Prevalence of selected viral infections among blood donors deferred for potential risk to blood safety

Prevalence of hepatitis B & C infections in prospective blood donors deferred due to history of jaundice

Background & objectives

As per national guidelines, prospective blood donors with a history of jaundice of unknown cause are deferred permanently to prevent the transmission of hepatitis B and C. The validity of this guideline was tested by comparing prevalence rates of hepatitis B and C in prospective blood donors deferred due to a history of jaundice, with that of donors who were found fit.

Methods

Blood samples of 212 consecutive donors (male, n=203) deferred due to a history of jaundice were studied for hepatitis B and C by rapid test kits as well as by chemiluminescence (n=115) or ELISA (n=97). Consecutive healthy donors (n=549; male, n=518) were also studied by ELISA (n=266) or chemiluminescence (n=283).

Results

The cumulative prevalence detected by rapid test kit and ELISA/chemiluminescence tests of hepatitis B (n=10) and C (n=2) among donors deferred due to a history of jaundice (n=212) was 5.7 per cent [95% confidence interval (CI): 2.9, 9.9]. The prevalence of reactive results among healthy donors (n=549) by ELISA/chemiluminescence tests was 3.3 per cent (95% CI: 1.9, 5.2), which included hepatitis B (n=15) and hepatitis C (n=3) cases. Compared to healthy donors, the odds of seropositivity among jaundice-deferred donors was 1.7 (95% CI: 0.8, 3.6), P=0.15. For rapid test-negative deferred donors, the odds of seropositivity by ELISA/chemiluminescence declined to 0.4 (0.1, 1.5), P=0.19.

Interpretation & conclusions

The prevalence rates of hepatitis B and C in prospective blood donors deferred due to a history of jaundice of unknown aetiology did not differ significantly from that in healthy donors. The current practice of permanently deferring such donors depletes valuable donor pool. A strategy of rejecting only those donors who are found reactive on pre-donation testing by rapid test needs further validation.

Efficacy of Blood Donor Selection: Comparing Sero-Prevalence of Transfusion-Transmissible Infections Among Eligible and High-Risk Behavior Deferred Donors in Iran

Background: Eliminating high-risk individuals has a special role in ensuring blood safety. Due to epidemiological, demographic, and even cultural changes in each country, this process should be continuously evaluated and reviewed, if necessary. Objectives: This study aimed to evaluate the impact of the current donor selection procedure on blood safety in Iran. Methods: A total of 2,525 high-risk deferred donors who were referred between 2018 and 2019 were evaluated regarding hepatitis B surface antigen, hepatitis C virus antibody, and human immunodeficiency virus antigen and antibody. All repeatedly reactive samples were evaluated by confirmatory tests. Characteristics' parameters, donor status, and TTI marker rates of the participants and 1,315,871 eligible donors in the indicated period obtained from the national database on blood donors, were compared. Data were analyzed using SPSS version 24.0. Results: The prevalence of HBV, HCV, and HIV in 100,000 deferred donors was 1148, 515, and 119, respectively. This prevalence was 26, 28, and 33-times higher than the eligible donors, respectively. Unlike HBV, its prevalence among males was almost twice that of females among the deferred group. In the eligible group, females had a higher prevalence for HBV and HCV as compared to males. The HCV and HBV (6.7 and 4.3-fold) among deferred first-time donors had a significantly higher prevalence compared with the eligible first-time donors (P‐value < 001). Notably, the higher was the education degree, the lower was the prevalence of infection in both groups. Conclusions: Current deferral criteria and donor selection procedure in Iran are an opportunity to eliminate high-risk individuals from the blood donation.

Knowledge and Attitude Regarding Hepatitis B and C Among Blood Donors and Nondonors in North India

BACKGROUND

The selection of a low-risk blood donor involves a dialogue between the trained medical staff and the volunteer blood donor, and this is where the knowledge of the prospective blood donor with regard to the risk factors for acquiring hepatitis B and C and the mode of spread through a blood transfusion is of utmost importance. Therefore, the study was conducted to assess the knowledge and attitude on hepatitis B and C with regard to blood donation, in the existing and the potential donor base.

