HBV, HCV and HIV seroprevalence among blood donors in Istanbul, Turkey: how effective are the changes in the national blood transfusion policies?

Viral safety of recovered plasma for contract fractionation; an Iranian experience, 2006-2015

OBJECTIVE

The current study analysed the viral safety among Iranian blood donors.

BACKGROUND

Plasma products demand is increasing in the world. With contract plasma fractionation, the plasma wastage decreases and the access of patients to plasma-derived medicines (PDM) improves.

STUDY AND DESIGN METHOD

Screening results including hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (HCV), and human immunodeficiency virus (HIV) Ag/Ab of 19 054 036 donations from 2006 to 2015 were analysed. The plasma for fractionation was tested for HBV DNA, HCV RNA, HIV RNA, HAV RNA, and Parvovirus B19 DNA by fractionators. New samples were collected from the positive donors and retested. The prevalence of serological and nucleic acid testing (NAT) markers per 10⁵ donations, 95% confidential interval (CI), and p-values were calculated.

RESULTS

The prevalence of markers was as follows: 250/10⁵ donations for HBsAg from 516 in 2006 to 116/10⁵ donations in 2015; 74/10⁵ donations for HCV, decreasing from 127 to 41/10⁵ and 3.6/10⁵ for HIV during current study. During 10 years, 5 713 641 units of recovered plasma were shipped for contract fractionation to produce PDM; 0.26/10⁵ donations for HBV DNA and 0.14/10⁵ for HCV RNA were reported positive. The results of five retested samples for HBV and one sample for HCV were negative.

CONCLUSION

The prevalence of HBV, HCV, and HIV in blood donations was extremely low. Thanks to the availability, high quality and safety of recovered plasma as a result of the improvements in the quality system at IBTO, this plasma could be used for the production of PDMPs.

Knowledge, Attitude, and Practice Regarding HIV, HBV, and HCV Among Medical Students of Syrian Private University, Damascus, Syria

BACKGROUND

Hepatitis B, Hepatitis C, and HIV/AIDS are infections that constitute major health concerns impacting national health systems worldwide. This is the first study to determine Syrian medical students' attitudes, awareness and knowledge of HIV/HBV/HCV, regarding general knowledge about, clinical features, transmission, and prevention.

METHODS

This cross-sectional study was conducted at Syrian Private University on World AIDs Day (1/12/2019), Damascus, during the Syrian war crisis. Data were collected through self-administered surveys which targeted social demographic information, general knowledge, attitude, towards HBV, HCV, HIV. Data were divided and analysed according to the source of information, study year, marital status, and GPA using one-way analysis of variance to assess the level of knowledge.

RESULTS

Of 317 respondents, the majority (59.8%) were males with age ranging from 18 to 30 years of age. . The majority of students 188(59.3%) showed an average level of knowledge, 73(23%) showed a good level of knowledge. This study revealed adequate knowledge. However there were misconceptions regarding transmission pathways. The majority 173(54.6%) had a positive attitude, and 144(45.4%) had a neutral attitude, while none had a negative attitude towards HIV/HBV/HCV infected individuals. Clinical year students (mean 73.0%, SD ± 10.0%) demonstrated higher levels of awareness compared to pre-clinical students (mean 39.7%, SD ± 13.0%).

CONCLUSIONS

This study revealed that medical students have adequate knowledge regarding HIV/HBV/HCV. Medical students play a pivotal role in raising awareness and disseminating knowledge among the community, thus more effort should be concentrated on developing educational programs to limit the risks of such infections.

Utility of grey zone testing strategy in transfusion transmissible infection testing in blood bank is of limited value!

