100 Int J Res Med. 2014; 3(3);100-104 e ISSN:2320-2742 p ISSN: 2320-2734
Prevalence and trend of transfusion-transmissible infectious diseases
among blood donors in
Bhavnagar district – A 5 year retrospective analysis
Madhuri Agrawal1*, Ramkumar K. Singhal4, Pragnesh. H. Shah2, Bharti B. Parghi3, Bhavin Padiyar3 , Rekha R. Iyer3.
1
Tutor, Department of Pathology, Govt.Medical College Bhavnagar,Gujarat 2
Associate Professor, Department of Pathology, Govt. Medical College Bhavnagar 3
Assistant Professor, Department of Pathology, Govt. Medical College Bhavnagar 4
Resident Doctor, Department of Anatomy, Govt.Medical College Bhavnagar
INTRODUCTION
Transfusion transmitted infections (TTIs) are a great concern of safety for patients. Since the starting of blood transfusion scientifically in early 1940s, various transfusion associated problems have come to the forefront for the scientific community. These include TTI, all immunization to various blood and issues related to cold chain maintenance. TTI was first observed in the process of blood transfusion in late 1940. Till early 1970, blood bank personnel were only
*Corresponding Author
Dr. Madhuri Agrawal
Tutor in Department Of Pathology Govt. Medical College Bhavnagar, Gujarat, india
Email: madhuriagrawal12@gmail.com
concentrating on a few blood borne infections like syphilis and viral hepatitis despite the constant awareness regarding the presence of multiple agents.1
Blood transfusion service (BTS) is an integral and indispensable part of the healthcare system. The priority objective of BTS is to ensure safety, adequacy, accessibility and efficiency of blood supply at all levels.2 Transfusion of blood and blood components, as a specialized modality of patient management saves millions of lives worldwide each year and reduces morbidity. It is well known that blood transfusion is associated with a large number of complications, some are only trivial and others are potentially life threatening, demanding for meticulous pretransfusion testing and screening. Use of unscreened blood transfusion keep the
ORIGINAL ARTICLE
BSTRACT:
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 to study the Seroprevalence of transfusion transmitted infections amongst voluntary as well as replacement blood donors at Blood Bank and yearly comparison and study of the trend of incidence of HIV, HBV, and HCV & Syphilis positivity. MATERIALS AND METHODS: In this study, we aimed to access the prevalence and trend of HIV, HBV, HCV and Syphilis over the last 5 years (January 2009 to December 2013) among the blood donors who came to donate Blood at Blood Bank, Sir. T. Govt. Medical College & Hospital, Bhavnagar, Gujarat as well as in various blood donation camps organized by the same blood bank. RESULTS:
From the total of 49168 blood donors, 944 (1.92%) had serological evidence of infection with at least one pathogen, either of HIV, HBV, HCV, Syphilis or Malaria. These included 73 (0.15%) with HIV, 535 (1.08%) with HBV, 55 (0.11%) with HCV and 277 (0.56%) with Syphilis, 4(0.008%) with malaria. The prevalence of HIV, HbsAg, HCV and syphilis among replacement donors were 1.13, 4.46, 0.46 and 1.26%, respectively, which was much higher than in voluntary donors it was 0.13, 0.99, 0.10 and 0.47%, respectively. CONCLUSION:
Voluntary blood donors have been found to be safer than replacement blood donors vis-à-vis markers for HIV, HBsAg, HCV and syphilis. This finding emphasises the ever present need for adopting voluntary blood donation. Strict selection of blood donors and comprehensive screening of donor’s blood using standard methods are highly recommended to ensure the safety of blood for recipient.
101 Int J Res Med. 2014; 3(3);100-104 e ISSN:2320-2742 p ISSN: 2320-2734 patient at risk of acquiring many
transfusion transmitted infections (TTI) like hepatitis viruses (HBV, HCV), human immune deficiency viruses(HIV), syphilis, malaria etc. Transfusion departments have always been a major portal to screen, monitor and control infections transmitted by blood transfusion. Blood transfusion departments not only screen TTI but also give clue about the prevalence of these infections in healthy populations.3
We report the trends in the detected sero prevalence of hepatitis B (HBV), hepatitis C (HCV), Human ImmunodeficiencyVirus (HIV),and syphils and over a period of 5 years from 2009 to 2013 in a tertiary care hospital based retrospective study. This provides information regarding the safety of blood transfusion and an accurate assessment of known risks versus benefits of blood transfusion .
