“Hepatitis C virus (HCV) seroprevalence among blood donors in Ranchi”

1. Dr. Manoj Kumar, M.D.(Micro), D.T.C.D., Tutor, Department of

Microbiology ,Sri Krishna Medical College, Muzaffarpur
2. Dr. Suresh Prasad,M.D.(Path.), Professor , Dept. of Microbiology,
RIMS, Ranchi
3. Dr. L.B. Pandey, M.D.(Path.), Professor & H.O.D, Dept. of Microbiology,
Rajendra Institute Of Medical Sciences, Ranchi

INTRODUCTION:

Hepatitis C virus (HCV) is an enveloped, positive single stranded RNA virus

classified in the Flaviviridae family . Six major genotype (1-6) and 11 subtypes have

been described for HCV .

Since its discovery in 1989, HCV has been recognized as a major cause of chronic

liver disease, second only to HBV, worldwide with approximately 123 million infected

people, which comprise approximately 2 % of the global population. Out of 123 million, at

least 20 million people reside in India with an estimated prevalence up to 0.9% 1.Prevalence

of HCV in blood donors in different countries around the world has been reported between

0.3 to 1.5 % 2.

Injection drug use is generally considered to be predominant source of new

HCV infection in developed countries, while unsafe therapeutic injection and

transfusion are likely to be major modes of transmission in the developing world.

Treatment option for chronic HCV infection is limited . Because, there is no vaccine

and post exposure prophylaxis for HCV, the focus of primary prevention should be

safer blood supply in developing world.

The detection of antibodies to structural and non structural proteins of HCV

has become important as an indicator of past or present infection in most laboratories.

Present study was conducted with the aim to detect the seroprevalence of HCV

among blood donors at government hospital and different blood banks in Ranchi,

India.

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MATERIALS AND METHOD

The study was carried in government hospital and five other registered blood banks in

Ranchi, India. It was a cross – sectional study carried out for a period of six months

from September to December in the year 2006. A convenience sample of 1834 blood

donors participated in the study and was screened for the presence of HCV antibody

in their sera. All examination was done by single investigator. The tests were done by

Signal HCV. 3 ml of blood was withdrawn with a 5 ml syringe. Serum was separated

from the cells by centrifugation at speed of 3500 rotation per minute for 5 minutes.

Serum was subjected to anti HCV testing by a rapid chromatographic immunoassay

(Signal HCV, Span diagnostic, India) kit, which detect antibody directed to NS3,

NS4, NS5 and Core antigen of HCV. Presence of this red line indicates a positive

result, while its absence indicates a negative result. All positive samples were

repeated using same method. Sample that gave repeatedly reacting result was

considered positive for anti HCV.

RESULTS

A total of 1834 blood donors were screened for the presence of HCV antibody in their

sera. All donors were replacement donors. 1765 were male (96.24%) and rest 69

(3.76%) were female. None of the female donor was found positive (Table 1). Out of

1834 donors, 3 (0.16%) donors were HCV positive. Prevalence of 0.22% was found

in age group (21-30) years and 0.2% was found in age group (31-40) years (Table 2).

DISCUSSION

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 HCV infection is prevalent throughout the world. But the seroprevalence of

HCV differs according to subjects of study. Its prevalence is high among patients with

high risk group, but low among general population. Population based study is not

feasible in most part of the world. So, studies are typically cross sectional in design

and are done in selected population e.g. blood donors.

A total of 1834 blood donors were investigated for HCV antibodies. All the

blood donors were replacement donors, who donated blood for their friends and

relatives for the specific needs in the hospital. Out of 1834 donors, three (0.16%) were

HCV positive.

In the present study prevalence of 0.22% was found in age group of 21-30

years, and 0.2% was found in age group of 31-40 years. No case was found among

other age groups. A study found maximum prevalence rate of 1.8% in the age group

20-29 years. In addition there was a clear trend of decreasing prevalence with

increasing age, possibly implying a higher exposure rate to HCV in younger subjects.

Another study suggested highest seroprevalence among males of the age group 40-49

years (9.4%) and females of the age group 30-39 years (8.5%). It was also found in

another study that prevalence of anti HCV increased with age from 1% in those 20 to

29 years of age, to a peak of 4.3% in those of 40 to 49 years of age 3. 3Among older

persons, anti HCV prevalence decreased to 1.6% in persons of 50 to 59 years of age

and 0.9% in persons 60 years of age and older.