Several blood banks use grey zone (GZ) phenomenon (defined as samples with optical density within 10% below the cut off in enzyme immuno-assay [EIA]/chemiluminescence immunoassay [CLIA]) to further augment blood safety. There is paucity of data regarding usefulness of GZ sample and its application in Transfusion Transmissible Infection (TTI) screening procedures in blood transfusion services. We looked at our GZ sample results and their confirmatory test results to verify if it adds to blood safety in our set-up? We performed a prospective analytical study on blood donors' samples over two years. All the donors' samples were screened for TTI using CLIA. Samples with signal/cut-off ratio between ≥0.90 and <1.00 were classified under GZ. They were re-tested in duplicate and submitted to confirmatory testing: Neutralization Test for HBsAg, Immunoblot for HCV, and Western blot for HIV. Among the 50,064 blood donors donating the blood during study period, 573 (1.14%) donors were reactive for HBsAg, HCV, and HIV. Forty-seven (0.1%) TTI samples were GZ, but none was "confirmed positive." The utility of GZ testing seems to be limited. However, this may be continued for sake of "erring on the side of caution" and since this only results in negligible wastage (0.1%) of blood units.

Evaluation of the diagnostic performance and optimal cutoff value of a fourth-generation ELISA, VIDAS HIV-1/2 Duo Ultra assay, in a low-prevalence country

In this study, we described the largest analysis to date conducted with VIDAS® HIV Duo Ultra assay. Additionally, we analyzed the diagnostic performance and cutoff values (TV) of HIV Duo Ultra assay and total cost analysis for HIV testing. Of 11,642 enzyme-linked immunosorbent assay (ELISA)-positive samples referred to our center for confirmation, 2000 were positive with HIV Duo Ultra, and of these, 87% were HIV-1 positive and 0.6% were HIV-1 indeterminate with the confirmatory test. Overall, the false-positivity rate was 1.75% for HIV Duo Ultra assay. The sensitivity and specificity were 100% and 99.1%, respectively, when the TV was set at the recommended cutoff value. Even increasing the cutoff value four times, sensitivity and specificity remained high, pointing out that a TV of 0.99 is highly indicative of HIV positivity. Retesting samples with HIV Duo Ultra assay decreased 80% of the confirmatory tests, revealing a significant decrease of 78% in the total costs and reporting time.

Seroprevalence of transfusion transmissible viral infections (HIV, HBV and HCV) among voluntary blood donors at University of Gondar Comprehensive Specialized Hospital, Gondar; Northwest Ethiopia

BACKGROUND

Human immunodeficiency virus, hepatitis B virus and hepatitis C virus are among the greatest threats to blood safety for the recipient. They are also the leading cause of death, chronic and life-threatening abnormalities. Therefore, this study was aimed to assess the Sero-prevalence of HIV, Hepatitis B and C virus among blood donors at the University of Gondar Comprehensive Specialized Hospital.

METHODS

A retrospective cross-sectional study was used to estimate the seroprevalence of HIV, Hepatitis B and C virus among blood donors at the University of Gondar Comprehensive Specialized Hospital from May-July 2018. Screening of HIV, HBV, and HCV was done by using the Enzyme-Linked ImmunoSorbent Assay. Records of 5983 first time blood donors were collected and reviewed by using a checklist from registration book. Data was entered in statistical package EP Info version 3.5.1, and data cleaned and analyzed using the statistical package SPSS version 16.0.

RESULTS

Of 5983 blood donors, 85.5% (5118/5983) donors were males and 14.5% (865/5983) were females. The median age was 27 years and the highest blood donations age category was between 20 to 51.2% (29/5983) followed by 30 to 39 years of age, 21.6% (1295/5983). The prevalence of HIV, HBV and HCV infections were 2.5% (95% CI: 1.07-2.398), 4.1% (95% CI: 0.461-1.053) and 1.6% (95% CI: 0.845-3.354), respectively. HIV infection was significantly associated with gender (p = 0.021, x^{2 =} 5.358) and HCV infection with age group (p = 0.003, x² = 17.673). Of all donated blood, 8.2% (489/5983) had serological evidence for at least one of the screened pathogens and 58 (0.96%) of them had multiple infections.