MATERIALS AND METHODS

This is a cross-sectional study conducted on 4000 participants, including 2000 blood donors and 2000 nondonors. The study tool was a pilot-tested, self-administered questionnaire, content and construct validated using Delphi methodology.

RESULTS

The mean age of the study participants was 25.12 ± 8.43 years ranging from 18 to 60 years; 24.64 ± 8.31 years in donors and 25.61 ± 8.55 years in non-donors. The study included 69.8% males and 30.2% females, with 87.5% males and 12.6% females in donors and 52.1% males and 47.9% females in non-donors. Overall knowledge score was 51.02%, being 51.21% in donors and 50.84% in non-donors. Overall attitude score was 47.93%, being 47.09% in donors and 48.77% in non-donors. There was a low degree of significant linear correlation between knowledge and attitude in the study participants.

CONCLUSION

Based on the results obtained in the study, it is evident that neither the existing level of knowledge nor the attitude of both donors and nondonors towards hepatitis B and C is adequate for being able to select a low-risk blood donor.

Prevalence of Hepatitis B and C Viral Markers in Blood Donors Deferred from Donating Blood on the Basis of a History of Jaundice of Unknown Origin

BACKGROUND AND AIMS

The aim of the present study was to know the prevalence of viral hepatitis markers among blood donors deferred on the basis of a history of jaundice of unknown origin and to predict the impact of this deferral on blood safety.

METHODS

Observational study included 200 blood donors deferred on the basis of a history of jaundice of unknown origin and carried out serology and Individual Donation Nucleic Acid Testing (ID-NAT) for hepatitis B and hepatitis C.

RESULTS

Five (2.5%) out of 200 blood donors deferred on the basis of history of jaundice were reactive on ELISA. Three out of five were reactive for HBsAg; whereas two for anti-HCV antibodies. Out of the 12 ID-NAT initial reactive, 10 samples discriminated on further testing; 4 for HBV, 5 for HCV and 1 was co-infection (HBV + HCV). The odds of being picked up as sero reactive on ELISA was 2.53 (95% CI; 1.04-6.19) and being picked up as ID-NAT yield was 13.08 (95% CI; 5.29-32.37) in donors deferred on a history of jaundice of unknown origin as compared to selected donors without a history of jaundice, with the difference in means achieving statistically significance at P = 0.03 and <0.001 respectively.The potential of deferral on a history of jaundice of unknown origin has a capacity to interdict 2-3 HBV and/or HCV reactive blood donors on serology and 5 HBV and/or HCV reactive blood donors on ID-NAT from entering the quarantine blood supply per 100 donors.

CONCLUSION

The findings of the present study support that a deferral for a history of jaundice of unknown origin after attaining the age of 12 years in the present scenario of transfusion transmissible infectious disease screening in India.

Good Feasibility of the New German Blood Donor Questionnaire

BACKGROUND

We assessed the effect of the uniform donor questionnaire (UDQ) on deferral rates in first-time and repeat donors. We focused on the introduced question about unprotected sexual contact with a new partner. Another goal was a stratified comparison of the deferral rates of the donor questionnaire (DQ) and UDQ.

METHODS

Data on donors and deferrals using the DQ and UDQ were collected at four blood establishments. The comparison included a 2-year period by questionnaire version. For the comparison of the questionnaires, an adjusted multinomial logistic regression was performed.

RESULTS

The analysis included 260,848 donations. First-time (FTD) and repeat donations (RD) showed higher deferral rates with the UDQ (FTD +5.4%, RD +1.4%). Deferral due to a new partner was 3.0% in first-time and 0.4% in repeat donors. The majority of these occurred in the youngest age groups. The most frequent deferral criterion was 'disease' (5.1%).

CONCLUSION

The regression revealed stronger predictors for deferral than the questionnaire version. Especially younger age carried a higher and independent risk for deferral. The additional deferrals of mainly young first-time donors due to a new sexual partner may identify those donors with potential heterosexual risk behavior who would otherwise not be identified.

