Top PDF The risk of transfusion –transmissible hepatitis c infection among blood donors in sokoto, north western Nigeria

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.

Results: Of 197568 cases of the blood donated during 2007 and 2014, 0.29% was positive for Hepatitis B surface antigen, 0.006% for anti-human immunodeficiency virus and 0.06% for anti-hepatitis C virus. The prevalence of human immunodeficiency virus remained stably below 0.02% during the study period whereas the prevalence of Hepatitis B surface antigen showed a downward trend over the period of 8 years. The trend of hepatitis C virus infection frequency had increasing patterns from 2007 to 2009 and decreasing patterns thereafter to 0.05%. CUE was chosen in 1442 (0.7%) donations. Out of this number, 864 (59.9%) were first time blood donors and 578 (40.08%) repeat donors. CUE-positive donations had significantly higher risk of TTIs markers (p< 0.000).

Hepatitis C virus (HCV) was identified in 1989 as the major agent of post-transfusion hepatitis previously desig- nated under the name of “ non-A, non-B hepatitis [7]. It is a blood-borne pathogen transmitted most efficiently by percutaneous membrane exposure to contagious blood. It is estimated that 60% of hepatitis C cases are related to injection drug use (IDU) [8]. HCV infection is highly rec- ognized as a major healthcare problem throughout the world and around 130 to 170 million people are chronic carriers of this virus in the world, with an average sero- prevalence estimated at 2.2%. This rate varies from coun- try to country: it is very low in Europe, higher in Southeast Asia and Africa [7]. HCV causes 85% persistent infection, of this 70% of them develops chronic hepatitis, resulting in cirrhosis of the liver within 20 years and hepatocellular carcinoma (HCC) in a further 10 years [9]. Hepatitis C virus is associated with the seropositivity of the human immunodeficiency virus infection [2].

exposure to high risk sex. This may be explained by the low economic status initiating young adolescents to mul- tiple sexual relationships, thus making them vulnerable to HBV and other co-infections. The findings corrobo- rate local studies that found sex for cash payment associ- ated with HIV and other co-infections [12]. In contrast, different results were observed in Egypt showing that TTIs was not associated with high risk sex [26]. In rela- tion to age and gender, none was associated with any of the TTIs seroprevalence, although previous local stud- ies had reported different results showing that adults’ aged ≥ 20 years were more likely to get infected by HIV compared to young adolescents aged 10–19  years [12]. Moreover, females were more likely to test HIV positive compared to males [13]. The variation observed may be related to the difference in study population. In relation to blood transfusion history, there was no association with any of the TTIs. However, a similar study in Egypt reported different results showing HCV seroprevalence of 72% among donors with transfusion history [26]. Meanwhile, a previous local study had reported HIV transfusion transmission risk of 2% among recipients [8]. On the contrary, this study did not find any associa- tion between TTIs seroprevalence and blood transfusion history. Recent implementation of high quality screen- ing assays, coupled with stringent pre-donation screen- ing, and enhanced haemovigilance may have influenced decrease in transfusion risk observed earlier. Meanwhile, previous exposure to illicit drug use was not associated with TTIs seroprevalence. However, different results have been reported in Egypt showing 47.5% of blood donors with drug use history testing HCV positive [26].

Blood safety therefore remains an issue of major concern in transfusion medicine in Sub Saharan Africa [15]. There is high incidence of blood-demanding health situations in northern Ghana resulting from anemia, malnutrition, accidents, surgical and obstetri- cal emergencies associated with blood loss, etc. The higher the demand for blood transfusion services, the higher the possibility of transmitting HBV and other blood-borne pathogens through contaminated blood. Illiteracy, lack of adequate health information, low socioeconomic situation in the region, inadequate trained health personnel and some inappropriate cul- tural practices linked with transmission dynamics including polygamy tend to augment the disease trans- mission. Furthermore, the National blood transfusion service ’ s agenda, Government policies as well as that of championing stake holders to combat the disease are not clearly known. The study therefore was conducted to determine the prevalence of hepatitis B infection among blood donors at Tamale Teaching Hospital Blood Bank which will indicate the risk of transfusing infected blood if the blood is not properly screened. The investigation will provide justification for re-stra- tegizing and initiating more sensitive interventions that will help minimize or possibly eliminate hepatitis B infection in Ghana.

