1
|
Zhang Q, Mei Z, Wei L, Liu D, Xie C, Xu Y. Prevalence and Trends of Transfusion-Transmissible HBV Infection Among Blood Donors in Southwestern China: A Six-Year Retrospective Study. Int J Gen Med 2024; 17:3907-3918. [PMID: 39257611 PMCID: PMC11385688 DOI: 10.2147/ijgm.s472609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 08/17/2024] [Indexed: 09/12/2024] Open
Abstract
Objective Hepatitis B virus (HBV) infection is a significant global public health concern, with variable prevalence rates across regions. The prevalence of transfusion-transmitted HBV infection (TT-HBV) via donated blood necessitates an evaluation of blood safety and potential risks to the population. This study assessed the prevalence of HBV infection among blood donors in Southwestern China over 6 years. Methods We analyzed 903,023 blood donations from a central blood center in Southwestern China between January 2017 and December 2022. The prevalence of HBV in donations was determined for one-time and repeat donors, considering birth cohorts and covariates. Demographic characteristics, donation frequency, and anti-HBV antibody status were analyzed to estimate the incidence of TT-HBV. Results One-time donors provided 47.78% of the samples, and 52.22% were from repeat donors. The HBV prevalence decreased from 1.0% in 2017 to 0.87% in 2022 in one-time donors and from 0.30% to 0.09%, respectively, in repeat donors. A significantly lower HBV prevalence was identified in the post-1992 birth cohort (0.33%) than in the pre-1992 birth cohort (1.67%). The estimated incidences of TT-HBV occurring from one-time donors, repeat donors, post-1992 birth cohort donors, and pre-1992 birth cohort donors were 20.76, 13.84, 0.82, and 20.98 per 104 person-years, respectively. Conclusion Our findings indicate a decreasing trend in HBV prevalence among blood donors in Southwestern China over the 6-year study period. This decline may be attributed to the widespread administration of HBV vaccinations and stringent screening measures implemented by blood donation centers. Continuous monitoring for HBV among blood donors is necessary to evaluate the effectiveness of preventive measures and inform future strategies to reduce transmission.
Collapse
Affiliation(s)
- Qiaolin Zhang
- Department of Clinical Laboratory, Chongqing Blood Center, Chongqing, People's Republic of China
| | - Zhu Mei
- Department of Clinical Laboratory, The First People's Hospital of Chongqing Liangjiang New Area, Chongqing, People's Republic of China
| | - Lan Wei
- Department of Clinical Laboratory, Chongqing Blood Center, Chongqing, People's Republic of China
| | - Dong Liu
- Department of Clinical Laboratory, Chongqing Blood Center, Chongqing, People's Republic of China
| | - Chengbing Xie
- Department of Clinical Laboratory, Chongqing Blood Center, Chongqing, People's Republic of China
| | - Yongzhu Xu
- Department of Clinical Laboratory, Chongqing Blood Center, Chongqing, People's Republic of China
| |
Collapse
|
2
|
Wei L, Chen M, Wang F, Li M, Liu D, Xie C, Yang D, Wen S, Xu Y. Analysis of hepatitis B Virus Test results among blood donors in Chongqing, China. BMC Infect Dis 2024; 24:857. [PMID: 39179973 PMCID: PMC11342658 DOI: 10.1186/s12879-024-09753-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 08/13/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) infection is a major concern regarding blood safety in countries with a high HBV prevalence, such as China. We aimed to understand the prevalence of HBV infection among blood donors in Chongqing and provide an important basis for developing appropriate blood screening strategies. METHODS Dual enzyme-linked immunosorbent assays (ELISAs) for hepatitis B surface antigen (HBsAg) were conducted in parallel with nucleic acid testing (NAT) of donors. All HBsAg-reactive and/or HBV DNA-positive blood samples were tested for HBsAg and hepatitis B DNA levels. RESULTS A total of 117,927 blood donor samples were collected from the Chongqing Blood Center between April 2020 and November 2020. In total, 473 HBV-ineligible samples were retained for HBsAg and DNA confirmation. A total of 272 samples were confirmed to be HBsAg+, including 2 HBV DNA - and 270 HBV DNA + samples. A total of 201 donations were HBsAg-, including 72 HBV DNA - samples. The rate of HBV infection was 