Prevalence of antibodies to hepatitis C virus in apparently healthy Port Harcourt blood donors and association with blood groups and other risk indicators

Seroprevalence of transfusion transmitted infections in healthy blood donors: A 5-year Tertiary Care Hospital experience

INTRODUCTION:

Transfusion transmitted infections (TTIs) can cause threat to bloody safety as blood transfusion is an important mode of transmission of TTI to the recipient, hence, to prevent transmission of these diseases, screening tests on blood bags is an important step for blood safety.

AIM:

This study was undertaken with the aim of determining the seroprevalence of TTI in healthy blood donors in a tertiary care blood bank.

MATERIALS AND METHODS:

A retrospective study was carried out over a period of 5 years from January 2007 to December 2011. Serum samples were screened for hepatitis B surface antigen (HBsAg), antibodies to human immunodeficiency virus (HIV) Type 1 and 2, hepatitis c virus (HCV) and syphilis using enzyme-linked immunosorbent assays with the third generation kits and venereal disease research laboratory test, respectively.

RESULTS:

A total of 76,653 healthy donors were included out of which majority of donors were male (91.79%). The overall seroprevalence of HIV, HBsAg, HCV, and syphilis were 0.26%, 1.30%, 0.25%, and 0.28%, respectively.

CONCLUSION:

Methods to ensure a safety blood supply should be encouraged. For that, screening with a better selection of donors and use of sensitive screening tests including nucleic acid testing technology should be implemented.

Blood transfusion safety; current status and challenges in Nigeria

The attainment of blood transfusion safety in Nigeria (and probably the rest of Sub-Saharan Africa) remains an uphill task due to a number of factors, ranging from shortage of blood, poor implementation of blood transfusion guidelines, infrastructural deficits to high prevalence of transfusion-transmissible infections (TTIs), particularly hepatitis and human immune deficiency viruses. We reviewed available data on blood transfusion practices and safety in Nigeria using the PubMed, PubMed Central, Google Scholar, and African Index Medicus search engines, through a combination of word and phrases relevant to the subject. The World Health Organization has been in the forefront of efforts to establish safe, available, and affordable blood transfusion services in most parts of Africa through encouraging adequate blood donor recruitment, donor blood testing, and collection as well developing strategies for the rational use of blood. Even though modest improvement has been recorded, particularly with regards to donor blood screening for common TTIs, considerable efforts are needed in the form of robust public enlightenment campaigns (on blood donation) and continuous system improvement to drive the current transfusion practices in the country toward safety and self-sustenance.

The Prevalence of Transfusion Transmitted Infections in ABO Blood Groups and Rh Type System

Screening of blood and blood products is important to reduce the risk of transfusion transmitted infections (TTIs). The transfusion of unscreened or inadequately screened blood and blood products are the major source of TTIs. The aim of this paper is to find out the prevalence of TTIs in ABO blood groups and Rh type system. A total of 4128 blood donors were screened from January 2010 to April 2014. Serological tests were performed for hepatitis B surface antigen (HBsAg), anti hepatitis C virus (Anti-HCV), anti HIV-1 and 2, venereal disease research Laboratory test (VDRL) and malaria parasite (MP) antigen. In seroreactive donors, HBsAg, Anti-HCV, VDRL, MP antigen and anti HIV were positive in 40 cases, 26 cases, 19 cases, 6 cases and 2 cases, respectively. Highest percentage of HBsAg, Anti HCV, VDRL, MP antigen and anti HIV was observed in blood group A negative (2/50), O negative (1/66), B negative (1/91), AB positive (2/377) blood group respectively. In the present study, the total number of Rhnegative donors is lower when compared to Rh-positive blood donors, but Rh-negative blood donors show higher percentages of seroreactivity for TTIs. Larger scale studies at molecular level are required to improve the knowledge of this aspect.

