Genetic diversity and occult hepatitis B infection in Africa: A comprehensive review

BACKGROUND Occult hepatitis B infection(OBI)is a globally prevalent infection,with its frequency being influenced by the prevalence of hepatitis B virus(HBV)infection in a particular geographic region,including Africa.OBI can be transmitted th-rough blood transfusions and organ transplants and has been linked to the development of hepatocellular carcinoma(HCC).The associated HBV genotype influences the infection.AIM To highlight the genetic diversity and prevalence of OBI in Africa.METHODS This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and involved a comprehensive search on PubMed,Google Scholar,Science Direct,and African Journals Online for published studies on the prevalence and genetic diversity of OBI in Africa.RESULTS The synthesis included 83 articles,revealing that the prevalence of OBI varied between countries and population groups,with the highest prevalence being 90.9%in patients with hepatitis C virus infection and 38%in blood donors,indicating an increased risk of HBV transmission through blood transfusions.Cases of OBI reactivation have been reported following chemotherapy.Genotype D is the predominant,followed by genotypes A and E.CONCLUSION This review highlights the prevalence of OBI in Africa,which varies across countries and population groups.The study also demonstrates that genotype D is the most prevalent.

The prevalence of transfusion transmitted virus infection in blood donors

INIRODUCIIONA newly discovered DNA virus,transfusiontransmitted virus (TTV),was reported as a cause ofpost-transfusion hepatitis of unknown etiology inJapan.In order to investigate TTV prevalence insouthern China,a study was carried out amongblood donors,patients with liver diseases andhemodialysis to determine the epidemiologicalcharateristics.

TT viral infection through blood transfusion:retrospective investigation on patients in a prospective study of post-transfusion hepatitis

AIM To investigate the role of bloodtransfusion in TT viral infection(TTV).METHODS We retrospectively studied serumsamples from 192 transfusion recipients whounderwent cardiovascular surgery and bloodtransfusion between July 1991 and June 1992.Allpatients had a follow-up every other week for atleast 6 months after transfusion.Eightyrecipients received blood before screeningdonors for hepatitis C antibody(anti-HCV),and112 recipients received screened blood.Recipients with alanine aminotransferase level】2.5 times the upper normal limit were testedfor serological markers for viral hepatitis A,B,C,G,Epstein-Barr virus and cytomegalovirus.TTV infection was defined by the positivity forserum TTV DNA using the polymerase chainreaction method.RESULTS Eleven and three patients,whoreceived anti-HCV unscreened and screened'blood,respectively,had serum ALT levels】90 IU/L.Five patients(HCV and TTV:1;HCV,HGV,and TTV:1;TTV:2;and CMV and TTV:1)were positive for TTV DNA,and four of them hadsero-conversion of TTV DNA.CONCLUSION TTV can be transmitted viablood transfusion.Two recipients infected byTTV alone may be associated with the hepatitis.However,whether TTV was the causal agentremains unsettled,and further studies arenecessary to define the role of TTV infection inchronic hepatitis.

Occult hepatitis B virus infection and blood transfusion

Transfusion-transmitted infections including hepatitis B virus(HBV) have been a major concern in transfusion medicine. Implementation of HBV nucleic acid testing(NAT) has revealed occult HBV infection(OBI) in blood donors. In the mid-1980 s, hepatitis B core antibody(HBc) testing was introduced to screen blood donors in HBV non-endemic countries to prevent transmission of non-A and non-B hepatitis. That test remains in use for preventing of potential transmission of HBV from hepatitis B surface antigen(HBs Ag)-negative blood donors, even though anti-hepatitis C virus testshave been introduced. Studies of anti-HBc-positive donors have revealed an HBV DNA positivity rate of 0%-15%. As of 2012, 30 countries have implemented HBV NAT. The prevalence of OBI in blood donors was estimated to be 8.55 per 1 million donations, according to a 2008 international survey. OBI is transmissible by blood transfusion. The clinical outcome of occult HBV transmission primarily depends on recipient immune status and the number of HBV DNA copies present in the blood products. The presence of donor anti-HBs reduces the risk of HBV infection by approximately five-fold. The risk of HBV transmission may be lower in endemic areas than in non-endemic areas, because most recipients have already been exposed to HBV. Blood safety for HBV, including OBI, has substantially improved, but the possibility for OBI transmission remains.