65.33% (309/473) in men, which was significantly higher than that in women (p < 0.001). The HBV failure rate was higher among the first-time donors (p < 0.05). Of the 182 NAT R/HBsAg N/N samples (Nucleic acid test reactivity/2 anti-HBsAg tests negative), 37.91% (69/182) were false positives. The proportion of hepatitis B infections in the 18 NAT R/HBsAg N/R (Nucleic acid test reactivity/1 anti-HBsAg tests negative) samples was 94.44% (17/18), of which 50% (9/18) were occult HBV infection. A total of 95.83% (69/72) of the false positives were from the NAT R/HBsAg N/N group, and 58.33% (42/72) were first-time donors. CONCLUSION Our data showed a strikingly high HBV infection rate among blood donors in Chongqing. Double ELISA and single NAT can effectively prevent HBV leakage and improve blood safety. First-time donors have a high rate of HBV transplant failure; therefore, donors should be retained and recruited from low-risk groups.
Collapse
Affiliation(s)
- Lan Wei
- Chongqing Blood Center, 21# Road Huafu, Jiulongpo District, Chongqing, 400052, P.R. China
- Key Laboratory of Diagnostic Medicine Designated by the Ministry of Education, Chongqing Medical University, Chongqing, P.R. China
| | - Min Chen
- Chongqing Blood Center, 21# Road Huafu, Jiulongpo District, Chongqing, 400052, P.R. China
| | - Fang Wang
- Chongqing Blood Center, 21# Road Huafu, Jiulongpo District, Chongqing, 400052, P.R. China
| | - Meijun Li
- Chongqing Blood Center, 21# Road Huafu, Jiulongpo District, Chongqing, 400052, P.R. China
| | - Dong Liu
- Chongqing Blood Center, 21# Road Huafu, Jiulongpo District, Chongqing, 400052, P.R. China
| | - Chengbing Xie
- Chongqing Blood Center, 21# Road Huafu, Jiulongpo District, Chongqing, 400052, P.R. China
| | - Dongyan Yang
- Chongqing Blood Center, 21# Road Huafu, Jiulongpo District, Chongqing, 400052, P.R. China.
| | - Siyang Wen
- Department of Laboratory Medicine, The Second Affiliated Hospital of Chongqing Medical University, 1# Road Yixueyuan, Yuzhong District, Chongqing, 400016, P.R. China.
| | - Yongzhu Xu
- Chongqing Blood Center, 21# Road Huafu, Jiulongpo District, Chongqing, 400052, P.R. China.
| |
Collapse
|
3
|
Li Y, Zhang X, Huang Y, Gao L, Gao Z, He M. The prevalence of Human Immunodeficiency Virus infection among voluntary blood donors in mainland China: A systematic review and meta-analysis. J Med Virol 2024; 96:e29599. [PMID: 38647039 DOI: 10.1002/jmv.29599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 02/08/2024] [Accepted: 03/30/2024] [Indexed: 04/25/2024]
Abstract
Human immunodeficiency virus (HIV) infection through transfusion has been an imperative challenge for blood safety. Despite the implementation of screening strategies, there was still the residual risk of transfusion-transmitted HIV. Considering that the prevalence of HIV infection in blood donors is significant for evaluating blood safety and potential risks to the population, meta-analysis was applied to investigate the HIV prevalence among voluntary blood donors during the past 27 years to characterize the epidemiology and related risk factors of HIV in blood donors. The literature concerning the HIV screening reactive rate and prevalence in Chinese voluntary blood donors was collected through the systematic searching of four electronic databases. After integrating data, following the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses guidelines, data manipulation and statistical analyses were conducted by Stata 12.0. The results indicated that overall HIV prevalence was 0.0178% (95% confidence interval [CI], 0.0169%-0.0187%) with a remarkable rise, which varied from 2000 (0.0034%) to 2015 (0.027%). The HIV window period infection rate was 0.0475‱ (95% CI, 0.0304‱-0.0646‱). Importantly, subgroup analysis revealed the heterogeneity in gender, occupations, education and donation frequency. With the effective control of HIV transmission through blood, HIV prevalence declined in China to some extent in recent years, and the characteristics of HIV epidemic in some provinces have drastically changed. However, remaining relatively high HIV prevalence and overall increased trend of HIV prevalence since the 21th century demonstrates the potential residual risk of blood transfusion, and the whole society is supposed to pay close attention to HIV infection.
