Top PDF Prevalence of transfusion transmissible infections in blood donors of Pakistan

national program for donor selection, recruitment, reten- tion, and education; this will minimize donations from donors who might transmit diseases to the recipients. Equally important is to evaluate the burden and risk factors for TTIs in the general population [1]. The accurate figures of TTIs in our population are still un- known due to the lack of understanding, un-availability of screening tests, limited access to health facilities and the unavailability of surveillance systems [2]. Furthermore, voluntary donors have been reported to be the safest group of donors because they usually have better health seeking behavior than the replacement blood donors and

One of the problems in providing safe blood units is the risk of transfusion-transmissible infections (TTIs). Viral infections such as hepatitis C virus (HCV), hepatitis B virus (HBV) and human immunodeficiency virus (HIV) are the greatest concerns [1]. Screening for TTIs is a routine practice to guarantee the safety of blood products. Moreover, monitoring the trends in the prevalence of TTIs in blood donors will provide a mechanism to evaluate the safety of the blood supply and the effectiveness of donor deferral criteria [2]. To improve the safety of the blood, other measures, such as the use of confidential unit exclusion )CUE), have also been adopted by many blood banks. The main goal of the CUE process is detecting donors who are infected but are in the window period. This process was designed for detecting donors who denied their involvement in high-risk activities during the pre-donation interview [2] and an opportunity to confidentially exclude their blood [3]. In 2015, World Health Organization (WHO) reported that the prevalence of HBV, HCV and HIV infections among donors varies from 0.008% to 6.08%, 0.004% to 1.96%, and 0.0004% to 2.0%, respectively in different parts of the world [4]. The prevalence of HBV, HIV and HCV infections in Iran is 0.7% [5], 0.004% [2] and 0.5% [6] in blood donors, respectively. Therefore, this study was conducted to report the prevalence and trends of TTIs infections and the prevalence of CUE among blood donors in Kurdistan province, west of Iran, during an eight-year period. To

8. Abdallah TM, Ali AAA. Sero-prevalence of transfusion- transmissible infectious diseases among blood donors in Kassala, eastern Sudan. J Med Med Sci. 2012;3(4):260–262. 9. Fessehaye N, Naik D, Fessehaye T. Transfusion transmitted infections—a retrospective analysis from the National Blood Transfusion Service in Eritrea. Pan Afr Med J. 2011;9:40–46. 10. Teo KS, Saparudin MS, Zain Z, Morshidi MA, Metassan N, Jaberudin R, Teo BC, Yakup S, Lim A, Ashikin NW. Transfusion transmissible infections in Brunei Darussalam: a blood donor study. Brunei Int Med J. 2011;7(6):321–327. 11. Tessema B, Yismaw G, Kassu A, Amsalu A, Andargachew M, Emmrich F. Seroprevalence of HIV, HBV, HCV and syphilis infections among blood donors at Gondar University Teaching Hospital, Northwest Ethiopia: declining trends over a period of 5 years. BMC Infect Dis. 2010;10:1

In the present study, we investigated the overall preva- lence of various TTIs in blood donors giving blood at four regional Chinese blood centers from 2000 to 2010. The overall prevalence rates for HIV, HBV, HCV and syphilis were 0.08%, 0.86%, 0.51% and 0.47%, respect- ively. The seroprevalence of TTIs appears to be substan- tially lower among blood donors than in the general population of China, because of successful screening and the selection of donors who are at a lower risk for infec- tion. Although the risk of TTI has been reduced dramat- ically, the majority of Chinese blood centers currently still rely on serology tests, with no NAT testing for rou- tine donor screening. A few studies have demonstrated a relatively high residual risk compared to developed coun- tries [27-30]. Fortunately, the government has realized the importance of NAT testing. In 2011, NAT testing on HBV, HCV, and HIV was piloted in eleven selected blood centers. It will be implemented at all provincial-level blood centers in the next several years. The population prevalence of TTIs which potentially threaten the safety of the blood supply, along with rising transfusion demands for blood, have stimulated an increased awareness of the importance of strengthening the safety of the blood supply and blood transfusion in China. We believe the residual risk of TTIs will be greatly reduced after NAT implementation.

