|Year : 2014 | Volume
| Issue : 2 | Page : 91-94
Epidemiological profile of seropositive blood donors at a tertiary care hospital in North India
Jency Maria Koshy1, Anand Manoharan2, Mary John1, Rupinder Kaur3, Paramdeep Kaur4
1 Department of Medicine, Christian Medical College, Ludhiana, Punjab, India
2 Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
3 Department of Pathology, Christian Medical College, Ludhiana, Punjab, India
4 Department of Community Medicine, Christian Medical College, Ludhiana, Punjab, India
|Date of Web Publication||11-Jun-2014|
Jency Maria Koshy
Department of Medicine, Christian Medical College Ludhiana, Ludhiana - 141 008, Punjab
Source of Support: None, Conflict of Interest: None
Background: Transfusion-transmissible infections HIV, HBV, and HCV are among the greatest threats to blood safety for transfusion recipients. Seroprevalence among blood donors is a useful source of information on their prevalence in the community. The present study was undertaken to determine the profile of the seropositive blood donors attending the blood bank at Christian Medical College, Ludhiana, Punjab. Materials and Methods: This was a 3-year cross-sectional study, (1 st January 2008 till 31 st December 2010) whereby the data of the blood donors screened during this time were analyzed. We further studied the epidemiological profile of the seropositive donors. Results: There were a total of 32,829 donations. Seroprevalence of HIV, HBV, and HCV were 0.27%, 1.11% and 1.53%, respectively. Most of them were males (96.76%) and were in the age group of 18-30 years. Replacement donors constituted 95.75%. Occupation of seropositive donors included business, various services, and agriculture. There were 89 students who were seropositive. Conclusions: Seroprevalence among blood donors has shown a significant (P value for HIV 0.05, HBV < 0.001, HCV 0.004) decreasing trend over the 3 years. The professional distribution reveals the shift in seroprevalence from the high-risk group to the general population. Introducing pre test and post test counselling in blood banks will identify patients at an earlier stage where treatment would be more effective. The need to shift the burden to voluntary blood donation cannot be overemphasised.
Keywords: Blood donors, HBV, HCV, HIV, seropositive donors
|How to cite this article:|
Koshy JM, Manoharan A, John M, Kaur R, Kaur P. Epidemiological profile of seropositive blood donors at a tertiary care hospital in North India. CHRISMED J Health Res 2014;1:91-4
|How to cite this URL:|
Koshy JM, Manoharan A, John M, Kaur R, Kaur P. Epidemiological profile of seropositive blood donors at a tertiary care hospital in North India. CHRISMED J Health Res [serial online] 2014 [cited 2019 Aug 18];1:91-4. Available from: http://www.cjhr.org/text.asp?2014/1/2/91/134268
| Introduction|| |
Blood transfusion is a life-saving intervention and millions of lives are saved globally through this procedure. However, Transfusion-transmissible infections (TTI) such as HIV, HBV and HCV are among the greatest threats to blood safety for transfusion recipients and pose a serious public health problem.
The burden of patients with HIV/AIDS (Acquired Immune Deficiency Syndrome) has gradually been increasing worldwide. As per global estimates a total of 33.3 million people are living with HIV.  The prevalence of HIV in India is 0.3% among the general population.  The prevalence of HIV among blood donors was noted to have a wide range between 0.02% and 8.5% in various studies. ,,,,, Punjab is classified as a low prevalence state as per NACO (National AIDS Control Organisation) 
According to the World Health Organisation (WHO), HBsAg (Hepatitis B surface antigen) prevalence among the general population ranges from 0.1% to 11.7%.  HBV prevalence in the general population in India is 2-8% and 1-2% in the blood donors, according to various studies. ,,
Approximately 3% of the world population is infected with Hepatitis C virus (HCV).  The global seroprevalence of HCV among blood donors varies from 0.4% to 19.2%. However, overall HCV prevalence in India has been reported to be less than 2%. ,,,,
Considering the mandatory requirement of screening of all blood donors, seroreactivity among them provides an insight into seroprevalence in the general population. It also gives an opportunity to study the profile of these seropositive patients. Hence this study was undertaken to determine the profile of the blood donors who are seropositive for HIV, HBV and HCV attending the blood bank.
| Materials and Methods|| |
The study was a 3 years (1 st January 2008 till 31 st December 2010) cross-sectional study, where the records of all the blood donors were analyzed. As per the guidelines all the donors underwent a screening after obtaining a written consent.
