Profile of blood donations with a positive serology in Southern Brazil

Syphilis seroprevalence and risk factors among first-time blood donors in Brazil: A comprehensive repeated cross-sectional analysis spanning a decade

BACKGROUND

Syphilis remains a global health challenge, with rising incidence rates worldwide Prevalence surveys conducted in Brazil over extended periods of time are scarce. This study examines the secular trends and risk factors for syphilis seroprevalence among first-time blood donors in Brazil.

METHODS

A retrospective analysis was conducted as part of a multicenter, repeated cross-sectional survey of blood donors from four major Brazilian blood centers, covering the period from 2007 to 2020. First-time donors who had undergone valid treponemal screening tests were included in the final dataset. Demographic characteristics and serological results were analyzed to identify risk factors for syphilis seroprevalence using multivariate Poisson models. An interaction term between age group and donation year was added to the final model. Model comparisons were performed using Likelihood Ratio Tests (LRT) and Akaike Information Criterion (AIC).

RESULTS

1,424,850 donations from first-time donors were included during the study period. The overall syphilis seroprevalence was 2.19%, with significant heterogeneity across centers. Risk factors for increased seroprevalence included male gender, older age, lower education level, and self-reported black or mixed skin color. Notably, an increasing trend in syphilis seroprevalence was observed among younger donors and those born after 1990. Interaction analyses revealed significant effects between visit period and key demographic variables (age group, gender, education, and ethnicity), with the interaction between age group and donation year indicating higher seroprevalence among younger age groups in recent years.

CONCLUSION

The study highlights a high syphilis seroprevalence among first-time blood donors in Brazil, which has significant implications for blood safety and public health. The increasing trend among younger donors suggests a shift towards newer infections, warranting continued surveillance in this demographic.

Risk Factors for Viral Coinfections in Blood Donors in Bahia, Brazil

Human Immunodeficiency Virus (HIV), Human T Lymphotropic Virus (HTLV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) coinfection may lead to disease progression or worsen its clinical presentation. Viral coinfections screening during blood donation is critical. To identify risk factors for coinfection among blood donors, we assessed the blood donations at the Fundação de Hematologia e Hemoterapia da Bahia, from 2008 to 2017. We compared serological/molecular evidence of single infection versus two or more viral blood-borne infections-BBI). A multivariable logistic regression model was performed to evaluate independent associations between characteristics of donors with single infection and multiple infection using "non-infection" category as reference. Among 777,446 collected blood donations, 27 358 (3.5%) were reactive, most (n = 26 677, 97.6%) for a single infection and 681 (2.4%) for coinfection. The most frequent coinfections were HBV-HIV (30.6%), HBV-HCV (30.4%), and HBV-HTLV (24.4%). Male sex, lower education, being single, and being a first-time donor were independently associated with both single and coinfections. Nevertheless, the adjusted odds for risk factors of coinfections were much higher than those for single infection. Donors with single and coinfection for BBI shared identical risks, but they were significantly higher for coinfection. Preventive strategies addressing the identified risks can decrease transmission of viral BBI by blood transfusion.

Simultaneous determination of HCV genotype and NS5B resistance associated substitutions using dried serum spots from São Paulo state, Brazil

Hepatitis C virus (HCV) is responsible for more than 180 million infections worldwide, and about 80 % of infections are reported in Low and Middle-income countries (LMICs). Therapy is based on the administration of interferon (INF), ribavirin (RBV) or more recently Direct-Acting Antivirals (DAAs). However, amino acid substitutions associated with resistance (RAS) have been extensively described and can contribute to treatment failure, and diagnosis of RAS requires considerable infrastructure, not always locally available. Dried serum spots (DSS) sampling is an alternative specimen collection method, which embeds drops of serum onto filter paper to be transported by posting to a centralized laboratory. Here, we assessed feasibility of genotypic analysis of HCV from DSS in a cohort of 80 patients from São Paulo state Brazil. HCV RNA was detected on DSS specimens in 83 % of samples of HCV infected patients. HCV genotypes 1a, 1b, 2a, 2c and 3a were determined using the sequence of the palm domain of NS5B region, and RAS C316N/Y, Q309R and V321I were identified in HCV 1b samples. Concerning therapy outcome, 75 % of the patients who used INF +RBV as a previous protocol of treatment did not respond to DAAs, and 25 % were end-of-treatment responders. It suggests that therapy with INF plus RBV may contribute for non-response to a second therapeutic protocol with DAAs. One patient that presented RAS (V321I) was classified as non-responder, and combination of RAS C316N and Q309R does not necessarily imply in resistance to treatment in this cohort of patients. Data presented herein highlights the relevance of studying circulating variants for a better understanding of HCV variability and resistance to the therapy. Furthermore, the feasibility of carrying out genotyping and RAS phenotyping analysis by using DSS card for the potential of informing future treatment interventions could be relevant to overcome the limitations of processing samples in several location worldwide, especially in LMICs.