MATERIAL AND METHODS
The present study was conducted at Blood Bank,Sir.T.General Hospital and Govt. Medical College Bhavnagar. Tests are routinely done on every blood unit to exclude HIV, HBV, HCV, Syphilis .Data was collected over a period of 5 years from January2009to December 2013. In a 5 years period 49162 donors were tested. Donors were selected by the standard criteria for donor fitness. The screening for HIV was done by ELISA (4th Generation, Qualisa Tulip Diagnostics, India). HBsAg was detected by ELISA (3rd generation Hepalisa, J. Mitra and Co. India), Anti-HCV test was done by ELISA (3rd generation Qualisa Tulip Diagnostics India) and Test for Syphilis was done by ELISA(3rdgeneration Trepolisa Tulip Diagnostics India) from 2012 before it Screening for syphilis was done by Rapid Plasma Reagin (RPR)method . One step,
rapid, immunochromatographic test was
done for detection of plasmodium
falciparum and plasmodium vivax antigen. All the reactive samples were repeated in duplicate as recommended by NACO (National AIDS Control Organization). Repeat reactive were labelled as ELISA positive for respective infection and were discarded.
RESULTS
A total of 49168 apparently healthy adult donors were screened during the study period. Among them 45952 (93.45%) were males and 3216 (6.54%) were females. 46436 (94.44%) were voluntary donors
(VD) while 2732 (5.56%) were
replacement donors (RD) (Table 1). The overall prevalence of HIV, HbsAg, HCV, syphilis and malaria were 0.15, 1.08, 0.11, 0.56 and 0.008% respectively. Regarding different TTIs, highest numbers of blood donors
(1.08%) were having Hepatitis B followed by Syphilis (0.56%), HIV (0.15%), HCV(0.11%). and Malaria (0.008%). Only 4 of Malaria cases were seen in the year 2013(Table 2).
Seropositivity of HIV, HbsAg and HCV has decreased from 0.32 to 0.0.08% ,1.67 to 1.02 and 0.3 to 0.09% respectively. Seropositivity of syphilis has increased from 0.12 to0.90 from year 2009 to 2013(Table 2). The reason for this might be use of ELISA Kits better diagnostic test for syphilis from 2012 as compare to RPR in 2009.
The prevalence of HIV, HbsAg, HCV and syphilis among replacement donors were 1.13, 4.46, 0.46 and 1.26%, respectively, while in voluntary donors it was 0.13, 0.99,0.10 and 0.47%, respectively (Table 3).
Table 1Total blood collection and sex distribution of donors
Year Total donors Voluntary donors Replacement donors Males Females
2009 6900 5352 1548 6446 454
2010 8167 7912 255 7704 463
2011 9129 8832 297 8411 718
2012 11293 10925 368 10443 850
2013 13679 13415 264 12948 731
102 Int J Res Med. 2014; 3(3);100-104 e ISSN:2320-2742 p ISSN: 2320-2734 Table 2Trend of HIV, HBsAg, HCV and syphilis and malaria in blood donors
Year Total donors
HIV HBsAg
Malaria
HCV Syphilis
2009 6900 22 (0.32%) 115 (1.67%) 21 (0.3%) 8 (0.12%) 0
2010 8167 13 (0.16%) 101 (1.23%) 4 (0.04%) 31 (0.37%) 0
2011 9129 14 (0.15%) 75 (0.82%) 9 (0.10%) 40 (0.43%) 0
2012 11293 13 (0.11%) 104 (0.98%) 9 (0.08%) 74 (0.79%) 0
2013 3679 11 (0.08%) 140 (1.02%) 12 (0.09%) 24(0.9%) 4(0.03%)
Total 49162 73 (0.15%) 535 (1.08%) 55 (0.11%) 277(0.56%) 4(0.008%)
Table 3 Incidence of TTI (%) amongst voluntary (V) and replacement (R) donors during 5 year period (2009–2013)
Year HIV HbsAg HCV VDRL
V (%) R (%) V (%) R (%) V (%) R (%) V (%) R (%)
2009 0.30 0.39 1.51 2.19 0.24 0.52 0.07 0.26
2010 0.11 1.57 0.88 12.15 0.03 0.78 0.34 1.57
2011 0.11 1.34 0.71 4.04 0.09 0.34 0.42 1.01
2012 0.09 0.82 0.89 1.63 0.07 0.27 0.65 0.82
2013 0.05 1.51 0.99 2.27 0.08 0.38 0.87 2.65
0.13 1.13 0.99 4.46 0.10 0.46 0.47 1.26
DISCUSSION
With every unit of blood, there is1% chance of transfusion associated problems including TTI. The risk of TTI has declined dramatically in high income nations over the past two decades, but the same may not hold good for the developing countries. The national policy for blood transfusion services in our country is of recent origin and the transfusion services are hospital based and fragmented.4 Voluntary donors (VD) are motivated blood donors who donate blood at regular intervals and replacement donors (RD) are usually one time blood donors who donate blood only when a relative or a friend is in need of blood. The majority (93.46%) of the donors in our study were males which is comparable to the studies done by others. They are Pallavi et al.4 Mysore, Rao and Annapurna et al.5 in Pune, Rose et al.6 in Vellor, Arora D et al.