Clinical Characteristics of Transmitted Transfusion Virus Infection in Children

Clinical characteristics of transmitted transfusion virus (TTV) infection and its pathogenicity in children were evaluated. Serum TTV DNA from 118 children (mean age : 7.8±2 8 years) was detected by nested PCR. The product of PCR was cloned and sequenced. The positive rate for serum TTV DNA in 20 healthy children, 9 cases of acute hepatitis, 51 cases of chronic hepatitis, 24 cases of nephritis or nephrotic syndrome and 14 cases of hypoplastic anemia or acute leukemia was 20 %, 11 %, 29 %, 42 % and 21 % respectively, but there was no significant difference in TTV DNA frequency among them ( P >0.05). Of the 16 patients receiving immunosuppressive agent for a long time, 7 (44 %) were positive for TTV DNA, and of the 17 cases not receiving immunosuppressive agent, 5 (29 %) were positive with the difference being not significant ( P >0.05). Essential characteristics were pathogen carrier or asymtomatic infection in children with TTV infection. Long term employment of immunosuppressive agent did not increase the incidence in TTV infection. There was still high prevalence in TTV infection in healthy children not receiving blood product, suggesting the possibility of non hematogenous transmitted transfusion in TTV transmission.

Safety of Blood Maintained in Zimbabwe: Low Transfusion Transmissible Infections among Blood Donors

Background: Low level of transfusion transmissible infections (TTIs) is an indicator of a well-performing blood donor program. Aim: The study was designed to estimate the prevalence of TTIs and to evaluate the demographic characteristics of reactive and non-reactive blood donors in Zimbabwe in 2018. Methods: A cross-sectional study was conducted using routinely available data from January to December 2018 in five branches of National Blood Service Zimbabwe (NBSZ). After initial screening for high-risk behavior with a questionnaire, weight, blood pressure and hemoglobin level, eligible donors were invited for blood donation. The following laboratory tests for TTIs were done: antibodies and antigen tests for human immunodeficiency virus 1 and 2 (HIV 1/2), tests for the surface antigen of hepatitis B virus (HBV), testing for hepatitis C virus (HCV) antibody and antibodies for treponema pallidum. Information on age, gender, NBSZ branch, marital status, occupation, donor type (first time/repeat) and TTIs test results were extracted from the NBSZ electronic database (e-Delphyn blood bank software). Results: Out of a sample of 1586 blood donors, thirteen (0.81%) were reactive to at least one TTI marker;five (0.32%) were reactive for human immunodeficiency virus, seven (0.44%) for hepatitis B and one (0.06%) for syphilis. There were no samples with co-infection and hepatitis C virus markers. The prevalence of TTIs was highest in the 31 - 45 years age group (2.3%) and among first-time blood donors (4.7%). The prevalence of all TTI was low with the highest prevalence of 0.44% for the hepatitis B virus. Conclusion: Continued concerted efforts will help to maintain satisfactory blood safety in Zimbabwe.

Levels, Trends and Inter-Regional Variations in Transfusion Transmissible Infection Positivity among Blood Donors in India: Evidence from India’s National HIV Program