The blood of donors who were found to be fit for blood donation was tested for HIV, HBsAg, and HCV (by the third-generation Elisa kit by Ortho Clinical diagnostics using the automated chemiluminescence technology with a sensitivity of 99.96%), Malaria parasite (by Pan Malaria antigen card test by microgene with a sensitivity of 100%) and syphilis (by Treponemal pallidum hemagluttination by microgene).
We further studied the epidemiological profile of the seropositive donors and classified them according to gender, age, type of donation, their profession and geographical distribution. The data was then analysed by calculating descriptive statistics using SPSS version 16.0.
| Results|| |
The study analyzed a total of 32,829 donors. There were 955 seropositive patients with an overall seroprevalence of 2.9%. Among the seropositive patients 88 were HIV, 364 were HBV and 503 were HCV positive with a seroprevalence of 0.27%, 1.11%, and 1.53%, respectively [Table 1]. Seroprevalence among blood donors has shown a significant (P value HIV 0.05, HBV < 0.001, HCV 0.004) decreasing trend over the 3 years.
There were 15 donors with co-infections. Majority (eight donors) had HBV-HCV co-infection, followed by HIV-HCV (5 donors) and HIV-HBV co-infection (1 donor). There were a total of 31,765 males (96.76%) and 1064 females (3.24%). More than half of the seropositive donors were males between 18 and 30 years of age.
The donors were either replacement or voluntary. Voluntary donors constituted a very small proportion of the seropositive donors [Table 2].
|Table 2: Distribution of seropositive donors according to the type of donation|
Click here to view
The donors were classified according to their profession [Figure 1]. Among the HBV-positive donors 25% of them were men in various services followed by business men (18%) and agriculturists (16%). Among the HCV-positive donors 23% of them were service men and business men followed by agriculturists (16%). Laborers and students were 9% each. We also looked at the distribution of students who where seropositive [Table 3].
The donors were grouped according to their geographical distribution according to the states they came from. Majority of our donors were from Ludhiana district. The districts from where our donors were governed by their proximity to Ludhiana district. We also had identified seropositive donors from the neighboring states and union territories.
| Discussion|| |
Every year more than 90 million units of blood are collected worldwide.  To improve blood transfusion safety, WHO recommends an integrated strategy including establishment of well-organised blood transfusion services, prioritization of blood donation from voluntary non-remunerated donors, screening of donated blood from at least the four major transfusions-transmissible infections with quality assured assays, rational use of blood and implementation of effective quality control systems. 
In this cross-sectional analysis there were a total of 32,829 donations over 3 years. Seroprevalence of HIV, HBV, and HCV were 0.27%, 1.11%, and 1.53%, respectively. In our study the seroprevalence of HCV is more among blood donors as compared to HIV and HBV. However, most of the previous studies have noted a higher prevalence of HBV as compared to HIV and HCV [Table 4]. This could be attributed to the high prevalence of injectable drug users (IDU) in Punjab. Among the 157 IDUs from Punjab Jindal et al. noted that 16.6, 17.8, and 33.7% were found to be positive for HIV, HBV, and HCV infections, respectively. 
In studies done in Punjab, the prevalence of HIV among blood bank donors was 0.12% as against 0.3% in the general population.  In the present study the prevalence was 0.27%, which was higher than the previous studies and is comparable to the seroprevalence of the general population (0.3%) of Punjab. 
In the present study majority of the donors were males (96.76%) which are quite similar to the other studies. Buseri et al., noted that 85.1% of the seropositive donors were males.  Most of the seropositive donors were among the young productive population between 18 and 30 years of age followed by 31-40 years of age. According to the study done by Kakepoto et al., higher rate of prevalence of HBsAg and HCV was observed in the younger age group of 21-30 years.  Buseri et al., noted that the highest prevalence of HIV was between 18 and 47 years and that for HBV was between 18 and 27 years of age. 
