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Annals of African Medicine, Vol. 5, No. 4, 2006, pp. 182-184 Hepatitis C Virus Infection in Blood Donors: An Emerging Risk to Transfusion Services H. M. Muktar, M. Jones and J. Ashie Department of Haematology and Blood Transfusion,
Ahmadu Bello University Teaching Hospital, Zaria, Nigeria Code Number: am06043 Abstract Background:Hepatitis C infection is
transmissible via transfusion of blood and blood products. Little work exists
in local literature on its prevalence. Key words: Hepatitis C, regular blood donors Résumé Introduction: Sanguine et produits du sang, il y a un très peu du
documents dans la littérature locale sur sa fréquence. Mot clés: Hépatite C, donneurs réguliers du sang Introduction Hepatitis C is emerging as an important transfusion transmissible infection that is associated with chronic liver disease such as cirrhosis and hepatocellular carcinoma.1, 2 Blood transfusion is an important modality in the management of several medical and surgical conditions whereby many lives are saved daily by the administration of blood. HIV and Hepatitis B virus had long been known to be transmissible via blood transfusion which led to the institution of screening measures to reduce the hazards of blood transmission. Hepatitis C has been shown to be transmissible through other routes.3 Globally it is estimated that there are about 170 million chronic carriers of hepatitis C virus with about 3% of the worlds population infected with the virus.4The prevalence of hepatitis C virus infection varies widely across regions ranging from as low as 1% reported in Nigeria to as high as 20%-30% in some rural communities of Egypt.5,6 As at present there is no vaccine for the prevention of infection with hepatitis C virus. The only feasible strategy for the control of the infection in the community is by keeping exposure to blood to a minimum7. Institution of effective screening procedures will greatly reduce the risk of transmission via blood and blood products as adequate treatment is not currently readily available.8 This study was aimed at establishing the prevalence of hepatitis C virus infection in our institutions, main blood donation unit which serves both the hospital and the community. Materials and Methods The study was carried out at the blood donor bay of the department of Hematology and Blood Transfusion Ahmadu Bello University Teaching Hospital, Zaria (ABUTH), Nigeria from June 2000 June 2002. The subjects were the regular blood donors to the Blood Transfusion unit of the hospital. Blood donors in this study comprised of voluntary donors, patient replacement donors and spouses of antenatal clinic attendees. All subjects for blood Transfusion satisfied the routine minimum donation criteria. Five milliliters of venous blood was collected into an EDTA bottle and thoroughly mixed. The hepatitis C sero status of the donors was determined within 2 hours of collection. For the detection of hepatitis C virus infection, Clinotec Diagnostic test kits were used. The test is an immunochromatographic test designed for qualitative determination of antibodies to hepatitis C virus. It is a third generation method using direct binding principle with sandwich antigen. It has a sensitivity of 99.5% and a specificity of 99.7% based on information of the manufacturer. Results During the period a total 4633 regular blood donors between the ages of 19 and 42 years were screened for hepatitis C antigen. This comprised of 4588 (99%) males and 45(1%) females. Two thousand one hundred and sixty two (46.67%) were voluntary donors, 918 (19.81%) were replacement donors while 1503 (32.44%) were relations/husbands of antenatal clinic attendees. Two hundred and forty one (5.2%) were positive for hepatitis C virus. There were 236 (5.1%) males and 5 (0.1%) females. Table 1 shows the age-specific prevalence rates of the subjects which ranged from 0.09 % in the age group ≥40 years to 1.7% in the age group 20-24 years. Table 2 shows the yearly distribution and year specific prevalence rates: the lowest prevalence rate was in 2000(3.4%) while the highest prevalence rate was in 2001(6.9%). Table 1: Age specific prevalence rate of Hepatitis C virus in blood donors at Ahmadu Bello University Teaching Hospital
Table 2: Yearly distribution of donors screened for Hepatitis C virus in Ahmadu Bello University Teaching Hospital (2000-2002)
Discussion The prevalence rates of hepatitis C virus infection in this report was 3.4% - 6.9% (mean 5.2%). The results of this study have clearly highlighted the fact that hepatitis C virus infection is common in our donor population. The study showed that more than 99% of the donors are males. This is because males are more culturally more prominent in the environment. This study was able to establish the presence of hepatitis C virus infection in all age groups of the donors with more than 75% of the infection occurring in the productive age groups 20-34 years. The highest prevalence rate occurred in the age group 20-24 years. The productive age group in the community is relied upon for regular blood supply. The effect of these is a decrease in the available young males for blood donation. The 5.2% mean prevalence rate obtained in this study is much higher than the 1% earlier obtained in our sister hospital in Kaduna in 1998 using the same methodology, 5 but similar to 6% obtained in Jos in the same north central Nigeria.9 In Egypt, the prevalence rate ranged between 20% to 30%6while among the urban black blood donors in south Africa, it was 1.2%, much less than the finding in this report but higher than the 0.36% obtained in volunteer blood donors in the United States.10,11 .Across Europe hepatitis C virus prevalence rates are generally low ranging from 0.13% in German blood donors to 0.68% in French blood donors.12,13 Increasing prevalence of hepatitis C virus infections in our donor population in addition to the burden of HIV and Hepatitis B virus infection further depletes safe blood supply. Even though screening of blood reduces the possibility of transfusion of transmissible infections, screening tests that are highly sensitive should be employed to ensure safe blood pool for transfusion. It is hoped that the data generated will assist in reinforcing the hospitals screening policy. Acknowledgement We are grateful to the staff of Department of Haematology and Blood Transfusions, Ahmadu Bello University Hospital, Zaria, Nigeria for helping with data collection and to Professor A. M. Yakubu of the Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria for his useful suggestions. References
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