Several studies have reported on the prevalence of HCV among blood donors

from India and abroad. Panigrhi et al (1997) 4 reported seroprevalence of 1.85% after

5922 healthy blood donors were screened at All India Institute of Medical Science,

New Delhi. 564 Chronic liver disease patient were screened and 78 (13.83%) were

found positive. HCV was associated with 9% of acute cases. Garg S. et al (2001) 5 had

conducted a retrospective study among blood donors. A total 46957 donors were

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tested, out of which 42291(90.1%) were replacement donors and 4666 (9.8%) were

voluntary donors. The replacement donors had high incidence (0.328%) as compared

to voluntary donors (0.285%).

Bharucha ZS.(2005)6reported the prevalence of anti HCV antibody in New Delhi

using a large number of healthy voluntary blood donors, yielding an overall

prevalence of 1.57%. No significant difference was found between the HCV positivity

rate of male (1.57%) and female (1.47%) donors, family (1.58%) and altruistic

(1.51%) donors and first time (1.55%) and repeat (1.61%) donors. Singh B et al

(2004) 7screened 128589 blood donors and found seroprevalence of 0.25-0.9%. Out of

the total 83.6% were replacement donors. Seropositity was definitely higher in

replacement donors than in voluntary donors.

CONCLUSION

The seroprevalence of HCV globally ranges between 0.2-2 percent. Among

Indian blood donors, the seroprevalence varies from 0.48 -1.5 percent. Transmission

of HCV infections by transfusion of blood and blood products to a recipient is most

efficient route.

Present study therefore screened 1834 blood donors to find out the

seroprevalence of HCV among blood donors at RIMS Ranchi and different blood

banks in Ranchi. HCV positivity was found in 3 (0.16 %) of 1834 blood donors. All 3

HCV positive donors were males, no female blood donors was found positive for anti

HCV. These data suggested that seroprevalence of HCV is relatively low among

blood donors at Ranchi, when compared to other studies. From the present study, it is

clear that age has significant role on seroprevalence of HCV. All though gender has

no significant role on HCV seroprevalence but there were no female positive donor

most probably, due to small (3.76%) sample size.

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 These variations in prevalence might have been be due to geographical and

temporal variation associated with the incidence and prevalence of the infection and

also to variation in iatrogenic causes of HCV, which has not been fully evaluated in

India and most probably, to the type of HCV kit used.

It appeared from the present study that the overall prevalence of anti HCV-

antibodies in blood donors of Ranchi is low, but this emphasizes the necessity of

careful selection of blood donors and rigorous screening for HCV by all blood banks

to provide safe blood and blood components. There have been reports of HCV

infection acquired due to transfusion of screened blood and blood products, the

possible explanation could be due to transmission acquiring during ‘window period’

of infection in donors. The only way to prevent HCV infection among blood donors is

by education the people regarding risk factors of HCV, by encouraging voluntary

donation of blood and increasing blood safety by proper screening.

REFERENCES

1. Chowdhury A, Santra A, Chaudhuri S, Dhali GK, Chaudhuri S, Maity SG,

Naik TN, Bhattacharya SK, Mazumder DN. Hepatitis C virus infection in the

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 general population: a community-based study in West Bengal, India.

Hepatology. 2003 Apr; 37(4):802-9.

2. World Health Organization. Hepatitis C - global prevalence (update). Weekly

Epidemiological Record, 1999, 74:425-427

3. Sonwane BR, Birare SD, Kulkarni PV. Prevalence of seroreactivity among

blood donors in rural population.: Indian J Med Sci. 2003 Sep;57(9):405-7

4. Panigrahi AK, Panda SK, Dixit RK, Rao KV, Acharya SK, Dasarathy S, Nanu

A. Magnitude of hepatitis C virus infection in India: prevalence in healthy

blood donors, acute and chronic liver diseases. J Med Virol. 1997 Mar;

51(3):167-74.

5. 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 Oct;44(4):409-12 Indian J Med Res. 1996

Aug;104:177-81.

6. Bharucha ZS. Donor management in South-East Asia region (SEAR). Dev

Biol (Basel). 2005;120: 145-53.

7. Singh B, Verma M, Verma K. Markers for transfusion-associated hepatitis in

north Indian blood donors: prevalence and trends. Jpn J Infect Dis. 2004

Apr;57(2):49-51

TABLES

Table 1 showing Gender distribution of blood donors and HCV positive donors

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 Gender No. of Blood donors No. of HCV positive donors

Male 1765 3
Female 69 0
Total 1834 3

Table 2 showing Age distribution of blood donors and HCV positive donors

No. of Blood donors No. of HCV positive donors

Age in years
No. Percentage No. Percentage
18-20 272 14.8 0 0
21-30 876 47.8 2 0.22
31-40 487 26.5 1 0.20
41-50 159 8.7 0 0
51-60 40 2.2 0 0
Total 1834 100.0 3 0.16