Collapse
Affiliation(s)
- Yuhui Li
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China
- Blood Center of Shaanxi Province, Institute of Xi'an Blood Bank, Xi'an, China
| | - Xinhui Zhang
- Guizhou Center for Disease Control and Prevention, Guiyang, China
| | - Yang Huang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China
| | - Lei Gao
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China
| | - Zhan Gao
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China
| | - Miao He
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China
| |
Collapse
|
4
|
Li L, Li Y, Lu S, Dong J, Xu H, Zhang Q, Weng R, Yin Y, He R, Fang P, Shi H, Yu Y, Wu J, Liu Z, Hess JR. Epidemiological survey and screening strategy for dengue virus in blood donors from Yunnan Province. BMC Infect Dis 2021; 21:104. [PMID: 33482756 PMCID: PMC7821518 DOI: 10.1186/s12879-021-05810-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 01/15/2021] [Indexed: 01/07/2023] Open
Abstract
Background Dengue virus (DENV) infection is increasingly common in southern China and can be transmitted through blood transfusion but is not currently part of donor screening throughout the region. We assessed DENV prevalence among donors at the Xishuangbanna Blood Center, Yunnan, to support development of DENV screening strategies. Methods Blood samples were collected randomly between June 2019 and August 2019. These were screened for anti-DENV IgG and IgM using enzyme-linked immunosorbent assay (ELISA). Then, all reactive samples and some randomly-chosen non-reactive samples were used to detect DENV RNAs using real-time polymerase-chain-reaction (RT-PCR) assays. After RT-PCR, samples were further tested for soluble nonstructural protein 1 (NS1) using the colloidal gold method. Donors demographics were also collected and assessed. Results Over the study period, 2254 donor samples were collected and tested for anti-DENV IgG and IgM by ELISA. This revealed 598 anti-DENV IgG and/or IgM reactive samples, a serological prevalence of 26.53%. Of these, 26 were RT-PCR positive and/or NS1 positive. Significant differences in DENV prevalence were noted by occupation (P = 0.001), education (P < 0.001), and ethnicity (P = 0.026). Conclusion The prevalence of DENV in Xishuangbanna Blood Center was higher than most other blood centers that have implemented DENV donor screening. Our study provides first-hand data about the prevalence of DENV and allows the development of a screening strategy for clinical use.
Collapse
Affiliation(s)
- Ling Li
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, China
| | - Ying Li
- Xishuangbanna Blood Center, Xishuangbanna, China
| | - Shaofang Lu
- Xishuangbanna Blood Center, Xishuangbanna, China
| | - Jing Dong
- Xishuangbanna Blood Center, Xishuangbanna, China
| | - Haixia Xu
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, China
| | - Qian Zhang
- Xishuangbanna Blood Center, Xishuangbanna, China
| | - Rong Weng
- Xishuangbanna Blood Center, Xishuangbanna, China
| | - Yundi Yin
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, China
| | - Rui He
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Chengdu, China.,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, China
| | - Peng Fang
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Chengdu, China.,Anhui Medical University, Hefei, China
| | - Hua Shi
- Xishuangbanna Blood Center, Xishuangbanna, China
| | - Yinghan Yu
- Xishuangbanna Blood Center, Xishuangbanna, China
| | - Ji Wu
- Xishuangbanna Blood Center, Xishuangbanna, China.
