ORIGINAL ARTICLE
Year : 2022 | Volume
: 25 | Issue : 3 | Page : 74--79
Prevalence of transfusion transmissible infections among voluntary blood donors: The need for adoption of sensitive screening assays
Ayuba Zakari1, Dapus Obadiah Damulak1, Lateef Salawu2, Ochaka Julie Egesie1, Ezra Danjuma Jatau1, Jasini James3, Grace Pam Jem4,
1 Department of Haematology and Blood Transfusion, College of Health Sciences, University of Jos, Jos, Nigeria
2 Department of Haematology and Immunology, Obafemi Awolowo University, Ile-Ife, Nigeria
3 Federal Medical Centre Yola, Yola, Nigeria
4 Department of Haematology and Blood Transfusion, Jos University Teaching Hospital, Jos, Nigeria
Correspondence Address:
Dr. Ayuba Zakari
Department of Haematology and Blood Transfusion, College of Health Sciences, University of Jos, PMB 2084, Jos, Plateau State
Nigeria
Abstract
Background: Transfusion-transmissible infections (TTIs) in blood donors increase the risk of acquisition of these infections in blood and blood products recipients. Sensitive screening methods reduce the risk of transmission of TTIs to blood and products recipients. Objectives: The study sought to determine the prevalence of TTIs among voluntary non-remunerated blood donors (VNRBDs) and examine the need for the use of advanced donor screening methods to ensure blood infection safety.. Materials and Methods: This was a cross-sectional study conducted at the National Blood Transfusion Service (NBTS). Consenting VNRBD aged 18–65 years, were consecutively recruited during routine blood drives organized by the NBTS, between August and October 2016 after completing a structured questionnaire. Samples from donated blood units were screened for Human immunodeficiency virus (HIV), Hepatitis B virus (HBV), Hepatitis C virus (HCV), and syphilis using the fourth-generation ELISA. Results: The data obtained from 865 participants were analyzed. One hundred and eighty-two (21%) participants tested positive for TTIs. The prevalence of HBV, HCV, HIV, and syphilis among the participants was 14.7%, 4.6%, 1.8%, and 1.6%, respectively. Coinfection was found in 8.7% of the study participants. A statistically significant association was established between the sex of the participants and TTIs (χ2= 6.217, P = 0.0013). Conclusion: The prevalence of TTIs among VNRBD was high. Due to its attendant consequences on blood infection safety and implication on donor retention, there is a need for adoption of sensitive screening assays to ensure blood safety.
How to cite this article:
Zakari A, Damulak DO, Salawu L, Egesie OJ, Jatau ED, James J, Jem GP. Prevalence of transfusion transmissible infections among voluntary blood donors: The need for adoption of sensitive screening assays.Sahel Med J 2022;25:74-79
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How to cite this URL:
Zakari A, Damulak DO, Salawu L, Egesie OJ, Jatau ED, James J, Jem GP. Prevalence of transfusion transmissible infections among voluntary blood donors: The need for adoption of sensitive screening assays. Sahel Med J [serial online] 2022 [cited 2023 Dec 6 ];25:74-79
Available from: https://www.smjonline.org/text.asp?2022/25/3/74/389944 |
Full Text
Introduction
Blood transfusion is a life-saving intervention and requires the strict implementation of all safety measures. Safety measures such as meticulous donor selection, donor deferral, mandatory screening of blood for transfusion-transmissible infections (TTIs), and the use of pathogen reduction techniques reduce the chances of transmission of viruses through blood.[1] However, a residual risk of transmission still exists where unscreened blood is transfused, and where donors who are in a window period donate blood and the available screening methods are not sensitive enough to detect the presence of the blood pathogens.[2],[3]
The WHO Global Status Report on Blood Safety and Availability 2016 indicated that 13 countries out of which 6 are from Africa, were not able to test 100% of the blood collected for one or more of the four TTIs – Human Immunodeficiency Virus (HIV), Hepatitis B virus (HBV), Hepatitis C virus (HCV), and syphilis.[4] The identified gaps include but not limited to frequent disruptions of basic testing kits.[5] Worldwide, there is a high burden of HIV, HBV, and HCV and because blood donors are recruited from the general population, sensitive and reliable screening method for TTIs is needed to interdict transmission transmissible blood pathogens.[6],[7]
This study sought to determine the prevalence of TTIs among voluntary blood donors and examine the need for widespread availability of advanced screening methods to ensure blood infection safety.
