Blood Donors In France Research Articles

Syphilis testing in blood donors, France, 2007 to 2022.

BackgroundSyphilis in blood donors (BD) has increased in many countries.AimWe aimed to describe trends in syphilis seroposivity in BD in France, to identify risk factors and assess if a non-treponemic test (NTT) could define BD having recovered from syphilis for more than 1 year.MethodsThe analysis covered the period 2007 to 2022 and 45,875,939 donations. Of the 474 BD syphilis-positive in 2022, 429 underwent additional investigations with an NTT. History of syphilis was obtained at the post-donation interview or based on serology results for repeat donors.ResultsUntil 2021, positivity rates remained stable (mean: 1.18/10,000 donations, range: 1.01-1.38). An increased rate was observed in 2022 (1.74/10,000; p = 0.02). Over the whole study period, prevalence was 2.2 times higher in male than in female BD (4.1 times higher in 2022). The proportion of males with an identified risk factor who have sex with men increased from 16.7% in 2007 to 64.9% in 2022. Based on NTT, 79 (18%) of the donors who were seropositive in 2022 were classified as having been infected in the previous year. History of syphilis was available for 30 of them. All had an infection within the previous 3 years. Among seven donors with a syphilis < 12 months before testing, one had an NTT titre ≥ 8, three a titre between 1 and 4, three were negative.ConclusionSyphilis seropositivity increased considerably in BDs in 2022, mostly in males, notably MSM. Available data did not allow appropriate evaluation of the NTT to distinguish recent from past infection.

Insights on 21 Years of HBV Surveillance in Blood Donors in France.

Hepatitis B virus (HBV) infection is the most frequent viral infection found in blood donors (BDs) in France. We analyzed the epidemiological and sero-molecular data on HBV infection gathered over the past two decades by the French haemovigilance surveillance network, blood screening laboratories, and the national reference center for transfusion infectious risks (NRC). Between 2000 and 2020, 6149 of the 58,160,984 donations (1.06/10,000) tested HBV positive, 98% of them from first-time blood donors (FTBDs). In addition, 2212 (0.0071%) of the 30,977,753 donations screened for HBV DNA tested DNA positive, of which 25 (1.1%) were positive only for this marker. HBV prevalence decreased by 2.8-fold and the residual risk for transfusion-transmitted HBV infection decreased 13-fold and was divided by 13. The major risk factor for HBV infection was the origin of donors (endemic country, 66.5%), followed by parenteral exposure (10.7%). In the whole HBV-positive BD population, genotype D was predominant (41.8%), followed by genotypes A (26.2%) and E (20.4%), reflecting the geographical origin of donors. The low and decreasing prevalence and incidence of HBV infection in French BDs, coupled with a screening strategy using three HBV markers (HBsAg, anti-HBc and DNA), ensures a high level of blood safety, further reinforced by the implementation of pathogen-reduction measures.

Effectiveness of the HCV blood screening strategy through eighteen years of surveillance of HCV infection in blood donors in France.

The question of maintaining blood screening based on both Hepatitis C virus (HCV) infection antibodies (Ab) and Nucleic Acid Testing (NAT) has been raised in several countries. The French blood donor surveillance database was used to address this issue. In France, HCV-NAT was implemented in mini pools (MP) in 2001 and in individual testing (ID) in 2010. HCV-positive donations are further investigated including detection of RNA with an alternative polymerase chain reaction assay: Amplicor HCV v2.0 (Roche; LOD95 50 IU/mL) from 2001 to 2006 and CobasTaqMan (CTM) HCV 2.0 assay (Roche; LOD95 9.3 IU/mL) since 2007. From 2001 to 2018, 3,058/48.8 million donations were confirmed HCV positive: 64.4% were Ab+/NAT+, 35.1% Ab+/NAT- and 0.5% Ab-/NAT+. From 2001 to 2018, the NAT yield decreased from 0.65 per million donations to 0, and NAT+ donations dropped from 77% to 46% of the total of HCV donations. 2,491/3,058 were further tested for HCV-RNA: 1,032 (816 NAT+, 216 NAT-) with Amplicor and 1,459 (897 NAT+, 562 NAT-) with CTM. Four (3 MP and 1 ID-NAT, 0.5%) of the 778 NAT negative donations had low viral loads. The decline in HCV-NAT yield cases raises the question of the relevance of NAT. Conversely, the increase in Ab+/NAT-donors, suggesting a growing number of resolved infections, argue for Ab discontinuation. In our experience, at least 0.5% of Ab+/NAT-donations had low RNA level when retested. Although the risk of viral transmission by such donations is probably low, the uncertainty associated with their infectivity goes against the removal of Ab in blood screening in our country.