| | - Zhong Liu
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Chengdu, China. .,Key Laboratory of Transfusion Adverse Reactions, CAMS, Chengdu, China.
| | - John R Hess
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, USA
| |
Collapse
|
5
|
Gao Z, Liu J, Fu P, Huang M, Cao R, Wen X, Zhang C, He T, Mao W, Liao D, Ke L, Yang Y, He M, Liu Y, Wang J, Dodd RY, Ness P, Shan H. Estimation of hepatitis B-positive rates in Chinese blood donors by combining predonation and postdonation screening results. Transfusion 2019; 59:1749-1754. [PMID: 30758046 DOI: 10.1111/trf.15158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/16/2018] [Accepted: 11/25/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Chinese blood centers use Hepatitis B surface antigen (HBsAg) rapid test (RT) in pre-donation and two rounds of screening with different enzyme-linked immunosorbent assays in post-donation. Nucleic acid testing (NAT) on screening non-reactive (SC-) donations has been gradually implemented since 2010. Yet RT+ and SC-/NAT+ donors are seldom included in hepatitis B virus (HBV) positive rate estimates in Chinese blood donors. METHODS We performed HBsAg neutralization test (NT) on whole blood (WB) with pre-donation RT+ results and post-donation screening reactive (SC+) samples from Mianyang and Chongqing in 2015. The annual totals of pre- and post-donation NT+ donors were combined with the annual totals of SC-/NAT+ donors to derive the estimated HBV positive rates. RESULT In Mianyang and Chongqing, 59.4% and 68.2% of RT+ donors in Jan-Aug 2015 contributed for NT, 95.5% and 97.2% of which were NT+ respectively. In 2015, 422 and 667 donors from Mianyang and Chongqing respectively were HBsAg RT+, yielding estimated 403 and 648 pre-donation RT+/NT+ deferrals. 411 and 668 post-donation SC+ samples were NT tested from Mianyang and Chongqing, of which 249 and 323 were NT+ respectively. An estimated 63 donors in Mianyang and 88 donors in Chongqing were SC-/NAT+. The estimated HBV confirmed positive rate in blood donors are 1.59% in Mianyang and 1.01% in Chongqing. CONCLUSION Pre-donation HBsAg RT effectively intercepts donations from HBV infected donors. Using NT confirmatory results from RT+, SC+ and SC-/NAT+ donors, this study provides a model for more accurate estimation for HBV positive rates in China.
Collapse
Affiliation(s)
- Zhan Gao
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Jing Liu
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ping Fu
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Mei Huang
- Mianyang Blood Center, Mianyang, China
| | - Ru'an Cao
- Mianyang Blood Center, Mianyang, China
| | | | | | - Tao He
- Chongqing Blood Center, Chongqing, China
| | - Wei Mao
- Chongqing Blood Center, Chongqing, China
| | - Dan Liao
- RTI International, Rockville, Maryland
| | - Ling Ke
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Yashan Yang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Miao He
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Yu Liu
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Jingxing Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Roger Y Dodd
- American Red Cross Holland Laboratory, Rockville, Maryland
| | - Paul Ness
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Hua Shan
- Stanford University Medical Center, Stanford, California
| |
Collapse
|
6
|
Prevalence, incidence and residual risk of transfusion-transmitted HBV infection before and after the implementation of HBV-NAT in northern Brazil. PLoS One 2018; 13:e0208414. [PMID: 30566494 PMCID: PMC6300202 DOI: 10.1371/journal.pone.0208414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 11/18/2018] [Indexed: 12/17/2022] Open
Abstract
