Trends and epidemiological analysis of hepatitis B virus, hepatitis C virus, human immunodeficiency virus, and human T-cell lymphotropic virus among Iranian blood donors: strategies for improving blood safety

Abstract

Background Blood transfusion is associated with potential risks of transfusion-transmitted infections (TTIs). Different strategies are needed to monitor blood safety and screen the donors’ efficacy, such as evaluation of the prevalence and trends of TTIs. This study was conducted to evaluate the prevalence and trends of TTIs, including hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and human T-cell lymphotropic virus (HTLV 1/2), and the impact of the donors’ characteristics such as age, sex, and donor status on the prevalence of TTIs in blood donors in seven large provinces of Iran from 2010 to 2018. Methods This study was conducted on the data collected from all blood donations in seven Iranian Blood Transfusion Centers including Ardabil, Alborz, Guilan, West Azarbaijan, North, Razavi, and South Khorasan from April 2010 to March 2018. Demographic characteristics, number of donations, donor status, and screening and confirmatory serological results of all blood donations were collected from Iranian Blood Transfusion Organizations (IBTO) national database. The prevalence and trend of HBV, HCV, HIV, and HTLV 1/2 infections were reported according to the donation year and donor’s characteristics. Results The analysis of the prevalence and trend of TTIs in 3,622,860 blood donors showed a significant decreasing trend in first-time and regular donors. Additionally, compared to first- time donors, regular donors made safer blood donations with lower risks of HBV, HIV, HCV and HTLV 1/2 (P < 0.0001). Although the prevalence of HTLV 1/2 and HBV was higher in females, TTIs had a significant decreasing trend in males and females. Finally, it was found that the prevalence of HBV and HTLV 1/2 increased with age up to 40–49 years and then decreased thereafter. Conclusions The decreasing trends of TTIs in Iranian donors during 9 years may indicate that the various strategies implemented by IBTO have been effective in recent years. Other factors such as a decrease in the prevalence of specific TTIs in the general population might have also contributed to these declines.

Updates on the Epidemiology of the Human T-Cell Leukemia Virus Type 1 Infection in the Countries of the Eastern Mediterranean Regional Office of the World Health Organization with Special Emphasis on the Situation in Iran

“…However, over time, no change was observed in the HTLV-1 infection rate among the general population of Razavi Khorasan province [21,26,30]. Statistically significant higher rates of HTLV-1 infection were reported in Iranian females as compared to males [30][31][32]41,42,[44][45][46]51]. In that sense, a recent meta-analysis estimated a three-fold higher infection rate among female blood donors as compared to male donors (0.64%, 95% CI: 0.13-3.01% and 0.20%, 95% CI: 0.15-0.27%, respectively) [63].…”

“…Regular screening of all donated blood units for antibodies against HTLV-1/2 followed by confirmatory tests was introduced in northeastern Iran in 1995 [64] and then extended to some provinces in the north and northwest parts of the country. These tests were performed among first-time and regular blood donors, and as a result, many surveys revealed a gradual decrease in HTLV-1 prevalence among Iranian blood donors from 0.13% in 2009 to 0.03% in 2018 (Table 1) [31,32,63]. A declining trend in the infection rate among blood donors was documented in Razavi Khorasan [41,42,45,47] as well as other provinces of Iran [48,51].…”

Hepatitis delta virus infection in Turkey: A meta-analysis of prevalence

“…This population-based study [4] , comprising 5,533 screened individuals, reported a 4% HBV prevalence and a 2.8% prevalence among HBsAg-positive individuals for HDV, which is similar or slightly lower than our estimate of 3.37% in blood donors. In general, in Turkey and other neighboring countries such as Iran, the HBV prevalence data from blood donors are considered, to some extent, ambiguous because they may underestimate the HBV burden in the region because high-risk groups for HBV/HDV are rejected from blood donation without pre-transfusion HBsAg assessment [16 , 17] . Blood donation in Turkey is on a voluntary basis and assessment of high-risk groups is done through a detailed questionnaire before blood donation.…”

Lower prevalence of anti‐HTLV‐1 as expected by previous models among first‐time blood donors in Japan

“…Blood donation sessions, therefore, provide almost no opportunity for potential HTLV‐1 carriers to self‐select and avoid blood donation in relation to subjective symptoms. Surveys of HTLV‐1 seroprevalence targeting a large number of blood donors have thus been conducted around the world 15–18 . However, it has been well recognized that blood donors in almost all countries of the world are not always representative of the general population of that country, particularly with respect to bloodborne viruses (“healthy donor effect”) 19,20 .…”

“…Surveys of HTLV-1 seroprevalence targeting a large number of blood donors have thus been conducted around the world. [15][16][17][18] However, it has been well recognized that blood donors in almost all countries of the world are not always representative of the general population of that country, particularly with respect to bloodborne viruses ("healthy donor effect"). 19,20 A survey of a hospital-based population in Nagasaki prefecture in Japan, which is endemic for HTLV-1, yielded a 50% higher prevalence than that reported from blood donor screening.…”