Giving blood: providing treatment, providing knowledge

Abstract Background In France, 1,6 million donors contribute 3 million blood donations / year collected and tested by the French public transfusion service (Etablissement Français du Sang - EFS). At each donation, 2 ml plasma of are stored for 3 years for further testing if needed. In addition to providing life-saving blood products, blood donors may also provide knowledge through the sharing of their health data and bioresource collected at time of donation. Objective To describe how blood donors can provide knowledge in addition to blood products. Results Over the last 10 years, blood donors in France have enabled several studies performed by EFS in collaboration with research and reference laboratories as well as public health authorities. A linked assessment of Ab titers (+ clinical history) in donors having given blood before and after the 2009 H1N1 flu epidemic, as well as measles, rubella and hepatitis E virus seroprevalence studies (+ specific health questionnaires) have generated high value epidemiological data. Screening for arboviruses (such as Zika virus) and hepatitis A virus in donors during epidemics have increased knowledge of infectious spread and disease characteristics. Testing of plasma samples collected before variant Creutzfeldt-Jakob disease occurrence in two donors revealed the presence of circulating prion more than 1 year before diagnosis. A project to further take advantage of such a bio resource is underway. Upon occurrence and notification of a disease (or any pre-defined health event) in one of the 1,4 million repeat blood donors, all samples from prior donations would be gathered in a cohort of samples of all donors having notified an identical health event. Such cohorts would provide valuable samples to assess disease-specific biomarkers at pre-symptomatic phases. Conclusions Providing the opportunity to donors to give knowledge in addition to blood can result in production of high value biomedical data. Giving blood, being a public health actor. Key messages Blood donors may provide knowledge and bioresources in addition to blood products. Blood donors in France have enabled several large-scale epidemiological studies.

Epidemiology of Hepatitis E Virus in European Countries.

Over the last decade the seroprevalence of immunoglobulin (IgG) anti hepatitis E virus (HEV) has been increasing in European countries and shows significant variability among different geographical areas. In this review, we describe the serological data concerning the general population and risk groups in different European countries. Anti-HEV antibody prevalence ranged from 1.3% (blood donors in Italy) to 52% (blood donors in France). Various studies performed on risk groups in Denmark, Moldova and Sweden revealed that swine farmers have a high seroprevalence of HEV IgG (range 13%–51.1%), confirming that pigs represent an important risk factor in HEV infection in humans. Subtypes 3e,f are the main genotypes detected in the European population. Sporadic cases of autochthonous genotype 4 have been described in Spain, France, and Italy. Although most HEV infections are subclinical, in immune-suppressed and transplant patients they could provoke chronic infection. Fulminant hepatitis has rarely been observed and it was related to genotype 3. Interferon and ribavirin treatment was seen to represent the most promising therapy.

Human Gyrovirus in Healthy Blood Donors, France

Human Gyrovirus in Healthy Blood Donors, France

Résultats de trois méthodes pour la détection de la mutation précore G1896A du virus de l’hépatite B chez les donneurs de sang français : PCR temps réel, séquençage et test Inno-LIPA

Aim To screen hepatitis B virus (HBV) genotypes and associated basal core promoter (BCP; T1762A/A1764) and precore (PC; A1896) mutations among the 100 HBV surface antigen (HBsAg) positive voluntary blood donors in France. Methods HBV genotypes were determined by using direct sequence analysis. Three methods were used to detect G1896A mutation: non-commercial real-time PCR (PCRTR°, line probe assay (InnoLiPA HBV PreCore, INNOGENETICS ®) and direct sequencing of precore gene. HBV viral load was quantified with two commercial real-time PCR (COBAS ® AmpliPrep/COBAS ® TaqMan ® HBV Test/Roche and Real Time HBV/M2000/Abbott). Results The mean age of donors was 30 (18–64). Patients were from Africa (42%), Europa (50%), and Asia (8%). HBV/D was the most predominant (37%) genotype followed by HBV/A (31%) and HBV/E (22%). PC and BCP mutants were found in 57% with Inno-LIPA HBV test and 59% with both PCRTR and sequencing methods. A significant difference in the viral load of blood donors with wild and PC mutants was observed with the Taqman Cobas real time PCR (3,19 Log 10 UI/ml versus 4,93 Log 10 UI/ml, p < 0.05). Precore phenotype determination was in agreement with the three PC mutation detection methods in 56% of cases. Conclusions Non-Caucasian genotype E was present in the French blood donors. PC mutation was more common than BCP mutations in this study. As HBV infected blood donors were more often asymptomatic carriers, we could speculate that the G1896A mutation may favour the asymptomatic state, supporting previous observations.