Materials and Methods
Background of the study area
The study was conducted at the regional National Blood Transfusion Service (NBTS), located in Jos, the capital of Plateau State, North-Central Nigeria. The NBTS serves the North-Central geopolitical region of the country comprising Plateau, Nasarawa, Benue, Taraba and part of neighboring States of Bauchi and Kaduna. The NBTS is a high-output blood bank: between 2009 and 2013, the NBTS collected 30,255 units of blood (approximately 6,051 units per year) of which 5612 (18.5%) tested positive for the three TTIs (HIV, HB and HCVs) using a fourth-generation ELISA.[8]
Study design
This was a cross-sectional study carried out in prospective blood donors aged 18–65 years recruited during routine donor drives organized by the NBTS.
Data collection
Each consenting participant filled a structured questionnaire that addressed socio-demographic and risk factors for TTIs. After filling the questionnaires, participants were weighted and finger-prick blood samples obtained for hemoglobin estimation using HemoCue® hematology point of care device. Those whose weight and hemoglobin concentration were within acceptable limits had light refreshment, and after which venous blood was collected in adult blood bags. Subsequently, 5 ml of blood was expressed from the blood bag tubing into plain vacutainers. The samples obtained were transported in ice-pack to NBTS center where they were centrifuged, and the sera tested for HBV, HCV, HIV, and Syphilis using the semi-automated Genscreen™ Fourth-generation ELISA (Bio-Rad, France) while HCV and syphilis were screened for using the DIA. PRO Fourth-generation ELISA kits (Sesto San Giovanni Milano-Italy).
Data analysis
The Statistical package for the Social Sciences (SPSS) software version 16.0. 2007: Chicago, IL: SPSS Inc was used for the data analysis. Mean and the standard deviation were used to summarize continuous variables. Chi-square was used to test the relationships between the categorical variables. P <0.005 was considered statistically significant. Results were presented in tables.
Ethical approval
The study was part of a wider study titled “The Outcome of Nucleic Acid Amplification Test in HIV p24 Antigen-Negative Blood Donors in Jos, Nigeria.” The study was undertaken after due approval from the Ethical Committee of the NBTS. The participants gave informed consents and were assured of the confidentiality of their information.
Results
From August to October 2016, a total of 1018 donors were recruited. However, the record of 865 participants was retrieved and analyzed, giving a retrieval rate of 85%.
The mean age of the blood donors was 29.2 ± 10.1, and an age range of 18–63 years [Table 1]. The highest number of donors belonged to the age group of 20–30 years. There were more males (69.9%) than females (30.1%) with a male: female of 2.3:1 [Table 1]. Majority of blood donors were students 539 (62.3%), followed by the civil servants 97 (13.2%). Forty-four (6.3%) were self-employed, while 40 (4.6%) were traders, 11 (1.1%) teachers, and 6 (0.9%) farmers. Thirty-two (5.0%) of the participants were unemployed while other vocations, including security personnel and clergies, constituted the remainder (9.9%). Majority of blood donors (87.2%) attained tertiary level education. Participants with secondary and primary level education were 6.1%–0.1%, respectively. Fifty-seven (6.6%) had no formal education [Table 1].{Table 1}
Six hundred and twenty-four (71.9%) participants were single, followed by 237 (27.4%) who were married. Widows and divorced were 4 (0.4%) and 2 (0.2%), respectively [Table 1].
All the participants (100%) were voluntary nonremunerated donors. First-time and repeat donors were 595 (68.8%) and 270 (31.2%), respectively [Table 1]. Among the repeat donors, the frequency of donation ranged from 2 to 17 times.