Several studies have proven that the prevalence among new volunteer blood donors is consistent with those found in other populations. Moreover, comparisons of prevalence and impact with countries with similar criteria to those of France (England, Canada, and the USA) show that the differences between the rates of the population of volunteer blood donors of these four countries are also found at the general population in these countries. Finally, if the improvement of donor selection over time has undoubtedly played a key role in decreasing the prevalence and impact, this change resulted probably also the preventive measures taken in the general population to avoid including new infections [22]. With the constant improvement of donor selection firstly, and secondly, to progress in the development of more sensitive screening tools and in the development of innovative screening measures blood components today present a very low viral risk [22].

Although the frequency of TTI reported in this study is nearly similar to that of a previous local study, signifi- cant differences pertaining to seroprevalence and trends of particular TTIs was observed. The most dominant type of TTI over the study duration was HBV (2.0%). The reported prevalence was lower when compared to results obtained from similar studies conducted in the region [1, 7, 20]. Further, the high prevalence of HBV among blood donors in SSA has been attributed to the high prevalence [8%] and endemicity of the virus in the region [2]. A point reflected in estimated transfusion risk models which place HBV above HIV in Africa [2]. These results point to the possibility that the prevalence of HBV in the general population maybe comparatively high. Equally notably is the fact that prevalence of HBV markers exhibited a statistically significant association with sex, age categories, regions and donor type. Behav- ioural, cultural and socio-economic differences associ- ated with membership to these categories may explain the observed variation. In particular, the high seropreva- lence of HBV markers (and HCV) in donors below 17 years of age may be linked to the fact that most young people acquire piercings or tattoos at this age - This hypothesis is highly speculative and warrants fur- ther investigation.

Our study showed increasing trend of voluntary blood donation with male predominance. Amongst the blood donors, seropositivity of HbsAg was highest followed by HCV, syphilis, HIV and Malaria. High seropositivity with significantly increasing trend of HbsAg was observed in the study. It needs further investigation including studying the prevalence rate of HBV in the general population to address the issue. Decreasing trends with low prevalence of HIV and HCV observed in the study is an encouraging sign supporting the growing awareness of these life threatening diseases. Malaria and VDRL appears to be sporadic findings and detection is mainly based on available sensitive kits. So we conclude that substantial risk of transfusion-transmissible infections is still prevailing with the blood transfusion services and ensuring that blood safety has a long way to go.

Socio-demographic characteristics influence the distri- bution of TTIs among blood donors. In Kenya, national blood transfusion services (NBTS) rely mainly on young voluntary blood donors, particularly secondary schools, colleges and University students, majority in the age range of 15–24 years [13]. Blood donations from school students are preferred over adult donors owing to lower HIV prevalence estimated at 1% compared to 6.6% preva- lence recorded in adults aged 30–34 years [13]. However, a study carried out in Kenya using stimmunology still detected a significant number of early pre-seroconver- sion of HIV carriers both among adults and teenage pop- ulation [14]. This study sought to establish the dominant demographic and other risk factors still playing a role in TTIs seropositivity recorded in the region despite recent safety interventions.

prevalence of 0.69% documented in their study and 0.247% reported by Makroo and colleaques among repeat donors donating in a tertiary health care centre of Northern India (Luksamijarulkul et al., 2002; Makroo et al., 2011). The higher rate of HBV and HCV among our repeat donors compared to donors of the Asian region suggest regional variation in the prevalence of these infections agents, susceptibility and lifestyle. We suggest the conservation of safe committed donor pool by vaccination with potent HBV vaccine and the development of same against HCV and HIV. There were no TTIs detected among 2.2% donors who donated 16 times and above (Table 1) confirming the superior safety of blood collected from long term over first-time and short term committed voluntary donors. The detection of markers of TTIs in our committed donors of up to 15 times, suggests the need to intensify the application of donor selection criteria and safe lifestyle counseling at each donation visits. This step would identify and defer donors initially safe but subsequently at risk of contracting and transmitting TTIs and also encourage still safe ones to maintain low risk lifestyle while screening all blood units donated for TTIs appropriately before transfusion. The absence of detectable markers of HBV, HCV, HIV and syphilis among our donors of above 15 times donation provide a group from which blood can be collected and use in dire situation, such as transfusion demands in crisis situations in conflict prone setting like ours with limited number of blood donors. The retention of safe donors and follow up for regular repeat blood donation offers the opportunity to detect, study and better understand disease progression in acute HIV and other viral infections in safe donors who become reactive.