In India, transfusion transmissible infections (TTIs) are monitored for trends at the blood bank level, but limited efforts have been made to analyze data from a large number of blood banks and present it at the national, regional and state levels. The Computerized Management Information System (CMIS), National AIDS Control Organization’s (NACO) online data capturing system, systematically collects information on TTIs in a monthly aggregated format from blood banks across the country. This information is being captured in NACO’s annual reports, but a systematic scientific analysis and publication of the same have not been attempted so far. Hence, the objective of this study is to analyze and report TTIs among blood donors in India at three different levels—national, regional and state—from 497 consistent blood banks reporting through CMIS during 2008-2012. National level analysis shows an increasing trend in voluntary blood donation from 9.28 lakh to 19.02 lakh, and a decreasing trend in TTIs, with female donors constituting only 6% of the entire pool of donors. Of the five TTIs studied, in 2012 Hepatitis-B-surface Antigen (HBsAg) positivity was highest (0.9%), followed by Hepatitis C Virus (HCV) (0.45%), syphilis (0.23%), HIV (0.17%) and malaria (0.03%). Regional analysis indicated that voluntary donation was high in the Eastern and Western regions, with 11% of female donors in Eastern India in 2012. All the TTIs showed a declining trend, except HCV, which showed a rising trend in the Eastern and Southern regions. The level of positivity for all the five TTIs was higher than the national average in the Eastern region. Among the TTIs, HIV positivity among voluntary donors was below the national average, while in Mizoram both HBsAg and HCV of more than 1% seropositivity and VDRL of 1.7% in Arunachal Pradesh had been reported. Malaria has the lowest national positivity, with Nagaland reporting a high positivity of 0.4%. Although the national and regional trends in TTI positivity are declining, regional level variations in TTIs, especially in hepatitis, suggest the importance of advocating for pre-donation counseling and educating donors on self-exclusion.

Advances in research on influencing factors of hepatitis B virus infection caused by blood transfusions

As one of the main factors affecting safe blood transfusion, hepatitis B virus(HBV) infection through blood transfer seriously endangers human health. Therefore, studies should focus on both reducing infection rate of HBV and accurately evaluating the risk of infection. This study discusses the main factors affecting HBV infection that results from blood transfusions, with the aim of gaining insights into reducing HBV infection.

A 10 Years Comparative Study to Assess Trends in Seroprevalence of Transfusion Transmitted Infections among Blood Donors at Gwalior, India

Introduction: Transfusion Transmitted Infections (TTIs) threaten safety of the recipients and the community as a whole and are the subject of real concern worldwide. Aims and Objectives: To know the prevalence of transfusion transmitted infections amongst the blood donors, to evaluate the changing trends of TTIs and to compare these observations within the study as well as with the other relevant studies. Place and Duration of Study: This study was carried out at Blood Bank, Department of Pathology, Gajra Raja Medical College, Gwalior, India, from January 2004 to December 2013 (ten years). Materials and Methods: In this study 122,006 voluntary and replacement donations were screened for TTIs;HIV, HBV, HCV, Syphilis, Malaria and their seroprevalence was calculated. Further study was divided in Group “A” (from 2004 to 2008) and Group “B” (from 2009 to 2013) to compare the results. Results: Out of total 122,006 blood units collected, 79,750 (65.3%) were voluntary and 42,256 (34.7%) were replacement donors. The seropositivity of TTIs in the entire study, in group “A” and in Group “B” was 3.26% (3985/122,006) (p = 0.000005), 2.25% (1238/54,874) (p = 0.000005) and 4.09% (2747/67,123) (p = 0.000005) respectively. In Group “A” and “B” seroprevalence of HIV, HBV, HCV, Syphilis and Malaria was 0.29%, 1.16%, 0.61%, 0.06%, 0.11% and 0.13%, 3.15%, 0.24%, 0.17%, 0.03% respectively. Conclusion: Our study concluded that there was significant increase in seroprevalence of HBV and syphilis whereas decreasing pattern in HIV, HCV and Malaria was observed in last five years as compared to previous five years among the blood donors.

Transfusion-transmitted virus co-infection in other types of hepatitis and its genotypes

