Mandatory Screening Test Research Articles

PP122 The Feasibility Assessment For Domestic Introduction Of Newborn Pulse Oximetry Screening For Critical Congenital Heart Disease

IntroductionCritical congenital heart disease (CCHD) refers to a group of heart defects that cause serious, life-threatening symptoms in the neonatal period and requires timely surgical or catheter interventions. We reviewed evidence for incorporating a mandatory neonatal CCHD screening test as a national public health project for all neonates born in Korea by analyzing the validity and cost-effectiveness of neonatal CCHD screening using pulse oximetry in Korea.MethodsWe performed a rapid literature review to establish models for the diagnostic accuracy and economic evaluation of pulse oximetry. Also, we analyzed the prevalence, mortality, and medical expenditure for different types of CCHD using the national health insurance (NHI) data. We analyzed the cost-effectiveness of pulse oximetry by comparing the group of neonates who received a combination of a physical examination and pulse oximetry, and group of neonates who only received a physical examination. For the cost-effectiveness analysis for the CCHD screening test in this study, we used a duration of one year, diagnostic accuracy as the clinical endpoint, and Life Year Gain (LYG) as the effectiveness indicator.ResultsWe used recent systematic review he pooled sensitivity can be enhanced from 76.5 percent (pulse oximetry alone) to 92 percent (combined with physical examination). We used a total of 2,334 neonates with CCHD data for the economic model. Our analysis revealed that adding pulse oximetry to the routine neonatal physical examination leads to 2.34 of LYG and a cost difference of USD1,080,602, showing a ICER of KRW610,063,240 (USD461,857)/LYG.ConclusionsConsidering the benefit of LYG and cost of reducing the complications and after effects of newborns with CCHD who survived early diagnosis, it is considered to be worthwhile in Korea for a mandatory screening test.

419P Breast arterial calcifications on mammogram and its clinical implications

Mammogram is a mandatory screening test for women from 40 years of age in the most parts of the world. While the structural screening for Coronary artery disease doesn’t exist but Women with breast cancer share common risk factors for coronary artery disease (CAD) as well. By using mammogram we can detect the potentially high risk patients, common for both the diseases and this is going to help in long way. Literature suggests that breast arterial classification exist in up to 8- 26% in women undergoing mammogram.

Ensuring safe blood supply

Abstract Background: The use of unscreened blood exposes the patient to many transfusion-transmitted infections (TTIs) including hepatitis B and C viruses, human immunodeficiency virus (HIV), malaria and syphilis, among others. Thus, blood transfusion demands for meticulous pre-transfusion testing and screening. Methods: In this retrospective study carried out from September 2019 to September 2021, 5 mandatory screening tests for TTIs, namely, anti-HIV 1 and 2, anti-hepatitis C virus antibodies, hepatitis surface antigen (HBsAg), serological testing for syphilis and malarial parasite antigen detection were performed. Results: From 2019 September to 2021 September, 2576 blood donations (n = 2474; 96% males) were studied. Of these, 529 (20.5%) were from voluntary donors (VD) and 2047 (79.5%) from replacement donors (RD). Thirty-four (1.3%) of the total 2576 blood donors tested positive for one of the TTIs, including 6 (17.6%) VD and 28 (82.4%) RD. Conclusions: Strict selection of blood donors is mandatory and the need to increase voluntary blood donations can ensure safe blood supply and reducing the occurrence of TTI.

