Trends of Infectious Disease Markers Among Healthy Blood Donors In Northern India: A Ten Year Study

Diagnostic challenges due to hepatitis B virus surface antigen mutations outside the major hydrophilic region

The number of observed cases of occult hepatitis B virus infection (OBI) in eastern India has been increasing. Here, S gene mutations were identified in apparently healthy individuals with OBI, and the S protein variants from these patients were characterized in vitro. Plasma samples from 217 healthy blood donors were collected from three different regions in eastern India and screened for hepatitis B virus (HBV) infection using a nucleic acid amplification test and immunoassays for serological markers. S protein variants found in positive plasma samples were characterized using a liver cell line. Twenty-nine of the 217 plasma samples tested, were positive for HBV DNA and were negative for hepatitis B surface antigen (HBsAg) and antibody to HBV core antigen (anti-HBc). Sequencing of the HBV S gene revealed a novel S protein mutation (L173H) in an area outside the major hydrophilic region. Known OBI-associated mutations (S34L, P178R), a mutation resulting in a stop codon at position 196, associated with lamivudine-resistance, the substitution I81T, and a dual mutation (G145A and Q101H) were also identified. S proteins containing these mutations, produced by transfection of human hepatoma (Huh7) cells with recombinant plasmids, were undetectable or gave significantly weaker signals than the wild-type control, despite similar levels of S mRNA production for the mutant and wild-type plasmids. The OBI cases in this study were unexpectedly seronegative. In vitro analysis revealed that the mutations identified here caused the virus to evade immunodetection using commercial immunoassays, thereby rendering a large portion of the population "silently" infected with HBV.

Seroprevalence of Hepatitis B Infection Among Blood Donors in a Tribal-Preponderant State of India: A Seven-Year Retrospective Observational Study

Background Blood transfusion is an essential and lifesaving procedure for many acute and chronic diseases. Though saving millions of lives, it carries the risk of transfusion of transfusion-transmitted infections (TTIs), including hepatitis B. Detection of this infection prior to transfusion saves potentially vulnerable patients from an additional burden and prevents the further spread of disease. Aim and objectives Our present study aimed to determine the seroprevalence of hepatitis B virus (HBV) in blood donors at the Rajendra Institute of Medical Sciences (RIMS) in Jharkhand, a tribal-preponderant state of India. Materials and methods After obtaining approval from the institutional ethics committee, a retrospective observational study was conducted among the eligible blood donors visiting RIMS from April 2016 to March 2023. A total of 195,507 subjects were included in the study. All blood donation samples collected in ethylenediaminetetraacetic acid (EDTA) vials were tested for five TTIs: human immunodeficiency virus 1 and 2, HBV, hepatitis C virus (HCV), malaria and syphilis. HBV testing was conducted via chemiluminescence technique to check f or the presence of hepatitis B surface antigen (HBsAg) in plasma. Results Among the study sample of 195,507 donors, the prevalence of HBsAg positivity was 0.87%. Among all the TTIs, more than 50% (51.93%) were HBsAg positive. The positivity percentage was higher in male donors and HBsAg positivity rose with an increase in replacement donors. Conclusions HBV is a major health concern in developing countries such as India due to its high endemicity. Therefore, early detection of HBV carriers in the blood donor population helps in curbing the spread of further infection and it also helps policymakers to develop different health programs to reduce further incidence of the infection in the general population.

Seroprevalence of Hepatitis C Virus Among Blood Donors in a Tribal-Preponderant Region of India

INTRODUCTION

Hepatitis C is a global health burden with significant morbidity and mortality. It primarily affects the liver and causes acute hepatitis, chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. Common modes of transmission of hepatitis C virus (HCV) infection are blood transfusion, needlestick injury, and mother-fetus transmission, among which transmission, blood transfusion is one of the most important causes. Blood transfusion is one of the pillars in the management of patients that saves lives and improves morbidity. Blood donation in India is done by voluntary and replacement blood donors of both sexes. The aim of this study is to determine the seroprevalence of HCV among blood donors in the Jharkhand state, a tribal-preponderant region of India, and to see the trend over the years.

MATERIAL AND METHODS

This is a nine-year retrospective observational study from 2015 to 2023 that screened for anti-HCV antibodies (third-generation kit: Abbott Diagnostics) using the chemiluminescence technique.

RESULTS

In this study, in total, 249,461 units of blood were collected, of which the majority of donations were by male and replacement donors (RDs) comprising 230,757 (92.50%) and 188,047 (75.38%), respectively. The mean number of blood donations by replacement and male donors (MDs) was more than for voluntary donors (VDs) and female donors (FDs) (20894.11 ± 3041.71 RDs vs. 6823.77 ± 2332.96 VDs, p < 0.0001 and 25639.66 ± 2810.08 MDs vs. 2078.22 ± 828.16 FD, p < 0.0001), respectively. The overall prevalence of HCV was 0.63%, and all seropositive donors were male.

CONCLUSION

Replacement blood donation contributes to the major part of blood donation and is primarily done by males in this tribal population-dominant region of India. Seroprevalence of HCV is high in the population of this part of India, and there is a constant or slightly upward trend in hepatitis C infection among individuals.

Exploring the unseen effect of COVID 19 pandemic on blood transfusion services in a tertiary care centre

Background

The coronavirus pandemic confronted blood transfusion services with major challenges. The present study was conducted to explore the effect of the COVID-19 pandemic on blood transfusion services including seroprevalence of transfusion-transmitted infections.

Material and Methods

A retrospective cross-sectional study was conducted and data on blood donation, utilization, camps, plateletpheresis and seroprevalence of transfusion-transmitted infections (TTI) was retrieved from software from March to September 2020 and 2021 and compared with corresponding time periods of three preceding non-pandemic years.

Results

There was a decline of 53.79% and 34.4% in blood donations in 2020 and 2021 respectively with a significant reduction in voluntary donations from 91.8% in the pre-pandemic period to 72.2% in 2020 and 77.7% in 2021. Replacement donors increased by 60.81% and 72.89% in 2020 and 2021 respectively. There was a decline of 48.4% in the number of plateletpheresis procedures in 2020 which increased in 2021 during the dengue outbreak. The decline in total blood donations and issue of packed red blood cells was statistically significant but supply and demand were balanced with no deficit. TTI seroprevalence increased from 1.01% to 1.49%(p<0.001) and 1.51%(p<0.001) in 2020 and 2021 respectively. Replacement donors showed a significantly higher TTI prevalence as compared to voluntary donors(p<0.001). A significant increase in prevalence was observed for Syphilis (0.4%) in 2020 and HBsAg (0.54%), HCV(0.63%) and syphilis (0.25%) in 2021.

Conclusion

The potential consequences of the COVID-19 pandemic on blood safety cannot be undermined. Developing a strong database of regular voluntary donors can be instrumental in dealing with future waves and surges in infections.