Background Nucleic acid testing (NAT) for virus detection during blood screening has helped to prevent transfusion-transmitted infections worldwide. In northern Brazil, NAT was implemented in 2012 for HIV and HCV and more recently, in January 2015, the screening for HBV was included and currently used concomitant with serological tests (HBsAg and anti-HBc). This study aims to evaluate the prevalence and the incidence of HBV infection among voluntary blood donors at ten regional blood centers of HEMOPA Foundation in Pará state and to compare the residual risk of transfusion-transmitted HBV infection before and after the Brazilian HBV-NAT implementation. Methods The prevalence (restricted to first time donors- FT) and seroconversion rate (restricted to repeat donors- RP) of HBV were calculated based on rates of confirmed positive samples. Residual risk was based on the incidence and window period (WP) model described by Schreiber and coauthors. Logistic and Poisson regression were used in the statistical analysis by SPSS v20.0. A p value <0.05 was considered statistically significant. Results HBV prevalence in the periods before and after the implementation of HBV-NAT were 247 and 251 per 100,000 donations, respectively. Seroconversion rates were 114 and 122 per 100,000 donations in the two periods, respectively. The residual risk (RR) for HBV decreased significantly in the posterior period to the HBV-NAT implementation, when compared to RR before implementation, with a reduction of 1:144,92 to 1:294,11 donations (p <0,001). Conclusions The RR to HBV decreased after the implementation of HBV-NAT, increasing significantly the transfusional security in the North region of Brazil at HEMOPA Foundation.
Collapse
|
7
|
Li L, Han T, Zang L, Niu L, Cheng W, Lin H, Li KY, Cao R, Zhao B, Liu Y, Ou G, Liu X, Qi Y, Li Y, Liu Z. The current incidence, prevalence, and residual risk of hepatitis B viral infections among voluntary blood donors in China. BMC Infect Dis 2017; 17:754. [PMID: 29212443 PMCID: PMC5719753 DOI: 10.1186/s12879-017-2861-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 11/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are few data available on the prevalence, incidence, and residual risk of transfusion-transmitted HBV (TT-HBV) infections among Chinese blood donors. This study investigated the demographic characteristics of blood donors, as well as the prevalence, incidence, and residual risk (RR) of TT-HBV infections in six large blood centers in different regions of China. METHODS The demographic characteristics and HBV screening test results of blood donors from six blood centers in different regions in China were collected and analyzed. The hepatitis B surface antigen (HBsAg) yield approach was used to estimate the incidence of HBV. Then, the RR of TT-HBV infections was evaluated using the incidence-window period model. RESULTS The majority of donors were between 18 and 35 years old (including 35), with the exception of the Changzhi Blood Center where a majority of donors were between 35 and 55 years old (including 55). The prevalences of HBV were 0.13%, 0.078%, 0.16%, 0.07%, 0.20%, 0.25% in Hefei, Dalian, Changzhi, Kaifeng, Mianyang and Fujian, respectively. The estimated corresponding incidences were 213.44, 161.59, 989.80, 278.05, 125.31 and 352.19 per 105 person-years. Using an infectious window period of 59 days, the RR for HBV was estimated to be 34.14, 25.85, 158.35, 44.48, 20.04 and 56.35 per 105 person-years in Hefei, Dalian, Changzhi, Kaifeng, Mianyang and Fujian, respectively. CONCLUSION Despite the introduction of more sensitive assays in blood screening, our data revealed that the current residual risk of TT-HBV infection was still high (overall 56.53 per 105 py). A continuous monitoring of the residual risk of transfusion-transmitted infections is crucial for safe blood management.