Sero-positivity of transfusion transmitted infections and reactive donors response to counselling among healthy blood donors

Human Blood is essential and life saving in certain medical and surgical conditions and considered as “liquid of life” as it is not replaced by any artificially prepared medicine, though there are tremendous advances in medical sciences. Though Safe blood practice is emphasised since many years, yet there are many side effects of blood transfusion, of which temporary and reversible are easily recognised and treated. Whereas others especially few transfusion transmitted infections which have long term morbidity and mortality needs attention. Recognising these dreaded transfusion transmitted infections in donated blood will help to procure safe blood and help to treat the reactive donors at the earliest. Indirectly reducing the prevalence of transfusion transmitted infections (TTIs) in the community. Tracing the reactive donors and initiating treatment at the earliest, which often would be a window period of transfusion transmitted disease, helps to formulate the strategy to curb the economic burden besides reducing morbidity and mortality.1)To know the seroprevalence of transfusion transmitted infection among healthy blood donors; 2)To study reactive donors response to counselling; 3)To suggest strategy to collect and issue safe blood with aim to reduce TTIs.: A retrospective study of 6.5 years done by review of blood donor registry maintained in blood bank from 2014 to June 2020. All the blood donors were clinically examined, and were asked fill up questionnaire and consent form as per standard guidelines. Mandatory screening tests suggested by WHO like for HIV, HBV, HCV and Syphilis were done and prevalence among both voluntary and replacement donors were calculated. Counselling for reactive donors done and they were directed to undergo advice and treatment by respective department concerned. SPSS software and MS excel sheet were used to analyze the data.Analysis of data revealed replacement blood donors outnumbered voluntary donors. TTIs were more common among replacement donors compared to voluntary. Most number of reactive donors were among men aged between 26 to 35 years. Prevalence of HIV, HBV, HCV, Syphilis and Malaria were 0.062%, 0.655%, 0.006%, 0.146% and0.006% respectively in our study. Among reactive donors responders were 108(85.71%) as compared to non-responders 18(14.28%).Following strict measures to select donor and to counsel donor before donation with appropriate privacy will help to decrease seroprevalence of Transfusion Transmitted Infections. Counselling reactive donors help to seek treatment at the earliest along with unnoticed ongoing blood donations by them. By knowing seroprevalence rate and response of reactive donors, Government and health administration should make and implement policy for safe blood collection and transfusion.

Services Available in the Transfusion Medicine Department of Sir Salimullah Medical College and Mitford Hospital

Background: Blood, is a scarce non substitute, which necessitates it for patients to have a reliable safe access to blood products at all levels. In order to identify the shortcomings in this process, this study has been designed to assess the current status of the transfusion medicine department services in one of the tertiary level hospital in Dhaka city. Subjects and Method: This cross-sectional study was conducted in the Transfusion Medicine department of Sir Salimullah Medical College and Mitford Hospital, Dhaka in 2018. The study population was a total of 275(14 Service Providers purposively interviewed & 261 blood donors taken as per convenience). Data was collected by using semi structured questionnaire, open- ended questionnaire from the Head of the Department and check list. Results: The findings revealed that all basic tests and mandatory screening tests were conducted in the unit except Bone Marrow examination and Apheresis. Important record registers (Donor care, Donor deferral register etc.) were present but not updated. Few SOPs were available but were not kept at work stations. No screening curtains were provided for donor privacy and no technicians used gloves at work. Only 1.5% donors were Voluntary. About 36% were first time donors. About 19% of donors mentioned a delay of nearly an hour for completion of donation process, though 80.5% donors were still satisfied with staff behavior. WHO criteria was followed for Donor selection in the unit. Pre and post donation counselling was extremely dissatisfying. Despite of no stocks, the unit organized mere Voluntary Blood donation activities. Conclusion: A huge number of patients rely on tertiary hospitals for blood transfusions, as it is a life-saving procedure. Voluntary blood donation can be increased by encouraging Government–NGO collaboration along with use of software for holding details of regular donors.