Syphilis is sexually transmitted disease that represents a major public health problem, spreading worldwide specially in developing countries. The prevalence of syphilis in this study was 5.4%, this study is in agreement with values ranging between (1.1% - 12.4%) reported from different African countries [31], but it was higher than 2.7% showed by study done in eastern Sudan [8], and 3.6% found by Chikwemet et al in Nigeria [32], and 0.1% in south Nigeria [33], 0.85% found by Gupta et al [34], and lower if compared with 23% study done by Elagib and Abalmagid in south western Sudan [35], and 15% found bey Elfaki et al [6], at whit Nile state, Sudan study showed 6.8% by Elsharif at al [36], and 12.8% was a survey in blood donors Ethiopia [37], 12% by Muttee et al among Tanzanian donors [38], 7.5% by Adjetet et al [39]. The most rate of co-infection in this study is BBV and syphilis 5.1%.

from Southern Africa [9, 12]. Although this value com- pares favourably to findings from a study in North West Ethiopia [3], the prevalence was lower when compared to studies conducted in Egypt (4.3%) [21] , Tanzania 1.5% [22], Ethiopia [1] and Sudan 3.4% [23]. This result cor- roborates the assertion that HCV poses less risk to blood transfusion in Southern parts of Africa by virtue of low prevalence [2]. However, it is important to note that the presence of anti-HCV antibodies among apparently healthy blood donors in Eritrea confirms the presence of HCV in the country. In addition, our data also demon- strated that there has been an upward trend in HCV prevalence over the years – the sharp uptick in 2016 is particularly noteworthy. Although this finding should raise concern, it should be viewed in light of previous re- ports which noted that HCV antibody tests tend to have high false positive misclassification in African popula- tions [24, 25]. The high frequency of false-positive anti- bodies (FPA) for HCV has been associated with infectious agents such as malaria, Schistosoma mansoni , Syphilis, HIV, malnutrition or other chronic infections [24]. Therefore, it’s our opinion that in the absence of confirmatory nucleic acid based tests (NAT) for HCV; categorical estimates of the frequency of HCV among blood donors in this population may be elusive.

cirrhosis, chronic hepatitis, and hepatocellular carcinoma [7, 8]. Some important ways for the transmission of HBV are the utilization of unsterilized medical instruments, blood transfusion, sharing of individual items, offering needles to drug addicts, barber risk, reuse of contaminated needles and syringes without sterilization for therapeutic injections, vertical transmission , furthermore by unsafe sexual interaction with HBV infected patients [9-12]. The prevalence of HBV infection among the developing countries of Asia, the Pacific Islands and Africa is very high as compared to developed countries like Australia, Western Europe, and the USA, where the prevalence of HBV is very low [13]. In Russia, Japan, and Eastern Europe about 2- 8% of their population are infected with HBV. It is estimated by world health organization (WHO), that about 0.6 million deaths of the people occur annually due to HBV infection. As per 2010 report of WHO, it was observed that 0.12 billion individuals were infected with HBV in China followed by India with 0.04 billion and Indonesia with twelve million infected individuals [14]. In Pakistan, HBV is also a prominent public health issue, and its rate of infection is rising rapidly [15]. The reason for high infection rate might be due to deficiency of suitable public health services, poor financial condition or lack of awareness about the transmission of major sexually transmitted diseases (STDs) i.e. HBV, HCV, and HIV [16]. According to different research studies performed in the various regions of Pakistan, showed that the prevalence rate of HBV is 2- 10% among healthy blood donors, 5-9% among medical services staff, 3.16% among the pregnant women, 3.6-18.66% among the general population, 10-20% of patients with temporary diagnosis of hepatitis and 3.16- 10.4% among professional blood donors [17].

With the introduction of routine blood screening for HCV antibody and improvements in the tests for detecting HCV in mid-1992, transfusion-related hepatitis C has virtually disappeared. At present, injecting drug abuse and Hemodialysis are the most common risk factor for contracting the infection. HCV is a small (40 to 60 nanometers in diameter), enveloped, single strand-ed RNA virus of the family Flavi-viridae and genus hepacivirus. There are at least six major genotypes and more than 50 subtypes of HCV (7). These differ in nucleotide sequence by more than 30% over the complete virus genome. A number of subtypes, which differ in nucleotide sequence by more than 20% have also been described (8-9).The genotypes of HCV show a distinct geographical distribution. Genotypes 1a, 1b, and 2a are the predominant genotypes in the United States and Western Europe. Genotype 4 is the predominant genotype of the Middle East. Types 5 and 6 are largely confined to South Africa and South East Asia, respectively (10)