Replacement donors constituted 95.75% of the seropositive donors. Most of the studies have shown higher prevalence among replacement donors as compared to the voluntary donors. The replacement donations comprised 95.6% while the voluntary donations were 4.3% of the total donations in the study done by Meena et al.,  It was also noted that the prevalence in the replacement donors was significantly higher compared to the voluntary donors among both HBV and HCV-positive donors (1.47% vs. 0.29% in HBV-positive donors and 0.58% vs. 0.17% in HCV-positive donors).
Seropositivity among the voluntary donors (0.27%) was less as compared to the replacement donors (0.60%) among the 16,520 HCV-positive donors studied by Thakral et al.,  Kakkar et al., from our institution noted that 94.7% of the donors were replacement donors.  This probably reflects a basic lack of awareness in the general population the presence of misconception and fear associated with donating blood, the lack of health education and the indifferent attitude of the health sector. The need to shift the burden to voluntary blood donation cannot be overemphasized.
Most of the seropositive donors were business men, men in various services, agriculturists, etc. It was a matter of concern to notice the number of students who were seropositive. This might be related to the large number of IDU in Punjab. As per the 2009 estimates, the prevalence of HIV among IDUs in India is 9.2%, whereas that in Punjab is 26.1%. 
Findings noted was supported by the UNAIDS report of 2010 which noticed a shift in seropositivity from the high-risk population to the general population.  Among the screened donor population over 6 years screened by Mathai et al., Class III donors constituting drivers, business men and men in uniform showed a significantly higher incidence of transfusion transmissible infection for HIV (0.38%).  Health care workers constituted only a small fraction of the study and the prevalence among them was low.
| Conclusions|| |
Seroprevalence among blood donors has shown a significant (P value for HIV 0.05, HBV <0.001, HCV 0.004) decreasing trend over the 3 years. Higher seroprevalence of HCV as compared to HIV and HBV could be attributed to the high prevalence of IDU in Punjab. The professional distribution reveals the shift in seroprevalence from the high-risk group to the general population. Introducing pre-test and post-test counseling in blood banks will identify patients at an earlier stage where treatment would be more effective. It will prevent further transmission which has an impact on the family members and community at large. The need to shift the burden to voluntary blood donation cannot be overemphasized.
| Acknowledgment|| |
We would like to acknowledge the help of the Blood bank staff at Christian Medical college Ludhiana.
| References|| |
|1.||UNAIDS Global report 2010/HIVprevalence Map. (Monograph on the Internet). Available from: http://www.unaids.org/globalreport/HIV_prevalence_map.htm [Last cited on 2011 May 10]. |
|2.||Singh B, Verma M, Kotru M, Verma K, Batra M. Prevalence of HIV and VDRL seropositivity in blood donors of Delhi. Indian J Med Res 2005;122:234-6. |
|3.||Adhikari L, Bhatta D, Tsering DC, Sharna DK, Pal R, Gupta A. Infectious disease markers in blood donors at Central Referral Hospital, Gangtok Sikkim. Asian J Transfus Sci 2010;4:41-2. |
|4.||Mathai J, Sulochana PV, Satyabhama S, Nair PK, Sivakumar S. Profile of transfusion transmissible infection and associated risk factors among blood donors in Kerala. Indian J Pathol Microbiol 2002;45:319-22. |
|5.||Kakepoto GN, Bhally HS, Khaliq G, Kayani N, Burney IA, Siddiqui T, et al. Epidemiology of blood borne viruses: A study of healthy blood donors in Southern Pakistan. Southeast Asian J Trop Med Public Health 1996;27:703-6. |
