Standardization of B19 IgG ELISA to study the seroepidemiology of parvovirus B19 in North Indian voluntary blood donors

Ensuring Transfusion Safety: Screening Blood Donors for Human Parvovirus B19

Ensuring the safety of blood and blood products is a vital aspect of healthcare. The potential for transmission of pathogens through blood and blood products makes transfusion safety a significant concern. Despite advancements in testing methodologies, donated blood products still pose a risk for infection transmission. Human parvovirus B19 (B19V) is a small, single-stranded, non-enveloped DNA virus transmissible parenterally by blood transfusion. B19V causes a wide range of clinical manifestations, which is generally harmless in healthy individuals. B19V infection may cause severe complications, such as aplastic crises, as it affects erythrocyte progenitor cells in individuals with increased erythrocyte turnover. Additionally, B19V can be transmitted from pregnant women to their foetus, potentially causing hydrops fetalis and foetal death. The potential for transmission through blood and blood products makes B19V a significant concern for transfusion safety. In response to the growing recognition of B19V's impact on transfusion safety, various international health organisations have introduced guidelines to minimise its transmission through blood and plasma products. However, the implementation of these guidelines varies globally, with some regions, such as India, still lacking formal protocols for B19V monitoring. This review article explores the existing methodologies for screening blood donors for B19V, assesses the associated transfusion risks, and considers the implications for public health and clinical practice. By emphasising advancements in diagnostic techniques and the challenges of their implementation, this article provides a comprehensive overview of efforts to reduce the transmission of B19V through blood transfusions, thereby ensuring safer blood supplies and improved patient outcomes.

Parvovirus B19 Seroprevalence in Women with Bad Obstetric History in Kirkuk

BACKGROUND

In Iraqi community, abnormal pregnancy form a major social ans psychological and health problem. The underlying etiology of this health phenomenon was varied and includes sets of infections and autoimmune diseases. Globally human parvovirus 19 infection is common and the infection attribute to bad obstetric outcomes. Global maternal parvovirus B19 remote infection rate was with a range of 13.2% to 97.9%, while the range of acute infection was 0.5% to 97.9%. In Arab countries, the IgG seroprevalence was 53.3% to 74%, while IgM seroprevalence range was 2.2% to 84%.

OBJECTIVE

To evaluate the role of Parvovirus B19 as an etiology of bad obstetric outcome in women in Kirkuk, Iraq.

MATERIALS AND METHODS

Descriptive Case Control Study. Women included in the study were recruited from Kirkuk General Hospital and their age ranged from 14 to 48 years. A 663 women were included in the study and 237 of them were none pregnant, while the pregnant were 215. Additionally, the study included 211 women with inevitable abortion. A control group (306 women) women with history of normal pregnancy (Pregnant=149; non-pregnant=157). Clinical and laboratory investigations were conducted on all patients and control groups to exclude other causes [7]. Medical and obstetric data and demographic characteristics gathered through interview according to previously designed questionnaire [7]. ELISA kits were used to determine Parvovirus B19 IgM and IgG antibodies.

RESULTS

The overall parvovirus seroprevalence was 93% and with no significant difference between women with normal (89.5%) and those with abnormal (93.1%) pregnancy outcomes . In addition, parvovirus IgM overall seroprevalence was 56.3%. Furthermore, current parvovirus infection was higher in women with BOH (52.6%) than that in women with normal pregnancy (49.7%) outcomes. Parvovirus IgM seroprevalence was 52.6% in women with BOH and 49.7% in women with normal pregnancy, however, the difference was not statistically significant. In contrast, the acute infection with parvovirus was significantly (X2=11.8, P=0.001) lower in women with normal pregnancy (49.7%) than in those with inevitable abortion (64.9%), While IgG seroprevalence difference was not significant between the two groups. Infection seroprevalence was more frequent in housewife, uneducated women, large family size, non-smoker, rural area, non animal exposure, repeated abortion, congenital anomalies, and anaemia.

CONCLUSION

Parvovirus B19 infection may be with bad obstetric outcomes if occurred during pregnancy and OR confirm a significant association of the infection with parvovirus with smoking, occupation, crowding index, education, animal exposure and number of repeated abortion.