The importance of sexual activity in the transmission of HCV has not been well-established [37]. Nevertheless, studies with blood donors suggest an association between sexual transmission and HCV [10,11,17,31,40]. This study detected an independent association between sexu- al behavior and positive anti-HCV test. The results of the logistic regression model show that the number of sexual- ly transmitted diseases during life and sexual intercourse with injection drug users and with HBV or HCV carriers were independent risk factors for anti-HCV positivity. Even though number of sexual partners and sexual orien- tation were associated in the bivariate analysis, they were not independent of other risk factors such as transfusion and injection drug use by the donor or his/her sexual part- ner. In South America, the prevalence of HCV infection in heterosexuals attending STD clinics and with no history of injection drug abuse (11.5%) is greater than in North America (6.0%) and Europe (1.9%) [37]. It is speculated that HCV transmission may be facilitated by sexually transmitted diseases [41,42]. However, there is a possibil- ity that HCV seropositivity associated with sexual inter- course with injection drug users or HBV/ HCV carriers may result from actual sexual transmission of HCV – al- though it may also result from exposure to unreported parenteral risk factors or from sharing certain personal items, such as toothbrushes or razors, which can result in accidental exposure to the partner's blood [11,33,42]. In conclusion, this case-control study confirmed some in- dependent risk factors for anti-HCV positive test described in other studies of blood donors. The hierarchical multi- variate analysis identified age, schooling, incarceration, past transfusion, tattooing, intravenous drug use, number of sexually transmitted diseases, sexual intercourse with injection drug users and partners with hepatitis B or C as the main risk factors for HCV seropositivity in the present population of southern Brazilian donors. Some character- istics of sexual behavior were detected as independent risk factors, suggesting that sexual intercourse is an important source of transmission. The identification of groups at risk and the planning of interventions aimed at controlling HCV infection should take these findings into account. Competing interests

In the study of Manzini et al., they estimated that 2298 units per million donated units could potentially contain HBV-DNA representing a risk 100 times higher than the risk of transfusing HBV-DNA-positive donation collected during the window phase of the infection (estimated to be 15.78 units per million donated units) [19]. Whether HBsAg-negative/anti-HBc-positive units can transmit HBV infection to recipients is debated [30,31]. The low viremic content and often the concomitant presence of neutralizing anti-HBs antibodies have led several authors to conclude that donated blood from anti-HBc/anti-HBs- positive is safe. The English experience seems reassuring as no case of hepatitis B transmission was related to transfusion in a survey of 20,000 blood units controlled only for HBsAg [32]. However, the prevalence of HBV is very low in Northern Europe and the number of units traced was relatively small, while the transfusion risk may be different in areas such as Italy, where HBV re- mains endemic. In four large studies of post-transfusion hepatitis performed in the 1970s in the United States, Australia and The Netherlands, the overall rate of HBV infection after receipt of blood tested for HBsAg only varied from 1% to 2.5%; however in all se- ries, hepatitis B was more frequent after transfusion with anti-HBc- positive than with anti-HBc-negative blood, with the rate of transmission varying between 2% and 8.6% among recipients of anti-HBc-positive blood [31,33-35]. A num- ber of other studies showed cases of HBV transmission after the transfusion of anti-HBc-positive blood [36,37].

Despite the 2.6% HIV sero-positivity in our study which is lower than from several sub-Saharan Africa countries, where HIV prevalence ranges from 3 to 5% [44], it is much higher than 0.1% Jijiga Ethiopian Somali region [19], a 1.6% magnitude from both Yrgalem and Hawassa studies, South Ethiopia [20, 45] 0.18, 1 and 1.13% reports from Eritrea, Nyala Hospital western Sudan and South Africa respectively [34, 35, 46], 0.4% in Khartoum [47], and from Egypt in which it was no cases reported [48]. The higher report from our study is probably due to the rise in seropositivity of HIV among the general population recently, the highest geographic distributions of HIV infection in the study area which is similar to Ethiopian national data [49]. As well variation in the burden of the dis- ease in the society, population differences regarding social behavior, lifestyle, socioeconomic status, level of awareness and variation in study setting plus a strin- gent nonstop creation of awareness on HIV in the previously stated study might also explain in-part for the observed variations.