Services Available in the Transfusion Medicine Department of Sir Salimullah Medical College and Mitford Hospital

<i>Background</i>: Blood, is a scarce non substitute, which necessitates it for patients to have a reliable safe access to blood products at all levels. In order to identify the shortcomings in this process, this study has been designed to assess the current status of the transfusion medicine department services in one of the tertiary level hospital in Dhaka city. <i>Subjects and Method</i>: This cross-sectional study was conducted in the Transfusion Medicine department of Sir Salimullah Medical College and Mitford Hospital, Dhaka in 2018. The study population was a total of 275 (14 Service Providers purposively interviewed &261 blood donors taken as per convenience). Data was collected by using semi structured questionnaire, open- ended questionnaire from the Head of the Department and check list. <i>Results</i>: The findings revealed that all basic tests and mandatory screening tests were conducted in the unit except Bone Marrow examination and Apheresis. Important record registers (Donor care, Donor deferral register etc.) were present but not updated. Few SOPs were available but were not kept at work stations. No screening curtains were provided for donor privacy and no technicians used gloves at work. Only 1.5% donors were Voluntary. About 36% were first time donors. About 19% of donors mentioned a delay of nearly an hour for completion of donation process, though 80.5% donors were still satisfied with staff behavior. WHO criteria was followed for Donor selection in the unit. Pre and post donation counselling was extremely dissatisfying. Despite of no stocks, the unit organized mere Voluntary Blood donation activities. <i>Conclusion</i>: A huge number of patients rely on tertiary hospitals for blood transfusions, as it is a life-saving procedure. Voluntary blood donation can be increased by encouraging Government–NGO collaboration along with use of software for holding details of regular donors.

Seroprevalence of transfusion-transmissible infectious agents (HIV, HBV, HCV, plasmodium species and treponema pallidum infections) among blood donors at a Tertiary Care Teaching Hospital in Chennai: Changing trends over a period of five years

Introduction: Transfusion-transmissible infections (TTI) are principal threat to the recipient of a blood transfusion. Consequently, Drugs and cosmetics act asserts that mandatory screening tests must be performed to rule out TTI (human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), Plasmodium species and Treponema pallidum). The principal intention of this study was to resolve the seroprevalence and inclining trends of TTI amongst blood donors at a tertiary care teaching hospital in Chennai. Materials & Methods: A detailed retrospective study and analysis of successive blood donors'(both voluntary and replacement) records covering over the period from January 2010 and December 2014 was carried out. Statistical analysis was performed to establish the trends interconnected with TTI. Results: 2006 (1.2%) donor blood samples from 165809 successive blood donors were tested to be serologically reactive for at least one infectious agent, amongst which 14(0.008%) samples tested contained more than one TTI agents. Correspondingly, on the whole seroprevalence of TTI agents - HIV, HBV, HCV, Plasmodium sp. and Treponema pallidum infections was 0.04%, 1.14%, 0.022%, 0.0006 and 0.0006%. A statistical significant correlation was identified between HBV and HIV viral infections. Furthermore, appreciably declining tendency in seropositivity of HIV, Plasmodium sp. and Treponema infections and continuing increasing drift of perilous HBV and HCV sero-reactivity was identified throughout the study phase. Conclusion: A considerably significant fraction pool of blood donations spread HIV, HBV and HCV infections. Compulsory screening of donors' blood with stringent selection of voluntary blood donors along with by prescribed standard techniques are particularly recommended to guarantee the protection of recipient undergoing blood transfusion. Keywords: Drugs and cosmetics act 1940, Mandatory screening test, Seroprevalence, Transfusion-Transmissib

The role of detection of anti-HBc IgM in HBs Ag negative blood donors

Background: Post Transfusion hepatitis B viral infection continues to be a major problem even after adoption of mandatory screening test, HBsAg by ELISA test in blood banks. In Egypt, HBsAg is still the only HBV screening test of blood donors in most bloods banks. However HBsAg negative blood donors does not rule out the risk of transmission of hepatitis B, as the donor may be in the ‘window period’ or has a mutant strain. During this period, detection of the antibody to the hepatitis B core antigen (anti-HBc) IgM type serves as a useful serological marker. The objective of this study: To evaluate the significance of screening anti-HBc IgM for HBsAg negative blood donors to reduce the risk of transfusion transmitted HBV infection in Egypt.Study design and methods: Four hundred HBsAg negative blood donors were randomly selected from Alzahra university hospital blood bank, for further screening by anti-HBcIgM by ELISA test, then positive samples for anti-HBcIgM were tested for HBV DNA by PCR . Results: Nine (2.25%) out of selected 400 samples were positive for anti-HBcIgM, and 4 (1%) out of these 9 samples were positive for HBV DNA. Conclusion: Anti HBcAg IgM screening test should be implemented as an additional screening test for blood donors in Egypt, to improve transfusion safety as it is an indicator of occult HBV during window period .

