ABSTRACT
Background:
A high seroprevalence of various transfusion-transmitted infections (TTIs) in donated blood is the main safety concern, especially in low- and middle-income countries. As per the World Health Organization (WHO) recommendation, all blood donations must be tested for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), Treponema pallidum infection, and malaria, which mainly comprises the major bulk of TTIs.
Aims:
The purpose of this study is to observe the seroprevalence of hepatitis C virus and Treponema pallidum infection over the period of 5 years in blood donors of our blood center along with their epidemiological determinants with respect to age, sex, residence, occupation, and type of donors
Materials and Methods:
Retrospective study was conducted for the period of 5 years, from 1st January 2017 to December 2021, estimating the seroprevalence of hepatitis C and Treponema pallidum infection in the blood donors along with their epidemiological determinants
Results:
Out of 19,689 donations in 5 years, 690 (3.50%) units were positive for transfusion-transmissible infections with 1.67% donors seropositive for HCV, 1.23% for Treponema pallidum infection, 0.42% for HBV, and 0.18% for HIV. The prevalence of TTIs was found to be highest in 2020 (4.52%) and least in 2017 (2.57%). Out of a total of 330 HCV cases detected in 5 years, 84.85% of cases were seen in voluntary donors. Rural donors constituted 71.21% of cases. The majority of cases were seen in the age group of 18–30 years, i.e., 61.82%, and a maximum number of cases were seen in the farmers (31.21%), followed by laborers and construction workers (21.21%). Out of a total of 242 cases of Treponema pallidum infection, 84.29% were seen in voluntary blood donors. Demographic data showed 70.24% of cases in rural donors. Occupational data revealed a maximum number of cases in farmers (34.29%), followed by laborers (21.90%).
Conclusion:
Higher seroprevalence of HCV and Treponema pallidum infection in our region as compared with other areas is a matter of great concern about the growing infection rate of these in our area. Stringent use of donor selection criteria and more vigorous donor screening is utmost need of the hour for reducing the burden of TTIs in blood transfusion services.
Keywords: Prevalence, screening, syphilis, transfusion transmissible infections, trends
Introduction
Blood transfusion is a life-saving procedure as there are no substitutes for blood despite the research into blood that saves millions of lives every year globally and therefore is an indispensable part of the World Health Organization’s (WHO) list of essential medicines.[1] WHO recommends achieving self-sufficiency to meet the transfusion needs based on blood donations collected from all types of blood donors, namely, voluntary nonremunerated donors (VNRDs), family, or replacement. According to WHO, 118.5 million units of blood are donated each year globally from 171 countries with 58%–60% of donations being collected from low- and middle-income countries while Europe and America contribute to a quarter of the global burden.[2]
Shortcomings in the screening of blood and blood components carry a very high potential for transmitting blood-borne infections that can be otherwise fatal to the recipients. A high seroprevalence of various transfusion-transmitted infections (TTIs) in donated blood is the main concern for safety issues, especially in middle- and low-income countries due to a high prevalence of TTIs among the donors, inadequate screening protocols with rampant human immunodeficiency virus (HIV) infection, viral hepatitis mostly hepatitis B virus (HBV), and hepatitis C virus (HCV) along with Treponema pallidum infection, and malaria being the major contributors of TTIs.[3]
WHO recommends that all blood donations must be tested for these five infectious agents that mainly comprise the major bulk of TTIs.[4] Other noteworthy agents are human T-lymphotropic virus (HTLV-I/II), parvovirus B19, West Nile fever, cytomegalovirus (CMV), dengue virus, trypanosomiasis, and transmissible spongiform encephalopathy may be transmitted through transfused blood and blood components but are not routinely tested.