The majority of donors tested in this study were family replacement donors rather than voluntary non-remunerated blood donors. All the cases of HCV infection was concentrated among family replacement donors. Our finding is in agreement with previous report which observed a higher prevalence of HCV among family donors compared to voluntary donors 52 . Our finding is also in agreement with report by Durro and Qyra1 53 in Albania, which indicated that the prevalence of HBV was significantly higher in family replacement donors than in voluntary donors. In addition, in a report from Pakistan by Asif and colleagues 54 , a significantly higher prevalence of HCV was observed among family replacement donors than in voluntary donors. Difference in infection rates between voluntary and replacement donors have been observed in many previous studies 55-57 . Our finding is also in agreement with recommendation by the WHO that voluntary non-remunerated blood donors who give blood out of altruism are the safest source of blood. Family replacement donors are often under pressure to donate blood when their relations are admitted in hospital and in need of blood transfusion even when they know that they are potentially at risk for HCV from high risk behaviours. They are more likely to conceal medical history and be involved in high risk behaviour that can potentially predispose them to infection with HCV and thus pose a great threat to the safety of blood supply. The number of voluntarily donated blood has continue to fall over years in Nigeria due to logistic and organizational problem associated with the Nigerian National Blood Transfusion Service 13 . The net result of this failure in the stewardship of blood and blood products is that the commercial and family replacement donors continues to predominate.

As published by NACO in 2007, Family/replacement donors still provide more than 45% of the blood collected in India. Such donors are supposed to be associated with a significantly higher prevalence of transfusion-transmissible infections (TTIs) including HIV, hepatitis B, hepatitis C, syphilis and malaria. For a safe blood service in our country, where comprehensive laboratory tests are neither possible nor pragmatic, it is best to switch over to 100% voluntary donations, as it is now established that only voluntary non-remunerated regular donation is the safest. Thus, one of our key strategies to enhance blood safety is to focus on motivating non-remunerated blood donors and phasing out even replacement donors [2].

A large percentage of the blood donors harbor transfusion- transmissible infections, 8.2% with at least one screened pathogen and 0.96% with multiple infections. The preva- lence of TTI infection high for all blood donors especially for age groups such as 20 – 29 and 30 – 39 years. Therefore, strict selection of blood donors with the emphasis on get- ting voluntary donors and highly sensitive and specific tests for screening of donors ’ blood for HIV, HBV, and HCV using standard methods are highly recommended to ensure the safety of blood for the recipient. The prevalence of HIV-HBV, HIV-HCV, and HBV-HCV co-infection need to be studied on a larger scale for a better understanding of the impact on clinical condition and treatment response.

This retrospective analysis of blood bank data on TTI from India is the first of its kind to cover 497 blood banks across 29 states [3]-[5] [10]. Hence this study provides a better representation across regions in India than earlier studies. The study shows an overall decline in TTIs at the national level among voluntary and replacement do- nors, while at the regional level all TTIs have been declining among voluntary donors, except HCV. The level of hepatitis infections (both HBsAg and HCV) was found to be higher than HIV at the national level among volun- tary and replacement donors. The high positivity levels of the two hepatitis infections in the Eastern and West- ern regions of the country shows the need for additional attention by the blood safety program in these two re- gions, rather than the entire country. Studies [11]-[13] have linked hepatitis infections with a history of tattooing and blood transfusion. Our study does not have the scope to explore the profile of donors with Hepatitis infec- tions. Hence, it is suggested that qualitative studies are conducted to explore the reasons for hepatitis infection among blood donors, specifically in the Eastern and Western part of India. In addition, the blood safety program could educate donors on the importance of providing uninfected blood through pre-donation counseling, and self-exclusion of donors based on their infection status, vulnerability to infectious diseases and their history of high-risk behaviors.

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.