NATSpert ID TripleH: A novel individual donor multiplex nucleic acid amplification test to reduce risk of transfusion-transmitted infections: Two-year experience of a blood bank in central India

Background: In India serological screening is mandatory for all donated blood for hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) while Nucleic Acid Amplification Testing (NAT) is not a mandatory screening test. There is a risk of transfusion-transmitted infections (TTI) during window period using serology. Aims and Objectives: The aim of this study was to analyse NAT screening using an indigenously developed, Indian manufactured Individual Donor NAT (ID-NAT) and compare it with serology. Materials and Methods: All blood donations between June 2017-March 2019 were screened serologically for HBV, HCV and HIV at an Indian blood bank. Blood donations also underwent ID-NAT screening using the NATSpert ID TripleH detection assay based on real time PCR. The results were analysed to identify yield cases. Results: In the study, 30,772 blood donor samples were screened serologically out of which 214 were reactive. 30,558 serologically non-reactive blood donations and 77 randomly selected, serologically reactive blood donations were screened using NATSpert. Out of 30,635, 85 donor samples were reactive on the NATSpert which included 77 serology positive and 8 NAT yield cases. The NAT yield found was 2 each for HBV/HIV and 4 of HCV. Conclusion: The NATSpert ID TripleH offers a statistically significant advantage over EIA in ability to detect TTI in blood donors (P < 0.05, Fishers Exact Test). The NAT yield of 1:3829 was in line with other Indian studies. NATSpert assay will provide a significant improvement in blood safety and offer a cost benefit compared to the imported products.

Frequency of Hepatitis B core antibody and Hepatitis B Virus DNA among apparently healthy male blood donors in Eastern Libya

Background/Objectives: Hepatitis B virus (HBV) infection represents one of the most serious blood transfusion-transmitted viral infections. By implementation of the hepatitis B surface antigen (HBsAg) screening assay, blood banks in Libya have been considerably increased blood transfusion safety in term of protecting against the transmission of HBV infection. However, several studies demonstrated that donors who are HBsAg negative and hepatitis B core antibody (anti-HBc) positive maybe a potential source for posttransfusion hepatitis B. The aim of this study is to determine the presence of anti-HBc and HBV DNA (hepatitis B viral DNA) in healthy HBsAg-negative blood donors in eastern Libya (Tobruk region). Materials and Methods: A total of 500 serum samples were tested for HBsAg and obtained from healthy blood donors in blood bank unit in Tobruk Medical Center. All donors were tested for anti-HBc, using commercial ELISA and microwell methods (MBS-SRL, Milano, Italy). The reactive samples were further tested for the presence of HBV DNA using polymerase chain reaction (PCR). Results: In this study, the seroprevalence rate of anti-HBc sample was 54 (10.8%) among donors. The majority of anti-HBc-positive cases (52 of 54) were in the age group of 20–49 years. Of the 54 anti-HBc-positive samples, 4 (7.4%) were tested positive for HBV DNA by PCR. Conclusion: Among all the samples, the rate of anti-HBc was 10.8%. This finding is comparable to a previous study performed in northwestern Libya. The present study estimated the expected exclusion rate of anti-HBc-positive donated blood that would be an important factor to consider before adopting anti-HBc testing in addition to HBsAg testing as a mandatory screening test to further enhance transfusion safety.

