Evaluation of screening effectiveness of hepatitis B surface antigen and anti-HCV rapid test kits in Pakistan

Waheed, Usman; Abdella, Yetmgeta; Saba, Noore; Arshad, Muhammad Imran; Wazeer, Akhlaaq; Ahmad, Farooq; Usman, Javaid; Arshad, Abida; Zaheer, Hasan Abbas

doi:10.4103/jlp.jlp_172_19

Cited by 16 publications

(15 citation statements)

References 11 publications

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“…As the blood collections in Pakistan are predominantly "family replacement" instead of the WHO recommended regular voluntary donations, 59 the probability of acquiring the infection increases. The rampant use of poor quality RDTs 60 for screening purposes intensifies the situation. Hence, unsafe blood transfusions remained an important driver of the hepatitis epidemic in the country.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis on the Epidemiology of Hepatitis B and Hepatitis C Virus among Beta-Thalassemia Major Patients in Pakistan

Waheed

Saba²,

Wazeer

et al. 2021

J Lab Physicians

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Beta-thalassemia major patients are the leading consumers of blood transfusions in Pakistan and, therefore, have a greater risk of acquiring transfusion-transmitted infections, most notably hepatitis B and C virus (HBV and HCV). The present study includes a comprehensive review on the status of HBV and HCV in beta-thalassemia major patients in Pakistan. For this purpose, we examined original articles assessing the epidemiology of HBV and HCV in transfusion-dependent thalassemia patients.We searched 10 major subscription databases from January through February 2020, that is, Medline, PakMediNet, CINAHL, Scopus, PubMed, Web of Science, Embase, Science Direct, Google Scholar, and Directory of Open Access Journals. The World Health Organization resources were also explored for relevant reports. The search criteria included published articles up to December 31, 2019, with no language restrictions. Articles identified were introduced into the Endnote version X9 software and then screened for relevance and duplication. The results were stated as the pooled prevalence for the overall study and also for region-wise subgroups.A total of 33 studies conducted from 1995 to 2019 were included in the review. All 33 articles yielded information on HCV prevalence, while 19 of them provided information on HBV prevalence. The overall sample size was 8,554 that tested the prevalence of HCV in thalassemia patients. The sample size from the 19 studies that tested the prevalence of HBV was 6,184. The overall pooled prevalence of HBV was computed to be 4.13%, while the pooled prevalence of HCV was 29.79%. The majority of the studies were obtained from the Punjab Province (33.33%), followed by Khyber Pakhtunkhwa Province (24.24%).The total sample size of 33 studies was less than 10% of the total number of estimated thalassemic patients, that is, 100,000. Further studies or a national baseline survey are imperative to confirm the actual frequency of HBV and HCV in thalassemia patients across the country.

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Section: Discussionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis on the Epidemiology of Hepatitis B and Hepatitis C Virus among Beta-Thalassemia Major Patients in Pakistan

Waheed

Saba²,

Wazeer

et al. 2021

J Lab Physicians

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“…In many blood banks, poor quality, cheap and rapid manual methods are being used for quick screening along with poor laboratory practices. 44 This can lead to a significant probability of missing an infection in the donor population with a multifold increased risk of transmission to transfusion recipients. Rates of voluntary donations are meager accounting for less than 13% of all donations.…”

Section: Discussionmentioning

confidence: 99%

“…42 The seroprevalence of HBV in blood donors varied from 1.55% to 3.76%, HCV from 2.55% to 7.23%, HIV from 0 0.01% to 0.04% and syphilis varied from 0.59% to 1.16% %. [42][43][44][45][46][47] Our review showed a cumulative frequency of 2.04% (n=16,203) for HBV and 2.44% (n=17,660) for HCV among blood donors. Transmission of HBV and HCV through blood transfusion is a significant concern.…”

Section: Discussionmentioning

confidence: 99%

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A Systematic Review of Transfusion Transmissible Infections Among Blood Donors and Associated Safety Challenges in Pakistan

