|Year : 2022 | Volume
| Issue : 1 | Page : 8-12
Seroprevalence of transfusion-transmitted infections among blood donors in a tertiary care hospital in Puducherry
Jayasree Cherukat, Rajendra Kulkarni, Abhishekh Basavarajegowda
Department of Transfusion Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
|Date of Submission||13-Jan-2021|
|Date of Decision||21-Jan-2021|
|Date of Acceptance||24-Jan-2021|
|Date of Web Publication||29-Nov-2021|
Dr. Abhishekh Basavarajegowda
Room No 5042, Superspeciality Block, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry
Source of Support: None, Conflict of Interest: None
Introduction: Although significant strides have happened in making blood transfusions safe, with each transfusion, there is a chance to transmit transfusion-transmitted infections (TTI), namely viral, bacterial, parasitic, and prions. The primary objective of this study was to assess the seroprevalence of the five mandatorily to be tested TTI's in India among blood donors at our center. Methodology: This was a cross-sectional observational study conducted in the Department of Transfusion Medicine, a tertiary care hospital in Puducherry, from August 2015 to February 2017. Enzyme-linked immunosorbent assay was done for HIV, HCV, HBsAg/hepatitis B surface antigen, and rapid plasma reagin test was done for syphilis. Rapid card testing was done for malaria. Results: There were a total of 28,380 donors during the study period. In the present study, the overall seroprevalence of TTI's was 3.06%. The individual seropositivity rates were 0.30% for HIV, 2.15% for HBsAg, 0.51% for HCV, and 0.08% for syphilis. There was no case of malaria diagnosed in the study period. Conclusion: The seroprevalence of TTI in Puducherry was similar to those reported elsewhere in the country. It was comparable to the national average with regard to HIV and HCV, higher for HBV and much lesser for syphilis.
Keywords: Puducherry, seroprevalence, transfusion-transmitted infections
|How to cite this article:|
Cherukat J, Kulkarni R, Basavarajegowda A. Seroprevalence of transfusion-transmitted infections among blood donors in a tertiary care hospital in Puducherry. J Prim Care Spec 2022;3:8-12
|How to cite this URL:|
Cherukat J, Kulkarni R, Basavarajegowda A. Seroprevalence of transfusion-transmitted infections among blood donors in a tertiary care hospital in Puducherry. J Prim Care Spec [serial online] 2022 [cited 2022 May 27];3:8-12. Available from: https://www.jpcsonline.org/text.asp?2022/3/1/8/331485
| Introduction|| |
Blood transfusions are many times lifesaving measures. They play an essential role in medical and surgical management. Nevertheless, blood transfusions are not always safe. With each transfusion, there is a chance of transmission of transfusion-transmitted infections (TTI) such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, malaria, cytomegalovirus (CMV), and bacterial parasites. Most of the problems are due to concealment of medical history by replacement donors, donors donating in the window period, and poor quality of the testing kits. This can be eliminated with adequate predonation screening, counseling, avoiding replacement donation, strict quality control, and TTI screening in blood donors using state of the art technology methods.
In India, blood donor screening for HIV, hepatitis B, hepatitis C, malaria, and syphilis is mandatory.
This study will help us know the prevalence of TTI's and compare them with the national average. It allows us to identify low-risk donors and formulate an inventory of seronegative donors who can be called in times of need to donate and retain them in good health and habits.
| Methodology|| |
The study was done in the Department of Transfusion Medicine, JIPMER, Puducherry, among routine blood donors ranging from August 2015 to February 2017. It was a cross-sectional study including all eligible blood donors who donated at our blood bank and camps conducted by us. Less volume collections were excluded. After filling the donor questionnaire/proforma, donors were screened using a setlist of deferral criteria as per national guidelines and departmental standard operating procedure with a medical examination followed by a finger prick test for checking donor's Hemoglobin and blood group.
Five milliliters of blood was collected routinely from all donors at the time of donation in a clean test tube. This was allowed to clot. Samples were centrifuged at 2000 rpm for 2 min for separation of serum. Then tests were carried out – enzyme-linked immunosorbent assay (ELISA) for HIV, HCV, HBsAg/hepatitis B surface antigen using serum separated after centrifugation. A rapid plasma reagin test (RPR) was done for syphilis using the serum. During donor screening for grouping and checking hemoglobin, whole blood is routinely drawn by the finger-prick method using a lancet. This was used for testing for malaria using rapid cards.
For HIV third-generation indirect ELISA (which detects anti-HIV 1 and anti-HIV 2) was done using “HIV Microlisa” (J Mitra and Co Pvt Ltd). For HCV, “Microlisa HCV” (J Mitra and Co Pvt Ltd) – a third-generation Indirect ELISA which detects anti-HCV was used. HBsAg testing was done using third-generation direct ELISA using kits by J Mitra and Co Pvt Ltd-”HEPALISA.” RPR screening was done using kits by Tulip, India, and malaria screening using the rapid card-”Malascan plus” (by Zephyr Biomedicals, a sandwich immunoassay that detects P falciparum specific histidine-rich protein-2 and Pan malaria-specific lactate dehydrogenase).