7
in Southern Haryana, Singh Ket al. 8 in Coastal Karnataka, Pahuja et al.9 in Delhi and Singh B et al.10 noting more than 90%of the male donors.
The overall seroprevalence of HIV, HBsAg, HCV and Syphilis were 0.15, 1.08, 0.11 and 0.56%. The data providing a picture of TTI burden in India has come from various seroprevalence studies (Table 4). Serosurveys are one of the primary methods to determine the prevalence of TTI. The assessment helps in determining the safety of blood products and also gives
an idea of the epidemiology of these diseases in the community8. For HIV, India is second only to South Africa in terms of overall number of people living with HIV. The Indian National AIDS Control Organization (NACO) suggested an overall prevalence of 0.91% (2005) in India with 0.25% in Delhi9. The prevalence of HIV in various parts of India is different with high rate in western and southern parts10. The present study showed a HIV prevalence of 0.15%. Similarly, Shah N et al.0.16%15 have noted, which is low as compare to other studies 4,7,9,11,12,13. (Table 4)
The VDRL reactivity in our study was 0.56% which is lower value as compared to other studies in India7,11,13,14 and higher than studies done by Pallavi P et
al(0.28%),Shah Net al(0.23%) and
Chandra T et al(0.01%) Table 4
The prevalence of Malaria was 0.008%. 4 Malaria positive cases seen in 2013 only (Table 2). There are very few studies available on prevalence of Malaria among blood donors. In Mysore, no donor from 39060 was found to be positive for
Malaria.4 HIV, HBsAg and HCV
prevalence in our study showed a slightly blood donors. In Mysore, no donor from 39060 was found to be positive for
Malaria.4 HIV, HBsAg and HCV
103 Int J Res Med. 2014; 3(3);100-104 e ISSN:2320-2742 p ISSN: 2320-2734
Table 4 : TTI prevalence in India Comparison of TTI prevalence rate in different parts of India
Place HIV% HBsAg % HCV% SYPHILIS% Reference
Ludhiana 0.084 0.66 1.09 0.85 Gupta N. et al(2004)14
Delhi 0.56 2.23 0.66 - Pahuja S etal(2007) 9
Lucknow 0.23 1.96 0.85 0.01 Chandra T etal (2009)12
Haryana 0.3 1.7 1.0 0.9 Arora D et al (2010) 7
West Bengal 0.28 1.46 0.31 0.72 BhattacharyaP et al 11(2007)
Bangalore, 0.44 1.86 1.02 1.6 Srikrishna Aetal Karnataka (1999)13
Ahmedabad, 0.16 0.98 0.11 0.23 Shah N et al (2013)15
Mysore 0.44 1.27 0.23 0.28 Pallavi P et al(2011)4
Present study 0.15 1.08 0.11 0.56 (2014)
From 0.2 to 0.90 from year 2009 to2013 (Table 2). And 0.30-0.09% respectively. Seropositivity of syphilis has increased Reason for this might be use of ELISA Kits which is better diagnostic test for syphilis from 2012 as compare to RPR in 2009-2011 or this may be reflective of changing life style and more open social norms. There has been a constant difference between seropositivity for HIV, HBsAg, HCV and Syphilis amongst voluntary and replacement blood donors in our study. The prevalence of HIV, HbsAg, HCV and syphilis among replacement donors were 1.13, 4.46, 0.46 and 1.26%, respectively, which was much higher than in voluntary donors it was 0.13, 0.99,0.10 and 0.47%, respectively. Studies8,10 have showed high seropositivity rate in RD compared to VD, a similar finding as we noted in our study.