Predonation screening of candidate donors and prevention of window period donations

BACKGROUND

Infectious window period donations slip through routine donor screening procedures. To explore the potential value of predonation screening of candidate donors, we compared the proportion of incident transfusion-transmissible infections in candidate donors, in first-time donors, and in repeat donors.

STUDY DESIGN AND METHODS

A retrospective analysis was performed of all incident hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections in candidate, first-time, and repeat donors in the Netherlands during the period 2009 to 2013.

RESULTS

In total, 176,716 candidate donors, 144,226 first-time donations, and 4,143,455 repeat donations were screened for HBV, HCV, and HIV infection. Acute HBV infection was identified in the predonation sample of six candidate donors. One first-time donor, testing HIV-negative at predonation screening, tested positive for anti-HIV and HIV RNA in the first donation 29 days later. Among repeat donations we identified 15, one, and six incident HBV, HCV and HIV infections, respectively. The proportion of incident infections among candidate donors/first-time donations/repeat donations was for HBV, 3.40/0/0.36; for HCV, 0/0/0.02; and for HIV 0/0.69/0.14 per 100,000, respectively.

CONCLUSION

Predonation screening of candidate donors very likely causes a loss of donations, but it might prevent undetected window period donations. Further studies are necessary to determine the value of predonation screening as an additional safety measure.

Evaluation of blood donors questionnaire in a developing country: The case of Gabon

BACKGROUND

Blood transfusion is a life-saving therapeutic act without alternative. Each blood transfusion carries the risk of blood-borne pathogens transmission. The present study, is the first establishing the usefulness of blood donors screening questionnaire in the setting of the Gabonese National Blood Transfusion Center.

STUDY DESIGN

Nine hundred and thirty-four blood donors aged between 18 and 48 years old were initially enrolled and submitted to physical examination (body-mass index and blood pressure). After physical examination 854 donors were judged fit for blood donation and were randomly distributed in two groups. The first group of donors did not take the screening questionnaire; whereas the second group went through the screening questionnaire. Both groups were then tested for human immunodeficiency virus, hepatitis B, hepatitis C and syphilis.

RESULTS

Data revealed a seroprevalence among the donors of 2.5%, 2.5%, 1.1%, and 3.3% for the human immunodeficiency virus, hepatitis B, hepatitis C and syphilis markers respectively. In the Gabonese setting, blood donors' screening questionnaire reduced respectively by 0.6%, 0.35% and 1.3% the proportion of hepatitis B, hepatitis C and treponema pallidum seroreactive donors being selected for donation. The questionnaire had no positive effect on discriminating human immunodeficiency virus positive donors.

CONCLUSION

Blood donors' seroprevalence of blood-borne pathogens is relatively important in our setting. Blood donors' screening questionnaire reduced the proportion of hepatitis B, hepatitis C and syphilis seropositive blood donors. The questionnaire did not effectively discriminate human immunodeficiency virus-infected donor candidates.

Effectiveness of blood donor questionnaire directed at risk factor for transfusion transmitted infections in Pakistani population

Background:

Deferring blood donors who admit to high-risk behavior on questioning are likely to eliminate those in window period for transfusion transmitted infections (TTI). However, many questions have been implemented in some countries as part of donor history questionnaire, based on precautionary principle and not on evidence, and can result in increased donor losses. This study aims to identify effective risk-directed questions having high predictive value, in local context which can form part of blood donor deferral policies. For this, a case control study in a hospital blood bank having donation services was carried out prospectively over a period of three years.

Materials and Methods:

Two hundred and twenty donors, who were repeatedly reactive for HBsAg, anti-HCV, anti-HIV with EIA, and syphilis with TPHA, were the cases. Eight hundred and eighty four controls were the donors who tested negative for all TTI test. All donors answered seven hepatitis risk directed questions and their responses and reactivity status for TTI were used for statistical analysis with SPSS ver. 15.

