Introduction
Blood transfusion is a key element of modern health care. The aim of blood transfusion is to provide safe and effective blood and blood products.1 Transfusion transmitted infections such as human immunodeficiency virus (HIV), and hepatitis B virus (HBV), and hepatitis C virus (HCV) are among the greatest threat to blood safety for the recipient and pose a serious public health problem.2 Morbidity and mortality infected blood transfusion have far reaching consequences, not only for the recipients, but also for their families and wider society.3, 4
Increasing prevalence of HIV, HBV, HCV among the humans have raised the problems of blood safety. Hence, continuous monitoring of the magnitude of transfusion transmissible infections in blood donors is important for estimating the risk of transfusion transmitted infections and optimizing donor recruitment strategies to minimize infectious diseases transmission.2 Continuous improvement and application of donor selection criteria and sensitive screening tests reduce the risk of TTIs.5
Hence, the present study was carried out with the aim of determining sero-prevalence of TTIs among blood donors in our tertiary care hospital.
Materials and Methods
Study
Study was conducted at Sanjay Gandhi institute of trauma and orthopedics, Bangalore from January 2015 to December 2018 (four years).
Data collection
Data was collected about blood donor’s age, sex, sero logical results of HCV, HBsAg, HIV, at the Time of Blood collection. This was done by using a structured questionnaire. Blood was collected from apparently healthy individuals of age 18-60 years with weight > 45 kg and hemoglobin concentration > 12.5gm%. All blood Donor samples were screened for hepatitis B surface antigen (HBs Ag), HCV and HIV. HIV, HBsAg, HCV were done by enzyme-linked immuno adsorbent assay(ELISA) procedure using third generation kits.
Laboratory Testing
From each blood donor bag, five milliliters of blood was collected in sterile test tube. Centralization at a speed of3500 revolutions per minute(rpm)for5minutes was done to separate the serum. 2ml of collected from each sample in sterile hepatitis c vials. Each donor was tested for HBsAg, anti-HCV and HIV.HIV was screened by using 3rd- generation ELISA technique(HIV 1/2: HIV merilisa). Blood samples tested by using sero logical assays for HIV infection were screened by ID NAT testing. HepatitisBviruswasscreenedbyusing3rd generation immuno assay ELISA (HBSAgmerilisa) and ID NAT testing hepatitis C virus byusingthehumananti-HCV3rd-generationELISA, (HCV merilisa) and ID NAT testing.
Exclusion criteria
All prospective donors who did not satisfy donor selection criteria of NACO guidelines.
Data management
Descriptive statistics was used to summarize the data where frequency tables and cross tabulations were used while describing the data in numbers and percentages.
Results
Donor characteristics: Total donors comprised of 8728: of which 7474 (85.63%) were males and 1254(14.36%) were females in the ratio of 5.9:1 in four years. (Table 1).
Table 1
Frequency of blood donors by gender and year wise
Prevalence of blood borne pathogens: Blood borne pathogens were detected among 73(0.83%) of donors and 8655(99.16%) of the donors were free from the three viral infections. Donors with positive result for HIV were 3/8728(0.03%), HBV 69/8728(0.79%), HCV 1/8728(0.01%). The hepatitis B infection was the predominant infection among TTIs constituting 69(94.52%) of all the TTIs. Multiple infections were not seen in present study. Prevalence of all the three infections were more common in 20-29-year age group constituting 37/73(50.68%). (Table 2).
Table 2
Age wise distribution of TTIs
| Age in years | HIV | HBS Ag | HCV | Total |
| < 20 | 0 | 08 | 0 | 08 |
| 20-29 | 02 | 34 | 01 | 37 |
| 30-39 | 01 | 16 | 00 | 17 |
| 40-49 | 0 | 10 | 0 | 10 |
| 50-60 | 0 | 01 | 0 | 01 |
| Total | 03 | 69 | 01 | 73 |
Sero prevalence rates of TTIs in voluntary and replacement donors in four years shows that TTIs are common among voluntary donors consisting
of 43/73(58.90%) as in Table 3.
Table 3
seroprevalence rates of TTIs: voluntary vs replacement donors.
Sero-prevalence of TTIs among males and females shows that males are affected more than females 64/73(87.67%).
Discussion
WHO and NACO’s aim is to achieve safe and appropriate blood supply by obtaining blood from healthy, voluntary, non -remunerated donors who have lower risk of TTIs compared to commercial and family replacement donors.
The aim of our study was to determine the seroprevalence of transfusion transmissible viral infection among blood donors. Most of the donors in our study were males 7474(85.63%) aged between 18 and 60 years. This is similar to the studies of Buseri et al,6 Anjali et al,7 Pallavi et al,8 Tessema et al. 2 High deferral rates due to anemia, low body weight might be the reason for lower percentage of female donors.
In the present study, seroprevalence of transfusion transmissible infections(TTIs) was 73 (0.83%)which is similar to study by SriKrishna et al, 9 Anjali et al, 7 Pallavi et al. 8
The seroprevalence of HIV, HBV, HCV were 0.03%, 0.79%,0.01%, respectively. This is similar to studies by SriKrishna et al, 9 Anjali et al, 7 Pallavi et al. 8 The reason for lower prevalence of TTIs compared to other studies could be due to our efforts in creating the awareness among donors about TTIs before donation.
Higher HIV prevalence rates were observed in the age group of 20-29 (0.02%), followed by 30-39(0.01%). Prevalence of HIV detected in 20-29 years age group was higher compared to other age groups. This may be due to the high-risk behavior in younger generation such as multiple sex partners, unprotected sex and intravenous drug abuse. The prevalence was more among females and replacement donors. This finding, in deviation to other studies may be random finding.
The prevalence of HBV, 0.79% is similar to studies by Adhikari et al,10 Sushma et al.11 Higher HBV prevalence rates were observed in the age group of 20-29 (0.38%), followed by 30-39(0.18%). Prevalence of HIV detected in 20-29 years age group was higher compared to other age groups. This may be due to the high-risk behavior in this age group. HBV infection by gender distribution showed that the prevalence of HBV among males was higher than females. A higher seroprevalence rate among male donors than female donors might be due to risk behavior of males, such as outside socialization, multiple sex relationships etc. Higher prevalence rate was observed among voluntary donors compared to replacement donors. This may be due to the asymptomatic, carrier state nature of the disease. Many donors were not aware of the presence of infection.
The prevalence of HCV was seen in 0.01%of blood donors. It was seen in 20-29-year age group which is similar to study by Tigabu et al.12 This might be due to high risk behavior in younger generation.
HCV infection by gender distribution showed that male had higher prevalence rate than females. This is similar to study by Tigabu et al. 12
The trends in TTIs in blood donors tend to decrease in this study. HIV, HBV and HCV went from nil, 0.19%, nil, in 2015, nil, 0.27%, 0.01 % in 2016, 0.02%, 0.18%, nilin 2017, 0.01%, 0.13%, nil 2018 respectively, similar to other studies. The lower prevalence and decreasing trend TTIs in this study might be due to the awareness on the disease, modes of spread and prevention and our attempts in creating awareness among donors before blood donation.