CONCLUSION
Low seropositivity for HIV, HBsAg and HCV diseases in our study could be attributed to inclusion of more number of voluntary donors ,proper counseling of blood donors and donor selection criteria followed by rationale use of blood. As is apparent from the results of present study the results of which are comparable to other studies in India, voluntary blood donors have significantly lower rates of prevalence for markers of TTIs as compared to replacement blood donors. Awareness of general population about voluntary regular blood donation should be created to minimize the chances of
spreading transfusion transmitted
infections. The current practice of
selection of voluntary donors over Replacement donors to meet with the need for blood in a general hospital coupled with more numbers of voluntary donor drives in the community as well as availability of better testing reagents (particularly for HIV and HCV infections) is sure to lower down the threats of
transmitting TTIs to patients via
transfusion of blood and blood products.
Acknowledgement
The author acknowledges to all blood donors who donated blood for saving the lives of patients as well as doctors and technicians of Blood Bank of Sir T hospital for their excellent technical support.
REFERENCES
1. Choudhary N. Transfusion transmitted infections: How many more?Asian J Trans Sci 2010;4:71-2.
2. Islam MB (2009) Blood transfusion services in Bangladesh.Asian J Transf Sci 3:108–110
3. Khan ZT, Asim S, Tariz Z, Ehsan IA, Malik RA, Ashfaq B et al (2007) Prevalence of Transfusion transmitted infections in healthy blood donors in Rawalpindi District, Pakistan–a five year study. Int J Pathol 5:21–25
4. Seroprevalence and Trends in
104 Int J Res Med. 2014; 3(3);100-104 e ISSN:2320-2742 p ISSN: 2320-2734 5. Rao P, Annapurna K (1994) HIV status
of blood donors and patients admitted in KEM hospital, Pune. Ind J Hemat Blood Transf 12:174–176
6. Dolly R, Annie S, Thaiyanayaki P,
George PB, Jacob TH (1998)
Increasing prevalence of HIV antibody among blood donorsmonitored over 9 years in blood bank. Indian J Med Res 108:42–44
7. Arora D, Arora B, Khetarpal A (2010) Seroprevalence of HIV, HBV, HCV and syphilis in blood donors in Southern Haryana. Indian J Pathol Microbiol 53:308–309
8. Singh K, Bhat S, Shastry S (2009) Trend in seroprevalence of Hepatitis B virus infection among blood donors of coastal Karnataka, India. J Infect Dev Ctries 3:376–379
9. Pahuja S, Sharma M, Baitha B, Jain M (2007) Prevalence and trends of markers of hepatitis C virus, hepatitis B virus and human immunodeficiency virus in Delhi blood donors. A hospital based study. Jpn J Inf Dis 60:389–391 10. Singh B, Verma M, Kotru M, Verma
K, Batra M (2005) Prevalence of HIV and VDRL seropositivity in blood
donors of Delhi. Indian J Med Res 122:234–236
11. Bhattacharya P, Chakraborty S, Basu SK (2007) Significant increase in
HBV, HCV, HIV and syphilis
infections among blood donors in West Bengal, Eastern India 2004–2005. Exploratory screening reveals high
frequency of occult HBV
infection.World JGastroenterol
13:3730–3733
12. Chandra T, Kumar A, Gupta A (2009) Prevalence of transfusion transmitted infections in blood donors: an Indian experience. Trop Doct 39:152–154 13. Srikrishna A, Sitalakshmi S, Damodar
P (1999) How safe are our safe donors. Indian J Pathol Microbiol 42:411–416 14. Gupta N, Kumar V, Kaur A (2004)
Seroprevalence of HIV, HBV,HCV and syphilis in voluntary blood donors. Indian J Med Sci58:255–257.
15. Shah N, Shah J M, Jhaveri P, Patel K, Shah C K, Shah N R(2013) Sero prevalence of HBV, HCV, HIV and syphilis among blood donors at a tertiary Care Teaching Hospital in
Western India.Gujarat Medical Journal