Association of ABO and Rh Blood Groups to Blood-Borne Infections among Blood Donors in Tehran-Iran

BACKGROUND

The aim of this study was to investigate the prevalence of hepatitis B, hepatitis C, HIV and syphilis infections in blood donors referred to Tehran Blood Transfusion Center (TBTC), and determine any association between blood groups and blood- borne infections between the years of 2005 and 2011.

METHODS

This was a retrospective study conducted at TBTC. All of the donor serum samples were screened for HBV, HCV, HIV and syphilis by using third generation ELISA kits and RPR test. Initial reactive samples were tested in duplicate. Confirmatory tests were performed on all repeatedly reactive donations. Blood group was determined by forward and reverse blood grouping. The results were subjected to chi square analysis for determination of statistical difference between the values among different categories according to SPSS program.

RESULTS

Overall, 2031451 donor serum samples were collected in 2005-2011. Totally, 10451 were positive test for HBV, HCV, HIV and syphilis. The overall seroprevalence of HBV, HCV, HIV, and syphilis was 0.39%, 0.11%, 0.005%, and 0.010%, respectively. Hepatitis B and HIV infections were significantly associated with blood group of donors (P <0.05) ; percentage of HIV Ag/Ab was higher in donors who had blood group "A" and percentage of HBs Ag was lower in donors who had blood group O. There was no significant association between Hepatitis C and syphilis infections with ABO and Rh blood groups (P>0.05).

CONCLUSION

Compared with neighboring countries and the international standards, prevalence of blood-borne infections is relatively low.

Decreasing prevalence of transfusion transmitted infection in Indian scenario

Transfusion transmitted infections are major problem associated with blood transfusion. Accurate estimates of risk of TTIs are essential for monitoring the safety of blood supply and evaluating the efficacy of currently employed screening procedures. The present study was carried out to assess the percentage of voluntary donors and replacement donors and to find out prevalence and changing trends of various TTIs blood donors in recent years. A study was carried out on blood units of voluntary and replacement donors which were collected from January 2008 to December 2012. On screening of 180,371 replacement units, seropositivity of transfusion transmitted disease in replacement donors was 0.15% in HIV, 1.67% in hepatitis B surface antigen, 0.49% in hepatitis C virus, 0.01% in VDRL, and 0.009% in malaria. Of 11,977 voluntary units, seropositivity of transfusion transmitted disease in voluntary donors was 0.08% in HIV, 0.24% in hepatitis B surface antigen, 0.001% in hepatitis C virus, 0.008% in VDRL (sexually transmitted disease), and 0.01% in malaria. From results it has been concluded that prevalence of transfusion transmitted infection (HIV, HBV, HCV, VDRL, and malaria) was more in replacement donors in comparison to voluntary donors. Extensive donor selection and screening procedures will help in improving the blood safety.

New tools in HCV diagnosis, in light of the enhanced awareness and the new drugs for treatment: SMARTube and stimmunology

With improved HCV therapy, challenges regarding HCV diagnosis, such as seronegative window period, false positive readings, and differentiation between recent, chronic, and resolved infections, are of increasing importance. To address these challenges an innovative device—SMARTube HIV & HCV—was used. Blood samples were tested for anti-HCV antibodies before and after incubation in the SMARTube, which promotes the in vitro stimulation of in vivo HCV primed lymphocytes, thus enhancing levels of anti-HCV antibodies. Comparing antibody levels, in concordant samples before and after SMARTube, yielded the Stimulation Index (SI). Among 5888 fresh blood samples, from various populations and regions worldwide, 641 were seropositive using plasma, while SMARTube processing (yielding enriched plasma, termed SMARTplasma) enabled diagnosis of 10 additional carriers in high-risk cohorts, that is, earlier detection. Using SMARTplasma eliminated all false positive results, using the current assays. In addition we show that SI calculation may serve as an important tool for differentiating between those who recently seroconverted, carriers of long-term infection, and those who have cleared the virus. SMARTube and the SI could lead to better, more informative diagnosis of HCV infections and play an important role in changing the way we treat both the infected individuals and the epidemic as a whole.

