Incidence Of Post-transfusion Hepatitis Research Articles

Prevalence of transfusion transmitted infections in children with inherited coagulation disorders

Background: Factor replacement and blood product transfusion are the main stay of treatment of inherited coagulation disorders. Even though interventions with these products have led to the decrease in morbidity and mortality of these patients, repeated use of these products especially before 1980s where the viral inactivation of factors and blood bank screening methods were not stringent, have led to the occurrence of transfusion transmitted diseases in haemophiliacs especially hepatitis C infection.Methods: 50 children including adolescents under the age of 18 years with inherited coagulation disorders were screened for hepatitis B and C infection during 2 medical camps conducted at an interval of 6 months, blood samples and medical information were collected prospectively during these periods. The blood samples were tested for surrogate marker for hepatitis B and anti HCV using enzyme immunoassay.Results: All the children screened were negative for hepatitis B and C markers.Conclusions: The incidence of post transfusion hepatitis has dramatically decreased following stringent blood donor screening methods as well as availability of purified and recombinant factors. The current risk of transfusion transmitted infections in these patients are very low almost comparable with general population.

Economic Rewards for Blood Donation: Validity of the Donor Questionnaire as Litmus Test

In a recent issue of Science , Lacetera, Macis, and Slonim summarize new information regarding the impact that economic rewards have on the blood supply and safety (1). For many years, the WHO has taken the stance that economic incentives decrease the safety of the blood supply. In support of the WHO position, the establishment of an all-volunteer blood supply led to a dramatic decrease in the incidence of posttransfusion hepatitis C. The authors submit, however, that the position of the WHO is based on studies that failed to control for several confounding variables (percentage of first-time donors, location of donation, and use of prisoners). Recent randomized field surveys reviewed by the authors found that economic incentives increase …

低濃度ＨＢＶキャリア血液による感染

Blood safety as regards transfusion-transmitted viral infection is of great concern. Recently, the incidence of post transfusion hepatitis B virus (HBV) infection has decreased through the introduction of more sensitive screening, such as hepatitis B surface antigen (HBsAg), anti-HBV core antibody (anti-HBc) and nucleic acid amplification test (NAT), as well as the registration of screened donors. However, the risk of HBV infection due to blood transfusion still persists. We experienced a case of HBV infection by blood transfusion in a 75-year-old man suffering from chronic pancreatitis and pyloric stenosis. He received blood units from eight donors for gastrectomy on Nov. 22, 2000. Although hepatitis was not suspected, laboratory studies for liver function were carried out. Twelve weeks after transfusion, HBsAg was found in his serum on Feb. 13, 2001. The 8 donors' retained blood was tested by the individual nested PCR method, and one was found to be positive. To investigate a causal relationship, HBV DNA nucleotide sequences of the patient and donor were analyzed. Sequences concurred in both and belonged to genotype C with mutation of core promoter. These findings revealed that post-transfusion hepatitis cannot be completely prevented in spite of the introduction of sensitive screening containing NAT. Patients who receive transfused blood units should undergo follow-up testing for hepatitis virus.

Impacts of blood screening on the incidence of posttransfusion hepatitis C in Japan.

Impacts of blood screening on the incidence of posttransfusion hepatitis C in Japan.

血小板輸血後，Ｂ型肝炎を発症した再生不良性貧血症例の検討

We report a patient with hepatitis B and aplastic anemia who was infected with donor hepatitis B virus during the so-called window period. A 22-year-old man was found to be anemic at age 7 and diagnosed as having aplastic anemia. He was given oxymetholon 25-50mg/day for 14 years (total 226g). On August 3, 1995, a hepatic tumor developed as a complicated of anabolic steroid use. He had a liver biopsy on October 24, 1996. To prevent bleeding, he was received platelet concentrate (PC) transfusions at 20 units on October 23, 1996, 20 units on the 24, and 10 units on the 25. Histological findings suggested hepatic adenoma. Eleven weeks after PC transfusion, S-GPT became elevated, so donor's blood was tested at the Japanese Red Cross Central Blood Center. HBV-DNA was positive by the nested PCR method in retained donor blood. At 16 weeks after PC transfusion, the patient's laboratory data were as follows: HBsAg and HBcAb were positive, HBsAb was negative, S-GOT was 236IU/L and S-GPT was 695IU/L. These values have since steadily improved, and bone marrow transplantation will be carried out after recovery. Recently, the incidence of post-transfusion hepatitis has decreased. Further reduction in risk will be obtained through the introduction of more sensitive screening tests, such as HBsAg (EIA) and PCR methods, and the registration of screened donors.