CONCLUSIONS

This study showed a significant prevalence of HIV, HBV, and HCV among blood donors, 2.5% (147/5983), 4.1% (244/5983) and 1.6% (98/5983), respectively. Therefore, strict selection of blood donors with an emphasis on getting voluntary blood donors, and highly sensitive and specific tests for screening of blood donors for HIV, HBV, and HCV using standard methods are highly recommended to ensure the safety of blood for the recipient.

Investigation of an algorithm for anti HCV EIA reactivity in blood donor screening in Turkey in the absence of nucleic acid amplification screening

PURPOSE

In this study we aimed to propose an algorithm for initial anti HCV EIA reactive blood donations in Turkey where nucleic acid amplification tests are not yet obligatory for donor screening.

METHODS

A total of 416 anti HCV screening test reactive donor samples collected from 13 blood centers from three cities in Turkey were tested in duplicate by Ortho HCV Ab Version 3.0 and Radim HCV Ab. All the repeat reactive samples were tested by INNO-LIA HCV Ab 3.0 or Chiron RIBA HCV 3.0 and Abbott Real Time HCV. Intra-assay correlations were calculated with Pearson r test. ROC analysis was used to study the relationship between EIA tests and the confirmatory tests.

RESULTS

The number of repeat reactive results with Ortho EIA were 221 (53.1%) whereas that of microEIA, 62 (14.9%). Confirmed positivity rate was 14.6% (33/226) by RIBA and 10.6% (24/226) by NAT. Reactive PCR results were predicted with 100% sensitivity and 95% specificity with S/CO levels of 8.1 with Ortho EIA and 3.4 with microEIA.

CONCLUSIONS

Repeat reactivity rates declined with a second HCV antibody assay. Samples repeat reactive with one HCV antibody test and negative with the other were all NAT negative. All the NAT reactive samples were RIBA positive. None of the RIBA indeterminate or negative samples were NAT reactive. Considering the threshold values for EIA kits determined by ROC analysis NAT was decided to be performed for the samples above the threshold value and a validated supplemental HCV antibody test for the samples below.

The HBsAg Prevalence Among Blood Donors From Eastern Mediterranean and Middle Eastern Countries: A Systematic Review and Meta-Analysis

CONTEXT

The world health organization (WHO) recommends that all blood donations should be screened for evidence of infections, such as hepatitis B. The present study aimed to determine the prevalence of hepatitis B surface antigen (HBsAg) in blood donors at the eastern Mediterranean region office (EMRO) of the WHO and middle eastern countries.

EVIDENCE ACQUISITION

A meta-analysis was carried out based on the results of an electronic literature search of PubMed, Ovid, Scopus, and Google Scholar for articles published from January 1, 2000, to August 31, 2015. In accordance with a significant homogeneity test and a large value of I2, the random effects model was used to aggregate data from the studies and produce the pooled estimates using the "Metan" command.

RESULTS

We included 66 eligible studies. The pooled prevalence of HBsAg in blood donors of both EMRO and middle eastern (E and M) countries was 2.03% (95% confidence interval [CI]: 1.79 - 2.26). In addition, the prevalence rates in the EMRO countries was 1.99% (95% CI: 1.84 - 2.14) and 1.62% in the Middle Eastern countries (95% CI: 1.36 - 1.88). The prevalence among blood donors with more than one study was 1.58% in Egypt, 0.58% in Iran, 0.67% in Iraq, 2.84% in Pakistan, 3.02% in Saudi Arabia, 1.68% in Turkey, and 5.05% in Yemen.

CONCLUSIONS

Based on the WHO classification of hepatitis B virus (HBV) prevalence, the prevalence of HBsAg in blood donors from E and M countries reached an intermediate level. However, there were low prevalence levels in some E and M countries.