Translation of individualized medicine into clinics and the discourse of “hypothetical ethics”

The analysis of the ethical discourse on Individualized Medicine (IM) within the context of PPPM, shows that the most extensively studied areas are (still) relatively far away from a practical implementation. The discussion of IM as an engine of a dictatorship of prevention, in which IM is placed in the context of the ethical acceptability of mandatory screening tests or the rejection of the principle of solidarity under the banner of personal health responsibility, can be understood as a prime example. However, such discussions are situated within the range of a purely hypothetical ethics, since the extensive medical knowledge and applications they are based on merely exist in the anticipation of potential successes, rather than the outcome of the real research context of IM, which - particularly in the area of complex diseases - does not go far beyond the level of rather trivial recommendations for a fundamentally healthy lifestyle. On the other hand, if one focuses on the reality in the field of IM research, it becomes evident that there are promising approaches mainly in two areas, both of which are not very promising for hypothetical ethics: The fields of biomarker-based prediction of the course of a disease (e.g. in oncology) and the biomarker-based prediction of the success of drug and non-drug interventions. The progress in research in Germany's largest joint project for IM, GANI_MED – Greifswald Approach to Individualized Medicine – exactly points in that direction: The promising studies within GANI_MED refer to limited and clearly defined questions. The endocrinologically based prediction of the course of a metabolic syndrome as well as the use of biomarkers for the prediction of treatment response for immunoadsorption in dilated cardiomyopathy are to be named here as respective examples. Obviously, both examples can be understood as examples for the ethical problems of marginal utility, but they certainly give no reason for an alarmist self-promotion of bioethics. Even if one concedes that the alarm calls off bioethics have been provoked through excessive promise of healing and output of IM-propagators and stakeholders in medicine and human biology, it has to be noted that the current status of research raises a very differentiated and, in parts decidedly, clear-cut record: The biomarker-based IM is - according to the thesis of the authors - certainly not the new paradigm of medicine, but a research approach, which may contribute progress in very limited areas in medical care.

Hepatitis E seroprevalence among blood donors: A pilot study from Western India

Background:Hepatitis E virus (HEV) is emerging as a potential threat to blood safety after several cases of transmission by transfusion or transplantation have been described. Currently, blood donors in India are not screened for HEV. The studies conducted on HEV in recent times in India have focused on epidemiology and future perspectives, but there is no published study on blood donors. To address possible issues surrounding blood safety and risk of HEV transmission within the Indian blood supply, HEV seroprevalence study was conducted in blood donors at our center.Materials and Methods:A total of 460 male voluntary blood donors were selected for the study and after taking their written consent. Serum anti-HEV IgM was detected by Dia.Pro HEV kit (Diagnostic Bioprobes Srl, Milano, Italy).Results:The study population was composed of 460 male voluntary blood donors and their age ranged from 18 to 60 years with a mean age of 30.48 years. Out of 460 donors, 22 (4.78%) donors were tested positive for IgM anti-HEV and the mean value alanine aminotransferase (ALT) was 26.06 IU/L, the highest being 93.5 IU/L. Normal reference value of ALT in our center was 40 IU/L. Out of 22 anti-HEV positive donors, 19 (86.36%) had ALT values above 40 IU/L.Conclusion:HEV seroprevalence of 4.78% in our center. Though reports of HEV transmission through blood has been reported from various parts of the world, before making it as a mandatory screening test among blood donors in India, further studies with confirmatory assay of HEV need to be done.