OBJECTIVE: To identify the influence of transfusion transmitted virus (TTV) co-infection in other virus infected patients and its genotypes. METHODS: A conservative sequence of ORFl in the TTV genome was selected as primers and TTV DNA was measured in students and other hepatitis patients by using microplate nucleic acid hybridization and ELISA. The results were statistically analyzed. Nucleotide sequence of divergence >50% was used as color probe for distinguishing TTV genotypesⅠorⅡ. RESULTS: TTV DNA was detected in the sera from 2 (3.3%) of 60 students, 2 (14.3%) of 14 patients with non A-non E hepatitis, 6 (12%) of 50 patients with chronic hepatitis B, and 4 (16%) of 25 patients with liver cirrhosis, respectively. Statistical difference was observed between the patient group and the student group (P<0.05), but no significant difference in age, gender, serum ALT levels and TBiL between TTV DNA positive and negative patients (P>0.05). TTV genotype Type Ⅰ was by far the most frequent viral genotype (66.7%), followed by type Ⅱ (25%), and mixed infection (8.3%). CONCLUSIONS: These results suggest that the routes of TTV infection may be similar to those of HBV and HCV, and concurrent infection with HBV, HCV are common. TTV co-infection could not affect the clinical features of patients with liver diseases and the pathological process. TTV is not a main causative factor for patients with non A-non E hepatitis. Further study is needed to clarify the role of TTV in patients with non A-non E hepatitis.

Follow-up study of hepatitis C virus infection in uremic patients on maintenance hemodialysis for 30 months

INTRODUCTIONA high prevalence of antibodies to hepatitis C virus(HCV)(range from 3.3%-80%)has beenreported in hemodialysis(HD)patients,andworrisome as it often becomes chronic and induceschronic liver disease,therefore thenephrologists face a major challenge of how toprevent it.The main route of HCV transmission

High frequencies of HGV and TTV infections in blood donors in Hangzhou

ALM To determine the frequencies of HGV and TTVinfections in blood donors in Hangzhou.METHODS RT-nested PCR for HGV RNA detection and semi-nested PCR for TTV DNA detection in the sera from 203 blood donors, and nucleotide sequence analysis were performed.``RESULTS Thirty-two ( 15.8%) and 30 (14.8%) of the 203serum samples were positive for HGV RNA and TTV DNA,respectively. And 5 (2.5%) of the 203 serum samples were detectable for both HGV RNA and TTV DNA.Homology of the nucleotide sequences of HGV RT-nested PCR products and TTV semi-nested PCR products from 3serum samples compared with the reported HGV and TTV sequences was 89.36%. 87.94%, 88.65% and 63.51%.65.77% and 67.12%. respectively.``CONCLUSION The infection rates of HGV and/or TTV inblood donors are relatively high. and to establish HGV and TTV examinations to screen blood donors is needed for transfusion security. The genomic heterogeneity of TTV or HGV is present in the isolates from different areas.

Prospective study of mono-strand DNA virus(TTV) transmission byblood transfusion

Objective: To investigate the prevalence of transfusion transmitted virus (TTV) in blood donors, bloodrecipients and the incidence of TTV transmission by blood transfusion. Methods: TTV DNA and serum of hepatitis B virus (HBV), hepatitis C virus (HCV) in 130 blood recipients were detected, and TTV in their 340 corresponding blood donors was also detected. Results: There were 10. 6% (36/340) donors infected TTV, and thesame conditions in 8. 5 % (11/130) blood recipients before trans fusion. Eighteen cases (15. 1% ) were found to beTTV-positive after transfusion in the 119 blood recipients without TTV before, at least one of the correspondingdonors was found to be TTV-positive. There were 46 cases of post-transfusion hepatitis virus infection, 45 ofthem with HCV infection (including 7 cases co-infected with TTV) and two with HBV infection (including one coinfected with .HCV and one co-infected with TTV). The recipient with TTV and HBV co-infection and 3 of the 7cases with TTV and HCV infection had a ALT levels higher than 90 U/L, but only 2 cases of the 1O isolated TTVinfection had a mild ALT elevation. Conclusion: The result showed that prevalence of TTV was rather high inblood donors and hospitalized patients, and isolated TTV infection seems not related with significant ALT elevation.

