Seroprevalence of HAV and Mandatory Markers of Transfusion- Transmitted Infections in Blood Donors from Chiapas, Mexico: an Exploratory Study

Special Article: Blood Transfusion

J Blood Disord. 2023; 10(1): 1073.

Seroprevalence of HAV and Mandatory Markers of Transfusion- Transmitted Infections in Blood Donors from Chiapas, Mexico: an Exploratory Study

Dimas-González J1,2; Jean J3; Lagunas-Martínez A2; Díaz-del Monte G1; Gómez-González SM1; Becerril-Arenas J4; Arroyo-Pérez JA1#; Trejo-Gómora JE5#*

1Centro Nacional de la Transfusión Sanguínea, Dirección Técnica y de Investigación. Ciudad de México, México

2Instituto Nacional de Salud Pública, Centro de Investigación Sobre Enfermedades Infecciosas. Cuernavaca Morelos, México

3Instituto Nacional de Salud Pública, Centro de Investigación en Nutrición y Salud. Cuernavaca Morelos, México

4Grupo Ruvel, S.A. de C.V. Ciudad de México, México

5Centro Nacional de la Transfusión Sanguínea, Dirección General. Ciudad de México, México

*Corresponding author: Jorge Enrique Trejo-Gómor Centro Nacional de la Transfusión Sanguínea, Dirección General. Av. Othón de Mendizábal Oriente 555, Nueva Industrial Vallejo, Gustavo A. Madero, C.P. 07700, Ciudad de México, México. Tel: +52 55 6392 2250 Email: jorge.trejo@salud.gob.mx

#These authors contributed equally to this article.

Received: April 26, 2023 Accepted: May 26, 2023 Published: June 02, 2023

Abstract

Introduction: Blood transfusion saves millions of lives annually. However, blood transfusion is one of the leading risk factors for Transfusion-Transmitted Infections (TTIs). Therefore, the objective of this study was to explore the seroprevalence of both HAV and mandatory markers of TTIs in blood donors from Chiapas, Mexico.

Materials and Methods: The study included 3,067 blood donors from the Dr. Domingo Chanona Rodríguez Blood Bank located in Tuxtla Gutiérrez, Chiapas, and from 9 collection centers located in different regions of Chiapas. Screening was performed using Enzyme immunoassay (anti-HAV IgM) or Chemiluminescent microparticle immunoassay (HBV HBsAg, anti-HCV IgG/IgM, HIV Ag/Ab, anti-T. pallidum IgG/IgM, and anti-T. cruzi IgG).

Results: The seroprevalence of T. pallidum was the highest at 1.3%, followed by the seroprevalence of HAV and T. cruzi, both with 0.7%. Regions X and XV of the state of Chiapas presented the six markers of the analyzed TTIs. Blood donors at risk of being TTI reactive donated in regions IX and X. However, donors with qualified and unqualified employment and those who have donated more than 2 times are considered protective factors against TTIs.

Conclusion: We observed a high seroprevalence of HAV in this exploratory study. It is indispensable to increase the sample size of blood donors from the state of Chiapas because HAV is endemic to Mexico and it is probably transmitted through blood transfusion. Also, it is necessary to augment voluntary non-remunerated blood donations in the state of Chiapas, mainly in the Southern border regions, to decrease the risk of TTIs.

Keywords: Seroprevalence; HAV; Blood donors; Transfusion-transmitted infections

Abbreviations TTIs: Transfusion-Transmitted Infections; USA: United States of America; HAV: Hepatitis A Virus; HBV: Hepatitis B Virus; HCV: Hepatitis C Virus; HIV: Human Immunodeficiency Virus; T. pallidum: Treponema pallidum; T. cruzi: Trypanosoma cruzi; WHO: World Health Organization; CNTS: Centro Nacional de la Transfusión Sanguínea; CI: Confidence intervals

Introduction

Blood transfusion is essential for patient care and sometimes the only alternative for survival. When used correctly, it helps save millions of lives every year. Nevertheless, there is a risk of Transfusion-Transmitted Infections (TTIs) [1]. The risk of TTIs depends on several factors, such as local epidemiology, migration, and endemicity [2].

The World Health Organization (WHO) established mandatory screening of all donated blood for the following agents: HIV, HBV, HCV, and T. pallidum. Additionally, endemic agents of each area must be included [3]. According to regulations established in Mexico, screening tests must be carried out for HIV, HBV, HCV, T. pallidum, and T. cruzi [4]. HAV screening is not a mandatory marker in blood banks; nevertheless, it is the most common viral hepatitis worldwide. In Mexico, the prevalence is 69.3 to 79% in the general population [5-7]. In blood donors from France, the United States of America (USA), and China, the HAV prevalence is low (IgM 0.02%-0.079%) [8-11]. However, in Mexico, there is no evidence in this regard.

The state of Chiapas has high levels of extreme poverty that favor limited conditions in alimentation and health [12-14]. Additionally, the Southern region of Mexico where the state of Chiapas is located has a higher HAV seroprevalence (79.8%) in the general population and low socioeconomic status (82.2%) [7]. Therefore, the objective of this study was to explore the seroprevalence of HAV, as well as to determine mandatory markers of TTIs in blood donors from Chiapas, Mexico.

Material and Methods

Blood Donors

This study included 3,067 blood donors from the Dr. Domingo Chanona Rodríguez Blood bank located in Tuxtla Gutiérrez, Chiapas, and from 9 collection centers located in different socioeconomic regions of the state of Chiapas [12] (Figure 1B), during the period from January 2021 to April 2021. Blood donors with hemolyzed samples, insufficient volume, or incomplete information were excluded.

Screening for Transfusion-Transmissible Infections (TTIs)

The screening tests were performed in the Architect i1000RS System with the Architect HBsAg Qualitative (1P97), Architect Anti-HCV (6C37), Architect HIV Ag/Ab Combo (4J27), Architect Syphilis TP (8D06), and Architect Chagas (2P25) using serum samples. HAV screening was performed with HAV IgM Plus (72491) in the EVOLIS Twin Plus System (Bio-Rad, Marnes-la- Coquette France). The screening assays calculate the results based on sample ratio (Optical density sample/Cut-off value) for HAV and S/CO (Sample relative light units/Cut-off relative light units) for the other markers of TTIs. Samples with sample ratios or S/CO values<1.00 were considered non- reactive, and those with sample ratios or S/CO values ≥1.00 were considered reactive. All TTIs- reactive blood donors were repeatedly reactive, according to the established standards by the Official Mexican Norm NOM-253-SSA1-2012 [4], including HVA-reactive donors. All markers of TTIs were analyzed at the Centro Nacional de la Transfusión Sanguínea (CNTS) in Mexico City.

Statical Analysis

Statistical analysis was performed using Stata v. software 13 (Stata Corporation LLC, College Station, USA). The percentage of donor characteristics was calculated; seroprevalence of markers of TTIs with 95% Confidence Intervals (CI); mean, median, 25th and 75th percentile of sample ratio and S/CO of the markers of TTIs were obtained in duplicate. Additionally, a univariate logistic regression analysis was performed with characteristics of donors and donors reactive to TTIs. P values <0.05 are considered statistically significant.

Results

Characteristics of Blood Donors

The characteristics of the blood donors were: 32 years old on average, male (80%), with middle school and high school education (50.6%), qualified employment (50.6%), blood group O (80.7%), family blood donation/replacement (92.1%), and first-time donor (19.3%). In addition, region XV collected more units of blood (24.9%) (Table 1).