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Year : 2014 | Volume : 2 | Issue : 1 | Page : 8 - 10  


Original Articles
Sero Epidemiology of Hepatitis C in Blood Donors- 5 Yrs Study From Gandhi Hospital Blood Bank

Jijiya Bai1, Geeta V2, Bheeshma B3, Sreenivas G4, Shravan Kumar O5

1Professor of Pathology and Principal, 2Assistant Professor of Pathology, 3Associate Professor of Pathology, 4Associate Professor of Community Medicine, Government Medical College, Nizamabad. 5Professor and Head of Pathology, Gandhi Medical College, Hyderabad

Abstract:

Background: Transmissible infections such as HIV, Hepatitis and Syphilis are greatest threat to blood safety for the transfusion recipients. Infection with Hepatitis C virus [HCV] causes Hepatitis, Cirrhosis and Hepatocellular carcinoma.

Objectives: To evaluate the prevalence of anti HCV antibody among blood donors.

Methods: The study was conducted in Gandhi hospital Blood Bank for a period of five years from 2008-2012. A total of 43,390 healthy blood donors of both sexes were studied.

Results: 1172 were sero positive and all of them are males. 90 of these donors found to be reactive for anti HCV antibodies yielding an overall prevalence of 0.207%. The age distribution ranges from 20-40 years with 80% [72/90] constituting replacement donors [family members, friends of recipients] and 20% [18/90] are voluntary donors. 60% [63/90] belong to urban population and 40% [27/90] are rural.

Conclusion: The results of the present study shows that prevalence of HCV is high when compared with the Developed countries like US and England [0.001% and 0.0017%] but low when compared with Egypt[14%] and other cities of India Eg; Delhi[1.57%]. This represents a large reservoir of Hepatitis C infection capable of inflicting significant disease burden on the society.

Key Words: Blood donors, HCV.

Corresponding Author: Professor Dr.P.Jijiya Bai, Principal, Government medical college, Nizamabad, AP, email: dr_jijiyabai@yahoo.com

Introduction:

Transfusion- Transmissible infections such as Hepatitis B virus [HBV], HIV, HCV and Syphilis are the greatest threat to blood safety for transfusion recipients and pose a serious public health problem, the risk factors for acquired blood-borne infections include;

  1. Patients requiring multiple transfusions
  2. Patients with Thalassemia
  3. Hemato oncology disorders
  4. Chronic renal failure.

Hepatitis B & Hepatitis C infections are disseminated worldwide, 350 million are infected & 170 million are carriers. [1, 2] Hepatitis C virus is the most common cause of post transfusion non-A non-B hepatitis all over the world. [1] Hepatitis C virus (HCV) was discovered in1989 and belong to the Flaviviridae family and is an enveloped single stranded RNA virus, 50-60- nm in diameter with genome containing 9500 bases coding approximately 3000 Amino acids. The genome consists of a highly conserved 5’ non coding region (NCR), generally used for PCR amplification and have regulatory functions.

The prevalence of HCV antibodies in blood donors in developed countries ranges from 0.4 to 2.1%. In Brazil it is 0.9 to 2.6%, [3, and 4] in Egypt from12 to 14%, in India ranges from 0.6 to 5.2%, in England 0.0017%, [1] in US 0.001% and in France 0.0012%.                                                                                The average incubation period of HCV is 6-7 weeks. The acute illness [jaundice] is mild later on cirrhosis and Hepatocellular carcinoma develops. In fact up to 40% of blood donors with anti HCV serology have a history of previous parenteral exposure, [3] which suggests that many donors omit information in initial screening. The present study objective is to evaluate the prevalence of anti HCV antibodies in the voluntary and replacement donors of the blood bank of Gandhi hospital (a tertiary teaching hospital) over a period of 5 yrs, from 2008 to 2012.

Methods:

The study was done at Blood Bank, Gandhi Hospital Hyderabad, all blood donations   over a period of 5 yrs [2008-2013] were included. The donors are both voluntary & replacement donors. Voluntary donations were taken in the Blood bank or at voluntary blood donation camps. Replacement donors were either relatives or friends of patients. All samples were screened for Hepatitis B surface antigen, [HBS Ag], HIV abs, HCV abs, HCV abs by Micro ELISA 3rd generation kits, VDRL [venereal diseases research laboratory reactivity].

