updated 3/4/2009 2:22:51 PM ET 2009-03-04T19:22:51

Investigators in western India looking into a deadly hepatitis outbreak traced to infected syringes have uncovered a huge operation to illegally recycle hundreds of tons of used medical equipment, officials said Wednesday.

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Gujarat state authorities launched the probe two weeks ago after an outbreak of hepatitis B that has killed 56 people and sickened more than 100. The source has been traced primarily to infected syringes, health officials said.

Officials who raided dispensaries, private hospitals and laboratories in the Modasa district — the center of the outbreak — found a flourishing black market in reused medical equipment.

In the last few days, more than 300 tons of medical waste was discovered in warehouses, much of it packaged for resale, said a senior health official, speaking on condition of anonymity because he was not authorized to talk to the media.

In Ahmadabad, the state capital, investigators found warehouses where used syringes, needles, saline bottles, IV drips and vials had been sorted, washed and repackaged for sale, said Dr. Manish Fenci, a senior city health official.

“We have been able to unearth the network,” he said.

At least 20 doctors have been arrested for using or buying the equipment, state Health Minister Jaynarayan Vyas said.

Two doctors, a father and son believed to have been responsible for transmitting at least a dozen cases of hepatitis using the same syringe on multiple patients, have been charged with culpable homicide, police said.

Hepatitis B can lead to liver damage and cancer. It is spread through infected blood, semen and from using contaminated needles. It can be prevented through vaccination.

While the scale of the racket has caused a stir, the problem is a well known one. A recent survey by the private Indian Clinical Epidemiology Network estimated that more than 30 percent of needles used in India were reused.

Much of this is caused by ignorance of the dangers, bureaucratic tangles that prevent equipment reaching rural clinics and lack of proper legislation and oversight that allows thousands of unlicensed doctors to flourish.

But greed was also a factor, said Anil Naik, a former president of the Indian Medical Association in Gujarat. Even though medical institutions can buy genuine disposable syringes for as little as four cents many still reuse syringes.

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