|6.||Stokx J, Gillet P, De Weggheleire A, Casas EC, Maendaenda R, Beulane AJ, et al. Seroprevalence of transfusion-transmissible infections and evaluation of the pre-donation screening performance at the Provincial Hospital of Tete, Mozambique. BMC Infect Dis 2011;11:141. |
|7.||Buseri FI, Muhibi MA, Jeremiah ZA. Sero-epidemiology of transfusion-transmissible infectious diseases among blood donors in Osogbo, South-West Nigeria. Blood Transfus 2009;7:293-9. |
|8.||Punjab State AIDS Control Society. Overview of HIV, AIDS. (Monograph on the Internet). Government of Punjab Mohali: 2011. Available from: http://www.punjabsacs.org/docs/overview%20of%20HIV, AIDS%20in%20punjab%20till%20March%202011%20(In%20Eng).doc [Last cited on 2011 May 10]. |
|9.||Prevention of Hepatitis B in India- An Overview, World Health organisation South East Asia regional office, New Delhi; 2002.Available from http://qlibdoc.who.int/searo/2002/SEA_Hepat.-5. [Last cited on 2014 May 10]. |
|10.||Datta S. An overview of molecular epidemiology of hepatitis B virus (HBV) in India. Virol J 2008;5:156. |
|11.||Gupta N, Kumar V, Kaur A. Seroprevalence of HIV, HBV, HCV and syphilis in voluntary blood donors. Indian J Med Sci 2004;58:255-7. |
|12.||Panda M, Kar K. HIV, hepatitis B and C infection status of the blood donors in a blood bank of a tertiary health care centre of Orissa. Indian J Public Health 2008;52:43-4. |
|13.||WHO. Global surveillance and control of hepatitis C. Report of a WHO consultation organized in collaboration with the Viral Hepatitis Prevention Board, Antwerp, Belgium. J Viral Hepat 1999;6:35-47. |
|14.||Pahuja S, Sharma M, Baitha B, Jain M. Prevalence and trends of markers of hepatitis C virus, hepatitis B virus and human immunodeficiency virus in Delhi blood donors: A hospital based study. Jpn J Infect Dis 2007;60:389-91. |
|15.||Garg S, Mathur DR, Garg DK. Comparison of seropositivity of HIV, HBV, HCV and syphilis in replacement and voluntary blood donors in western India. Indian J Pathol Microbiol 2001;44:409-12. |
|16.||Sood G, Chauhan A, Sehgal S, Agnihotri S, Dilawari JB. Antibodies to hepatitis C virus in blood donors. Indian J Gastroenterol 1992;11:44. |
|17.||World Health Organization. Universal access to safe blood transfusion. World Health Organization, Geneva; 2008. Available from: http://www.who.int/bloodsafety/publications/UniversalAccesstoSafeBT.[Last cited on 2014 May 15]. |
|18.||World Health Organization. Aide- memoire: Blood safety. World Health Organization. Geneva; 2002. Available from: http://www.searo.who.int/entity/bloodsafety/Blood_Safety_Eng. [Last cited on 2014 May 15] |
|19.||Jindal N, Arora U, Singh K. Prevalence of human immunodeficiency virus (HIV), hepatitis B virus, and hepatitis C virus in three groups of populations at high risk of HIV infection in Amritsar (Punjab), Northern India. Jpn J Infect Dis 2008;61:79-81. |
|20.||Benjamin AI, Singh S, Sengupta P, Dhanoa J. HIV sero-prevalence and knowledge, behaviour and practices regarding HIV/AIDS in specific population groups in Ludhiana, Punjab. Indian J Public Health 2007;5:33-8. |
|21.||Meena M, Jindal T, Hazarika A. Prevalence of hepatitis B virus and hepatitis C virus among blood donors at a tertiary care hospital in India: A five year study. Transfusion 2011;51:198-202. |
|22.||Thakral B, Marwaha N, Chawla YK, Saliya K, Sharma A, Sharma RR, et al. Prevalence and significance of hepatitis C virus (HCV) seropositivity in blood donors. Indian J Med Res 2006;124:431-8. |
|23.||Kakkar N, Kaur R, Dhanoa J. Voluntary donors-need for a second look. Indian J Pathol Microbiol 2004;47:381-3. |
[Table 1], [Table 2], [Table 3], [Table 4]