Hepatitis C infection is very common in Punjab and is mentioned in the literature. According to a population-based serosurvey done by Sood et al. in Punjab, the reported prevalence of anti- HCV in this part of the country was 3.6% in 2014.[5] According to a study done by Kumari in Punjab, nearly 2.54% of the total screened blood donors were reactive for one of the four TTIs with nearly 50% HCV-positive donors.[6] In a study done by Dhiman et al. in north India, the seroprevalence of HBV, HIV, and HCV infection in healthy blood donors were 1.27%, 0.20%, and 0.50%, respectively. However, we have observed a high positivity rate of Treponema pallidum infection also in blood donors of our region, which is not so prevalent elsewhere.[7]
The latest updated global health sector strategies (GHSS) for the period 2022–2030 published in 2022 includes an overall target reduction of 90% in the number of new cases of Treponema pallidum infection and gonorrhea by 2030.[8] GHSS also strongly advocates integrating testing for HIV, HBV, HCV, sexually transmitted infections, tuberculosis, and other diseases on a regular basis thereby further emphasizing the promotion of further public awareness of the importance of hepatitis B and C prevention measures, their testing, and treatment protocols.
Proper screening of blood along with the appropriate selection of the donors is of paramount importance to ensure a safe blood supply. WHO has made it mandatory to test each donor’s blood for Treponema pallidum infection by a venereal disease reference laboratory (VDRL), and for hepatitis B surface antigen (HBsAg), anti-HCV and anti-HIV.[2] Testing for HIV, HCV, and HBsAg is routinely done in our blood center by enzyme-linked immunosorbent assay (ELISA) and Treponema pallidum by Treponema pallidum hemagglutination assay (TPHA) cards as has been recommended by WHO.
The purpose of this study is to observe the seroprevalence of hepatitis C virus and Treponema pallidum infection over the period of 5 years in blood donors of our blood center along with their epidemiological determinants with respect to age, sex, residence, occupation, and type of donors. Also, as the blood donors are normal healthy individuals, this study will help in understanding the trends of these infections in asymptomatic healthy individuals and their family members. Thus, family physicians and primary care providers can benefit from this knowledge and can create awareness among the general population about the modes of spread, high-risk activities, and prevention programs for these infections.
Materials and Methods
Study design and setting
Retrospective study was conducted in which estimation of seroprevalence of hepatitis C and Treponema pallidum infection in the blood donors was done along with its epidemiological determinants. The study was conducted in the department of immunohematology and blood transfusion (blood center) of a teaching hospital in southwest Punjab.
Ethical approval
The ethical clearance was taken from the institutional ethical committee. The study was retrospective in nature and no donor identity revealed at any point, the requirement of consent was waived off by the ethical committee.
Study period
Data were collected retrospectively from the blood center records for the period of 5 years, i.e., from January 1, 2017 to December 31, 2021.
Study population
All the donors were healthy voluntary donors or replacement donors fulfilling all the donor-selection criteria. The sociodemographic profile of all the donors was recorded in the data sheets of the blood center.
Sample collection
Samples were collected as routine protocol as per the Standard Operating Procedures of the Blood Center for the testing of TTIs. Testing for TTI serology was done as follows:
HIV serology: HIV antibodies were detected by fourth-generation ELISA by “Genscreen™ ULTRA HIV Ag- Ab” by BioRad.
HCV serology: IgG antibodies to HCV were detected by third-generation ELISA by “Monolisa™ Anti- HCV PLUS Version 3” by BioRad.
Hepatitis B surface antigenemia: HBsAg was detected by fourth-generation double-sandwich ELISA by “Monolisa™ HBs Ag ULTRA” by BioRad.
Treponema pallidum infection serology: Treponema pallidum infection was diagnosed using immunochromatography assay, i.e., by using Standard Diagnostics (SD) Treponema pallidum infection 3.0 card test.
Malaria: Malarial parasite was diagnosed by using the Pan Malaria Card test— “Advantage Malaria PAN + Pf Card” as well as by the examination of blood smear.
All the tests were done as per the manufacturers’ instructions. All the units that tested positive were discarded as per the standard operating procedures (SOPs) of the blood center made as per biomedical waste management guidelines.[9,10]
Inclusion criterion
All the healthy blood donors who donated blood in the blood center of our hospital.
Exclusion criteria
All the blood donors who were deferred before the donation after the rapid screening for transfusion-transmissible infections in TTI laboratory.
