Частота выявления маркеров гепатитов В и С у доноров крови

• Гариб А.К.Р.
• Алхамадани Али Хасанаин
• Аль-Арди И.
• Хуссейн А.М.

Резюме

Вирусные гепатиты В и С представляют собой глобальную проблему для здравоохранения во всем мире. В Ираке уровень заболеваемости гепатитом В у доноров крови составлял 3,6% в 1973 г., 4,1% в 1984 г. и менее 1% в 1990 г.

Цель исследования - сравнительное определение распространенности вирусов гепатита В (HBV) и С (HCV) среди доноров крови в Аль-Мутанне и в других городах Ирака.

Материал и методы. Исследование проведено с 1 января 2022 г. по 31 декабря 2023 г., в нем приняли участие 29 300 человек (29 220 мужчин и 80 женщин в возрасте от 25 лет до 61 года), посещавших Центральный банк крови/учебную больницу Аль-Хусейн в Самаве (центр провинции Аль-Мутанна). Доноры крови регулярно проходили серологический скрининг на маркеры гепатитов В и С. Статистический анализ проведен с использованием программного обеспечения SPSS.

Результаты и обсуждение. Серологический скрининг всех доноров на вирусные гепатиты В и С показал, что уровень инфицированности HBV при положительном тесте на анти-HBc был выше (1,4%) в общей сумме по сравнению с HBV (0,058%). Однако более низкий уровень инфицированности среди положительных тестов был на HCV (0,051%). Ни у одной женщины, участвовавшей в этом исследовании, не было положительных результатов на HBV и HCV, в то время как в 2022 г. была выявлена одна инфекция (0,006%) на анти-HBc. Не установлено существенной разницы между случаями инфицирования доноров в 2022 и 2023 гг. (р=0,19).

Заключение. Это первое крупномасштабное популяционное исследование в Аль-Мутанне (Ирак). Около 0,058% доноров крови были инфицированы HBV и 0,051% - HCV. В Аль-Мутанне уровень инфицирования HBV и HCV среди доноров крови ниже, чем в других провинциях Ирака.

Ключевые слова: гепатит В; гепатит С; анти-HBc; доноры крови; инфекции

Hepatitis is a liver inflammation produced by a variety of infectious viruses and noninfectious substances, which can result in a variety of health issues, some of which are fatal. The hepatitis virus has five primary strains, known as types A, B, C, D, and E. While they all cause liver disease, they differ in significant ways, including mechanisms of transmission, severity of the disease, geographical distribution, and preventative techniques [1].

Types B and C, in particular, cause chronic disease in hundreds of millions of people and are the leading causes of liver cirrhosis, liver cancer, and viral hepatitis mortality. Hepatitis B or C affects an estimated 354 million people globally, and for the vast majority of them, diagnosis and treatment are out of reach [2].

Vaccination can help prevent certain kinds of hepatitis. According to WHO research, immunization, diagnostic tests, medicines, and information campaigns could avert approximately 4.5 million premature deaths in low- and middle-income countries by 2030. WHO’s global hepatitis plan, which is supported by all WHO Member States, seeks to reduce new hepatitis infections by 90% and fatalities by 65% between 2016 and 2030 [1].

Hepatitis B is endemic in Iraq, with reported rates ranging from about 1% in the north to 3.5% in the south In 2017, 1926 cases of hepatitis B were reported, with 594 cases of hepatitis C [3, 4].

Wars and human catastrophes contribute to the spread of infectious diseases across areas and countries, resulting in alterations in the global infection map [5]. During the Syrian crisis, thousands of refugees fled from danger zones to neighboring nations, and northern Iraqi cities received them [6].

Chronic hepatitis B virus (CHB) infection increases the risk of liver cancer and cirrhosis, as well as early death, by 70-85% compared to the general population [6]. In the United States, an estimated 580 000 to 2.4 million people are infected with HBV [7], with two-thirds of them likely ignorant of their condition. CHB disproportionately affects people born outside the United States; non-U.S.-born people make up 14% of the general population but 69% of the U.S. population with CHB [8].

In Iraq, HBV infection has dropped during the last few decades. Hepatitis B in blood donors was 3.6% in 1973, 4.1% in 1984, and fewer than 1% in the 1990s [9, 10]. This reduction is the consequence of the government’s preventative and control activities, such as safe blood transfusion and safe injections, in addition to implementing the vaccine program.