Molecular characterization of genotype 2 and 4 hepatitis C virus isolates in French blood donors

The subtype distribution of 142 genotype 2 and 97 genotype 4 hepatitis C virus (HCV) isolates from the sera of 1,319 volunteer blood donors in France was determined by gene sequencing and by phylogenetic analysis of the NS5B region and E1 envelope. Findings underlined a wide range of subtypes in both genotypes, that is, 20 in HCV-2 and 11 in HCV-4. Eighteen of these 31 subtypes had not been defined previously. Some subtypes, that is, 2a, 2b, 2c, 2i, 2k, 4a, and 4d, showed numerous strains while subtypes in donors from West Africa or Central Africa showed an endemic profile with only a few strains. A Bayesian coalescence approach was used to estimate the demographic history of each HCV subtype. The estimated mean dates of the most recent common ancestors (MRCA) were 1,889 (confidence interval (CI), 1,842-1,930) for HCV-2a, 1,886 (CI, 1,843-1,921) for HCV-2b, 1,791 (CI, 1,699-1,848) for HCV-2c, 1,846 (CI, 1,803-1,878) for HCV-2i, 1,911 (CI, 1,879-1,937) for HCV-4a, and 1,957 (CI, 1,943-1,967) for HCV-4d. The period of spread for subtype 2b, 2c, and 2i was between 1900 and 1960 whereas rapid exponential spread for subtype 2a, 4a, and 4d occurred in the 1960s. The inferred histories of population growth indicated that transmission rates differed according to HCV subtype. These results may help to predict the future burden of HCV in France.

Human immunodeficiency virus type 1 incidence among blood donors in France, 1992 through 2006: use of an immunoassay to identify recent infections

In France, blood donations found to be positive for the presence of human immunodeficiency virus type 1 (HIV-1) are further tested to detect recent infections (< or =180 days) using an enzyme immunoassay (EIA-RI) developed in 2002. The characteristics of recently infected donors, estimates of HIV-1 incidence, and the residual risk of transfusion-transmitted HIV-1 are presented, in both first-time and repeat donors. Of the 1027 donations found to be HIV-1-positive between 1992 and 2006, a total of 459 could be retrospectively tested with the EIA-RI. Multivariate analysis was performed to determine the donor characteristics associated with recent infection. Incidence rates and residual risk obtained with the EIA-RI were compared to classical cohort estimates derived from repeat donor histories. Of the 459 HIV-1-positive donors studied, 105 (22.9%; 95% confidence interval [CI], 19.2-27.0) were identified as recently infected. Factors independently associated with recent infection were repeat donor status (adjusted odds ratio [AOR], 4.0; 95% CI, 2.4-6.9) and non-B subtypes (AOR, 2.0; 95% CI, 1.2-3.6). Incidence decreased from 4.3 (95% CI, 1.9-9.4) in 1992 through 1994 to 1.3 (95% CI, 0.6-2.8) per 10(5) in 2004 through 2006 in first-time donors and from 3.2 (95% CI, 2.0-5.0) to 0.8 (95% CI, 0.4-1.4) per 10(5) in repeat donors. Incidence and residual risk estimates were similar to those obtained with the classical cohort method. This study suggests that the EIA-RI can be used to estimate HIV-1 incidence in a population with low HIV incidence. The estimated HIV-1 incidence in the blood donor population confirms the extremely low risk (1 in 3,350,000 donations) of HIV-infected blood donations entering the blood supply in France.

Analysis of the 5′ Noncoding Region versus the NS5b Region in Genotyping Hepatitis C Virus Isolates from Blood Donors in France