Prevalence and Phylogenetic Analysis of Parvovirus (B19V) among Blood Donors with Different Nationalities Residing in Qatar

Human parvovirus (B19V) is the causative agent of erythema infectiosum in children and is linked to a wide range of clinical manifestations. Studies related to B19V prevalence in the Middle East and North Africa (MENA) region and other parts of Asia are very scarce. The objectives of this study were to estimate the seroprevalence (anti-B19V IgM and IgG), the viremia rate (B19V DNA), and the circulating genotypes of B19V among blood donors in Qatar. Methods: Donors’ blood samples (n = 5026) from different nationalities, mainly from the MENA region and South East Asia, were collected from 2014–2016. Samples were tested for the B19V DNA using RT-PCR. Furthermore, 1000 selected samples were tested to determine the seroprevalence of B19V antibodies using enzyme-linked immunosorbent assay (ELISA). Genotyping was performed on 65 DNA positive samples by sequencing of nested PCR fragments (NS1-VP1u region, 927 nt). Results: Only 1.4% (70/5026) of the samples had detectible B19V DNA in their blood. B19V DNA prevalence statistically decreased with age (p = 0.03). Anti-B19V IgG was detected in 60.3% (561/930) of the tested samples, while only 2.1% (20/930) were IgM-positive and 1.2% (11/930) were both IgM- and IgG-positive. B19V genotyping showed a predominance of Genotype 1 (100%). Sequence analysis of the NS1-VP1u region revealed 139 mutation sites, some of which were amino acid substitutions. Conclusion: Our results indicated a relatively high seroprevalence of B19V in Qatar. Most importantly, B19 DNA was detected among Qatari and non-Qatari blood donors. Therefore, blood banks in Qatar might need to consider screening for B19V, especially when transfusion is intended for high-risk populations, including immunocompromised patients.

PREVALENCE OF HUMAN PARVOVIRUS B19 IgG AND IgM ANTIBODIES AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINIC AT FEDERAL TEACHING HOSPITAL IDO-EKITI, NIGERIA

Background:

Human Parvovirus B19 (B19V) is a DNA virus, transmitted through respiratory secretions, hand-to-mouth-contact, blood transfusion and trans-placental transfer. It causes high mortality and morbidity in pregnant women, thus contributing to poor maternal and child health. B19V has been neglected due to dearth of epidemiological data. The aim of this study was to determine the sero-prevalence of Human Parvovirus B19 antibodies among pregnant women attending antenatal clinic at Federal Teaching Hospital Ido-Ekiti, Nigeria.

Materials and Methods:

This cross-sectional study enrolled pregnant women attending Federal Teaching Hospital Ido-Ekiti from January to May 2019 to obtain sero-epidemiological data. One hundred and twenty-two (122) consenting pregnant women were enrolled following institutional ethical approval. They were administered structured questionnaire and venous blood was collected in plain tubes for serum extraction. Sera samples were analyzed for IgG and IgM antibodies using the enzyme linked immunosorbent assay method. Percentages, median, chi-square and multivariate analysis were carried out using SPSS version 17.

Results:

The prevalence of IgG was 44.3% (54/122), IgM 41.8% (51/122), and IgG/IgM 28.7% (35/122) leaving 55.7% (68/122) of the population uninfected. The median age of participants was 22 (Interquartile range 18-25) years among which 36-45years had the highest prevalence which was not statistically significant (p=0.09 X² =4.75). There was association between miscarriage, still birth, history of blood transfusion and prevalence of Human Parvovirus B19 (p<0.05).

Conclusion:

There is a high Prevalence of B19V among pregnant women attending antenatal clinic in this study. This underscores the need for testing and immunization of pregnant women against B19V.