Data collection
It was done from the archives of the blood center using a predesigned proforma.
Statistical analysis
Microsoft Excel sheet was used to enter and analyze the collected data. Values in different categories were calculated as frequencies and percentages. Mean and standard deviations were calculated wherever applicable. For the comparison between categorical variables, Chi-square test and Fischer’s exact test were used, wherever applicable, and P value was calculated. A P value of <0.05 was considered significant at a confidence interval (CI) of 95%.
Results
There were 19,689 donations in 5 years, with 84.27% voluntary and 15.73% replacement donors. The majority of donors were males (97.79%) with only 2.21% female donors. A total of 690 (3.50%) units were positive for transfusion-transmissible infections with 1.67% donors seropositive for HCV, 1.23% for Treponema pallidum infection, 0.42% for HBV, and 0.18% for HIV [Figure 1].
Figure 1.
Pie chart showing the prevalence of various transfusion-transmissible infections over a period of 5 years (2017–2021)
Yearly trends in the rate of transfusion-transmissible infections
The prevalence of TTIs was found to be highest in 2020 (4.52%), with HCV being most prevalent (2.52%), followed by Treponema pallidum infection (1.37%). The least seroprevalence of TTIs was observed in 2017 (2.57%) [Table 1]. Seroprevalence of HCV was highest among all TTIs in all 5 years, with the highest rate in 2020 (2.51%), followed by 2021 (1.74%) and least in 2017 (1.03%). An increasing trend was seen in the prevalence of Treponema pallidum infection in the observation period, increasing from 1% in 2017 to 1.44% in 2021 with the average prevalence being 1.23%. The HBV prevalence rate was comparatively low, ranging from 0.31% in 2018 to 0.49% in 2020. HIV seroprevalence rate was least among all detected TTIs with a range of 0.12% in 2019 to 0.25% in 2021. There was no case of malaria detected in this period. No significant change in the yearly trends of the prevalence of TTIs under study was noted [Table 1, Figure 2].
Table 1.
Seroprevalence of HIV, HBV, HCV, and Treponema pallidum infection among blood donors over a period of 5 years
| Year | Total donors | HIV n (%) | HBV n (%) | HCV n (%) | Treponema pallidum infection n (%) | Total n (%) | χ 2 | P |
|---|---|---|---|---|---|---|---|---|
| 2017 | 3495 | 5 (0.14) | 14 (0.40) | 36 (1.03) | 35 (1.00) | 90 (2.57) | 14.17 | 0.2900 |
| 2018 | 3851 | 9 (0.23) | 12 (0.31) | 59 (1.53) | 37 (0.96) | 117 (3.04) | ||
| 2019 | 4103 | 5 (0.12) | 20 (0.48) | 59 (1.43) | 54 (1.31) | 138 (3.36) | ||
| 2020 | 4223 | 6 (0.14) | 21 (0.49) | 106 (2.51) | 58 (1.37) | 191 (4.52) | ||
| 2021 | 4017 | 10 (0.25) | 16 (0.40) | 70 (1.74) | 58 (1.44) | 154 (3.83) | ||
| Total | 19,689 | 35 (0.18) | 83 (0.42) | 330 (1.67) | 242 (1.23) | 690 (3.50) |
No malaria cases were detected in this period
Figure 2.
Yearly trends in seroprevalence of HIV, HBV, HCV, Treponema pallidum infection, and malaria among blood donors
Epidemiological correlation of HCV infection in blood donors
Out of total 330 HCV cases detected in 5 years; significantly higher (84.85%, P = <0.0000001) cases were seen in voluntary donors. Demographic data revealed 71.21% of cases in rural donors and 28.79% in urban, which was also significant (P = 0.0000001). The majority of cases were seen in 18–30 years age group (61.82%), followed by 30.91% in the age group of 31–45 years. The majority of cases of HCV were males (99.39%), where a majority of donors were also males (97.79%). As per the occupational data, a maximum number of cases were seen in the farmers (31.21%), followed by laborers and construction workers (21.21%). Out of a total of 16,592 voluntary donors, 280 (1.687%) were HCV-reactive as compared with 1.61% positivity in replacement donations. Out of a total of 435 female donors, only two were found to be HCV-positive, i.e., 0.46% as compared with 1.70% male HCV-positive cases out of 19,254 male donors [Tables 2-4].
