish to consult with your health care professional about whether to obtain a test for Hep B status.

If you are tested and found to be Hep B positive, there are multiple risk factors for this infection and you should discuss these with your healthcare professional. In Ontario, your healthcare professional will need to report your infection to the local health department who may contact you to investigate further.

If you are tested and confirmed to be Hep B negative, and if you have not previously been immunized, it may be prudent for you to ask your healthcare professional about proceeding with immunization.

I hope this summary is clear and helpful. If you have further questions, please do not hesitate to send an email to healthask@utoronto.ca.

Sincerely,

Professor Jill Matus
Vice Provost, Students & First-Entry Divisions

c. Toronto Public Health
c. Public Health Ontario

Also posted to: https://temertymedicine.utoronto.ca/news/letter-vice-provost-students-regarding-laboratory-activities-following-courses-psl-372h-2005