Prevalence of Human Parvovirus B19 in Neurological Patients: Findings from Region of Western Saudi Arabia

Human parvovirus (B19) infection causes Erythema infectiosum in persons with other hematological disorders like aplastic anemia and complications such as hydrops fetalis, spontaneous abortions. This study aimed to determine the prevalence of IgG and IgM antibodies in B19 infected neurological patients and to assess possible transmission related risk factors. This cross-sectional descriptive study comprised 140 neurological patients. Blood samples were screened for both IgG and IgM against B19 by ELISA and nested PCR. IgG and IgM accounted 6.4% and 3.5% prevalence in neurological patients. Both IgG and IgM revealed prevalence of 3.5% simultaneously in different age groups. IgG and IGM Nested PCR displayed 6.42% B19 viral DNA prevalence among samples analyzed. Among B19 risk associated factors, only history of blood transfusion (Odds Ratio=1.9:1, P=0.04) was significantly associated with B19 infection among neurological patients. Neurological patients showed very less prevalence of B19 infection and hence disclose no significant association on risk factors associated with its transmission.

Clinical impact & pathogenic mechanisms of human parvovirus B19: A multiorgan disease inflictor incognito

Human parvovirus B19 (B19V) causes myriads of clinical diseases; however, owing to lack of awareness and undetermined clinical impact, it has failed to become a virus pathogen of global concern. Cryptically, B19V causes significant morbidity and mortality. Half of the world population and 60 per cent of Indians are known to be serologically naive and are at risk of acquiring B19V infections. Cumulatively, our data showed 21.3 per cent B19V-infected patients with juvenile chronic arthropathy, recurrent abortions, multi-transfused thalassaemia and leukaemia. In addition, B19V-infected cases that ended fatally included patients with pure red cell aplasia, fulminant hepatitis and haemophagocytic syndrome. Novel clinical associations of B19V observed were amegakaryocytic thrombocytopaenia, myositis and non-occlusive ischaemic gangrene of bowel. B19V possesses multiple receptors which are distributed widely in human tissues. Vascular endothelial cell infection by B19V causes endothelialitis and vasculitic injuries besides antibody-dependent enhancement which empowered B19V to cause multiorgan diseases. Owing to lack of suitable animal model for B19V, true causal role remains to be determined, but numerous reports on B19V infections substantiate a causal role in multiorgan diseases. Hence, B19V infections need to be recognized, investigated and treated besides making efforts on vaccine developments.

First Report of Prevalence of Blood-Borne Viruses (HBV, HCV, HIV, HTLV-1 and Parvovirus B19) Among Hemophilia Patients in Afghanistan

Blood-borne viruses including Hepatitis B and C, HIV, HTLV-1 and parvovirus B19 are still a factor of concern, especially for hemophilia patients. Although the safety of the blood supply continues to improve worldwide, the blood supply system in Afghanistan was damaged by many years of conflict and political instability. To date, there are few studies focused on the prevalence of blood-borne viruses in hemophilia patients. This study is first to investigate the prevalence of five blood-borne viruses in Afghanistan hemophilia patients in four cities including Kabul, Herat, Mazar-i-Sharif and Jalal Abad. A total of 80 hemophilia male patients were screening for the presence of five transfusion-transmitted viruses using ELISA and PCR. Data obtained showed 2.5% seropositivity for HBV, 8.75% seropositivity for HCV, and 91.25% seropositivity for parvovirus B19. None of the patients were positive for HIV and HTLV-1 and the prevalence of HCV was higher in older patients rather than younger patients. This finding, the first to report in Afghanistan, shows a high prevalence of parvovirus B19 in Afghanistan hemophilia patients and implementation of highly sensitive screening is necessary.

Antibodies against human parvovirus B19 in pregnant women in Ogbomoso, Oyo State Nigeria