Risk factors for hepatitis C virus transmission obscure in nigerian patients

Aim. To determine the prevalence of anti-HCV and risk factors associated with HCV infection in Nigerians. Materials and Method. Patients attending a general outpatient clinic were administered a structured questionnaire on the risk factors for HCV infection. They were also tested for anti-HCV using a third generation enzyme-linked immunosorbent assay. Result. The seroprevalence of anti-HCV was 4.7%. Among the risk factors evaluated, none was found to be significantly associated with anti-HCV seropositivity. Conclusion. The risk factors associated with HCV infection in Nigerian patients are obscure. This warrants further studies on the epidemiology of this important cause of liver disease.

The challenges of meeting the blood transfusion requirements in Sub-Saharan Africa: the need for the development of alternatives to allogenic blood

As a resource, allogenic blood has never been more in demand than it is today. Escalating elective surgery, shortages arising from a fall in supply, a lack of national blood transfusion services, policies, appropriate infrastructure, trained personnel, and financial resources to support the running of a voluntary nonremunerated donor transfusion service, and old and emerging threats of transfusion-transmitted infection, have all conspired to ensure that allogenic blood remains very much a vital but limited asset to healthcare delivery particularly in Sub-Saharan Africa. This is further aggravated by the predominance of family replacement and commercially remunerated blood donors, rather than regular benevolent, nonremunerated donors who give blood out of altruism. The demand for blood transfusion is high in Sub-Saharan Africa because of the high prevalence of anemia especially due to malaria and pregnancy-related complications. All stakeholders in blood transfusion have a significant challenge to apply the best available evidenced-based medical practices to the world-class management of this precious product in a bid to using blood more appropriately. Physicians in Sub-Saharan Africa must always keep in mind that the first and foremost strategy to avoid transfusion of allogenic blood is their thorough understanding of the pathophysiologic mechanisms involved in anemia and coagulopathy, and their thoughtful adherence to the evidenced-based good practices used in the developed world in a bid to potentially reduce the likelihood of allogenic blood transfusion in many patient groups. There is an urgent need to develop innovative ways to recruit and retain voluntary low-risk blood donors. Concerns about adverse effects of allogenic blood transfusion should prompt a review of transfusion practices and justify the need to search for transfusion alternatives to decrease or avoid the use of allogenic blood. These strategies should include the correction of anemia using pharmacological measures (use of antifibrinolytics to prevent bleeding and the use of erythropoietin and oral and intravenous iron to treat anemia) use of nonpharmacologic measures (preoperative autologous blood transfusion, perioperative red blood cell salvage and normothermia to reduce blood loss in surgical patients). All these strategies will help optimize the use of the limited blood stocks.

Diversity of genotype and mode of spread of Hepatitis C virus in Northern India

BACKGROUND/AIM

Hepatitis C is caused by hepatitis C virus (HCV), which is classified into 6 genotypes. It leads to chronic hepatitis in 80% of the cases. Genotype of the virus helps in predicting response to antiviral therapy and also the duration of treatment. Therefore, it is important to know the prevalence of each genotype. Knowledge regarding the route of entry of HCV in the blood is also necessary to formulate a strategy to prevent its spread.

PATIENTS AND METHODS

One hundred and two newly diagnosed patients with chronic hepatitis C, having anti-HCV antibody-positive were included in the study. Their HCV RNA viral load and genotype were determined by Reverse Transcriptase PCR assay on Roche Cobas Ampliprep analyzer.

RESULTS

Genotype 3 was commonly detected in 58.8% patients followed by genotype 1 in 20.6%. Twelve patients had genotype 4 (11.8%) and 9 had mixed infection with genotypes 3 and 4. Among these patients, 43.1% of patients had a history of multiple injection exposure. Blood transfusion received by 6.9% and 2.9% had donated blood. Only 1 patient had a history of drug abuse.

CONCLUSION

The distribution of genotypes varies in different regions and therefore its knowledge is important, as it determines the response of the patient to the treatment. The use of autodisabled syringes, their proper disposal, following biomedical waste management guidelines, and organizing continued medical education and workshops will help in preventing the spread of HCV infection.