Ehsan

Wahab²,

Shafqat

et al. 2020

Blood

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Introduction: The blood transfusion (BT) system in Pakistan is fragmented, demand-driven, and depends on weakly regulated transfusion practices. This is primarily a big problem in smaller cities and remote rural areas. Pakistan has one of the highest hepatitis B virus (HBV) and hepatitis C virus (HCV) prevalence worldwide, estimated around 5 & 10 million cases, respectively. There is a considerable risk that transfusion-transmissible infections (TTIs) may have contributed to the current epidemic of HBV & HCV, affecting 7.4 % of the general population, and potential risk of HIV transmission in the country. In this systematic review, we aim to identify the prevalence of TTIs among the blood donor population and associated safety challenges. Method & Material: We conducted a systematic literature search to identify studies related to TTIs and transfusion safety in Pakistan from January 1, 2010, to January 31, 2020. A search was conducted using PubMed and PakMedinet.com (largest medical database of Pakistan); initial search retrieved 981 articles, 166 met the inclusion criteria, and after review by two independent reviewers, 33 articles met the final criteria for qualitative synthesis. Results: Analysis of 33 studies showed the seroprevalence of HBV of 2.04 % (0.81% to 4.22%), HCV of 2.44% (1.29 % to 10%), HIV of 0.038% (0% to 0.18%), syphilis of 1.1% (0.11-3.01%) and malaria of 0.11% (0.05-1.20). The rate of coinfections among blood donors varied from 0.0099% to 0.35 %. The highest number of coinfections were HCV & syphilis, followed by HCV & HBV infections. The rate of TTIs was dependent on the number of donors, donor types (replacement vs. voluntary), screening techniques used, number, and type of TTIs tested. There was a lack of universal screening for common TTIs. Syphilis and malaria were tested only 38 % & 46 % of all the blood donations. The studies with a high number of replacement donors (RDs) noted a high prevalence of TTIs of 2.5 % to 12 % compared to the studies with a high number of voluntary non-remunerated donations (VNRDs) reported TTIs rates of 1.57% to 6.2 %. There was a significant difference in the prevalence of HBV & HCV in VNRDs (0.48%) compared to RDs (4.15%). The rate of VNRDs was 0.10 % to 13%. The majority of blood donations were from male donors, representing more than 70 % of all donations. The female donations varied from 0.03% to 15 % in government/public blood banks than 29 % in private sector blood banks. The HBV & HCV infections and anemia were the most common causes of blood donation deferral. The 69.5 % of donors who tested positive for TTIs in a study reported previous blood donations. The educational status of donors noted to have an association with knowledge about the risk of TTIs. Odds of having limited knowledge about TTIs (OR: 4.04, CI: 1.567-10.435, p<0.01) were greater if donors had a secondary level of education compared to those with tertiary education. 48 % of blood donors did not know about the risk of TTIs through blood transfusion. There was notification of only about 54.25 % of all donors, who tested positive for any TTIs. This was mainly due to a lack of standardized reporting and follow up systems. Conclusion: This systemic review shows a high prevalence of TTIs, especially HBV, HCV & syphilis in the blood donor population. There is a high dependency on RDs, with minimal use of healthy voluntary blood donation practices, inadequate screening of high-risk donors, repeated collections of the blood from RDs, poor quality of screening methods, and limited knowledge of donors about their health. There is a lack of widespread standardized testing and follow up of patients who tested positive on initial testing. Large prospective multicenter clinical trials are required for a better understanding of the TTIs by testing and creating a follow-up system for both blood donors and recipients. Disclosures Anwer: Incyte, Seattle Genetics, Acetylon Pharmaceuticals, AbbVie Pharma, Astellas Pharma, Celegene, Millennium Pharmaceuticals.:Honoraria, Research Funding, Speakers Bureau.

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“…[ 18 ] Earlier studies on the prevalence of HBV in thalassaemia patients report a prevalence of 8.40%[ 19 ] in the Balochistan province, 3.0%[ 20 ] in Islamabad, 5.1%[ 21 ] in Karachi, 5%[ 22 ] in Rawalpindi, and 12.2%[ 23 ] in Bahawalpur. Although screening for HBsAg is mandatory under the Islamabad Blood Safety Ordinance,[ 24 ] the finding of HBsAg in thalassaemia patients indicates poor screening techniques[ 25 ] and low voluntary blood donations. The reporting of HBV infection incident in such patients urges quick response to monitor any uncontrolled transfusion in these patients and demands to maintain quality transfusion services.…”

Section: Discussionmentioning

confidence: 99%

Molecular and genetic characterization of hepatitis B virus among multitransfused thalassaemia patients in Islamabad, Pakistan

Ahmad

Waheed

Saba

et al. 2021

Journal of Family Medicine and Primary Care

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Background: Hepatitis B virus (HBV) is the aetiological agent of transfusion-transmitted hepatitis globally. Beta thalassaemia major individuals are at greater risk of contracting HBV infection due to multiple blood transfusions required for the medical management of these patients. Based on HBV genetic variability, it is divided into 10 genotypes. The determination of HBV genotypes has significant implications for clinical management and treatment regimens. Aim: This study was performed to assess the HBV epidemiology and circulating genotypes in multi-transfused β-thalassemia major patients with the aim to be considered while formulating the treatment pattern taking into account particular needs of thalassaemia patients. Materials and Methods: This study was performed from September 2018 to June 2019, at the Department of Pathology and Transfusion Medicine, Shaheed Zulfiqar Ali Bhutto (SZAB) Medical University, Islamabad. A total of 2,260 thalassaemia patients were enrolled in the study. The study was endorsed by the Ethics Committee of the SZAB Medical University, Islamabad. The samples were serologically screened for HBsAg on the LIAISON® XL Murex HBsAg Quant assay (DiaSorin S.p.A., Italy) a chemiluminescence based immunoassay (CLIA). HBV quantitative PCR kit was used to measure the HBV DNA in serum samples. The HBV genotypes were determined using universal primers targeting the P1 and S1 region amplification. Results: Of 2,260 thalassaemia patients, 64.6% were males while 35.4% were females. The HBsAg was identified in 98 individuals (4.33%). The PCR analysis was done for these 98 patients and in this cohort, genotype D was 59.18% ( n = 58), genotype A was 21.42% ( n = 21) while genotype C was 19.38% ( n = 19). Conclusion: The determination of HBV genotypes in the multi-transfused patients is key to the effective management of chronic HBV patients as the severity and course of the disease is dependent on a specific type of genotypes. Quality assured screening of donated blood will prevent the incidence of HBV in thalassaemia patients.

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Evaluation of screening effectiveness of hepatitis B surface antigen and anti-HCV rapid test kits in Pakistan

Cited by 16 publications

References 11 publications

A Systematic Review and Meta-Analysis on the Epidemiology of Hepatitis B and Hepatitis C Virus among Beta-Thalassemia Major Patients in Pakistan

A Systematic Review and Meta-Analysis on the Epidemiology of Hepatitis B and Hepatitis C Virus among Beta-Thalassemia Major Patients in Pakistan

A Systematic Review of Transfusion Transmissible Infections Among Blood Donors and Associated Safety Challenges in Pakistan

Molecular and genetic characterization of hepatitis B virus among multitransfused thalassaemia patients in Islamabad, Pakistan

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