Prospective study of the incidence of post-transfusion hepatitis (PTH) in high risk new-born babyes (NB)

Prospective study of the incidence of post-transfusion hepatitis (PTH) in high risk new-born babyes (NB)

Prevention of hepatitis B and C virus infection for prevention of cirrhosis and hepatocellular carcinoma.

In Taiwan, cirrhosis and hepatocellular carcinoma (HCC) have been common in medical practice since the 1960s. In 1969, Taiwan was shown to be a hyperendemic area of hepatitis B virus (HBV) infection with a high rate of hepatitis B surface antigen (HBsAg) positivity, 19% of the population being infected before the fourth decade of life. There is evidence indicating that more than 80% of chronic hepatitis, cirrhosis and HCC are the sequelae of chronic HBV infection. In 1984, after 3 years of preparation, a programme to control cirrhosis and HCC began. All neonates born to HBsAg+ mothers were given Pasteur plasma-derived vaccine 5 micrograms i.m. at 1, 5 and 9 weeks with a booster at 12 months. In 1986, all neonates were included in this programme. In addition, beginning in 1987, all non-vaccinated preschool children were also immunized and susceptible medical personnel and people from HBsAg+ households were recommended to receive the vaccine. Using data obtained from the 7-year evaluation study on the efficacy of this vaccine and some historical data, the HBsAg positivity rate in people born in the first few years after 1986 was estimated to be 2.6%. This rate is expected to decrease to 0.2% in those born after around 1990. In July 1992, an anti-hepatitis C virus (HCV) test was included in blood donor screening tests. This was followed by a decrease in the incidence of post-transfusion hepatitis (PTH) from 13 to 2.5% and there have been no anti-HCV+ PTH cases since. However, without immunization, the prevalence of HBsAg decreased among children in Taipei in 1989. This coincided with the widespread use of disposable syringes and needles and an improvement in the sterilization of medical instruments. Therefore, it is likely that HCV infection may also decrease as a result of these practices. Through the use of immunization and improved medical procedures, chronic hepatitis, cirrhosis and HCC may decrease in Taiwan by around 95%.

Blood screening to prevent post-transfusion hepatitis in Japan: effective for prevention as well as revealing for epidemiology of HBV and HCV infection in healthy subjects

Since 1968, when blood transfusion in Japan became dependent solely on voluntary blood donors and not on paid donors, Japanese Red Cross Blood Centers have successively introduced the most effective blood screening system for the time. Eventually, the incidence of post-transfusion hepatitis in Japan has been decreased to as low as 0.2–0.3% after 1992. In addition, as a result of the blood screening for hepatitis B virus (HBV) and hepatitis C virus (HCV) in more than seven million donors a year, we are getting ever increasing data on epidemiology of HBV and HCV infection among apparently healthy subjects in Japan.

Prospective assessment of donor blood screening for antibody to hepatitis C virus by first- and second-generation assays as a means of preventing posttransfusion hepatitis

In November 1989, the Japanese Red Cross began screening blood donors for the hepatitis C virus antibody (anti-HCV) by first-generation assay and high-titer hepatitis B virus core antigen antibody. A significant reduction in the incidence of acute posttransfusion hepatitis was reported; however, the incidence still ranged from 2 percent to 4 percent. The Red Cross changed to the second-generation assay in February 1992, the objective being the complete elimination of potential posttransfusion hepatitis. The aim was to elucidate the advantage of second-generation assay as a blood-donor screening test. The incidence of posttransfusion hepatitis after the introduction of second-generation assay was compared with that before the introduction of the first-generation assay and with that during its use. The incidence of posttransfusion hepatitis was 9.6 percent (216/2,240) before anti-HCV-s donor screening. It was 3.7 percent (24/655) and 0.9 percent (3/326) after the introductions of the first-and second-generation hepatitis C virus (HCV) assays, respectively (chi2 = 50.0, P < .01). Blood-donor screening by second-generation anti-HCV provided a significant benefit compared with the first-generation assay. (Hepatology 1996 Apr;23(4):708-12)

