Rising trends of HCV infection over a period of 4 years among blood donors in central India : A retrospective study

Objective: The aim of the study was to fi nd out the sero-prevalence of Hepatitis C infection among blood donors. Materials and Methods: All collected blood bags were screened for anti-hepatitis C virus antibodies (HCV Ab; MicroELISA 3rd generation, J. Mitra) during the study period of 4 years and data were analyzed. Results: A total of 28621 blood donors were screened for transfusion transmissible infections (TTIs) in which 80 donors were positive for Hepatitis C infection, constituted 11% of total sero-reactive donors. In 2009, only 10 cases were sero-reactive while in 2012, 36 cases were sero-reactive for Hepatitis C infection. Conclusions: Hepatitis C infection among blood donors are in rising trends in this study area. Voluntary donors are safer than replacement donors as they have very low sero-prevalence. As these blood donors represent the highly selective community of a general population in most of the countries. So the actual sero-prevalence of hepatitis C infection may be more in the general population. Promoting HCV screening, voluntary blood donation, diagnosis and treatment among blood donors are very important measures to control the transmission of HCV infection, decrease sero-reactive cases and ensure safe blood collection.


INTRODUCTION
HCV is recognized as the primary cause of transfusion-associated non-A-non-B viral hepatitis worldwide , [1] and is endemic in West Africa . [2]Hepatitis C virus (HCV) cause serious mortality, morbidity and fi nancial burden, thus are major global health problem . [3]The actual prevalence of HCV is diffi cult to assess because serological tests do not discriminate among acute, chronic, or resolved infection and the analyzed groups in most countries are not representative of the general population . [4]wever; most studies use blood donors as prevalence to report the frequency of HCV usually by anti-HCV antibodies and do not report follow-up HCV testing.Using blood donors as a prevalence source may underestimate the actual prevalence of the virus because donors are generally a highly selected population. [5]The aim of this study, was to fi nd out the sero-reactive cases of Hepatitis C infection among blood donors during 4 years in central india.

MATERIALS AND METHODS
The study was carried out in the Blood bank attached to a tertiary care hospital, Central India over a period of

RESULTS
A total of 28621 blood donors were screened for transfusion transmissible infections (TTIs) during the study period in which voluntary donors were 23133 while the replacement donors were 5488 as shown in [Table 1].
A total of 728 blood donors were found positive for transfusion transmitted infections (TTIs) during the study period in which Hepatits B was the most common infection followed by HIV and then, Hepatitis C infection.There is gradual rise in HCV infection per year as shown in [Table 2].
Rising trends of HCV infection among blood donors and seroprevalence of Hepatitis C infection was shown in [Table 3].
Using Chi-Square Value, signifi cant association was found between blood donors and HCV infection in four years duration.4].

DISCUSSION
With every unit of blood, there is 1% chance of transfusion associated problems including TTI. [6] The risk of TTI has declined dramatically in high income nations over the past two decades, primarily because of extraordinary success in preventing HIV and other established transfusion transmitted viruses from entering the blood supply. [7]ny studies including studies done by Rao and Annapurna et al., [8] in Pune, Rose et al., [9] in Vellor, Arora et al., [6] in Southern Haryana, Singh et al., [10] in Coastal Karnataka, Pahuja et al., [11] in Delhi and Singh et al., [12] showed that more than 90% were male donors as also in our study.
Among the studies done, Garg et al., [13] have reported an HCV prevalence of 0.28% in blood donors of Western India.Similar studies by Sri Krishna et al., [14] have noted a prevalence of 1.02%, Sood et al., and Pahuja et al., have reported a high prevalence of 2.2 and 2.23% in Delhi, respectively. [11]Added to this, HCV prevalence by Kaur et al., [15] was 0.78%, Singh et al., was 0.5% and Jain et al., it was 1.57% in New Delhi voluntary blood donors. [11]Internationally, various studies [11] have reported an HCV prevalence range of 0.42-1.2%.
Gao et al., [27] showed that HCV infection rate in paid blood donors was signifi cantly higher than in voluntary blood donors (15.53% vs 0.97%).It was observed that no signifi cant difference was found in HCV infection rates between male and female blood donors and the prevalence of HCV infection was found to increase with age.
In a study, done by Pallavi et al., [28] found that the incidence of Hepatitis C infection is more on replacement donors (0.23%) than volumtary donors (0.20%) Many studies were done in different parts of India regarding seroprevalence of Hepatitis C infection and when compared with our study, it was found that the sero-prevalence was low but it was in rising trends as shown in [Table 5].
Numerous researches have shown that paid blood donors are more likely to be infected with HCV than either employer-organized donors or true voluntary donors [27] .Those paid donors who were attracted by high compensation and chose to donate blood in illegal blood stations, also risked a greater risk of cross-contamination.The prevalence rate among plasma donors was signifi cantly higher than among whole blood donors (33.95% vs 7.90%), possibly due to cross-contamination of blood collection equipment by HCV positive plasma donors. [31]The elimination of paid plasma and whole blood donation could contribute to a reduction in HCV infection among blood donors.
In our study there were no paid donors.

CONCLUSION
Hepatitis C infection among blood donors are in rising trends in this study area.Voluntary donors are safer than replacement donors as they have very low sero-prevelence.As these blood donors represent the highly selective community of a general population in most of the countries, so the actual sero-prevalence of hepatitis C infection may be more in the general population.Promoting HCV screening, voluntary blood donation, diagnosis and treatment among blood donors are very important measures to control the transmission of HCV infection, decrease the sero-reactive cases and ensure safe blood collection.

Table 5: Prevalence of HCV infection in defferent regions of Indian
Different regions of India Prevalence of HCV(%) Ludhiana [29] 1.09 Delhi [11] 0.66 Lucknow [16] 0.85 Southern Haryana [6] 1.0 West Bengal [30] 0.31 Bangalore [14] 1.02 Present Study 0.28 4 years from January 2008 to December 2012.It was a retrospective study.All blood donations collected during this period were included.The donors were either voluntary or replacement donors.Replacement donors were either relatives or friends of patients.International Journal of Medicine and Public Health | Oct-Dec 2013 | Vol 3 | Issue 4

Table 4 : Sero-reactivity of HCV infection among voluntary and replacement donors yearwise
International Journal of Medicine and Public Health | Oct-Dec 2013 | Vol 3 | Issue 4