In Sub-saharan African countries, malaria is of greatest concern among parasitic diseases known or suspected to be transmitted by blood transfusion [8]. Transfusion-transmitted malaria can have serious consequences, as infection with Plasmodium falciparum may prove rapidly fatal especially in non or less-immune recipients such as children under five years and pregnant women. A review of 17 studies carried out between 1980 and 2009 in sub-saharan countries where malaria is endemic revealed a median prevalence of 10.2% in blood donors [9,10]. This prevalence reached 55% in Nigeria, highlighting the necessity to care about transfusion- transmitted malaria, especially in endemic settings and when receivers present particular risk associated with young age, pregnancy or immunodepression. In Cameroon, malaria is endemic and remains a major public health problem. Malaria-related morbidity and hospital mortality where respectively 30.1% and 22.9% in 2014 [11]. Sadly, despite this high endemicity, blood is still not systematically screened for malaria prior transfusion. Consequently, data on potential risk of induced malaria by blood transfusion are essentially lacking, and this risk need to be addressed in order to improve safety of blood transfusion. The present study aimed to determine prevalence of viral, bacterial and hemoparasites infections and associated risk with blood transfusion among blood donors at the General Hospital of Douala, the biggest and more populated city of Cameroon, with more emphasis on Plasmodium the causative agent of malaria.

Blood transfusion is one of the most important therapeutic options of life-saving intervention for recipients who are in diseased or non-diseased conditions with severe blood loss. However, it is associated with certain risks, which can lead to adverse consequences that may cause acute or delayed complications and bring the risk of transfusion-transmissible infections including HIV, hepatitis B and hepatitis C and syphilis [7–9]. Therefore, the National Blood Transfusion Center of Lomé (CNTS) qualifies blood for transfusion by testing HBV, HCV, HIV and syphilis. This study aimed to evaluate the seroprevalence of HBV, HCV and HIV from 2011–2015. We consider a cohort of donors including regular donors and first time donors. The number of donors ranged from 27,336–35,777 and was higher in 2014. In our study, male blood donors were higher compared to female. Adjelic et al. found a similar trend in Serbian blood donors [10]. Ou et al. found in Hong Kong that male donors were more likely to be frequent donors [11]. First time blood donors were lesser than regular donors who participated in the study. This can probably be attributed to the low engagement of people in blood donation exercises despite its enormous benefits. Moore et al. in a similar study observed that in a cohort of 48,725 donors, only 3% were first time donors [12], therefore supporting the need for advocacy and community intervention exercises to increase the pool of blood donors for this life-saving exercise.

Methods: Blood donors screened with HBsAg immunochromatographic rapid test kits at the blood transfusion units of two hospitals and found to be negative were recruited into the study. Questionnaires to elicit risk factors for HBV infection were administered and then 10 ml of blood was collected from each donor. Plasma samples obtained from these HBsAg negative blood donors were screened again for HBsAg using an enzyme-linked immunosorbent assay (ELISA) method, and those found negative were screened for the presence of total antibody to the HBV core antigen (anti-HBc) using ELISA method. Those positive to anti-HBc were then tested for HBV DNA, using an automated real- time PCR method.

Transfusion of blood and blood product is a life- saving measure and benefits numerous patients worldwide. However, transfusion is an important mode of transmission of infection to the recipients. In 2005, all member states of WHO signed a document that commits them to the provision of safe and adequate blood and blood products to patients [1]. Transfusion-transmitted infectious diseases remain a major topic of interest for those involved in blood safety [1]. To avoid infection by blood transfusion, safety is very important because of blood transfusion is an integral part of medical and surgical therapy. Therefore, the tests for HIV, HBV, HCV syphilis and malaria are mandatory in the blood bank [2]. Hepatitis B virus (HBV), hepatitis C virus (HCV) are a major global public health problem warranting high priority efforts for prevention, control and treatment [3]. Testing for hepatitis B surface antigen (HBsAg) is the commonly used screening test in developing countries [4]. The hepatitis C virus was discovered in 1989. It is transmitted via blood and blood products, both parenterally and through sexual contact [5]. Libya, a developing country of approximately 6 million people, belongs to the intermediate endemicity countries with a wide variance of sero-positivity among different regions and populations [6]. A national serological survey for HBV and HCV infections among the general population was performed in Libya during 2003 and revealed prevalence of 2.2% and 1.2% for HBV and HCV, respectively [7]. A local surveys reported that the rate of HBsAg positivity among blood donors ranged from 1.3% to 4.6% [8], while the rate of HCV antibodies was 1.2% [9,10]. Very recently, the frequency of HBsAg positive blood donors and anti-HCV among this sample was 0.8% and 0.7% respectively in blood donors in western Libya (Tripoli) [11]. There has

