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[Transfusion and hepatitis C]
1Centre de Transfusion Sanguine, Hôpital Saint-Antoine, France.
Insights
Hepatitis C transfusion risk significantly decreased due to donor screening and testing. New hemovigilance systems help monitor and prevent residual transfusion-transmitted Hepatitis C infections.
Area of Science:
- Transfusion Medicine
- Virology
- Public Health
Background:
- Hepatitis C posed a major transfusion risk, causing over 90% of non-A, non-B hepatitis and infecting thousands of recipients annually in France.
- Blood transfusion recipients, especially surgical and multitransfused patients, faced significant Hepatitis C exposure risks prior to the 1990s.
Purpose of the Study:
- To analyze the impact of improved donor screening and testing on reducing Hepatitis C transmission via blood transfusions.
- To evaluate the effectiveness of implemented measures and identify remaining risks in transfusion medicine.
Main Methods:
- Sequential introduction of surrogate markers (ALT, anti-core HBc) starting in 1988, followed by specific Hepatitis C virus antibody assays in 1990.
- Implementation of blood donor selection criteria and risk factor identification (intravenous drug use, previous transfusion).
- Estimation of transmission risk reduction using first and second-generation testing, and mathematical calculation for residual risk.
Main Results:
- Second-generation testing reduced Hepatitis C transmission risk by over 90%, from 1 in 1670 to 1 in 2000-6000 units transfused.
- Residual risk of transfusion-transmitted Hepatitis C is estimated at 1 in 100,000 donations, primarily due to infections in regular donors.
- The French hemovigilance system mandates notification of post-transfusion incidents to aid in residual case evaluation and prevention.
Conclusions:
- Enhanced donor screening and testing have dramatically reduced Hepatitis C transfusion risk.
- Ongoing vigilance and further research are needed to address residual risks, identify donor risk factors, and investigate potential roles of nosocomial infections and other viral agents.
Abstract:
Hepatitis C has been a major transfusionnal risk until the beginning of the 90's, since it accounted for more than 90% of non-A, non-B hepatitis, 5% to 10% of infected surgical recipients and up to 50% of multitransfused patients, alltogether 100,000 to 400,000 blood components recipients in France. The decline in incidence was based principally on sequential introduction of donor testing, starting with surrogate markers in 1988 (transaminase ALT and antibody anti-core HBc), followed since 1990 by specific assays (anti-hepatitis C virus antibodies) and on blood donor selection. Two risk factors have been identified in donors, intravenous drug use and previous transfusion. The risk of transmission was estimated, after screening by first generation tests at 1 per 1670 units transfused. After second generation testing, the risk ranged from 1 in 2000 to 1 in 6000 units transfused, corresponding to a reduction of more than 90%. The estimation of the residual risk (mean: 1/100,000 donations in USA), principally due to incidence in regular donor required mathematical calculation. The new "hemovigilance" system in France with mandatory notification of all posttransfusionnal incidents and infections will contribute to evaluate and to prevent residual cases. However, further studies are necessary to precise other risk factors in donors, as well as the role of nosocomial infections in recent cases, and possibly the role of additional agents such as GB viruses in post-transfusionnal hepatitis.