Results:

Positive predictive value for history of jaundice at any age for HBsAg was 20%, while PPV for history of surgery in previous six months for both HBsAg and anti-HCVHCV was also around 20%, based on pretest probability of 7%. The post-test probability for these questions was around 30%. Odds ratios with 95% CI did not reveal any significant association of hepatitis with any of seven questions. Donor losses after deferring on basis of two questions were 5.3% per year, while deferral rate after all seven questions was 20%.

Conclusions:

Donors should be permanently deferred if there is history of jaundice at any age, while deferral period after surgery should be one year. Other risk-directed questions should not be used to defer donors. Donor deferral policies should be evidence based and questions with proven efficacy should be made part of donor history questionnaire to minimize donor losses.

The impact of donor selection on blood safety in Iran

INTRODUCTION

Donor selection is a critical process to identify high risk volunteers and defer them from donating blood. Despite viral screening test on all donated blood, one cannot rely on screening tests alone to ensure a safe blood supply. Monitoring and assessment of the deferral procedure is of utmost importance to balance blood availability and safety. This study compares the prevalence of HIV, HCV, and HBV markers between deferred donors and accepted blood donors in order to evaluate the effectiveness of the current donor selection process in Iran.

MATERIALS AND METHODS

This study was carried out on deferred blood donors throughout the country. A blood sample was collected from participants and tested for three viral markers: HbsAg, anti-HCV, and anti-HIV. Repeatedly reactive samples were retested with a confirmatory screening assay. The prevalence of viral markers among deferred donors was compared with national statistical data on blood donors.

RESULTS

The prevalence of HIV, Hepatitis B, and Hepatitis C was 120 (CI 95%; 90-150), 1280 (CI 95%; 1170-1390), and 580 (CI 95%; 510-650) in 100,000 deferred donors respectively. A significant increase exists in the prevalence of HBV (1.7 times), HIV (24 times) and HCV (15 times) in deferred donors as compared to accepted blood donors.

DISCUSSION

The effectiveness of donor selection in identifying high risk individuals is obvious upon comparing the prevalence of selected viral infections in deferred donors with those accepted for blood donation. This study showed the role and necessity of donor selection criteria.

Successful exclusion of blood-borne viral disease in blood donors

BACKGROUND

All blood transfusion services have various rules to insure that blood products are kept safe for transfusion. Donor selection is crucial in providing safe blood. We propose in our study to determine the influence of donor selection on blood safety.

METHODS

In this case-control study, donors who were referred to the Qazvin Blood Transfusion Organization during 2007-2009 were selected. Based on a special questionnaire, all blood donors were examined by physicians and every donor was categorized as one of two types of rejected donors (high risk and low risk) or as accepted donors. Data were analyzed by SPSS version 13.0, using chi-square and Fisher's exact tests, where P<0.05 was considered significant.

RESULTS

Single donors, the self-employed, the unemployed and students were banned from donation due to high-risk criteria (P<0.0001, 0.003). Female donors were banned from donation due to low-risk criteria. Hepatitis B was more prevalent among cases rejected for donation due to high-risk criteria than among healthy controls (P=0.014); but not so for hepatitis C (P=0.058). Hepatitis B was not significantly more prevalent among those cases rejected for donation due to low-risk criteria, than among healthy cases.

CONCLUSION

Those having a history of unsafe sexual conduct and intravenous drug abusers and their spouses are at risk for hepatitis C. Cases rejected for donation due to low-risk criteria were banned from donation to maintain the donors' health, while other cases with low-risk criteria were banned to guarantee the blood recipients' health.

Transfusion safety in francophone African countries: an analysis of strategies for the medical selection of blood donors

BACKGROUND

The goal of selecting a healthy blood donor is to safeguard donors and reduce the risks of infections and immunologic complications for recipients.

STUDY DESIGN AND METHODS

To evaluate the blood donor selection process, a survey was conducted in 28 blood transfusion centers located in 15 francophone African countries. Data collected included availability of blood products, risk factors for infection identified among blood donor candidates, the processing of the information collected before blood collection, the review process for the medical history of blood donor candidates, and deferral criteria for donor candidates.