The proportion of the participants with TTI was 21.0% [Table 2]. The prevalence of HBV, HCV, HIV, and Syphilis among the participants was 14.7%, 4.6%, 1.6%, and 1.8%, respectively [Table 3]. Of the 182 (21.0%) with TTIs, the proportion of those with single and coinfections were as follows: HBV (62.6%), HCV (15.9%), HIV (6.6%), Syphilis (6.0%), HBV and HCV (4.4%), HBV and Syphilis (1.6%), HCV and Syphilis (1.6%), whereas 1.1% had HIV and HBV coinfection [Table 4]. The sex of the subjects showed a statistically significant association with TTIs (χ2 = 6.217; P = 0.0013) [Table 5]. However, no statistically significant association was established between the age group of the participants and TTIs (χ2 = 1.404; P = 0.844).{Table 2}{Table 3}{Table 4}{Table 5}
Discussion
The study revealed the prevalence of four TTIs in voluntary blood donors screened by an advanced testing method, the fourth-generation ELISA, unavailable in most blood banks in sub-Saharan Africa.
The mean age of the blood donors in this study was 29.2 ± 10.2 years. The majority of the blood donors belong to the age group 20–29 years (52.8%). The younger population of donors reported in this study was expected because most drives were conducted at youth camp meetings and at educational institutions where most of our subjects were pursuing their educational ambitions. It also explains why students constituted the largest proportion of donors in this study, with most of them attaining tertiary level education. This study seems to show an increase in blood donation response by young and educated people and to support the fact that the donor population in Africa is indeed young.[4] The role of education is crucial in meeting the blood needs of the society. Highly educated individuals are more likely to have adequate knowledge about blood transfusion and its benefits.[9],[10] With aggressive sensitization on the need to donate blood, a large number of youths can be recruited into the blood donor pool and be retained to meet the increasing blood needs of the population over many years.
There were more males than females in our study. The male dominance in this and other studies in sub-Saharan Africa may be due to the general belief in Africa that males are healthier than females.[11],[12] Moreover, the physiologic demand of pregnancy, delivery, lactation, and monthly menstrual flow are some of the reasons for deferral among female blood donors.[12]
All the participants in this study were voluntary nonremunerated donors that are considered the safest category of donors.[5] Such was expected because participants for this study were recruited during blood drives where voluntary allogeneic donations were expected. The World Health Organization reported an increase of 11.2 million donations from voluntary unpaid donors from 2008 to 2015, with some countries achieving 100% voluntary unpaid donations.[7] With the right policy in place, an increasing number of African countries can achieve blood sufficiency through voluntary blood donations.
Of the 855 participants, 595 (68.8%) and 270 (31.2%), were first-time and repeated donors, respectively. This finding is at variance with 50.5%–49.5% reported in an earlier study conducted in Jos.[9] The higher sample size in our study may explain why we had more first-time donors. The increase in the number of first-time donors in this study as against a previous study in this environment is a reflection of the renewed effort and aggressiveness on the part of the regional blood transfusion service in voluntary blood donor recruitment to meet its increasing blood demand.