Les nouveaux virus des hépatites « E, GB et suivants

Some cases of hepatitis were non A, non B, non C, non D. Hepatitis E virus (Calicivirus) transmission is fecal-oral similar to that of the hepatitis A virus. Viral hepatitis E is endemic and frequently epidemic in many developing countries, but exceptionally observed in France. A high mortality rate was observed in pregnant women. Recently, ELISA assays for IgM anti-HCV are available. Many hepatitis cases (acute and chronic) are not caused by known viruses (non A-non E). Four Flavivirus like have recently been cloned from infectious tamarin serum, derived from human viral hepatitis. Three viruses GB Virus A (GBV-A), GB Virus B (GBV-B) and GB Virus C (GBV-C) were identified. The GB viruses and HG Virus are not genotypes of hepatitis C Virus (HCV) and perhaps that GBV-A/GBV-C and HGV are closely related. GBV-A could be an indigenous tamarin virus. The new hepatitis (non A-non E) viruses were associated with blood transmission and with chronic diseases. The development of specific diagnostic reagents using polymerase chain reaction (PCR) and ELISA assays are essential to answer many questions on the epidemiology (and the incidence of post-transfusion hepatitis), and the pathogenesis of GBV and HGV viruses.

F2-12 Efficacy of blood screening on the incidence of post-transfusion hepatitis in Japan

F2-12 Efficacy of blood screening on the incidence of post-transfusion hepatitis in Japan

大阪医大耳鼻咽喉科における輸血の現況 輸血後肝炎について

Of the 667 patients who underwent surgery under general anesthesia in our department from May 1991 to December 1993, 37 received intraoperative blood transfusions. In a study of hepatitis caused by intraoperative blood transfusion, we surveyed the results of serum examinations, including transaminase, in these 37 patients. In this comparison of data, studies were extended to patients who received intraoperative blood transfusion in 1989, the year before the introduction of routine screening of blood for HCV. There was no difference in the range of fluctuation of postoperative transaminase values between the 1991.1993 and the 1989 patients. According to the criteria for the clinical diagnosis of HCV, HCV was found in only one of 10 patients 1989 and in one of 37 patients in 1991 to 1993. The last mentioned patient had a negative routine serum test for HCV. An other postoperative unfavorable event due to intraoperative blood transfusion was toxoplasma infection. Although the incidence of post-transfusion hepatitis has become much lower, we should continue to strive to reduce it still further. As one effective measure, we are now using autologous blood transfusion in selected cases. This method is promising for the future and will be come routine in the clinical practice of surgery.

Hepatitis testing.

There has been remarkable progress in hepatitis testing in recent years. This article reviews the transmission of Hepatitis A by blood products indicating that it is a rare event. However, it has been recently observed with certain preparations of Factor VIII concentrate. Hepatitis B transmission has been effectively reduced by the application of HBsAg screening tests, and screening for antibodies to HBcAb. Hepatitis C transmission has been substantially reduced by the used of the second generation tests for antibodies to HCV. A new generation of screening tests for HCV is expected to be licensed for use in the United States in the near future, and should further reduce the risk of transmission of HCV. At the present time, the incidence of post-transfusion hepatitis in hospitalized patients is indistinguishable from the incidence of hepatitis among patients who did not receive blood transfusion.

Incidence of post-transfusion hepatitis before and after screening for hepatitis C virus antibody.

