Residual risk estimates of transfusion transmissible hepatitis B, hepatitis C and human immunodeficiency virus using nucleic acid testing yield/window period model in an Indian setting

Abstract

Background Estimation of residual risk (RR) is necessary to understand status of blood safety with current testing strategies and need to improve it further. These estimates from India are lacking till date. Present study was aimed to estimate RR and incident rate (IR) of transfusion transmitted infectious disease (TTIDs) in Indian setting. Study Design and Methods Blood donor demographic data, serological testing results and nucleic acid testing (NAT) screening results were collected retrospectively from January 2015 to June 2017. Mathematical modelling using NAT yield/window period model was done to estimate IR and RR of TTIDs. Data was compared between different groups based on age‐group, gender, donation repeatability and type of donor. Results A total 106 119 blood donors donated 109 441 units with overall TTID reactivity of 2.22%. HBV was most prevalent TTID (1.26%) with RR of 16.1 per million followed by HCV and HIV with RR of 4.4 and 3.1 per million donations, respectively. NAT testing variably reduced RR ranging from 69.4% to 96.1% depending on TTID. Younger, repeat and voluntary donors had significantly lower prevalence of TTIDs compared to older, first time and replacement donors. Discussion Gaps in the blood safety could be bridged significantly by implementing NAT testing and using quality serological assays. Comparatively high RR despite using quality serological assays and ID‐NAT testing highlights need to develop long term strategies to improve blood safety by focusing on improving donor pool by recruiting regular voluntary donors among youth and imparting knowledge of healthy practices.

Effectiveness of Using Nucleic Acid Amplification Test to Screen Blood Donors for Hepatitis B, Hepatitis C, and HIV: A Tertiary Care Hospital Experience From Pakistan

“…The results are comparable to a local study by Moiz et al in which the RR of HBV transmission was 1 in 10,900 donors, and for HCV, it was 1 in 13,900 donors [ 6 ]. These rates are relatively higher in India, as shown by Pandey et al in a recently published study; they found RR with NAT of 16.1 per million donors and 4.4 per million donors for HBV and HCV, respectively [ 13 ]. Studies from western countries like US and Canada show that the RR of transmission of HCV and HIV is lower than that of HBV [ 14 , 15 ].…”

“…A recent China study reported that NAT yields were 1062.90 per million and 0.97 per million for HBV and HCV, respectively [ 23 ]. Another study from India also showed 74 HBV, 12 HCV, and 1 HIV NAT positive cases in 1033,22 first-time donors tested [ 13 ]. A detailed comparison of NAT yield reported in different studies is shown in Table 5 .…”

“…However, the HIV NAT yield in neighboring countries is higher than in Pakistan. India reported an HIV NAT yield of 1 in 1250 donors [ 13 ], whereas China reported 1.45 per million donors [ 23 ]. Western countries like the US (0.43 per million) [ 10 ], Italy (1.8 per million), and Germany (0.43 per million) [ 28 , 29 ] also have a high HIV prevalence and NAT yield.…”