A used ball of cotton wool as a source of nosocomially-acquired hepatitis C infection

BACKGROUND AND AIMS

An error involving the reuse of the same ball of cotton wool in stopping blood flow after venous blood collection from five antenatal women prompted further investigation and follow-up studies to rule out nosocomially-acquired blood borne viruses.

METHODS

The five women were screened for antibodies to the human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B surface antigen (HBsAg), using enzyme-linked immunosorbent assay (ELISA) /kits Murex HIV-1- ,2,0 (Murex Biotech, UK); ORTHO HCV 3.0 ELISA Test kit (Ortho Clinical Diagnostics, USA); and QUADRATECH CHECK 4-HBs one-step generation test kit (VEDALAB, France) respectively. The tests were repeated in 2005 on the five women, their husbands and twenty children, aged nine months to seven years borne by all the women within the period. Anti-HCV was detected in one out of the five women at the initial stage of the error (1997). No anti-HIV or HBsAg was found in any of the women. A repeat screening for anti-HIV, anti-HCV and HBsAg carried out seven years later (2005) on the five women, their husbands and twenty children aged nine months to seven years borne by all the women within the seven years revealed an HCV sero-conversion in two additional women. No anti-HCV or anti-HIV nor HBsAg was detected in any of the women, their spouses or their 20 offspring.

RESULTS

Anti-HCV was detected in one out of the five women at the initial stage of the error (1997). No anti-HIV or HBsAg was detected in any of the women. A repeat re-evaluation revealed an HCV sero-conversion in two additional women. No anti-HCV or anti-HIV nor HBsAg was detected in any of the women, their spouses or any of their 20 screened offspring.

CONCLUSIONS

This study provides evidence for the nosocomial transmission of HCV through the use of a contaminated ball of cotton wool. It also confirms the poor efficiency of sexual and vertical transmission of HCV and calls for improved hospital facilities and the use of skilled staff to perform essential duties.

Sero-epidemiology of transfusion-transmissible infectious diseases among blood donors in Osogbo, south-west Nigeria

BACKGROUND

Transfusion-transmissible infectious agents such as hepatitis B virus (HBV), human immunodeficiency virus (HIV), hepatitis C virus (HCV) and syphilis are among the greatest threats to blood safety for transfusion recipients and pose a serious public health problem. This cross-sectional study was undertaken with the aim of determining the seroprevalence of HIV, HCV, hepatitis B surface antigen (HBsAg) and syphilis and correlates the findings with sex and age to ascertain the associations, if any, in the occurrence of the pathogens.

MATERIALS AND METHODS

HBsAg, antibodies to Treponema pallidum and HCV were determined using Clinotech test strips. Antibodies to HIV types 1 and 2 were screened with Determine and Immunocomb. All the reactive samples were confirmed using enzyme-linked immunosorbent assays. Antibodies to Treponema pallidum were confirmed with a Treponema pallidum haemagglutination test.

RESULTS

A total of 1,410 apparently healthy prospective blood donors aged between 18 and 64 years (mean+/-SD, 32.58 +/- 10.24 years) who presented for blood donation at the Ladoke Akintola University of Technology Teaching Hospital Blood Bank, Osogbo were studied. The male:female ratio was 6:1. Of the prospective blood donors, 406 (28.8%) had serological evidence of infection with at least one infectious marker and 36 (2.6%) had dual infections. The overall seroprevalence of HBsAg, HIV, HCV and syphilis was found to be 18.6%, 3.1%, 6.0% and 1.1%, respectively. The highest prevalences of HBsAg, HIV, HCV and syphilis infections occurred among commercial blood donors and those aged 18 to 47 years old, the most sexually active age group. There were no significant associations between pathogens except for syphilis and HIV (p > 0.001).

CONCLUSION

The high seroprevalence of blood-borne pathogens among prospective blood donors in Osogbo, Nigeria calls for mandatory routine screening of blood donors for HBV, HIV, HCV and syphilis.