To evaluate the effectiveness of screening test for antibody to hepatitis C virus (anti-HCV), the incidence of acute post-transfusion HCV infection in patients who underwent cardiovascular surgery and received blood transfusion was studied. All patients were followed prospectively with serum biochemistry tests and viral hepatitis markers before and periodically for at least 6 months after cardiovascular surgery. None of them had history of liver disease and none tested positive for anti-HCV prior to blood transfusion. Before blood donors were screened for anti-HCV with a second-generation HCV diagnostic kit, 28 (12.4%) of 226 patients or 0.49% of 5,690 unit transfusion had seroconverted to anti-HCV during a 6-month follow-up. The incidence of post-transfusion hepatitis (PTH) C in 91 patients who had received 1-12 units transfusion was significantly lower than in 135 patients who had received more than 12 units transfusion (6.6 vs. 16.3%, p < 0.05). However, none of the 87 transfused patients, since anti-HCV screening in July 1992, developed PTH C (p < 0.05). The result demonstrates that screening for anti-HCV by a more sensitive second-generation HCV diagnostic assay may protect the patients studied from PTH C. It further provides a firm argument for the necessity of a nation-wide blood donor screening.

Incidence of Post-Transfusion Hepatitis before and after Screening for Hepatitis C Virus Antibody

To evaluate the effectiveness of screening test for antibody to hepatitis C virus (anti-HCV), the incidence of acute post-transfusion HCV infection in patients who underwent cardiovascular surgery and received blood transfusion was studied. All patients were followed prospectively with serum biochemistry tests and viral hepatitis markers before and periodically for at least 6 months after cardiovascular surgery. None of them had history of liver disease and none tested positive for anti-HCV prior to blood transfusion. Before blood donors were screened for anti-HCV with a second-generation HCV diagnostic kit, 28 (12.4%) of 226 patients or 0.49% of 5,690 unit transfusion had seroconverted to anti-HCV during a 6-month follow-up. The incidence of post-transfusion hepatitis (PTH) C in 91 patients who had received 1-12 units transfusion was significantly lower than in 135 patients who had received more than 12 units transfusion (6.6 vs. 16.3%, p<0.05). However, none of the 87 transfused patients, since anti-HCV screening in July 1992, developed PTH C (p < 0.05). The result demonstrates that screening for anti-HCV by a more sensitive second-generation HCV diagnostic assay may protect the patients studied from PTH C. It further provides a firm argument for the necessity of a nation-wide blood donor screening.

Impacts of blood screening on the incidence of posttransfusion hepatitis C in Japan.

Impacts of blood screening on the incidence of posttransfusion hepatitis C in Japan.

Prospective assessment of incidence of fulminant hepatitis in post-transfusion hepatitis: a study of 504 cases.

The incidence of posttransfusion hepatitis and "fulminant" hepatitis was investigated by a plan devised at our hospital in December 1982. Of 2959 blood recipients between January 1982 and December 1988, 504 (22.5%) developed posttransfusion hepatitis, with a mean transfusion volume of 10.2 units. Of the 504 cases of posttransfusion hepatitis, "icteric" (T-Bil > 2.0 mg/dl) and "overt icteric" hepatitis (T-Bil > 5.0 mg-dl) developed in 111 cases (22.0%) and 28 cases (5.6%), respectively. Of the 28 overt icteric hepatitis cases, 13 (2.8%) were thought to be true overt icteric posttransfusion hepatitis because the icterus was caused by other reasons in the other 15 cases (seven neonatal jaundice, four hemolytic anemia, one radiation hepatitis, one halothane-induced hepatitis; two other cases were excluded because chronic liver disease was diagnosed by imaging procedures despite serum ALTs in the normal range before transfusion). The anti-HCV serostatus was investigated in five of the 13 true overt icteric posttransfusion hepatitis patients using blood specimens taken 180 days or more following the onset of posttransfusion hepatitis. Anti-HCV seroconversion occurred in three of the five cases (60%). HCV seroconversions were not seen in the cases in which the icterus was due to other reasons.