Table 2.
Epidemiological determinants of hepatitis C virus infection over the period of 5 years
| 2017 n (%) | 2018 n (%) | 2019 n (%) | 2020 n (%) | 2021 n (%) | Total | |||
|---|---|---|---|---|---|---|---|---|
|
| ||||||||
| n (%) | χ 2 | P | ||||||
| Total HCV cases | 36 (100) | 59 (100) | 59 (100) | 106 (100) | 70 (100) | 330 (100) | ||
| Types of donors | ||||||||
| Voluntary donors | 5 (13.89) | 51 (86.44) | 55 (93.22) | 102 (96.27) | 67 (95.71) | 280 (84.85) | ||
| Replacement donors | 31 (86.11) | 8 (13.56) | 4 (6.78) | 4 (3.77) | 3 (4.29) | 50 (15.15) | 161.4 (CST)* | <0.0000001 |
| Residence of donors | ||||||||
| Urban | 15 (41.67) | 4 (6.78) | 5 (8.48) | 31 (29.25) | 40 (52.14) | 95 (28.79) | ||
| Rural | 21 (58.33) | 55 (93.22) | 54 (91.52) | 75 (70.75) | 30 (42.86) | 235 (71.21) | 56.17 (CST)* | <0.0000001 |
| Age of Donors | ||||||||
| 18–30 years | 23 (63.89) | 39 (66.10) | 28 (47.46) | 71 (66.98) | 43 (61.43) | 204 (61.82) | ||
| 31–45 years | 10 (27.78) | 15 (25.42) | 22 (37.29) | 32 (30.19) | 23 (32.86) | 102 (30.91) | 12.65 (CST)* | 0.1246 |
| 46–60 years | 3 (8.33) | 5 (8.48) | 9 (15.25) | 3 (2.83) | 4 (5.71) | 24 (7.27) | ||
| Gender of donors | ||||||||
| Male | 36 (100) | 59 (100) | 58 (98.31) | 105 (99.06) | 70 (100) | 328 (99.39) | ||
| Female | 0 (0) | 0 (0) | 1 (1.69) | 1 (0.94) | 0 (0) | 2 (0.61) | 2.368 (FET)† | 0.6684 |
| Occupation of donors | ||||||||
| Farmers | 15 (41.67) | 15 (25.42) | 25 (42.37) | 33 (31.13) | 15 (21.43) | 103 (31.21) | ||
| Laborer/Construction workers | 9 (25) | 12 (20.34) | 8 (13.56) | 23 (21.70) | 18 (25.71) | 70 (21.21) | 24.07 (CST)* | 0.2393 |
| Merchants | 4 (11.11) | 10 (16.95) | 12 (20.34) | 19 (17.93) | 21 (30) | 66 (20) | ||
| Students | 4 (11.11) | 11 (18.64) | 3 (5.08) | 16 (15.09) | 5 (7.14) | 39 (11.82) | ||
| Government/private jobs | 3 (8.33) | 6 (10.17) | 6 (10.17) | 10 (9.43) | 8 (11.43) | 33 (10) | ||
| Drivers | 1 (2.78) | 5 (8.48) | 5 (8.48) | 5 (4.72) | 3 (4.29) | 19 (5.76) | ||
*CST=Chi-square test, †FET=Fisher’s exact test
Table 4.