Hepatitis B, Hepatitis C, Human immunodeficiency virus and syphilis frequency among blood donors: A single center study

We aimed to provide updated results for seroprevalence of hepatitis B, hepatitis C viruses while presenting first data for human immunodeficiency virus and syphilis seropositivity amongst blood donors in Adana, Turkey. Screening and confirmatory test results of 62,461 donors were evaluated. HBsAg, anti-HCV, anti-HIV1/2 and syphilis seropositivity was 1.92%, 0.48%, 0.20%, 0.18% respectively, based on screening tests, and 1.66%, 0.05%, 0.003%, 0.10% respectively, according to confirmatory tests. Transfusion-transmitted infections (TTI) was more prevalent in low-educated donors. HBsAg and syphilis seropositivity rates were higher in married subjects. We found that the prevalence of HBV and HCV was significantly decreased in the last two decades in Adana. Importantly, this study provides first data in HIV and syphilis seropositivity rates among blood donors in our region and both HIV and syphilis seroprevalences were found to be low compared to many regions of Turkey. However, considering the fact that increasing number of immigrants may change prevalences and trends of TTI both in Adana and in Turkey, strict monitorization and yearly reporting of TTI rates seem necessary to be able to take proactive measures.

The seroprevalence of both hepatitis B and hepatitis C at the first-step health organizations and the difference between the urban and rural areas

BACKGROUND

Hepatitis B virus (HBV) and hepatitis C virus (HCV) are very important infectious agents for public health. The aim of this retrospective study was to assess the seroprevalence of hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs) and anti-HCV test results of patients who admitted to first-step health organizations in central and peripheral districts of Konya, the central region of Turkey during the period 2005-2010.

METHODS

In this study, HBsAg, anti-HBs and anti-HCV screening test results of patients who admitted to first-step health organizations in Konya during the period 2005-2010 were retrospectively investigated from the laboratory records. This study was approved by the Konya Health Directorate. All screening tests were performed on the automatic third-generation enzyme-linked immunosorbent assay (MEIA). This immunoassay method was carried out according to the instructions of the manufacturer. Borderline and positive results were retested.

RESULTS

Konya is the largest city of Turkey in terms of surface area and one of the economically developed cities. For HBsAg, anti-HBs and anti-HCV screening, whole test results of 5 years are given in Table 1 and Figure 1. The differences between the urban and rural for HBsAg (p = 0.062 > 0.05) and anti-HCV(p = 0.874 > 0.05) were not statistically significant. Among the markers only for anti-HBs, the difference between the urban and rural was statistically significant (P = 0.042 < 0.05). Of them, 4.15 % were positive for HBsAg, 36.46 % were positive for anti-HBs and 1.16 % were positive for anti-HCV.

CONCLUSION

In this study, Konya has been evaluated as two regions: central and peripheral. Our study showed us that distribution of the diseases vary from one region to another. We consider that difference in social diversity is one of the factors. These infections are major health problems. So the results of immunodiagnostic tests for HBsAg, anti-HBs and anti-HCV will be useful for guiding control actions and for new preventive strategies.

Hepatitis B, Hepatitis C and human immunodeficiency virus prevalences among first time blood donors in Istanbul, Turkey, 2004-2011

OBJECTIVE

This study aims to determine the yearly change rates of the HBsAg, anti-HCV and anti-HIV test results and their positivity rates obtained from the 68,393 donors who applied and donated blood for the first time at the Blood Center of the hospital.

MATERIALS AND METHODS

Using the ELISA method, screening tests were applied to the blood samples obtained from blood donors, and the HBsAg, anti-HCV and anti-HIV positivity rates were calculated at the end of year eight. However, HBsAg and anti-HCV positivities showed a decreased tendency of positivity in years.

RESULTS

A total of 68,393 donations were received within eight years. Seroprevalences for anti-HIV, HBsAg and anti-HCV tests were, respectively 0.01%, 1.54% and 0.38%. HBsAg and anti-HCV positivities showed a decreased tendency of positivity in years.

