Abstract
In India, transfusion transmissible infections (TTIs) are monitored for trends at the blood bank level, but limited efforts have been made to analyze data from a large number of blood banks and present it at the national, regional and state levels. The Computerized Management Information System (CMIS), National AIDS Control Organization’s (NACO) online data capturing system, systematically collects information on TTIs in a monthly aggregated format from blood banks across the country. This information is being captured in NACO’s annual reports, but a systematic scientific analysis and publication of the same have not been attempted so far. Hence, the objective of this study is to analyze and report TTIs among blood donors in India at three different levels—national, regional and state—from 497 consistent blood banks reporting through CMIS during 2008-2012. National level analysis shows an increasing trend in voluntary blood donation from 9.28 lakh to 19.02 lakh, and a decreasing trend in TTIs, with female donors constituting only 6% of the entire pool of donors. Of the five TTIs studied, in 2012 Hepatitis-B-surface Antigen (HBsAg) positivity was highest (0.9%), followed by Hepatitis C Virus (HCV) (0.45%), syphilis (0.23%), HIV (0.17%) and malaria (0.03%). Regional analysis indicated that voluntary donation was high in the Eastern and Western regions, with 11% of female donors in Eastern India in 2012. All the TTIs showed a declining trend, except HCV, which showed a rising trend in the Eastern and Southern regions. The level of positivity for all the five TTIs was higher than the national average in the Eastern region. Among the TTIs, HIV positivity among voluntary donors was below the national average, while in Mizoram both HBsAg and HCV of more than 1% seropositivity and VDRL of 1.7% in Arunachal Pradesh had been reported. Malaria has the lowest national positivity, with Nagaland reporting a high positivity of 0.4%. Although the national and regional trends in TTI positivity are declining, regional level variations in TTIs, especially in hepatitis, suggest the importance of advocating for pre-donation counseling and educating donors on self-exclusion.
Highlights
World Health Organization (WHO) has recommended mandatory screening of all donated blood units for transfusion transmissible infections (TTIs), including HIV, Hepatitis B, Hepatitis C and syphilis, prior to usage
Gender-wise donated units remained consistent over the study period, with 94% male and 6% female donors at the national level
At the national level (Figure 2), there has been a decrease in all TTIs among voluntary and replacement donors over the study period
Summary
World Health Organization (WHO) has recommended mandatory screening of all donated blood units for transfusion transmissible infections (TTIs), including HIV, Hepatitis B, Hepatitis C and syphilis, prior to usage. The diagnostic methodology in India ranges from rapid tests to Nucleic Acid Amplification Tests (NAT), depending upon the resources available [2] These differences in testing methodology have resulted in the diagnosis of infection status with varying window periods, which do not allow a common interpretation of TTI results across different blood banks in the country. A 10-year (2000-2009) study in a tertiary care center blood bank in Pune, India reported a significant decrease in transfusion transmissible viral infections, including HIV, HBsAg and HCV, among 51% replacement and 49% voluntary blood donors [3]. Another 5-year (2008-2012) study in a blood bank in Lucknow, India, reported declining TTIs among blood donors, with replacement donors having higher TTIs than voluntary donors [4]
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