Collapse
Affiliation(s)
- Ling Li
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, Sichuan, China
| | - Tingting Han
- No. 1 People's Hospital of Anqing, Anqing, Anhui, China
| | - Liang Zang
- Dalian Blood Center, Dalian, Liaoning, China
| | - Libin Niu
- Changzhi Blood Center, Changzhi, Shanxi, China
| | | | | | - Ka Yi Li
- Cooper Medical School of Rowan University, Camden, USA
| | - Ruan Cao
- Mianyang Blood Center, Mianyang, Sichuan, China
| | | | | | - Guojin Ou
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, Sichuan, China
| | - Xiao Liu
- No. 1 People's Hospital of Deyang, Deyang, Sichuan, China
| | - Yingjie Qi
- Anhui Provincial Infection Hospital, Hefei, Anhui, China
| | - Yanhua Li
- Department of Pathology, New York University School of Medicine, NYU Langone Health, New York, USA
| | - Zhong Liu
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, Sichuan, China. .,, 26 Huacai Rd, Longtan Industry Zone, Chenghua District, Chengdu, Sichuan, People's Republic of China.
| |
Collapse
|
8
|
Allain JP, Opare-Sem O. Screening and diagnosis of HBV in low-income and middle-income countries. Nat Rev Gastroenterol Hepatol 2016; 13:643-653. [PMID: 27625189 DOI: 10.1038/nrgastro.2016.138] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
HBV testing and diagnosis of HBV-related liver disease in low-income and middle-income countries differs substantially from that in developed countries in terms of access to resources and expensive technologies requiring highly specialized staff. For identification and classification of HBV infection, genomic amplification methods to detect and quantify HBV DNA are often nonexistent or available only in central laboratories of major cities. When samples from peripheral locations do arrive, delays in receiving results generate loss to follow-up. Testing is often limited to measurement of hepatitis B surface antigen (HBsAg), alanine aminotransferase levels, aspartate aminotransferase to platelet ratio index and hepatitis B e antigen (HBeAg) to determine indications for antiviral therapy (AVT). Utilization of AVT is limited by cost and availability, particularly when patients are not covered by health insurance. The natural history of HBV infection is influenced by genotypes B and C in East Asia, where decades of immune tolerance have led to mostly vertical transmission; in sub-Saharan Africa, where genotypes A1 and E predominate, infection is transmitted horizontally between young children, followed by a nonreplicative phase. In both regions, cirrhosis and hepatocellular carcinoma are common and would be considerably ameliorated by AVT. Implementation of the HBV vaccine since the 1990s in Asia and 2000s in Africa has decreased the incidence of HBV, but vaccine failure and insufficiently effective prevention remain concerning issues.
Collapse
Affiliation(s)
- Jean-Pierre Allain
- Department of Haematology, University of Cambridge, Science Village, Chesterford Research Park, Little Chesterford CB10 1XL, UK
| | - Ohene Opare-Sem
- Department of Medicine, Kwame Nkrumah University of Science and Technology, University Post Office, Kumasi, Ghana
| |
Collapse
|
9
|
Zhong L, Xi G, Zhang L, Liu S, Wan L, Yu L, Zhou M, Zhang J, He Y. The estimation of prevalence and risk factors of hepatitis B virus infection among blood donors in Chengdu, China. J Med Virol 2015; 88:260-7. [PMID: 26241150 DOI: 10.1002/jmv.24339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2015] [Indexed: 12/29/2022]
Abstract
The reported positive rates of hepatitis B virus surface antigen (HBsAg) among Chinese blood donors generally do not include data from pre-donation rapid tests. The aim of this study was to estimate the prevalence of serologic markers for HBsAg and risk factors among blood donors from Chengdu, China. From April 2010 to March 2011, a total of 16,875 blood donors were enrolled. Data from HBsAg tests before and after donations were collected to estimate the prevalence of HBsAg. A case-control study was conducted in 265 unique HBsAg-positive blood donors and 530 seronegative donors between January 2011 and October 2012. The odds ratio (OR) and 95% confidence interval (CI) were calculated using conditional logistic regression. The population attributable risk (PAR) was estimated. The prevalence of HBsAg was 3.17% (95%CI, 2.91-3.43%). The following risk factors were associated with HBV infection: non-vaccination for HBV (OR = 4.236; 95%CI, 2.72-6.60%), razor sharing (OR = 2.370; 95%CI, 1.46-3.84%), dental treatment (OR = 1.714; 95%CI, 1.21-2.43%), acupuncture (OR = 1.983; 95%CI, 1.20-3.28%), a family history of HBV infection (OR = 2.257; 95%CI, 1.32-3.86%), and endoscopy (OR = 2.17; 95%CI, 1.04-4.51%). The PAR values of the risk factors were 42.77%, 31.78%, 13.68%, 6.18%, 6.09%, and 2.85%, respectively, and the total PAR was 68.78%. The prevalence of HBsAg among Chinese blood donors is still high. HBV vaccinations can provide protection. Blood contact from sharing instruments is still a high risk route of transmission for HBV. Immunization programs and behavioral interventions should be used to prevent blood donation infections and improve blood safety.