P3.253 Sero Prevalence of HIV, Hepatitis B, Hepatitis C and Syphilis Among Blood Donors in Kathmandu, Nepal

<h3>Background</h3> Mandatory screening tests are performed for human HIV1/2, Hepatitis B and C and Syphilis by blood transfusion centres in Nepal because blood transfusion is the most efficient mode of transmission of these diseases. The study is aimed to determine the sero-prevalence of these four Transfusion transmissible infections. <h3>Methodology</h3> A cross-sectional retrospective study was conducted at Tribhuvan University teaching Hospital, Maharajgunj during the period from July 1st 2007 to June 30th 2011. Total of 11160 samples from Volunteer and replacement donors were screened for Anti-HIV, Anti-HCV and HBsAg by ELISA methods. The Reactive cases were confirmed by confirmatory method as per the national algorithm. <h3>Results</h3> The prevalence of HIV, HBV, HCV and syphilis were determined to be 0.17%, 0.44%, 0.71% and 0.35% respectively. HBV and HCV sero-prevalence was found to be higher among male blood donors but, Syphilis and HIV prevalence was higher in female donors in comparison to male donors. TTIs prevalence was highest among blood donors in the age group 21 to 30 years (P = &lt; 0.05). HIV was reported to be to more prevalent among replacement donors (0.33%) than volunteer donors (0.12%). Other TTIs were insignificantly more prevalent among volunteer donor than replacement donors. <h3>Conclusions</h3> Screening of donated blood should be done with highly sensitive and specific tests so as not to transfuse infected blood. It is also important to strengthen donor counselling before donation.

Procedure for granulocyte collection performed at the Blood Centre of the Faculty Hospital Ostrava

Granulocyte apheresis is a safe and effective method for granulocyte collection. We present a five year experience (2006-2010) of the Blood Center, Faculty Hospital Ostrava, Czech Republic. Donor granulocyte transfusion is one treatment option for haemato-oncology patients with severe neutropenia complicated by bacterial/fungal infections unresponsive to standard antibiotic/antifungal treatment. In this study, we describe the experiences of the Blood Centre at the Faculty Hospital in Ostrava of granulocyte apheresis. A total of 149 granulocyte units were collected for 33 patients from the Department of Haemato-oncology, University Hospital Olomouc, over a 5-year period (2006-2010). Information on donor selection, laboratory screening, mobilization regimen and granulocyte yield was obtained and analyzed. All mandatory screening tests for infection markers, AB0 and Rh and abnormal erythrocyte antibodies were performed. The cytomegalovirus status of the donors was not investigated. Steroids were the only mobilization regimen used, and were generally well accepted. The mean granulocyte yield was 12.6×10(9)/per transfusion unit (range 5.4-30.3). All granulocyte concentrates were irradiated and transfused according to AB0 Rh compatibility within 24 h after collection. Based on our experience, granulocytapheresis is a safe and effective method for obtaining granulocytes but the yield can be significantly influenced by other variables. From the recipients' perspective, the use of donor granulocytes supports an effective therapeutic modality.