Results:

A total number of 43390 blood units were collected from both sexes in 5 yrs, of this 80% [34712] were replacement donors and 20% [8678] were voluntary donors (Table 1). In our study we found about 1172 sero positive donors [2.77%] out of 43390 donors. 40% (470/1172) belong to rural back ground and 60% (702/1172) belong to urban back ground (Table 2). Out of 1172 sero positives, 661[1.52%] were found to be Hbs Ag carriers, 90[0.207%] were found to be HCV Positive, 409[0.94%] were HIV Positive and 12[0.027%] were VDRL Positive (Table 3). 8 were found to be sero reactive for >2 infections [co infection] 5 were positive for both HIV and Hbs Ag, 2 were positive for HCV and Hbs Ag infection. One infected with HIV and VDRL. All sero positive cases were male donors. In our study of HCV positive donors the Age group varies from20-40yrs of age. 80% (72/90) were replacement donors. 30% (27/90) belong to rural back ground.70% (63/90) belong to urban back ground.

Discussion:

Transfusion transmitted infections continue to be a threat to safe transfusion practices. With donation of every unit of blood, there is 1% chance of transfusion associated infection. [4] In our study voluntary donors were about 20% of the total. In northern India, the voluntary donor rates vary from 9.1% - 52.3%. [7] According to NACO [National Aids Control Organization] web site, voluntary donors in India were about 55%. In our study we have noted a steady increase in voluntary donors from12%-20% over a period of 5 years a trend noted in other studies also. [1, 6, and 7] However replacement donors will comprise a large portion of blood donors. [4]

All studies show that replacement donors have higher sero reactive rates than voluntary donors due to a number of factors including concealing high risk behavior & paid professional donors posing as relatives. Our studies also showed that out of 90 sero positive for HCV 72 were replacement donors. Promotion of voluntary donations would further reduce the risk both single as well as co infection. Hence the emphasis should be to maximize the risk of transmission transmitted infection in accordance with the national blood policy.

In our study HIV sero positive donors are 409[0.94%], Hbs Ag sero positive donors are 661[1.52%], HCV sero positive donors are 90(0.207), VDRL positive are 12(0.027%). Kapur and Mittal found that HIV & HbsAg positive cases are 12.2%, VDRL reactive are11.8%. [8] Jain et al [9] estimated the sero prevalence 9.9% are HbsAg positive, 6.3% are HCV positive, 1% show dual infection (HIV+HCV). Mathal et al [2] found that out of 31942 donors over 6 yrs period only 10 donors (0.03%) show mixed infection.  Where as in our study co infection found to be 8 (0.018%).

As is evident the prevalence of more than one Transfusion Transmitted infection is very low. Our study reveal that among blood type A, AB, B, O group donors, the prevalence of HCV infection were 8.18%, 7.58%, 8.15% and 7.85% respectively. No significant differences were found between blood typing and epidemic rate of HCV, Indicates that Blood type is not associated with susceptibility to HCV infection. While it was a different story in the study of Yee et al. in which type 0 blood donors were reported to have a higher rate of HCV infection, type AB showed relatively low rate.

Various studies reveal that professional blood donors (paid) were more likely to be infected with HCV infection than patients’ relatives and true voluntary donors. [7] The elimination of professional donors by proper screening methods prior to donation may reduce the HCV infection among blood donors.

Conclusion:

The study provides a comprehensive and relative data on the prevalence and trend of HCV infection among the blood donors. Since, no vaccine is presently available for immunization against HCV infection, Need of implementation of “Mandatory blood Law” and promoting HCV screening and diagnosing among blood donors are very important measures to control the transmission of HCV infection, Encouraging true voluntary blood donation, as well as screening and eliminating high risk persons from blood donation may reduce the incidence of HCV Infection among blood donors.