Collapse
Affiliation(s)
- Li Zhong
- Department of Quality Control, Chengdu Blood Center, Chengdu, China
| | - Guangxiang Xi
- Department of Blood Supply, Chengdu Blood Center, Chengdu, China
| | - Lanjiang Zhang
- Department of Blood Screening, Chengdu Blood Center, Chengdu, China
| | - Shuangli Liu
- Department of Blood Collection, Chengdu Blood Center, Chengdu, China
| | - Like Wan
- Department of Blood Preparation, Chengdu Blood Center, Chengdu, China
| | - Lian Yu
- Department of Donor Service, Chengdu Blood Center, Chengdu, China
| | - Min Zhou
- Department of Donor Service, Chengdu Blood Center, Chengdu, China
| | - Jie Zhang
- Department of Administration Office, Chengdu Blood Center, Chengdu, China
| | - Yi He
- Department of Quality Control, Chengdu Blood Center, Chengdu, China
| |
Collapse
|
10
|
Liu J, Zhang S, Wang Q, Shen H, Zhang M, Zhang Y, Yan D, Liu M. Seroepidemiology of hepatitis B virus infection in 2 million men aged 21-49 years in rural China: a population-based, cross-sectional study. THE LANCET. INFECTIOUS DISEASES 2015; 16:80-86. [PMID: 26268687 DOI: 10.1016/s1473-3099(15)00218-2] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/03/2015] [Accepted: 07/10/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hepatitis B virus (HBV) infection is highly endemic (7-8% prevalence) in rural China, causing high mortality and societal burden. Data from men of reproductive age is scarce and last reported in 2006. We assessed the seroepidemiology of men in rural China, aiming to provide updated baseline data for the prevalence of HBV infection. METHODS We established prevalence of HBV infection from data gathered through a nationwide population-based study of Chinese rural men aged 21-49 years. Data were obtained from a physical check-up programme for couples of reproductive age, the National Free Preconception Health Examination Project, that covered 31 provinces from 2010-12. We tested serological samples with ELISA and categorised participants' HBV status based on presence of HBsAg, anti-HBV core antibody (anti-HBc), and anti-HBV surface antibody (anti-HBs). FINDINGS 2 030 083 men were recruited into the database from Jan 1, 2010, to Dec 31, 2012, and 1 966 013 men provided serum samples for analysis. 124 274 men (6%) tested positive for HBsAg, 178 559 (9%) tested positive for anti-HBc, and 583 923 (30%) tested positive for anti-HBs. Isolated anti-HBs (an indicator of vaccine-mediated immunity) were present in 527 566 men (27%). And 1 234 127 men (63%) were negative for all HBV makers (susceptible population). HBsAg prevalence was higher in men aged 25-39 years (6·35-6·47%) than in other age groups (5·54-5·78%; p<0·0001). HBV markers were all more prevalent in the eastern region of China than in the central or western regions (all p<0·0001). 32 326 (26%) of 124 274 HBsAg-positive men tested positive for HBeAg (suggesting high infectiousness); this decreased with increasing age (p<0·0001). INTERPRETATION HBV prevalence in men in rural China has changed from highly endemic into intermediate endemic in the past two decades. However, the absolute number of HBV-infected men and the susceptible population is still very large. FUNDING Chinese Association of Maternal and Child Health Studies.