TT virus and hepatitis G virus infections in Korean blood donors and patients with chronic liver disease

AIM: To determine the prevalences of TTV and HGV infections among blood donors and patients with chronic liver disease in Korea, to investigate the association of TTV and HGV infections with blood transfusion, and to assess the correlation between TTV and HGV viremia and hepatic damage.METHODS: A total of 391 serum samples were examined in this study. Samples were obtained from healthy blood donors (n= 110), hepatitis B surface antigen (HBsAg)-positive donors (n=112), anti-hepatitis C virus (anti-HCV)-positive donors (n=69), patients with type B chronic liver disease (n=81), and patients with type C chronic liver disease (n= 19).TTV DNA was detected using the hemi-nested PCR. HGV RNA was tested using RT-PCR. A history of blood transfusion and serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were also determined.RESULTS: TTV DNA was detected in 8.2 % of healthy blood donors, 16.1% of HBsAg-positive donors, 20.3 % of antiHCV-positive donors, 21.0 % of patients with type B chronic liver disease, and 21.1% of patients with type C chronic liver disease. HGV RNA was detected in 1.8 % of healthy blood donors, 1.8 % of HBsAg-positive donors, 17.4 % of anti-HCV-positive donors, 13.6% of patients with type B chronic liver disease, and 10.5% of patients with type C chronic liver disease. The prevalence of TTV and HGV infections in HBV- or HCV-positive donors and patients was significantly higher than in healthy blood donors (P＜0.05),except for the detection rate of HGV in HBsAg-positive donors which was the same as for healthy donors. There was a history of transfusion in 66.7% of TTV DNA-positive patients and 76.9% of HGV RNA-positive patients (P＜0.05). No significant increase in serum ALT and AST was detected in the TTV- or HGV-positive donors and patients.CONCLUSION: TTV and HGV infections are more frequently found in donors and patients infected with HBV or HCV than in healthy blood donors. However, there is no significant association between TTV or HGV infections and liver injury.

超早产儿获得性巨细胞病毒感染的临床检测及分析

目的探讨获得性巨细胞病毒感染在超早产儿中的临床应用价值。方法回顾性分析本院新生儿科2023年7月1日至9月15日送检的1072例新生儿血清样本的巨细胞病毒相关抗体检测结果。结果1072例样本中有2例患儿确诊获得性巨细胞病毒感染。该2例患儿均为超早产儿(胎龄24~27+6周)、超低出生体重儿(750~999 g),均以血小板降低为首发表现,1例为输血获得性巨细胞病毒感染,另1例为母乳获得性巨细胞病毒感染。结论在超早产儿这类特殊人群中,输血治疗时需警惕输血获得性巨细胞病毒感染,同时也要谨防母乳获得性巨细胞病毒感染,必要时经巴氏消毒后再喂养。

外科手术患者术后切口感染的危险因素分析

目的分析外科手术患者术后切口感染的危险因素。方法回顾性分析2022年1月至2022年12月于九江市第一人民医院进行外科手术治疗的256例患者的临床资料,所有入选者均进行相应的手术治疗,根据术后切口感染发生情况分组,比较两组相关资料,分析外科发生切口感染的相关因素。结果256例患者中,有20例发生切口感染,术后切口感染发生率为7.81%(20/256)。单因素分析结果显示,感染组年龄>60岁、合并糖尿病、术前贫血、手术时间≥3 h、急诊手术、围手术期输血占比均高于未感染组,差异有统计学意义(P<0.05)。logistic回归分析结果显示,年龄>60岁(OR=6.316,95%CI=2.214~18.018,P=0.001)、合并糖尿病(OR=4.787,95%CI=1.877~12.209,P=0.001)、术前贫血(OR=4.756,95%CI=1.860~12.163,P=0.001)、手术时间≥3 h(OR=6.367,95%CI=2.458~16.491,P<0.001)、急诊手术(OR=6.574,95%CI=2.547~16.968,P<0.001)、围手术期输血(OR=5.441,95%CI=2.111~14.024,P<0.001)是外科手术患者术后切口感染的独立危险因素(P<0.05,OR>1)。结论手术为重要的治疗方法,但因本身具有创伤性,术后切口感染发生率较高,对于年龄>60岁、合并糖尿病、术前贫血、手术时间≥3 h、急诊手术、围手术期输血的患者,需重点管理,尽可能降低切口感染发生率。