The proportion of blood donors with TTIs in our study was 21.0%. The proportion of blood donors tested positive for HBV, HCV, HIV, and Syphilis in this study was 14.7%, 4.6%, 1.6%, and 1.8%, respectively. A similar study by Buseri et al.[13] reported a higher prevalence of HBV (18.6%), HCV (6.0%), HIV (3.1%), and a slightly lower prevalence of syphilis (1.1%), in Osogbo. The higher prevalence of HBV, HCV, and HIV in the above study may be due to the larger sample size used. The higher prevalence of syphilis reported in our study may be due to the advanced method (fourth-generation ELISA) used in our study compared to the Treponema Pallidum Hemagglutination test used by Buseri et al. A study conducted in neighboring Cameroun reported a slightly lower prevalence of HBV (12.14%) and HCV (1.44%) compared to our study. In contrast, the prevalence of HIV (4.4%) in their study was higher than ours.[14] The use of rapid test kits assay as against antigen-based test by the researchers may have resulted in the lower prevalence of HBV and HCV found in their study. This further justifies the need for an advanced screening method to reduce window period donations of blood and blood products. However, rapid tests can be used in predonation screening in TTI endemic areas to eliminate positive units before the advanced screening. The seroprevalence of HBV in our study is similar to the 14.6% reported by Uneke et al. in a previous study in our environment.[15] However, the prevalence of HCV in our study is lower than an earlier multicenter study in our geopolitical zone.[16] The prevalence of HIV in voluntary nonremunerated blood donor found in our study is lower than previously reported in Jos, which may be a reflection of the decline in the national prevalence of HIV.[9],[17] The seroprevalence of syphilis in this study was, however, higher than 0.9% previously reported by Damulak et al.[18] in our environment. The majority of those who tested positive for more than one pathogen had HBV and HCV coinfection, followed by those with HBV and HIV coinfection. The three TTIs share similar routes of transmission-hematogenous and sexual. The presence of coinfection can lead to more liver-related morbidity and mortality and increased lifetime cost of treatment and clinical care.[19]
The high burden of TTIs among prospective blood donors as revealed in our study calls for stringent criteria for donor selection, deferral and the use of a sensitive donor screening assays, to minimize the risk of introduction of a contaminated unit in the transfusion chain. This high prevalence of TTIs also means a higher number of discarded units by the centralized NBTS that may exert additional financial burden on an already strained blood service.[20],[21] Hepatitis B viral infection is vaccine-preventable, and its high prevalence among blood donors and the world at large suggests a gap in routine immunization against HBV. Aggressive sensitization, strengthening of childhood immunization, a special program on HBV immunization for school-age children, and enrollment of adults for HBV immunization, will drastically reduce the burden of HBV in Nigeria and other African countries. With widespread vaccination against HBV, more blood donors will be available to meet the transfusion need of society.
The introduction of sensitive assays against viral antigens and nucleic acid has improved pretransfusion testing of donor units and blood infection safety.[2] The fourth-generation ELISA used in this study is an advancement over the traditional serological methods and previous generations of ELISA.[22],[23] Although these assays are expensive, they are cost-effective when compared to the lifelong consequences of management of patients with transfusion-associated TTIs. With a high prevalence of TTIs, a less sensitive screening method when used for donor testing has a higher chance of missing a positive unit.[7] Compared to other routes of transmission, acquisition of TTIs through contaminated blood is highly efficient because of the high inoculum. Indeed, the chance of transmission of viruses via infected blood is almost 100%.[2] Our greatest undoing for the transfusionists will be for a patient to present to the hospital with infections such as malaria and typhoid fever, and end up with HIV, HBV or HCV infections as a result of unsafe transfusion. Blood transfusion in Africa is at risk because a significant proportion of blood donation and transfusions are unregulated and done at the level of primary health Centers and private hospitals. These Centers may not adhere to basic quality protocols and do not have access to advanced and sensitive test methods.[24],[25] The vulnerability of the transfusion chain in Africa is exacerbated by the frequent disruptions in basic blood testing kits.[7] This makes a case for increasing funding to the health sector and the NBTS in African countries more urgent. In the presence of high burden of TTIs among voluntary blood donors, widespread provision and adoption of the fourth-generation ELISA as the minimum screening method in blood banks will reduce the risk of transmittal of infections to recipients of blood and blood products.
Conclusion
The high prevalence of TTIs, especially HBV, found in this study confirmed earlier observations of increased burden of viral infections among allogeneic blood donors. There is, therefore, the need to ensure sustained widespread availability of reliable, sensitive donor screening assay methods across blood banks in Nigeria and Africa to reduce the risk of transfusion-related infections and improve blood safety.
Limitations
The study was unable to carry out individual donor unit nucleic acid amplification testing to detect those with acute infections due to resources constraints, as the cost of running individual NAT on all samples was enormous.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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