Only a single test was done for all the TTIs-ELISA for HIV, HBsAg, HCV; rapid test for malaria; and RPR for syphilis. As blood bank follows strategy 1 for screening, blood bags were discarded for all samples, giving positive or equivocal results. Samples that came reactive in the blood bank were sent to microbiology for confirmation. If the samples were again positive, the donor was notified and referred to the appropriate department for further management. For equivocal reports from microbiology, the donor was notified of his status and was told to undergo a repeat testing after 6 months.
All the data were entered into Microsoft Excel. The distribution data for the categorical data related to the donor's baseline characteristics such as gender, age, and TTIs were expressed as frequencies and percentages
| Results|| |
The total number of donors in this period was 28,380. Among these, there were 865 (3.05%) seropositive for one of the TTIs. The individual seropositivity rates were 0.31% (87 cases) HIV, 2.19% (621 cases) HBsAg, 0.51% (144 cases) HCV, and 0.05% (13 cases) syphilis. There were no cases of malaria during this period. The contribution of each TTI to the overall seroprevalence is depicted in [Figure 1]. There were six co-infections-1 with HIV and HCV, 2 with HBsAg and HCV, 2 with HIV and HBsAg, and 1 with HCV and syphilis. Among the total 32 seropositive female donors, 22 were positive for HBsAg, 4 for HCV, 4 for HIV, and 2 for RPR.
|Figure 1: Contribution of individual transfusion-transmitted infections to overall seroprevalence|
Click here to view
The sociodemographic characters of the seropositive donors are summarized in [Table 1]. HIV, which was seen to be more prevalent among drivers (25 out of 87).
| Discussion|| |
Transfusion transmitted infections continue to be a significant problem contributing to significant morbidity and mortality globally. In the current study, an attempt was made to see the seroprevalence of the five major TTIs-HIV, HBsAg, HCV, syphilis, and malaria in our hospital and also to see how various baseline characteristics of the donor (age, gender, marital status, first time/repeat donor, voluntary/replacement, education, and occupation) can influence the seropositivity patterns.
The study population comprised predominantly of males in the age group of 18–25 years (male: female ratio of 22:1). The seroprevalence of TTI's in our study was around 3.05% (HIV – 0.3%; HBsAg – 2.15%; HCV – 0.51%; syphilis – 0.08%; malaria – 0). Male gender, replacement donors, repeat donors, marital status (with married people having more), young age group (18–25 years), and certain occupations (class 2) were found to be the ones with a higher prevalence of TTI's.
In the present study, the overall prevalence of TTI's was found to be 3%. This result is in concordance with findings observed by Chandra et al. in a study conducted in a tertiary care hospital in North India in 2009 (3.05% seroprevalence). A much higher prevalence was observed by Manzoor et al. in a study from Pakistan, where the seropositivity among donors was 9.94%. Such high seroprevalence was attributed to the high prevalence of hepatitis C (which alone contributed 7.69%) in their population, contrary to what is found in our population (in the present study, only 0.51% of donors tested positive for hepatitis C). On the contrary, other studies have demonstrated a much lower seroprevalence rate –1.35% in the study by Leena et al. and 1.47% in the study by Adhikari et al.,
In our study, the seroprevalence of HBsAg was 2.15%. This is similar to the findings in the study by Chandra et al., where 1.96% of donors tested positive for hepatitis B. Hepatitis is the most common TTI in studies from most of the country except one study from Thiruvananthapuram, which showed an almost similar seroprevalence of HCV. Studies from Tanzania (8.8%) have shown a much higher rate. The higher prevalence may be due to low socioeconomic status.
The seroprevalence of HCV seen in our study was 0.51%. It is comparable to a study from Lucknow, which showed a seroprevalence of 0.85%. Also, Mathai et al. described a seroprevalence of 1.4% in a study conducted in Kerala. This is in agreement with our study. A study by Fernandes et al. from Karnataka showed a seroprevalence of 0.06%. In a study from Mozambique by Stokx et al., there were no reported cases of HCV. So it can be assumed that there is a significant regional variation for HCV seroprevalence.
HIV showed a seroprevalence of 0.3%. This agrees with a study by Chandra et al., which showed a seroprevalence of 0.23%. Similar results were also observed in the study done by Leena et al. in Andhra Pradesh (0.27%). A study by Makroo et al. from Delhi showed a seroprevalence of 0.24%. Hence, we can conclude that the seroprevalence we got in the present study is comparable to other studies from India.