In Libya, screening of HBV among blood donors is still done by HBsAg testing [5] which started in the early 1980s [4]. This program began by the Libyan health authorities in an attempt to reduce and prevent the disease by compulsory vaccinations of children and health workers [3,4]. Even though several studies have clearly demonstrated that a percentage of donors are HBsAg negative, some of them have been found to be not only anti-HBc positive but may also be carrying HBV-DNA in their blood when tested

In this present study, we observed a prevalence of iron deficiency (SF < 12 ng/ml) of 36 (24%). There is a paucity on information on ferritin levels among blood donors in Nigeria. Our finding is however consistent with report by Jeremiah and Koate [15] who obtained isolated iron deficiency (serum ferritin < 12 ng/mL) in 20.6% of their cohort of three hundred and forty-eight unselected consecutive whole blood donors in Port Harcourt, Nigeria. A previous report that investigated iron stores among Nigerian donors obtained a mean ferritin level of 49.19 ± 5.1 ng/ml and indicated that some blood donors may have pre-latent or latent iron deficiency at the time of donation and may manifest as iron deficient after blood donation [16]. Our finding is also consistent with previous report which indicated that the frequency of iron deficiency is high in blood donors and more depen- dent on the frequency of donation than on the accumulated number of donations [17]. The general impact of blood donation on iron status has been studied in Danish males. Iron stores were assessed by serum (S-) ferritin and haemoglobin (Hb) in a population survey comprising 1433 males in age cohorts of 30, 40, 50, and 60 years; 389 (27%) were blood donors and 1044 (73%) non-donors. Donors had lower serum ferritin, median 95 micro- grams/l, than non-donors, median 136 micrograms/l. Serum ferritin values less than 15 micrograms/l (depleted iron stores) were seen in 3.3% of donors vs. 0.4% of non-donors, and serum ferritin values of 15 - 30 micro- grams/l (small iron stores) in 9.8% of donors vs. 1.4% of non-donors. Iron-deficiency anaemia (serum ferritin less than 15 micrograms/l and Hb less than 129 g/l) was seen in 0.26% of donors vs. 0.10% of non-donors [18].

Transmission of HBV results from exposure to infectious blood and bodily fluids, blood transfusions and blood products using unscreened blood, medical or dental intervention without adequate sterilization of equipment, sharing equipment for injecting drugs, sharing straws and notes for snuffing cocaine, sharing razors, toothbrushes or other household articles, tattooing and body piercing if done using unsterilized equipment and vertical transmission from mother to child [4] . Without intervention the risk of perinatal HBV transmission is greatest for infants born to women who are hepatitis B surface positive [5]. There are three mechanisms of HBV transmission from HBsAg positive mothers: (i) trans-placenta intra-uterine transmission; (ii) during delivery by contact with maternal infected fluids in the birth canal; and (iii) post natal transmission from mother to child through breastfeeding or during child birth [6]. Children who do not become infected during the perinatal period remain at high risk of infection during early childhood [7]. HBV-related end-stage liver disease or hepatocellular carcinoma (HCC) are responsible for over one million deaths per year and currently represent 5 − 10% of cases of liver transplantation[8,9,10]. Nigeria has remained a hyper-endemic area for hepatitis B virus infection, with an estimated 12% of the total population being chronic carriers, despite the existence of a safe and effective vaccine [11].

The total of 686 blood samples were obtained from healthy blood donors who attended Tripoli’s central blood bank during the period from the first of January to end of May of 2015. This blood bank serves neighboring cities as well as Tripoli. All the donors were interviewed and medically examined by consultant before donation; as per the blood bank’s standard operating protocol; any donors who were anemic, or who had low body weight or low blood pressure at the time of donation, were excluded. All the donors were counseled and informed about the study, and consent was obtained from each donor to collect an Anonymous questionnaires were completed by each donor, which included personal and demographic data.