Rate of hepatitis C infection and Treponema pallidum infection in males and females over the period of 5 years
| Total in 5 years n (%) | ||||
|---|---|---|---|---|
|
| ||||
| Total Donors | 19689 | |||
|
| ||||
| Type of Donors | Males | Females | χ 2 | P |
| No of Donors | 19,254 (97.79) | 435 (2.21) | ||
| HCV reactive “n” (%) | 328 (1.70) | 2 (0.46) | 1.474 | 0.2252 |
| Treponema pallidum infection positive “n” (%) | 238 (1.24) | 4 (0.92) | ||
Epidemiological correlation of Treponema pallidum infection in blood donors
There were a total of 242 cases of Treponema pallidum infection detected in the study period, out of which 204 (84.29%) were seen in voluntary blood donors and 15.7% in replacement donors. Demographic data showed 70.24% of cases in rural donors. Males constituted 98.34% of the detected syphilis cases where the total number of male donors was 97.79%. The age group of 31-45 years represented maximum number of cases (52.06%), followed by 33.88% cases in the age group of 18–30 years. Occupational data revealed a maximum number of cases in farmers (34.29%), followed by laborers (21.90%), similar to HCV cases. The least number of Treponema pallidum infection cases were seen in students (6.19%) and donors involved in government or private fixed-time jobs (6.61%). Out of total 16,592 voluntary donations, 204 (1.23%) were positive for Treponema pallidum infection. The same rate was observed in replacement donations, i.e., 38 out of 3097 (1.23%). Only 4 out of 435 females (0.92%) were Treponema pallidum-positive as compared with 238 out of 19,254 males (1.24%) [Tables 3-5].
Table 3.
Rate of hepatitis C infection and Treponema pallidum infection in voluntary and replacement over the period of 5 years
| Total in 5 years n (%) | ||||
|---|---|---|---|---|
|
| ||||
| Total Donors | 19,689 | |||
|
| ||||
| Type of Donors | Voluntary | Replacement | χ 2 | P |
| No of Donors | 16,592 (84.27) | 3097 (15.73) | ||
| HCV reactive “n” (%) | 280 (1.687) | 50 (1.61) | 0.03256 | 0.8568 |
| Treponema pallidum infection positive “n” (%) | 204 (1.23) | 38 (1.23) | ||
Table 5.
Epidemiological determinants of Treponema pallidum infection over the period of 5 years
| 2017 n (%) | 2018 n (%) | 2019 n (%) | 2020 n (%) | 2021 n (%) | Total | |||
|---|---|---|---|---|---|---|---|---|
|
| ||||||||
| n (%) | χ 2 | P | ||||||
| Total Treponema pallidum infection cases | 35 (100) | 37 (100) | 54 (100) | 58 (100) | 58 (100) | 242 (100) | ||
| Type of donors | ||||||||
| Voluntary donors | 11 (31.43) | 28 (75.68) | 53 (98.15) | 58 (100) | 54 (93.1) | 204 (84.29) | ||
| Replacement donors | 24 (68.57) | 9 (24.32) | 1 (1.85) | 0 (0) | 4 (6.89) | 38 (15.70) | 98.01 (CST)* | <0.0000001 |
| Residence of donors | ||||||||
| Urban | 10 (28.57) | 4 (10.81) | 9 (16.7) | 21 (36.2) | 28 (48.27) | 72 (29.75) | ||
| Rural | 25 (71.43) | 33 (89.19) | 45 (83.3) | 37 (63.79) | 30 (51.7) | 170 (70.24) | 21.48 (CST)* | <0.0000001 |
| Age of donors | ||||||||
| 18–30 years | 13 (37.14) | 15 (40.54) | 15 (27.7) | 18 (31.03) | 21 (36.2) | 82 (33.88) | ||
| 31–45 years | 19 (54.29) | 19 (51.35) | 28 (51.85) | 28 (48.3) | 32 (55.17) | 126 (52.06) | 7.974 (CST)* | 0.4361 |
| 46–60 years | 3 (8.57) | 3 (8.11) | 11 (20.37) | 12 (20.68) | 5 (8.62) | 34 (14.04) | ||
| Gender of donors | ||||||||
| Male | 34 (97.14) | 36 (97.30) | 54 (100) | 58 (100) | 56 (96.55) | 238 (98.34) | ||
| Female | 1 (2.86) | 1 (2.70) | 0 (0) | 0 (0) | 2 (3.44) | 4 (1.65) | 3.596 (FET)† | 0.4634 |
| Occupation of donors | ||||||||
| Farmers | 12 (34.29) | 15 (40.54) | 19 (35.19) | 23 (39.65) | 14 (24.13) | 83 (34.29) | ||
| Laborers/construction workers | 8 (22.86) | 7 (18.92) | 11 (20.37) | 14 (24.13) | 13 (22.41) | 53 (21.90) | 12.55 (CST)* | 0.8958 |