创伤输血后感染患者血清T淋巴细胞表达情况及危险因素分析

目的 分析创伤输血后感染患者血清T淋巴细胞变化情况及其是否与患者发生感染有关,并分析患者感染的危险因素,以期为患者感染预防及是否需要进行免疫监测提供参考。方法 纳入2019年1月至2023年5月青海省第五人民医院收治的创伤输血病例126例,检测患者输血前后血清T淋巴细胞水平,根据患者是否发生感染分组为感染组(43例)、未感染组(83例),比较两组血清T淋巴细胞水平,并收集患者年龄、性别、创伤类型、是否使用免疫抑制剂、红细胞保存时间等一般资料进行单因素分析,将其中有统计学意义的资料纳入多因素Logistic回归分析模型完成创伤输血后感染的危险因素分析。结果 输血后患者CD3^(+)T淋巴细胞、CD4^(+)T淋巴细胞、CD4^(+)/CD8^(+)水平显著降低,CD8^(+)T淋巴细胞显著升高(P<0.05);感染组患者CD3^(+)T淋巴细胞、CD4^(+)T淋巴细胞、CD4^(+)/CD8^(+)水平显著低于未感染组,CD8^(+)T淋巴细胞水平显著高于未感染组(P<0.05);一般资料的单因素分析中感染组患者多发伤、使用免疫抑制剂、接受消化道脱污染治疗、平均红细胞保存时间≥14d、红细胞输入总单位数≥7个占比显著高于未感染组(P< 0.05),其余吸烟、酗酒、年龄、性别、平均血小板保存时间、是否合并糖尿病、血小板输入总单位数等资料无显著差异(P>0.05);多因素Logistic回归分析提示CD8^(+)T淋巴细胞升高、多发伤、使用免疫抑制剂、接受消化道脱污染治疗、平均红细胞保存时间≥14d、红细胞输入总单位数≥7个是创伤输血患者感染的独立危险因素,CD3^(+)T淋巴细胞、CD4^(+)T淋巴细胞、CD4^(+)/CD8^(+)增加为保护因素。结论 创伤输血后易对患者免疫功能产生影响,创伤输血后感染患者较未感染患者T淋巴细胞亚群紊乱现象更明显,创伤输血患者需重视其免疫监测,预防感染。

国内外血液安全监测报告若干数据指标的比较与分析

目的通过对国内外血液安全监测(haemovigilance,HV)报告中若干指标性数据进行比较分析,阐述各HV系统的特点和当前血液安全基本状况,探讨国内HV工作的发展方向。方法国际HV报告来自英国、法国、荷兰、德国、日本、澳大利亚和美国等HV系统的2020年度报告,国内HV报告来自中国输血协会血液安全监测专业委员会发布的2020年度血液安全监测报告。从上述HV报告中选择若干指标型数据予以分析,包括献血不良反应、输血不良反应、输血传播感染、输血相关死亡和输血相关肺部并发症。结果各国献血不良反应发生率最低为0.0022%(英国),最高为3.2550%(澳大利亚);输血不良反应发生率最低为0.0141%(德国),最高为0.3580%(法国);输血传播感染发生率最低为百万分之0.72(英国),最高为百万分之14.33(澳大利亚);输血相关死亡发生率最低为百万分之0.77(澳大利亚),最高为百万分之11.47(英国)。结论在已建立了成熟有效的HV系统的国家或地区,输血是高度安全的。各HV系统监测范围和判定标准的不同使得相关数据呈现极大差异。相较于国际HV系统,国内HV数据尚不全面,较复杂输血不良反应如肺部并发症的报告不足。

新型布尼亚病毒感染伴血小板减少综合征患者的急救护理

总结1例新型布尼亚病毒感染致发热伴血小板减少综合征患者的急救护理体会。护理要点:针对患者致病原因不明,护士详细追溯病史;确诊可疑病原体,迅速完善病毒学检查;紧急输注血小板、出血并发症的预防和监测;切断一切可能传播途径,采取综合措施预防交叉感染。经过21 h急诊多学科的紧急救治和精准护理,患者顺利转入重症监护室继续治疗,后期转院康复。