Prospective assessment of donor blood screening for antibody to hepatitis C virus and high-titer antibody to HBcAg as a means of preventing posttransfusion hepatitis

Since December 1989, the Japan Red Cross Blood Bureau has screened blood donors for hepatitis C virus antibody on the basis of enzyme-linked immunosorbent assay and high titers of antibody to HBc antigen. To elucidate the effectiveness of the new screening tests in preventing posttransfusion hepatitis, the incidence of posttransfusion hepatitis after the introduction of the new tests (December 1989 to December 1990) was compared with the incidence before their introduction (January 1982 to December 1988). The incidence of posttransfusion hepatitis was 9.8% (219 of 2240), with a mean transfusion volume of 10.2 units, before the screening and 3.7% (12 of 326), with a mean transfusion volume of 14.7 units, after the introduction of the new tests. Statistical analysis revealed a significant decrease of incidence of posttransfusion non-A, non-B hepatitis after the introduction of the new tests (X2 = 10.9, p < 0.01). Posttransfusion hepatitis B occurred in 3 of 2,240 recipients (0.13%) before the introduction of HBc antibody testing. No cases of posttransfusion B viral hepatitis developed after the introduction of the new tests. Hepatitis C virus antibody status was investigated in 7 of 12 posttransfusion hepatitis patients who contracted the disease after the new screening tests were initiated. Hepatitis C virus antibody seroconversion occurred in three of the seven cases (43%), as detected on first- and second-generation hepatitis C virus antibody assays and reverse-transcription polymerase chain reaction.

Prospective assessment of donor blood screening for antibody to hepatitis C virus and high-titer antibody to HBcAg as a means of preventing posttransfusion hepatitis

Since December 1989, the Japan Red Cross Blood Bureau has screened blood donors for hepatitis C virus antibody on the basis of enzyme-linked immunosorbent assay and high titers of antibody to HBc antigen. To elucidate the effectiveness of the new screening tests in preventing posttransfusion hepatitis, the incidence of posttransfusion hepatitis after the introduction of the new tests (December 1989 to December 1990) was compared with the incidence before their introduction (January 1982 to December 1988). The incidence of posttransfusion hepatitis was 9.8% (219 of 2240), with a mean transfusion volume of 10.2 units, before the screening and 3.7% (12 of 326), with a mean transfusion volume of 14.7 units, after the introduction of the new tests. Statistical analysis revealed a significant decrease of incidence of posttransfusion non-A, non-B hepatitis after the introduction of the new tests (x2 = 10.9, p < 0.01). Posttransfusion hepatitis B occurred in 3 of 2,240 recipients (0.13%) before the introduction of HBc antibody testing. No cases of posttransfusion B viral hepatitis developed after the introduction of the new tests. Hepatitis C virus antibody status was investigated in 7 of 12 posttransfusion hepatitis patients who contracted the disease after the new screening tests were initiated. Hepatitis C virus antibody seroconversion occurred in three of the seven cases (43%), as detected on first- and second-generation hepatitis C virus antibody assays and reverse-transcription polymerase chain reaction. (HEPATOLOGY 1993;18:235–239).

Hepatitis C antibodies in dialysis patients and patients with leukemia

The prevalence of hepatitis C antibodies (anti-HCV) among multitransfused patients was studied and compared with predicted values obtained from a post-transfusion hepatitis study and from data on the prevalence of anti-HCV among blood donors. The prevalence of hepatitis B core antibodies (anti-HBc) was also studied to determine the routes of transmission of hepatitis C virus. The patients consisted of 65 dialysis patients (57 on haemodialysis and 8 on continuous ambulatory peritoneal dialysis) and 71 leukaemia patients in long-term remission [49 with acute myeloid leukaemia (AML) and 22 with acute lymphatic leukaemia (ALL)]. The presence of anti-HCV was investigated using a second generation enzyme-linked immunosorbent assay. Reactive samples were confirmed by a second generation recombinant immunoblot assay. Anti-HBc was studied in the 65 dialysis patients and in 40 of the leukaemia patients. Three (4.6%) of the 65 dialysis patients and 12 (24.5%) of the 49 AML patients were anti-HCV positive whereas all of the ALL patients were seronegative. The total number of blood units transfused to 134 patients (data on two dialysis patients were not available) was 18,148, out of which 17,575 units had been transfused prior to the initiation of anti-HCV screening of blood donors. On the basis of the anti-HCV prevalence among blood donors and the incidence of post-transfusion hepatitis, the predicted number of seropositive patients was 11 and 18, respectively. Five of the 65 dialysis patients were anti-HBc positive, compared with only one of the 40 leukaemia patients.(ABSTRACT TRUNCATED AT 250 WORDS)