Subjective donor deferral as a tool for increased blood transfusion safety: A cross-sectional observational study

OBJECTIVES

This study aims at evaluating whether subjective donor deferral (SDD) has the potential for increasing blood transfusion safety.

BACKGROUND

Appropriate donor selection via clinical and serologic screening is necessary to prevent transfusion-transmissible infections (TTIs). One additional strategy adopted by some Brazilian blood transfusion centers (BTCs) is the rejection of a donation by the pre-donation interviewer based on subjective factors.

METHODS/MATERIALS

We conducted a STROBE-guided cross-sectional study including 105 005 prospective donors who presented to our BTC between 1 January 2013, and 31 December 2015. Donors were evaluated for age, gender, education level, donation type and history, confidential unit exclusion, SDD, and results of serologic screening for TTIs.

RESULTS

Even after controlling for potential confounding variables, subjectively deferred donors were more likely to have at least one reactive serology in the standard screening (OR: 2.80; 95% CI: 2.13-3.69; P < .001). They also had a higher risk for testing positive for syphilis (OR: 4.47; 95% CI: 3.05-6.55; P < .001), hepatitis B (OR: 5.69; 95% CI: 2.48-13.08; P < .001), and HIV (OR: 6.14; 95% CI: 3.22-11.69; P < .001).

CONCLUSIONS

Routine implementation of SDD in donor selection may be an effective additional measure to avoid TTIs, highlighting the importance of interviewer experience, perspicacity, and face-to-face contact with donors for blood safety assurance.

Seropositivity for syphilis among Brazilian blood donors. A retrospective study 2015-2020

INTRODUCTION

Syphilis is a transfusion-transmitted infection and the disease re-emerged in many countries, including Brazil, as a public health risk.

OBJECTIVE

Evaluate the prevalence of positive serology in blood donations rejected by Hemobanco (Curitiba- PR) from January 2015 to December 2020, with special focus in syphilis.

METHODOLOGY

In the studied period, we analyzed the number of blood donations discarded annually for each serological test performed on blood donors' samples, according to gender and donors age.

RESULTS

Within the studied period, 134,741 blood donation were analyzed. 54.5 % of sample were male. Otherwise, it was observed a significant increase in the number of donations by females (P < 0.0001). There was an increase of 437 % in the prevalence of syphilis positive serology made by donors with ≥ 60 years. Besides that, it was noticed a significant increase in donations by aged people throughout these six years (P < 0.0001). The percentage of total blood donation deferred had a significant reduction, although it was observed an increase in the rate of discarded blood bags due to positive serology in the first 4 studied years. It was observed an increase of 20 % in positive syphilis serology.

CONCLUSION

The greatest cause of discard of blood donations changed during the analyzed 5-years; there was an increase in seropositivity donations from donors with ≥ 60 years old. In 2015, Hepatitis B (0.8 %) was the most prevalent and in 2020, syphilis became more prevalent (0.82 %). The medical community should be aware of the rising number of cases of syphilis infection. There is an urgent need to implement actions against the dissemination of this disease.

Factors associated with sexually transmitted infection/HIV diagnosis among a predominantly university population in Brazil

In Brazil, the increasing prevalence of HIV infection in young people makes it critical to know its distribution in university communities. In this cross-sectional study, we evaluated the impact of STI/HIV testing campaigns on university campuses from 2013 to 2017. The participants took part in rapid testing for HIV, syphilis, hepatitis B and C, and counseling sessions. A total of 2691 people participated in the campaigns. Of these, 79.4% were single, and 50.3% were women. The median age was 24 years old, and 77.9% of participants had ≥12 years of formal education. Most reported having unprotected sex in the last year (87.4%). The positivity rates for HIV, syphilis, hepatitis B virus, and hepatitis C virus were 0.56%, 1.20%, 0.19%, and 0.11%, respectively. The characteristics associated with HIV infection were being men who have sex with men (MSM) (aOR = 12.06; 95% CI = 3.83-37.99) and having <12 years of schooling (aOR = 3.28; 95% CI = 1.03-10.38). Factors associated with syphilis seropositivity were older age (aOR = 1.06; 95% CI = 1.03-1.09), multiple partners (aOR = 2.44; 95% CI = 1.08-5.50), and being MSM (aOR = 5.40; 95% CI = 2.49-11.72). Positivity for hepatitis B tended to decrease with the years of testing (p = 0.023) and for hepatitis C to increase with age (p = 0.035). Our study observed a high vulnerability to HIV and syphilis infection in a university community, which needs an early prevention strategy, including regular testing, continuing sexual education, easy access to condoms, and pre- and postexposure HIV prophylaxis.