| Merchants | 6 (17.14) | 6 (16.22) | 11 (20.37) | 9 (15.51) | 13 (22.41) | 45 (18.59) | ||
| Drivers | 6 (17.14) | 4 (10.81) | 8 (14.81) | 3 (5.17) | 9 (15.51) | 30 (12.39) | ||
| Government/private jobs | 1 (2.86) | 3 (8.11) | 3 (5.55) | 6 (10.34) | 3 (5.17) | 16 (6.61) | ||
| Students | 2 (5.71) | 2 (5.40) | 2 (3.70) | 3 (5.17) | 6 (10.34) | 15 (6.19) | ||
*CST=Chi-square test, †FET=Fisher’s exact test
Discussion
Transfusion of safe and contamination-free blood is an important challenge for blood transfusion services throughout the world and requires thorough screening of all the donors through detailed donor questionnaires and screening of all the donated units by highly sensitive methods like ELISA or chemiluminescence. It has been estimated that the likelihood of transmission of TTIs is approximately 1% for each unit of blood/component transfused.[11] The prevalence of TTIs is higher in economically weaker countries as observed in the literature available.[12] This is because of the availability of more preventive and vaccination programs for the public in developed countries.
In the present study, the trends of TTIs over a period of 5 years and the epidemiological correlation of HCV and Treponema pallidum infection have been assessed. A total of 19,689 healthy screened donors donated blood in the period of 5 years from January 1, 2017 to December 31, 2021, out of which 690 (3.5%), turned out to be positive for any one of the screened transfusion-transmissible infections. This rate is comparable with other studies from India by Sharma et al. and Mondal et al. in which the percentage of donors with one of the TTIs was 4.09% and 2%, respectively.[13,14] Global comparison of TTIs prevalence revealed the rates as 11.5% in Jijiga, Ethiopia; 14.96% in Nigeria; 7.4% in Albania; 20.1% in Sudan; 1.5% in Saudi Arabia; 4.61% in Pakistan; and 4.04% in Brazil.[15-19,12,20] Thus the prevalence rates vary from region to region with most of the underdeveloped nations having much higher rates than developed nations.
The percentage distribution of TTIs in 5 years revealed the rates as 0.18% HIV, 0.42% HBV, 1.67% HCV, and 1.23% of Treponema pallidum infection. Our study showed the highest rate of prevalence of HCV (1.67%) in blood donors ranging from 1.03% in 2017 to 2.51% in 2020, which contrasts with studies in other parts of India and other countries where the highest prevalence was of HBV due to its higher infectivity. Studies done by Chandra et al. and Sharma et al., from India showed the highest percentage of HBV (1.67% and 3.51%, respectively), whereas HCV prevalence was 0.49% and 0.24%.[21,13] Similar findings were seen in studies by Tessema et al. from Ethiopia, Saba et al. from Pakistan, and Pessoni et al. from Brazil, where the rate of HBV was highest in blood donors, i.e., 4.7%, 1.95%, and 1.94%, respectively.[22,12,20] However, studies done by Sood et al. and Kumari from Punjab, India showed a high prevalence of HCV in this region.[5,6] The higher percentage of HCV in our region can be attributed to epidemiological differences and high-risk behavioral practices in southwest Punjab, which is an important difference as HBV is considered to be more infective. In a study done by Mondal et al. in Durgapur, India, the overall prevalence rates of HIV, HBV, HCV, and syphilis were found to be 0.14%, 0.45%, 0.66%, and 0.72%, respectively, which also showed a lower rate of HIV and higher rates of HCV and syphilis similar to our study.[14] The seroprevalence of HIV has decreased over the years, which may be attributed to more active prevention programs and growing awareness among people in recent years.