The 5' noncoding region (5' NCR) of the hepatitis C virus (HCV) has become the standard for genotyping even though several reports show that its use can result in classification errors. The purpose of this study was to perform genotyping based on sequence analysis of the NS5b region in a set of 357 HCV strains isolated from blood donors in France in 2002 and 2003. Results were compared with those previously obtained using 5' NCR analysis, and HCV subtype distribution was reevaluated. Twenty-six of 120 strains (approximately 22%) initially identified as genotype 1b by 5' NCR region sequence analysis were reclassified as genotype 1a by NS5b region sequence analysis. Similarly, 14 of 23 strains (approximately 61%) initially identified as 2a/2c were reclassified as non-2a and non-2c subtypes, and 12 of 22 strains (approximately 45%) initially identified as 4c/4d subtypes were reclassified as non-4c and non-4d subtypes. Sequence analysis of the NS5b region also revealed 5 putative new subtype 2 variants and 2 putative new subtype 4 variants. Although these findings demonstrated full agreement between 5' NCR and NS5b sequence analysis with regard to type classification, genotyping based on phylogenetic analysis of the NS5b region is more accurate for subtype determination than genotyping based on analysis of the 5' NCR. Sequence analysis of the NS5b region is mandatory for epidemiologic studies.

Acute porphyria: the cost of suspicion

Porphyria refers to a group of diseases of the nervous system or skin (or both) that are associated with the generation of excess porphyrin intermediates or their precursors as a result of decreased enzymatic activity during heme synthesis ( 1 Moore M.R. McColl K.E. Fitzsimons E.J. Goldberg S.A. The porphyrias. Blood Rev. 1990; 4: 88-96 Abstract Full Text PDF PubMed Scopus (19) Google Scholar ). The disease is primarily hereditary, transmitted often by an autosomal dominant mechanism. The genetic defects show both reduced penetrance and variable expressivity ( 2 Elder G.H. Genetic defects in the porphyrias types and significance. Clin Dermatol. 1998; 16: 225-233 Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar ). The diagnosis of clinical porphyria requires the presence of both symptoms and signs and a measurable biochemical abnormality ( 3 Tefferi A. Solberg Jr, L.A. Ellefson R.D. Porphyrias clinical evaluation and interpretation of laboratory tests. Mayo Clin Proc. 1994; 69: 289-290 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar ). In contrast, asymptomatic persons with defective enzymatic activity are often carriers of a mutant allele and are considered to have “latent disease” ( 4 Pierach C.A. Weimer M.K. Cardinal R.A. et al. Red blood cell porphobilinogen deaminase in the evaluation of acute intermittent porphyria. JAMA. 1987; 257: 601 Crossref Scopus (29) Google Scholar , 5 Lundin G. Lee J.S. Thunell S. Anvret M. Genetic investigation of the porphobilinogen deaminase gene in Swedish acute intermittent porphyria families. Hum Genet. 1997; 100: 63-66 Crossref PubMed Scopus (19) Google Scholar , 6 Nordmann Y. Puy H. Da Silva V. et al. Acute intermittent porphyria prevalence of mutations in the porphobilinogen deaminase gene in blood donors in France. J Intern Med. 1997; 242: 213-217 Crossref PubMed Scopus (100) Google Scholar ). Therefore, neither the detection of excess tissue porphyrins nor the demonstration of reduced enzyme activity is specific for clinically overt disease.

Prévalence du VIH, de l'HTLV et des virus des hépatites B et C chez les donneurs de sang en France, 1992–1996

Prevalence of HIV, HTLV, HBV and HCV in blood donors in France, 1992–1996 The prevalence of HIV, HTLV, HBV and HCV infections has been calculated by age and sex of blood donors and not, as generally done, according to the number of donations. This study has been conducted on the basis of two surveys. The first one collected information about the sex and age of the seropositive donors. A second survey, begun in 1992, collected information about the demographic characteristics of blood donors. This population has a higher male to female sex ratio (1:2 versus 1:0) and is younger than the general population. Thus, the prevalence of these viral infections has been determined according to sex, age and type of donors (first-time or repeat) from 1992 to 1996 and the trends have been analysed. The main results are the following: a decreasing prevalence of HIV in first-time donors from 1992 to 1996, more marked in men than in women and in the 18–29 year age group than in the other age groups; a slighter decrease in prevalence of HBV and HCV in first-time donors from 1992 to 1996 with no difference in this decrease between sex and age groups. HBs Ag prevalence in first-time donors was twice as high in men than in women and was highest in donors aged from 40 to 49 years in both sexes. Prevalence of antibodies to HCV in first-time donors was comparable in both sexes but varied greatly with age. In men, a peak was observed in the 30–39 age group and in women, the highest prevalence was seen in the 50–65 age group.

Screening of viral markers for HIV HBV and HCV infections in blood donors in France and residual risk of viral transmission by blood transfusion.

The first part of this article presents the results of screening tests for antibodies to human immunodeficiency virus (HIV) and hepatitis C virus (HCV) and for hepatitis B surface antigen (HBsAg) from 1986 to 1996. The second part presents the most recent

Acute intermittent porphyria: prevalence of mutations in the porphobilinogen deaminase gene in blood donors in France.