Infection caused by Human parvovirus B19 (HPVB19) during pregnancy has been associated with adverse effects on fetus such as intrauterine fetal death but there is dearth information about the seroprevalence and risk factors among pregnant women. This study was carried out to determine the incidence of specific IgM antibodies to HPVB19 among pregnant women attending Bowen University Teaching Hospital, Ogbomoso, Oyo State. A total of 185 participants, in the age range 18-49 years, who consented voluntarily after thorough explanation of the purpose of the study were recruited for the study. Specific IgM antibodies were detected using commercially available third-generation ELISA kits. Data on socio-demographic characteristics and potential risk factors were collected using structured questionnaires. Chi-square (χ²) test was utilized to assess the association between the socio-demographic variables and HPVB19 status (P ˂ 0.05). Logistic regression was done to determine the strength of association between the potential risk factors and HPVB19 status (P ˂ 0.05). The overall incidence of IgM antibody recorded was 2.70% (5/185). Pregnant women in the age group 36-45 (7.7%) years had the highest record. None of the socio-demographic characteristics and risk factor considered were significantly associated with acquiring HPVB19. However, a one-fold risk was observed among those who had previous history of blood transfusion (95% CI = 0.949-0.997, OR = 1.0) The findings in this study confirmed the presence of antibodies to HPVB19 among pregnant women in Ogbomoso. Public awareness, enlightenment, and screening for the virus should be encouraged to prevent fetal complications during pregnancy.

Seroprevalence of human parvovirus B19 amongst North Indian blood donors - do current donor testing guidelines need a relook?

OBJECTIVES

The present study was aimed to find out the prevalence of parvovirus B19  amongst healthy blood donors and blood transfusion recipients so as to determine the feasibility of providing seronegative blood components to vulnerable recipients.

METHODS

A total of 1000 samples were studied which included 800 blood donors and 200 transfusion recipients.The transfusion recipients included 100 multitransfused patients and 100 non transfused controls.All samples were subjected to parvovirus B19 ELISA for IgG and IgM antibodies.

RESULTS

Of the 800 blood donors,663(82.9%) were voluntary while 137(17.1%) were replacement donors.The seroprevalence of B19V IgG antibodies among healthy blood donors was found to be 34.1% whilst that of IgM antibodies was 1.4%.The seroprevalence of B19 V IgG antibodies was found to be 28.4% in the age group 18-35 years and 42.1% in donors more than 35 years of age(p ≤ 0.01). The overall seroprevalence of IgG antibodies in multitransfused patients was 34% and IgM antibodies was 7.0%.The B19 V IgG prevalence was 20% in the transfused patients aged 0-20 years and 48% in patients above 20 years of age (p ≤ 0.05).

CONCLUSION

The moderately high seroprevalence of B19 V IgG in blood donors and patients suggests endemicity of infection.However, prevalence of B19 V IgM antibodies in blood donors is low.With the widespread use of pooled plasma derived medicinal products and recognition of severe pathological effects in susceptible recipients, transfusion transmission of B19 V has become a major concern in the past few decades.We suggest screening of blood units to identify B19 V IgM negative units for transfusion to selected patients.

Parvovirus transmission by blood products - a cause for concern?

The introduction of dual viral inactivation of clotting factor concentrates has practically eliminated infections by viruses associated with significant pathogenicity over the last 20 years. Despite this, theoretical concerns about transmission of infection have remained, as it is known that currently available viral inactivation methods are unable to eliminate parvovirus B19 or prions from these products. Recently, concern has been raised following the identification of the new parvoviruses, human parvovirus 4 (PARV4) and new genotypes of parvovirus B19, in blood products. Parvoviruses do not cause chronic pathogenicity similar to human immunodeficiency virus or hepatitis C virus, but nevertheless may cause clinical manifestations, especially in immunosuppressed patients. Manufacturers should institute measures, such as minipool polymerase chain reaction testing, to ensure that their products contain no known viruses. So far, human bocavirus, another new genus of parvovirus, has not been detected in fractionated blood products, and unless their presence can be demonstrated, routine testing during manufacture is not essential. Continued surveillance of the patients and of the safety of blood products remains an important ongoing issue.