Collapse
Affiliation(s)
- Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Shikun Zhang
- Department of Maternal and Child Health, National Health and Family Planning Commission of the PRC, Beijing, China
| | - Qiaomei Wang
- Department of Maternal and Child Health, National Health and Family Planning Commission of the PRC, Beijing, China
| | - Haiping Shen
- Department of Maternal and Child Health, National Health and Family Planning Commission of the PRC, Beijing, China
| | - Man Zhang
- Center for Clinical Laboratory, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yiping Zhang
- Department of Maternal and Child Health, National Health and Family Planning Commission of the PRC, Beijing, China
| | - Donghai Yan
- Department of Maternal and Child Health, National Health and Family Planning Commission of the PRC, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
| |
Collapse
|
11
|
Li N, Zheng D, Xue J, Guo W, Shi J, Sun J, Lu C, Zheng W, Wu M, Cheng S. Cidan inhibits liver cancer cell growth by reducing COX-2 and VEGF expression and cell cycle arrest. Exp Ther Med 2015; 9:1709-1718. [PMID: 26136881 DOI: 10.3892/etm.2015.2351] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 06/04/2014] [Indexed: 12/12/2022] Open
Abstract
Cidan is a traditional Chinese medicine formula that has been used for >10 years as an antitumor drug. In the present study, the antitumor effect of cidan on hepatocellular carcinoma (HCC) and the underlying molecular mechanisms were investigated. A total of 372 patients with primary HCC, as confirmed by pathological examination in the Eastern Hepatobiliary Surgery Hospital and Beijing Oncology Hospital of Weida TCM, were prospectively enrolled in the study. In total, 92 patients were treated with cidan capsules for three months postoperatively, while 280 patients served as controls. The efficacy of cidan was analyzed by monitoring associated symptoms and liver function tests, including measuring the levels of α-1-fetoprotein, α-L-fucosidase, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase and γ-glutamyl transferase. In addition, in vivo analysis was performed using mice Hepa1-6 xenograft models, while in vitro studies were performed with SMMC-7721 and CSQT-1 cells; this included cidan-dependent cell viability and migration assays, cell cycle analyses and the evaluation of cidan effects on cyclooxygenase-2 (COX-2) and vascular endothelial growth factor (VEGF) mRNA transcription rates using quantitative polymerase chain reaction. The postoperative two-year overall survival (77 and 58% for the cidan and control groups, respectively; P<0.01) and disease-free survival (36 and 24% for the cidan and control groups, respectively; P<0.01) rates were superior in the cidan-treated group when compared with the control. In addition, the size and weight of the tumor xenografts in the C57BL/6 mice were significantly reduced in a time- and dose-dependent manner following cidan treatment (P<0.01). Cidan significantly reduced the cell viability of SMMC-7721 and CSQT-1 cells after four and five days when compared with the control (P<0.01). Furthermore, COX-2 and VEGF mRNA expression levels decreased following cidan treatment (P<0.01), and cidan treatment resulted in enhanced G1 and G2/M cell cycle arrest of CSQT-1 cells. Therefore, cidan effectively inhibited cell proliferation, reduced cell viability and downregulated COX-2 and VEGF expression levels in hepatoma cells.
Collapse
Affiliation(s)
- Nan Li
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, P.R. China
| | - Donghai Zheng
- Beijing Oncology Hospital Of Weida TCM, Beijing 100023, P.R. China
| | - Jie Xue
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, P.R. China
| | - Weixing Guo
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, P.R. China
| | - Jie Shi
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, P.R. China
| | - Juxian Sun
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, P.R. China
| | - Chongde Lu
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, P.R. China
| | - Weida Zheng
- Beijing Oncology Hospital Of Weida TCM, Beijing 100023, P.R. China
| | - Mengchao Wu
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, P.R. China
| | - Shuqun Cheng
- Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, P.R. China
| |
Collapse
|