Hepatitis C (HCV) is a viral illness of the liver. It can result in both acute and chronic illnesses. It has the potential to cause death. Symptoms include fever, exhaustion, loss of appetite, nausea, vomiting, abdominal discomfort, dark urine, and yellowing of the skin or eyes (jaundice). Early recognition and therapy can help prevent major liver damage and improve overall health.

Most acute HCV infections do not result in a fatal illness and are typically asymptomatic. Within six months of infection, 15-45% of infected individuals spontaneously recover from the virus without receive medical treatment [11].

HBV and HCV are spread by direct contact with blood, blood transfusions, intravenous injections, and unprotected sex. Transfusion of blood and its products is a known risk factor for acquiring HBV and HCV [12], but it is also a non-alternative life-saving therapy that saves thousands of lives annually [13].

Because there are no systematic serological tests for donors in underdeveloped countries, infection transfer from donors to recipients is becoming more common with HBV and HCV [14]. To address this, the World Health Organization (WHO) advised routine serological tests for transfusion-transmissible diseases (TTIs), such as HBV and HCV, to prevent their transmission [15].

The donors’ test results could indicate a safe blood supply. Furthermore, it was utilized to evaluate the HBV and HCV prevalence rates among blood donors, allowing health clinicians to better understand the epidemiology of such infections in the population.

The blood donor pre-donation screening technique resulted in a considerable drop in HBV and HCV prevalence rates [16]. Furthermore, educating donors on the modes of transmission of HBV and HCV increased their awareness of the risk factors [15].

In Iraq, the screening of donor blood for hepatitis B and C is a vital public health practice aimed at preventing the transmission of these viruses through blood transfusions. The Iraqi Ministry of Health has established protocols to ensure that all donated blood is thoroughly screened for hepatitis B, hepatitis C, and other infectious diseases. This screening is crucial for protecting recipients, especially vulnerable groups such as children and patients undergoing medical treatments. A study by Al-Hamdani et al. highlights that the implementation of strict blood screening measures has significantly decreased the incidence of transfusion-transmitted infections in the country [17].

Study aims - the current study aimed to determine the prevalence of markers of HBV and HCV infection among blood donors in Al-Muthanna, Iraq.

Material and methods

A total of 29,300 individuals (29,220 males and 80 females with an age range of (25-61 years) attending the Central Blood Bank/Al-Hussein Teaching Hospital at Samawah city (center of Al-Muthanna province) were enrolled in this study. Blood donations occurred exclusively during the study period from 1 January 2022 to 31 December 2023 and were included in the study. Demographic data which included age and gender were collected from the records of this blood bank.

Blood donors were routinely screened for the presence of serological markers of HBV and HCV infection (HBsAg, HCV RNA) or evidence of infection with HBV and HCV (anti-HBc IgM and IgG). Elisa is an enzyme immunoassay diagnostic kit that was used for the detection of infectious viruses. All donors came from Samawah City and the surrounding districts. Statistical analysis was carried out using SPSS software licensed to Swansea University, UK.

All ethical approvals and administrative orders were obtained before starting the study by the Ministry of Health and Environment, Al-Hussein Teaching Hospital, and the College of Nursing at Al-Muthanna University.

Results

Throughout the study, 14539 donors during the year 2022 (table 1) and 14761 during the year 2023 (table 2), were screened for HBV, HCV infections (HBsAg, anti-HBc IgM and IgG and HCV RNA). Among the donors, 29 220/29 300 (99.73%) were males, while 80/29 300 (0.27%) were females (table 3).

Regarding the screening for hepatitis to all donors, the results showed that the infection rate of the positive test for anti-HBc was higher (1.4%) in total sum compared to HBV (0.058%) of the study groups. However, the lower infection rate of positive tests was for HCV (0.051%). None of the females in this study they were positive for HBV and HCV while there was only one infection (0.0034%) for anti-HBc in 2022.

At the same time, no significant difference was observed between the donor’s infection in 2022 year and 2023 year (p=0.19). The age of donors ranged from 25 to 61 years (median 43 years) (see Figure).

Discussion

Geographically, the Al-Muthanna Governorate is one of the southern governorates; administratively, it is one of the middle Euphrates governorates. It is the second biggest governorate in size of Iraq, with an area of 51 000 km², but it is the least populated.