Genotyping of Human parvovirus B19 among Brazilian patients with hemoglobinopathies

Human parvovirus B19 (B19V) infection can be a life-threatening condition among patients with hereditary (chronic) hemolytic anemias. Our objective was to characterize the infection molecularly among patients with sickle cell disease and thalassemia. Forty-seven patients (37 with sickle cell disease, and 10 with β-thalassemia major) as well as 47 healthy blood donors were examined for B19V infection by anti-B19V IgG enzyme immunoassay, quantitative PCR, which detects all B19V genotypes, and DNA sequencing. B19V viremia was documented in nine patients (19.1%) as two displayed acute infection and the rest had a low titre viremia (mean 3.4 × 10(4) copies/mL). All donors were negative for B19V DNA. Anti-B19V IgG was detected in 55.3% of the patients and 57.4% among the donors. Based on partial NS1 fragments, all patient isolates were classified as genotype 1 and subgenotype 1A. The evolutionary events of the examined partial NS1 gene sequence were associated with a lack of positive selection. The quantification of all B19V genotypes by a single hydrolytic probe is a technically useful method, but it is difficult to establish relationships between B19V sequence characteristics and infection outcome.

Serological study on parvovirus B19 infection in multitransfused thalassemia major patients and its transmission through donor units

Background:

Human parvovirus B19 (B19) virus is a newly recognized agent for transfusion transmitted diseases. Beta-thalassemia major patients receive a hypertransfusion regimen, hence, are prone to acquire B19 infection; moreover, B19 escapes viral inactivation methods and donor units are not tested for B19, but there are just a couple of studies globally and none from the Asian continent. Hence, a study was designed to find the frequency of B19 infection and its transmission in multitransfused thalassemia patients.

Materials and Methods:

Ninety multitransfused beta-thalassemia major (thalassemia) patients, 32 controls (age, sex matched) without any history of transfusion were enrolled. Besides the donor units were tested in B19 un-infected patients. B19 specific IgG and IgM antibodies in the sera were analyzed by ELISA (in-house), using B19 VPI and VP2 recombinant and purified antigens; additionally HBsAg and anti-HIV and anti-HCV antibodies were tested for coexisting infections.

Results:

Seventy-three (81%) thalassemia patients tested positive for anti-B19 IgG antibodies as compared to seven (21%) in the controls group (P < 0.01), while anti-B19 IgM antibodies were detected in 37 (41.1%) compared to two (6.2%) in the controls (P < 0.01). Mean age of the thalassemia patient was eight years (range 2 – 18 years) and B19 infection was highest in the six-to-ten year range. Seropositivity increased with the number of transfusions. Two of the four HBsAg positive and five of the seven anti-HCV IgM antibody-positive patients also had anti-B19 IgM. After a six-month follow-up, four (25%) of the 16 seronegative patients seroconverted and anti-B19 IgM antibodies were detected in their donor units.

Conclusions:

Most of multitransfused thalassemics were B19 seropositive or had anti-B19 IgM; in the remaining uninfected group, B19 got transmitted through infected / IgM-positive donor units.

Parvovirus B19 antibodies and correlates of infection in pregnant women attending an antenatal clinic in central Nigeria

Human parvovirus B19 infection is associated with spontaneous abortion, hydrops foetalis, intrauterine foetal death, erythema infectiosum (5th disease), aplastic crisis and acute symmetric polyarthropathy. However, data concerning Nigerian patients with B19 infection have not been published yet. The purpose of this study was to establish the prevalence of B19 IgG and IgM antibodies, including correlates of infection, among pregnant women attending an antenatal clinic in Nigeria. Subsequent to clearance from an ethical committee, blood samples were collected between August-November 2008 from 273 pregnant women between the ages of 15-40 years who have given their informed consent and completed self-administered questionnaires. Recombinant IgG and IgM enzyme linked immunosorbent assay kits (Demeditec Diagnostics, Germany) were used for the assays. Out of the 273 participants, 111 (40.7%) had either IgG or IgM antibodies. Out of these, 75 (27.5%) had IgG antibodies whereas 36 (13.2%) had IgM antibodies, and those aged 36-40 years had the highest prevalence of IgG antibodies. Significant determinants of infection (p < 0.05) included the receipt of a blood transfusion, occupation and the presence of a large number of children in the household. Our findings have important implications for transfusion and foeto-maternal health policy in Nigeria. Routine screening for B19 IgM antibodies and accompanying clinical management of positive cases should be made mandatory for all Nigerian blood donors and women of childbearing age.