updated 2/5/2009 4:10:31 PM ET 2009-02-05T21:10:31

Patients who got hepatitis from contaminated syringes and medicine vials are joining infection control advocates to warn Americans about a problem they say is more common than people think.

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A recent federal report suggests they are right.

It found more than 60,000 people were exposed to hepatitis, and at least 400 people were infected with it in 33 U.S. outbreaks linked with blatant safety violations.

Many involved reuse of syringes: Health workers likely thought they were being safe by discarding the syringes' used needles and snapping on sterile ones. They were apparently unaware that the plastic barrel part of a syringe can become contaminated, too. Reusing it even with a fresh needle also can contaminate the medicine vial.

The number of reported infections isn't large for the time period, 1998 to 2008. But authorities believe many more cases go unreported, and the lack of care and cleanliness that went on in medical clinics and doctors' offices is disturbing. The most publicized cases occurred in Nevada, Nebraska and New York; one of the most recent outbreaks was in Illinois.

But they have happened in other states and in hospitals, too. The report says the cases it highlights "probably represent a much wider problem."

Some hygiene lapses among medical workers have received more attention, including inadequate hand-washing. But researcher Joseph Perz of the Centers for Disease and Prevention said that syringe reuse "is something that's obviously wrong."

Perz co-authored the report, which appeared in the Jan. 6 edition of Annals of Internal Medicine.

Hepatitis is a viral infection of the liver. The most common, form, hepatitis C, afflicts more than 3 million Americans, is potentially life-threatening and can cause permanent liver damage. It may cause no initial symptoms and can go undetected for years.

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