Chagas disease: a threat to safe blood transfusion

Chagas disease affects approximately 8 million infected people in Mexico and Central and South America and causes 12 500 deaths annually; 41 200 new cases are reported annually (2006). Coordinated multicenter programmes have decreased about 70% of new infections in South America due to the interruption of vectorial and decreased blood transfusion transmissions. Migration of the infected population from rural areas to urban centres in endemic and non‐endemic countries led to the urbanization and globalization of Chagas disease. Chagas disease is now an emerging disease in non‐endemic areas, where congenital, blood and organ transplant transmissions are associated with reactivation of chronic Chagas disease in patients under immunosuppression or HIV infection. Recent initiatives in non‐endemic countries have been implemented to control its transmission by blood transfusion and transplants of organs. Most of the infected people were asymptomatic individuals in the chronic phase of the disease, characterized by and low and intermittent parasitemia and diagnosed by serological tests. In endemic countries, universal mandatory screening tests for detection of Trypanosoma cruzi antibodies dramatically reduced blood transfusion transmission. In non‐endemic countries, where transfusion represents the most important way of transmission, different strategies have been registered: (1) blood donor selection and deferral; (2) blood donation testing; (3) blood donation testing in people who lived in endemic areas. Questionnaires containing well‐defined questions help to identify patients from endemic areas and their epidemiological data but are of limited value since they depend on donor information. High‐performance serologic tests were reported for the detection of anti‐T. cruzi antibodies like ELISA with epimastigotes or trypomastigotes or recombinant antigens, chemiluminescent, immunoblot and radioimmunoprecipitation assays. Almost 100% of sensitivity and specificity were registered when tested in samples of well‐defined chronic chagasic patients but gold standards are not validated in circumstances of low prevalence of the disease. Additionally, their value in cases of inconclusive results (one positive test and other negative or doubtful results) was not known. Unfortunately, molecular methods are less sensitive than serology for the chronic phase of the disease (45–100% sensitivity) and were not reliable for screening tests in blood banks. Perspectives of the reduction of parasites by photochemical treatment and ultraviolet (crystal violet, methylene blue, amotosalen, riboflavin, thiopirilium) were reported sometimes with slight changes in the blood products. However, the main challenge is to demonstrate their value for prevention of a broad spectrum of agents transmitted by blood transfusion (including príon disease) and inactivation of low parasite load. In summary, questionnaires including specific questions about donor epidemiology and high‐performance serologic tests have been useful for blood bank screening. The cost–benefit–effectiveness analyses of universal serologic screening vs. serologic screening of selected donors depend on the prevalence of positive donors and should be evaluated in different regions. Finally, as pathogen inactivation methods may represent remarkable improvement in blood bank transfusion, efforts from the academia are necessary to prove their safety and effectiveness, and from blood banking–transfusion medicine community and public regulators to their implementation aiming to increase the safety of blood transfusion for patients around the world.

Does anti-HBc reactivity reflect 'lifestyle' risk in north London blood donors?

To determine whether antibody to hepatitis B core (anti-HBc) reactivity, as a marker of hepatitis B virus infection, reflects a 'lifestyle' risk in donors in North London, we have obtained detailed histories from donors with various manifestations of HBV infection. Interviews based on a standardised questionnaire were conducted with 70 donors confirmed to be anti-HBc reactive. Comparison with controls (known to be anti-HBc-negative) and donors reactive for anti-hepatitis-C virus showed that current donor strategies are effective; in our area, reactivity for anti-HBc is not associated with a lifestyle risk for those donors who are unreactive in current mandatory screening tests. Blood from donors positive for both anti-HBc and anti-HBs should be considered suitable for transfusion purposes. This is consistent with the practice of accepting blood from naturally immune donors for preparation of hepatitis B immunoglobulin.

Seroprevalence of HIV, HTLV-I/II and other perinatally-transmitted pathogens in Salvador, Bahia.

Generation of epidemiological data on perinatally-transmitted infections is a fundamental tool for the formulation of health policies. In Brazil, this information is scarce, particularly in Northeast, the poorest region of the country. In order to gain some insights of the problem we studied the seroprevalence of some perinatally-transmitted infections in 1,024 low income pregnant women in Salvador, Bahia. The prevalences were as follow: HIV-1 (0.10%), HTLV-I/II (0.88%), T.cruzi (2.34%). T.pallidum (3.91%), rubella virus (77.44%). T.gondii IgM (2.87%) and IgG (69.34%), HBs Ag (0.6%) and anti-HBs (7.62%). Rubella virus and T.gondii IgG antibodies were present in more than two thirds of pregnant women but antibodies against other pathogens were present at much lower rates. We found that the prevalence of HTLV-I/II was nine times higher than that found for HIV-1. In some cases such as T.cruzi and hepatitis B infection there was a decrease in the prevalence over the years. On the other hand, there was an increase in the seroprevalence of T.gondii infection. Our data strongly recommend mandatory screening tests for HTLV-I/II, T.gondii (IgM), T.pallidum and rubella virus in prenatal routine for pregnant women in Salvador. Screening test for T.cruzi, hepatitis and HIV-1 is recommended whenever risk factors associated with these infections are suspected. However in areas with high prevalence for these infections, the mandatory screening test in prenatal care should be considered.