TABLE 1: Trends in voluntary and replacement sero positive blood donation:

YEAR

VOLUNTARY

REPLACEMENT

TOTAL

2008

31(20.26%)

122(79.74%)

153

2009

38(19.79%)

154(80.21%)

192

2010

56(20%)

224(80%)

280

2011

64(19.87%)

258(80.13%)

322

2012

45(20%)

180(80%)

225

Total

234(19.96%)

938(80.04%)

1172

 

TABLE 2: Background of blood donors

YEAR

RURAL

URBAN

2008

63(41.18%)

90(58.82%)

2009

77(40.10%)

115(59.90%)

2010

112(40%)

168(60%)

2011

128(39.75%)

194(60.25%)

2012

90(40%)

135(60%)

Total

470(40.10%)

702(59.90%)

 

 

TABLE 3: Sero reactivity of voluntary & replacement donors

 

Year

HIV

HBV

HCV

VDRL

Total

Vol

Repl

Vol

Repl

Vol

Repl

Vol

Repl

2008

8

(5.2%%)

31

(20.3%)

20

(13.1%)

83

(54.2%)

2

(1.3%)

8

(5.2%%)

0

1

(0.7%)

153

2009

18

(9.4%)

84

(43.8%)

9

(4.7%)

43

(22.4%)

6

(3.1%)

29

(15.1%)

1

(0.5%)

2

(1%)

192

2010

15

(5.4%)

89

(31.8%)

32

(11.4%)

124

(44.3%)

3

(1.1%)

13

(4.6%)

2

(0.7%)

2

(0.7%)

280

2011

19

(5.9%)

82

(25.5%)

39

(12.2%)

161

(50%)

4

(1.2%)

13

(4%)

2

(0.6%)

2

(0.6%)

322

2012

13

(5.8%)

50

(22.2%)

29

(12.9%)

121

(53.8%)

3

(1.3%)

9

(4%)

0

 

0

225

Total

73

(6.2%)

336

(28.7%)

129

(11%)

532

(45.4%)

18

(1.5%)

72

(6.2%)

5

(0.4%)

7

(0.6%)

1172

409(34.9%)

661(56.4%)

90(7.7%)

12(1%)

References:

  1. Singh B, Kataria SP, Gupta R. Infectious markers in blood donors of East Delhi: Prevalence and trends. Indian J Pathol Microbiol 2004; 47(4):477–9
  2. Mathai J, Sulochana PV, Satyabhama S, Nair PK, Sivakumar S. Profile of transfusion transmissible infections and associated risk factors among blood donors of Kerala. Indian J Pathol Microbiol 2002; 45:319–22.
  3. Garg S, Mathur DR, Garg DK. Comparison of seropositivity of HIV, HBV, HCV and syphilis in replacement and voluntary blood donors in western India. Indian J Pathol Microbiol 2001; 44:409–12.
  4. Nanda A, Tyagi S, Basu S, Marwaha N. Prevalence of transfusion transmitted infections among voluntary and replacement donors. Indian J Hemat Blood Transf 2001; 19:104–5.
  5. Sharma RR1, Cheema R, Vajpayee M, Rao U, Kumar S, Marwaha N et al. Prevalence of markers of transfusion transmissible diseases in voluntary and replacement blood donors. Natl Med J India. 2004 Jan-Feb;17(1):19-21.
  6. Rouet F, Chaix ML, Inwoley A, Anaky MF, Fassinou P, Kpozehouen A et al. Frequent occurrence of chronic hepatitis B virus infection among West African HIV type-1-infected children. Clin Infect Dis. 2008 Feb 1;46(3):361-6.
  7. Padmapriyadarsini C, Chandrabose J, Victor L, Hanna LE, Arunkumar N, Swaminathan S. Hepatitis B or hepatitis C co-infection in individuals infected with human immunodeficiency virus and effect of anti-tuberculosis drugs on liver function. J Postgrad Med. 2006 Apr-Jun;52(2):92-6.
  8. Tankhiwale SS, Khadase RK, Jalgoankar SV. Seroprevalence of anti-HCV and hepatitis B surface antigen in HIV infected patients. Indian J Med Microbiol. 2003 Oct-Dec;21(4):268-70.
  9. Saravanan S, Velu V, Kumarasamy N, Nandakumar S, Murugavel KG, Balakrishnan P et al. Coinfection of hepatitis B and hepatitis C virus in HIV-infected patients in South India. World J Gastroenterol. 2007 Oct 7;13(37):5015-20.

 

Acknowledgements: We sincerely thank all the technical and fourth class staff of Blood Bank of Gandhi Hospital for their help in compliting this study and also thank all the blood donors (both voluntary & replacement) at Gandhi Hospital during this time period.

Source of Support: Nil. Conflict of Interest: None.





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