RESULTS

During the year 2009, participating transfusion centers identified 366,924 blood donor candidates. A mean of 13% (range, 0%-36%) of the donor candidates were excluded based solely on their medical status. The main risk factors for blood-borne infections were having multiple sex partners, sexual intercourse with occasional partners, and religious scarification. Most transfusion centers collected this information verbally instead of having a written questionnaire. The topics least addressed were the possible complications relating to the donation, religious scarifications, and history of sickle cell anemia and hemorrhage. Only three centers recorded the temperature of the blood donors. The deferral criteria least reported were sickle cell anemia, piercing, scarification, and tattoo.

CONCLUSIONS

The medical selection process was not performed systemically and thoroughly enough, given the regional epidemiologic risks. It is essential to identify the risk factors specific to francophone African countries and modify the current medical history questionnaires to develop a more effective and relevant selection process.

Donor return after temporary deferral

BACKGROUND

The consequences of temporary predonation deferral are unsatisfactorily understood. Studies have found that deferral negatively impacts future donor return. However, the applicability of these findings across centers has not been established.

STUDY DESIGN AND METHODS

Using a cohort design, presenting donors with a temporary deferral in 2006 to 2008 in one of six categories (low hematocrit [Hct], blood pressure or pulse, feeling unwell, malaria travel, tattoos or piercing and related exposures, or could not wait or second thoughts) were passively followed for up to a 3-year period for the time to first return after deferral expiration at six US blood centers. Time-to-event methods were used to assess return. We also analyzed which donor characteristics were associated with return using multivariable logistic regression.

RESULTS

Of 3.9 million donor presentations, 505,623 resulted in deferral in the six categories. Low Hct was the most common deferral, had the shortest median time to return (time in days when 50% of deferred donors had returned), and had the largest cumulative proportion of donors returning. Deferrals of shorter duration had better return. Longer-term deferrals (up to 1 year in length) had the lowest cumulative return proportion, which did not exceed 50%. Return was associated with previously identified factors such as repeat donor status, older age, and higher educational attainment regardless of the type of deferral. In addition, return was associated with having been born in the United States and donation at fixed sites.

CONCLUSION

The category of temporary deferral influences the likelihood of future return, but the demographic and donation factors associated with return are largely consistent regardless of the deferral.

Alternative strategies in assuring blood safety: An overview

Assuring transfusion safety is an essential element of health care in all countries, requiring government commitment, national policy and a legal framework. Fundamental safety strategies include selection of low risk donors, Good Manufacturing Practices in preparation of blood components, and appropriate clinical use including avoidance of unnecessary transfusions. Hemovigilance, including surveillance for known adverse events and sentinel reporting of unexpected adverse events, enhances safety through benchmarking to promote best practices and by enabling rapid responses to new threats. Preventing transmission of infectious diseases is a principal safety concern. Selection of low risk donors includes use of screening questions to elicit risk factors known to be associated with transmissible infections. Laboratory testing for specific infectious disease markers is an established strategy for interdicting contaminated donations. The sensitivity, specificity, and operational convenience of laboratory testing have improved over time and newer technologies are imminent. Donor screening and laboratory testing, while highly effective in reducing risk, cannot eliminate all risk from known agents and must be developed de novo to address emerging infections. In contrast, pathogen reduction technologies offer the possibility for robust inactivation of a broad spectrum of blood transmissible agents and provide an added safeguard against newly emerging infectious threats of most types. Current pathogen reduction methods also inactivate leukocytes, adding safety benefits similar to leukocyte removal and product irradiation. However, to date, concerns about the safety and efficacy of cellular blood components treated by pathogen reduction have prevented approval of these technologies in the U.S. and Canada. FDA is promoting clinical and basic scientific studies to clarify these issues and would consider alternative approaches to assuring blood safety if pathogen reduction technologies are proven to be safe and effective.