Transfusion of blood and its components is lifesaving, however the patients are at a significant risk of contracting transfusion- transmitted infections (TTIs). The aim of the present study was to find out prevalence of TTIs in voluntary and replacement donors in a tertiary care hospital. This study was done in the Blood Transfusion Department, PGIMS Rohtak Haryana, a tertiary care centre in North India from January 2016- June 2018. Blood was collected from apparently healthy individuals following donor selection criteria after detailed history and examination. A total of 104090 donors were screened over the study period. TTIs testing were done with 3rd generation ELISA for HBV and HCV and HIV1 and 2 testing was done with 4th generation ELISA. Testing for malaria parasite was done by card test based on malarial (pLDH) antigen based principle. VDRL testing was done for syphillis. The total number of donors, who were found positive for TTIs, was 1806 (1.7%). The prevalence of HIV, HBV, HCV, syphilis infections among donors was 0.17%, 0.93%, 0.59% and 0.04% respectively. Prevalence of hepatitis infection (0.93%) formed the majority of the total TTI’s. No blood donors were found positive for malaria parasite. The present study shows lower prevalence of TTIs as compared to other studies because of higher proportion of voluntary blood donation and stringent donor screening. Avoiding unnecessary blood transfusion and use of highly sensitive tests including nucleic acid testing can help to further reduce the risk of TTIs in this scenario .

Materials and Methods: The present five years (1 st January 2012 to 31 st December 2016) study is a retrospective analysis of one million three hundred thirty-six thousand one hundred fifty-six (1,336,156) blood donor’s record at Madhya Pradesh Aids Control Society (MPSACS) Bhopal; donors donated their blood at National Aids Control Organization (NACO) supported blood banks, Madhya Pradesh, India. With the permission of MPSACS, donor’s data was collected, retrieved, tabulated, summarized and compared statistically by frequency distribution and percentage proportion. Chi-square (X 2 ) test was applied to evaluate the significant (p-value) ratio of difference

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 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 ORIGINAL ARTICLE

The prevalence of hepatitis infection in the general population in Northeast of Libya is not available due to the lack of publication for the past decades. Hepatitis markers are important tests in screening blood donors and prevent transfusion-related hepatitis. Total 78.987 donors were screened over an 8-year period from 2008 to 2015. The results of this study indicate that of the apparently healthy voluntary blood donors in four regions (172) 0.21% were positive for HBsAg and (197) 0.24% were positive for anti- HCV (total number 369). This prevalence for HBsAg is lower than that reported in the international finding in Libya during 2003 (2.2% for HBV and 1.2% for HCV) [8]. In Libya, a study conducted between 1991 and 2001 indicated that the prevalence of HCV infection ranged from 1.2% to 1.6% among blood donors, similar to the prevalence among the general population reported in 2014 of 1.2%, though it was much higher (20.5%) among hospital personnel but similar to that reported from the western region 0.8% for HBV and 0.7% for HCV [11]. This could be explained by the fact that families of blood receipts search for “physically healthy” blood donors. The prevalence of HBsAg among blood donors has been found to be 9.8% in Yemen [12], 1.2% in Egypt [13] and 1.2–1.7% in India [14].

Background: Timely transfusion of blood saves millions of lives, but unsafe transfusion practices puts millions of people at risk of transfusion transmissible infections (TTIs). Blood transfusion carries the risk of transfusion- transmissible infections including human immunodeficiency virus (HIVI&II), hepatitis B virus (HBV), hepatitis C virus (HCV), malaria and syphilis. With every unit of blood there are 1% chances of transfusion associated diseases. Methods: This study was conducted over a period of 3 years (1stJanuary 2015-31st December 2017) at hospital blood bank of Pt. Jawaharlal Nehru Government Medical College, Chamba (H.P). The study was conducted on both voluntary and replacement blood donors who came to our blood bank and voluntary blood donation camps in and around Chamba. Statistical analysis used. Collected data was analyzed using appropriate statistical softwares such as EPI-INFO and MS-Excel.

In addition to this, this study identified malaria screening of blood donated for transfusion purposes should be an essential task of blood bank laboratories in the study area. This study included malaria screening as part of the study even though malaria is not included as a screening test in blood transfusion centers in the region. Southern Ethiopia is endemic for malaria. It is possible to screen donors in blood bank centers for malaria. Blood bank centers employ adequate numbers of personnel to perform required activities the BTS (Blood Transfusion Service) protocol request. Overall, these findings and comparisons show that testing donor units for TTIs is of concern for the betterment of blood transfusion programs in Ethiopia. As blood donors are