The present study showed a seroprevalence of 0.08% for syphilis. A study from Delhi by Chandra et al. showed a similar seroprevalence (0.01%). Another study by Giri et al. from Maharashtra showed a seroprevalence of 0.07%. Both of these studies are in agreement with our study. On the contrary, a much higher seroprevalence was shown in the study by Bharat et al. in 2003 in a study from New Delhi (4%). A possible explanation for this discrepancy was offered in the study – that a considerable number of professional donors might have masqueraded as replacement donors.
The present study tested no positives for malaria. This agrees with most of the studies in India, as shown in [Table 2]. A study by Lakshmi et al. from Telangana showed a seroprevalence of 2 cases per 700. In a study from Nigeria by Uneke et al., a very high seroprevalence of 41% was reported. This is because of a high seroprevalence of malaria seen in sub-Saharan African countries.
|Table 2: Comparison of seroprevalence of transfusion - transmitted infections from other regions in India and the world |
Click here to view
The majority of seropositive donors in our study belonged to the 18–25 years age group (39%) with a gross male predominance (96% males). This may be because only very few females come forward to donate, and also among them; still, fewer only are usually fit to donate. This was similar to the study population described by Sethi et al. in a study on seroprevalence patterns among blood donors (41% of donors were aged 18–25 years and 95% were males). In the study by Leena an Mohd on seroprevalence of TTI's among blood donors, 68% of seropositive donors belonged to the age group of 18–30 years.
This age predilection is maybe seen because most of the donors in our center are college students (both voluntary and replacement) and because Puducherry is a cultural hub owing to the inflow of tourists from all around the world. This is a somewhat troubling finding because the most productive age group is being affected the most. Such proper interventions, like public education, especially about safe sex practices and behavioral changes, should be initiated.
Our study showed that most of the donors who tested seropositive were replacement donors (68%). A similar observation was made by Pahuja et al. in a study from Delhi where replacement donors were seen to have more seroprevalence of TTI's (99.48% replacement donors vs. 0.52% voluntary donors). Another study from Andhra Pradesh by Begum et al. showed a higher association of TTI positivity among replacement donors.
Higher seroprevalence of TTIs was noted in married as opposed to unmarried donors, and this difference was statistically significant. This is in accordance with a study from Brazil by Neto et al. and also a study from China by Li et al.,
Lakshmi and Anuradha showed a higher seroprevalence among drivers. In a study by Mathai et al. from Kerala for HIV and RPR, a statistically significant higher association was noted among the high-risk group drivers and military personnel. Likewise, our study class II was seen to be the most common occupational class involved. This is usually attributed to time spent away from home as they go long distances, either concerning work or searching for jobs.,
Higher seroprevalence was noted among repeat donors as compared to first-time donors. In a study by Sethi et al. from Uttarakhand, it was seen that first-time donors had a higher seroprevalence of TTI's. In a study by Andrade Neto et al. from Brazil, a higher prevalence was reported among first-time donors. This difference may be because of lapses in donor notification wherein donors who donated earlier and were TTI positive were not aware of their TTI status and hence donated again. People who tested positive elsewhere can donate at a different center later as there is no data transfer or a method to track these positive donors. It is also possible that the screening criteria become a little relaxed when the donor is a repeat donor. Hence, donors who donated earlier and were TTI positive were not aware of their TTI status and came to donate again.
Most donors with TTIs are O positive in the present study, followed by B positive. A similar finding has been described in a study by Karmakar et al. from Kolkata. This corresponds to the general prevalence of ABO phenotypes in our donor pool O positive blood group (38.43%), followed by B positive (34.37%). A recent large study from Jordan which included three and half lakh donors over 6 years could not find a significant association of TTIs either with ABO or Rh blood groups.
In most studies, the donor's educational status and its association with TTI seroprevalence have not been studied. A study by Song et al. done from China noted that lower educational status was associated with more risk of TTIs. In the current study, it is seen that people who have/are pursuing a bachelor's degree have the highest rate of TTIs. This may be due to a skewing of results because most of the donors in our study were students pursuing a bachelor's degree.
International comparison with regard to the seroprevalence, especially third world countries is included in [Table 2]. The TTIs are much higher in countries like Ethiopia, Yemen., It was lower in countries like Jordan, Malaysia with around 0.5% only.
This study's major strength was a considerably big sample size studied, i.e., 28,380 donors over 19 months. A significant limitation was that this being a cross-sectional study, association with the sociodemographic profile if any could not be studied.
| Conclusion|| |
The seroprevalence of TTI in Puducherry was grossly similar to those reported elsewhere in the country. It was comparable to the national average with regard to HIV and HCV infection. For HBV, it was comparatively higher, almost twice the national average. It was much lesser for syphilis, and none was reported for malaria.
The author would like to acknowledge Late Dr. Sajini Jacob for her support throughout the completion of the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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