Hepatitis B: Epidemiology and prevention in developing countries

Hepatitis B virus (HBV) infection is a serious global public health problem. The infection may be transmitted through sexual intercourse, parenteral contact or from an infected mother to the baby at birth and, if contracted early in life, may lead to chronic liver disease, including cirrhosis and hepatocellular carcinoma. On the basis of the HBV carrier rate, the world can be divided in 3 regions of high, medium and low endemicity. The major concern is about high endemicity countries, where the most common route of infection remains vertical transmission from mother to child. Screening of all pregnant women and passive immunization with human hepatitis B immunoglobulin are not affordable for many developing countries. The infection rate can be reduced by modifying behavior, improving individual education, testing all blood donations, assuring asepsis in clinical practice and screening all pregnant women. However, availability of a safe and efficacious vaccine and adoption of appropriate immunization strategies are the most effective means to prevent HBV infection and its consequences. The unsolved problem for poorest countries, where the number of people currently infected is high, is the cost of the vaccine. A future challenge is to overcome the social and economic hurdles of maintaining and improving a prevention policy worldwide to reduce the global burden of the disease.

Hepatitis B prevalence in the Turkish population of Arnhem: implications for national screening policy?

Despite the increased prevalence of hepatitis B and C in most migrant groups in The Netherlands, a national screening policy for these infections is not available. In order to estimate the prevalence of hepatitis B and C in the largest group of first-generation migrants (FGM) in The Netherlands, we conducted a screening project in the Turkish community of Arnhem. In a separate project we identified patients from the target population with chronic hepatitis B and C from hospital records (1990-2008). Educational meetings concerning hepatitis were organized, with all participants being offered a blood screening test. Participants were tested for hepatitis B surface antigen (HBsAg), antibodies to hepatitis B core antigen (anti-HBc) and antibodies to hepatitis C virus (anti-HCV). In total 709 persons were tested, a complete dataset was available for 647 patients. We found that 3·0% and 0·4% of Turkish FGM aged >24 years in Arnhem had active hepatitis B, defined as HBsAg positive, and tested positive for anti-HCV, respectively. The hospital records revealed another 32 patients, 28 with hepatitis B and four with hepatitis C representing 0·7% for hepatitis B and 0·1% for hepatitis C in relation to the total number of Turkish FGM in Arnhem. We believe that active hepatitis screening of FGM from Turkey should be part of the national health policy as it will benefit the individual and public health.

Reconstruction of the evolutionary dynamics of the hepatitis C virus 1b epidemic in Turkey

Worldwide, 12.5% of the more than 170 million people infected by hepatitis C virus (HCV), live in Eastern Mediterranean countries. In Turkey, the prevalence of HCV infection ranges from 0.3% to 0.4% of the general population. We investigated the distribution of HCV subtype 1b in Turkey by analysing the NS5b viral genomic region, using a Bayesian coalescent-based framework and phylogeographical analysis to estimate the origin of the HCV 1b subtype epidemic and the genetic diversification of the virus in Turkey. The dataset consisted of 24 NS5b sequences obtained from patients chronically infected with HCV subtype 1b admitted to the different health districts of Ankara hospital plus the reference sequences for phylogenetic analysis. An independent dataset including the same 342-nt NS5b fragment from all over the world (203 sequences) was used to calibrate the evolutionary rate. Using the relaxed clock model, we estimated a mean evolutionary rate of 0.84 × 10(-3) sub/site/year (95% highest posterior density interval HPD 0.16-1.5 × 10(-3)). The results of the phylogeographical analysis suggested that the HCV epidemic probably originated in Greece during the first decade of 1900 and, a few years later (in the 1920s or 1930s), successfully spread to neighboring countries such as Turkey and Cyprus. The clustering of the majority of the Turkish strains in a single monophyletic group suggests the subsequent segregated circulation of the virus in the country during the years 1940-1999, which was probably due to unsafe medical parenteral procedures, with drug addiction playing a relatively negligible role. The Bayesian skyline plot (BSP) showed a growth in the number of effective infections between the 1940s and the 1990s, when the curve reached a plateau that still remains today, suggesting a partial success of improved transfusional policies. A coalescent-based approach to population dynamics can improve our understanding of the origin and spread of epidemics in a limited geographical area.