Understanding non-disclosure of deferrable risk: a study of blood donors with a history of intravenous drug use

Non-disclosure of deferrable risk has received little attention in the literature. We examined deferrable risk (history of intravenous drug use [IVDU]) and donor attitudes towards truthfulness, the screening process and interpretation of the screening question as well as risk profile. Donors negative for all markers with a self-reported history of IVDU (N = 30) and matched controls were identified from an anonymous mail-out survey. In a separate survey, hepatitis C virus (HCV)-positive donors participated in a telephone interview, from which all those with IVDU history (N = 29) were selected plus matched controls (combined total 59 IVDU, 236 controls). IVDU donors, when compared with matched controls, tended to believe that it is OK not to answer truthfully if one believes that her/his blood is safe (18.6% vs. 4.7%) and that some questions are a little too personal (35.6% vs. 21.7%). IVDU donors were more likely than controls to say they failed to acknowledge screening questions appropriately (23% vs. 2.2%) or to agree that IVDU questions are mainly about recent drug taking or sharing needles (29% vs. 11%) even though the screening question asked about IVDU ever without any such qualifiers. IVDU donors were also more likely to have other lifestyle/risk factors such as history of sex with IVDU (45.5% vs. 1.7%). Donors with deferrable IVDU history may rationalise that revealing their status is not necessary and may misinterpret the question. Failure to acknowledge risk behaviour is complex, and some degree of non-disclosure may be an inherent part of pre-donation screening.

Comparison of the efficiency and the specificity of DNA-bound and free cationic porphyrin in photodynamic virus inactivation

The risk of transmitting infections by blood transfusion has been substantially reduced. However, alternative methods for inactivation of pathogens in blood and its components are needed. Application of photoactivated cationic porphyrins can offer an approach to remove non-enveloped viruses from aqueous media. Here we tested the virus inactivation capability of meso-Tetrakis(4-N-methylpyridyl)porphyrin (TMPyP) and meso-Tri-(4-N-methylpyridyl)monophenylporphyrin (TMPyMPP) in the dark and upon irradiation. T7 bacteriophage, as a surrogate on non-enveloped viruses was selected as a test system. TMPyP and TMPyMPP reduce the viability of T7 phage already in the dark, which can be explained by their selective binding to nucleic acid. Both compounds proved to be efficient photosensitizers of virus inactivation. The binding of porphyrin to phage DNA was not a prerequisite of phage photosensitization, moreover, photoinactivation was more efficiently induced by free than by DNA bound porphyrin. As optical melting studies and agarose gel electrophoresis of T7 nucleoprotein revealed, photoreactions of TMPyP and TMPyMPP affect the structural integrity of DNA and also of viral proteins, despite their selective DNA binding.

The consequences of temporary deferral on future whole blood donation

BACKGROUND

The consequences of temporary deferral are not well understood. This study sought to investigate blood donor return after deferral expiration.

STUDY DESIGN AND METHODS

A retrospective cohort analysis of allogeneic whole-blood donation was conducted. All deferred donors and a random sample of eligible donors were identified from the year 2000, with subsequent blood center visits through December 2005 captured. Stratified results are reported as the percentage returning, rates of return, and time to return. Measures of statistical association and Cox regression modeling are reported.

RESULTS

For first-time (FT) donors, 25 percent of temporarily deferred donors returned during the 5-year follow-up period compared to 47 percent of eligible donors (p < 0.0001); for repeat donors, 81 and 86 percent of deferred and eligible donors returned, respectively (p < 0.0001). Depending on the deferral category, 14 to 31 percent of FT and 58 to 90 percent of repeat donors returned. Rates (per year) of successful donation during the follow-up period were 0.09 for index-deferred FT donors, 0.28 for eligible FT donors, 1.0 for deferred repeat donors, and 1.45 for eligible repeat donors. Multivariate modeling indicated that in addition to deferral, age, sex, race, and education were associated with return in both FT and repeat donors.

CONCLUSION

The effects of deferral were more pronounced than expected, affecting both FT and repeat donors. For FT donors, the type and duration of deferral, while important, were not as relevant as hypothesized because so few returned, suggesting the need to develop appropriate interventions to recapture those donors likely to be eligible.