The rate of Treponema pallidum infection ranged from 0.96% in 2018 to 1.44% in 2021, with average being 1.23% This higher rate of syphilis was seen in other Indian studies done by Shah and Dholakia (1.65%), Bhattacharya et al. (0.72%), and Kumar et al. in Baster (1.05%), which are comparable with our study.[23-25] This increase in Treponema pallidum infection may also be attributed to demographic and behavioral practices in our region, which again raises a concern about the lack of proper and detailed donor screening by the staff.
Yearly analysis of the epidemiological profile of HCV revealed a higher proportion of positivity in replacement donors in all 5 years [Table 4]. For syphilis, no major variation was noted in the proportion of positivity in voluntary and replacement donors in 5 years (1.23%) in both. However, absolute number of cases of both HCV and syphilis were more in voluntary donors, i.e., 84.85% and 84.29%, respectively. This is because the majority donors in our setup are voluntary nonremunerated donors, i.e., 84.27% of total donors. Voluntary donors are believed to be of true altruistic nature and the risk of TTIs is considered to be less with voluntary blood donations. Rural donors being more common in our blood center, the positivity of both HCV and syphilis was more in rural donors as compared with urban.
Most of the positive HCV donors were seen in the age group of 18–30 years (61.82%) and donors with Treponema pallidum infection in the age group of 31–45 years (52.06%). This result was in concordance with another study by Mondal et al., in which HCV-positive donors were more in 18–27 years of age group and syphilis was most commonly positive in 38–47 years age group.[14] This may be due to a greater number of donors in these age groups as well as the prevalence of more high-risk behavior in the same. TTIs in our study were more prevalent in males as compared with females where the proportion of HCV-positive females was only 0.46% and syphilis-positive females was 0.92%. Other studies also show less positivity in females.[14,20] This is due to the lesser prevalence of high-risk behavior in females as well as the lesser number of female donors.
Another important observation in our study was the highest number of HCV and Treponema pallidum infection cases in farmers followed by laborers and construction workers and lesser number in students and people on government or private jobs. This is mainly due to two reasons. First, the majority of donors belonged to rural areas and worked as farmers. Second, these groups are generally with low education levels, which is most of the time associated with lower financial resources, poorer hygiene, and lack of preventive measures leading to more high-risk practices and increased detection of TTIs in these groups. Similar results were observed in a study done by Tessema et al. in Ethiopia where a higher number of TTI-positive cases were seen in daily laborers followed by farmers.[22] Better job profile and education level are the main reasons for lesser cases in students and people involved in government or private jobs as awareness about the preventive measures is better in these groups. Thus, to reduce the rate of TTIs, it is pertinent to include more voluntary donors, motivate more female and urban donors. Also, the educated strata of the society should also be motivated to actively participate in the blood donation process. Primary care providers and family physicians can also help in creating awareness among the general population regarding prevention strategies and healthy lifestyles.
Conclusion
The overall higher seroprevalence of HCV and Treponema pallidum infection in our region as compared with other areas is a matter of great concern about the growing infection rate of these in our area. Stringent use of donor selection criteria and more vigorous donor screening is utmost need of the hour for reducing the burden of TTIs in blood transfusion services. To overcome these shortcomings, blood centers are advised to implement educational programs specifically targeted for potential donor population aiming at reducing the risk of TTIs. To decrease the false negative cases for those samples donated in window period it has become imperative to apply more sensitive and specific screening tests such as nucleic acid amplification testing (NAT) and chemiluminescence immunoassays (CLIA) for the screening of TTIs.
Limitation
Due to the higher cost and dearth of technical expertise in NAT testing, it is not routinely used in most of blood centers and in our study setting also, screening was done by ELISA technique and NAT testing was not done.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
We are highly thankful to Dr. Hobinder Arora for help in the statistical analysis of data.
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