Acute intermittent porphyria (AIP) is an autosomal dominant disorder resulting from a 50% deficiency in porphobilinogen deaminase (PBG deaminase). The true prevalence in the general population of mutations in the PBG deaminase gene capable of causing AIP is unknown. However, it is important to identify asymptomatic carriers of AIP mutations because all are at risk to have an acute attack. We measured erythrocyte PBG deaminase from 3350 healthy blood donors. When a clear cut deficiency (< mean minus 2.5 SD) was found, the PBG deaminase gene was analysed by molecular biology technics. Four subjects with PBG deaminase deficiency were identified. Two had mutations in the PBG deaminase gene which are known to cause AIP. We conclude that, in France, the mutations of the PBG deaminase gene show a high prevalence in the healthy population. If only these two confirmed latent cases are used for the calculation, in France the minimal prevalence of the AIP gene is 1:1675.

Epidemiology of HCV infection in the general population and in blood transfusion.

The prevalence of HCV seropositivity observed in various populations raise the issue of the contamination routes and the corollary exclusion criteria of risk subjects from blood donation. There are various diagnostic methods for HCV infection. The biological diagnosis is reached at three levels: circulating antibody screening by second and third generation tests; screening validation by immunoblot, to distinguish between the various HCV specific antibodies and detection of viral nucleic acids by molecular biology. In blood donors in France, 0.5% were seropositive in 1990, 0.3% in 1992 and 0.1% (essentially new donors) in 1995. This decrease is the result of improved test specificity and sensitivity and donor selection. In Europe, prevalences range from 0.1-1.5% with a North-South gradient. In other countries: 0.3% in Canada, 0.6% in the USA, 1-2% in China, Thailand and Japan, from 0.2% to 20% in Africa. In risk populations contamination by blood is manifest: HCV seropositivity in 80% of drug abusers, 10-60% of dialysis patients before 1991, more than 80% of haemophiliacs treated before 1986, 10% of labile blood product recipients before 1988. The nosocomial transmission figures are even worse: 2-5% of hospitalized patients are thought to be contaminated. Perinatal and sexual contaminations are not excluded (3-30%) and they vary according to the degree of exposure and the viral type of post-transfusional HCV infection: prevention implies several types of action: information and education of populations about risk factors; medical interview before each blood donation; systematic serological testing; manufacturing measures for stable (SD processing) and labile (deleukocytation, plasma seroattenuation) blood products; prescription recommendations and follow-up measures; haemovigilance (clinical and biological follow-up of all recipients of human blood products).

Distribution of HLA‐A,B alleles in 13 panels of blood donors in France

In this study, we analysed 13 samples of the French population--4147 non-related individuals living in Bordeaux, Brest, Caen, Dijon, Limoges, Lyon, Marseille, Nancy, Paris, Poitiers, Rennes, Strasbourg and Toulouse--all of whom were typed for 10 alleles of the HLA-A locus and 16 alleles of the HLA-B locus. The results showed a strong heterogeneity (chi 2 = 675.13 for 324 df, p less than 10(5)). A diagram has been drawn up, showing the matrix of genetic distances obtained thanks to the B2 of Balkrishnan & Sanghvi (1968). This diagram enables us to envisage the hypothesis of 6 homogeneous clusters. A partition of chi 2 was used to test this 6 luster hypothesis: Paris and Caen (p = 0.98); Nancy, Strasbourg (p less than 5%); Rennes, Brest (p less than 1%); Dijon, Lyon, Marseille (p = 0.89); Limoges, Poitiers (p = 0.18); Toulouse, Bordeaux (p less than 10(-5)). The heterogeneity within these clusters represents only 1/43 of the total heterogeneity.

Selective IgA deficiency in Australian blood donors.

Selective serum IgA deficiency (defined as a serum IgA level less than 50 mg/l) was detected in 14 of 6,191 Australian blood donors screened by double diffusion analysis of serum specimens in agarose. This prevalence rate of 0.23% (1 in 442) is the same as that found in blood donors in Sweden but is higher than rates found in blood donors in France (0.05%), Norway (0.08%), USA (0.15%). England (0.19%) and Finland (0.20%). Antibodies to human IgA were detected in the serum of three of 11 blood donors with selective IgA deficiency (27%). There was no evidence in the present study of blood transfusion reactions from these anti-IgA antibodies when they were transfused into recipients.