Because of Iraq’s turbulent political and socioeconomic environment during the past few decades, it is impossible to determine the frequency of hepatitis infection in the country’s general population. As far as we are aware, research on blood donors provides the only published information on the prevalence of viral hepatitis in Iraq. Tests for hepatitis seromarkers are crucial for screening blood donors and preventing hepatitis linked to transfusions. Donors with isolated anti-HBc antibodies but hidden HBV infection may be unidentified by HBsAg testing. Every donor with HBV infection has a lifetime positive anti-HBc test result. Anti-HBs positivity is therefore a marker of prior infection in the majority of anti-HBc positive individuals. Anti-HBc screening is still helpful, however, since it is preferable to weed out all anti-HBc-positive donors to avoid transfusion-related HBV infection [18].

A recipient receiving blood transfusions from donors within the window period may develop post-transfusion hepatitis B. During the window period, anti-HBc has proven to be a highly reliable indication of occult HBV infection. Anti-HBc detection has made a substantial contribution to the decline in post-transfusion hepatitis B infection rates.

A first serological test for the hepatitis C virus is necessary to identify circulating antibodies, which signify viral exposure. Nucleic acid testing is required after this to identify the active infection and determine whether the virus is present in the blood. A serum or plasma enzyme immunoassay is used in the conventional diagnostic route to identify HCV antibodies [18].

Our research indicates that 14,539 donors were examined for markers of HBV and HCV infection in 2022 and 14,761 donors in 2023. Out of the donors, there were 29,220 males (99.7%) and 80 females (0.3%). The Al-Muthanna Governorate has a lower rate of HBsAg prevalence among blood donors than the national average.

In a previous study conducted in Egypt recruiting healthy volunteer blood donors, HBV positivity was reported for 5% of the subjects. Similarly, in a study conducted in Kuwait, the prevalence of HBsAg-positive subjects among Kuwaiti nationals and non-Kuwaiti Arabs was 1.1 and 3.5%, respectively [19]. Also, a study conducted in Saudi Arabia, it was found that the prevalence of HBV-positive was 3.8% among blood donors [20]. On the other hand, a study conducted in Iran showed that the prevalence of HBV amongst blood donors decreased from 1.79% in 1998 to 0.41% [21]. According to our research, 0.051% of blood donors all of whom were male had HCV.

Findings of this study when compared to other Iraqi governorates, showed that blood donors in Al-Muthanna Governorate had a lower prevalence of HCV infection. When compared with a previous study in Basra that conducted in 2013 found that the percentage was 0.12% of all blood donors had HBV [22].

However, in another previous study in Baghdad between 2006 and 2009, the prevalence of HBV was 0.6% in all blood donors who visited the National Blood Bank, with men having a greater frequency (0.8%) than women (0.5%) [9].

Also, the prevalence of HBV among all blood donors was found to be 0.7% in another cross-sectional observational research conducted in the Babylon governorate; this incidence was larger in women (4.6%) than in males (0.7%) [10]. When compared with other research conducted on blood donors in the Babylon governorate between February 2007 and February 2008, it revealed that 0.5% of blood donors had anti-HCV antibodies [10].

The last previous study was carried out in the Iraqi province of Dhi-Qar between August 2020 and October 2020. According to the study’s outcomes, only (3.2%) of blood donors had HCV infection [11] furthermore the prevalence of HBV was 3.5% in 2023. Moreover, in Duhok, Northern Iraq, between January 1 and December 31, 2014, revealed that HCV-Ab prevalence in blood donors was 0.78%.

Conclusions

This is the first large population study in Al-Muthanna, Iraq. Around 0.058% of blood donors had HBV and 0.051% had HCV while 1.46% had anti-HBc for males and 0.0034% for females as the only serological evidence of HBV infection.

In Al-Muthanna, the rate of HBV and HCV infection among blood donors is lower than in other countries and Iraqi governorates. HBV infection is more common than HCV infection in blood donors. Iraq can thereby strengthen its efforts to control hepatitis B and contribute to the worldwide aim of eliminating viral hepatitis as a public health issue. Continued success will necessitate a dedication to innovation, cooperation, and evidence-based approaches.

Acknowledgments

The authors would like to thank staff in the Central Blood Bank/Al-Hussein Teaching Hospital for their help. We also express our full heart of gratitude to all the blood donors for their great assistance and cooperation throughout the study.

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