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Infectious disease markers in blood donors in northern Thailand
Y Mundee1, N Kamtorn, S Chaiyaphruk
1Blood Bank, Faculty of Medicine, Maharaj Nakorn Chiang Mai Hospital, Thailand.
Insights
Excluding paid blood donors and implementing p24 antigen testing significantly improved blood safety in Thailand. These strategies are crucial for reducing human immunodeficiency virus type 1 (HIV-1) transmission in blood transfusions.
Area of Science:
- Public Health
- Infectious Diseases
- Blood Transfusion Safety
Background:
- A significant human immunodeficiency virus type 1 (HIV-1) epidemic, primarily heterosexual, emerged in Thailand in 1988, with northern Thailand being most affected.
- Blood banks in Chiang Mai initiated HIV-1 antibody screening in February 1988 and p24 antigen testing in April 1992.
Purpose of the Study:
- To analyze trends in HIV-1 antibody prevalence among different donor types (paid, replacement, voluntary) from 1988 to 1993.
- To evaluate the prevalence of HIV-1 p24 antigen and other infectious agents (syphilis, Hepatitis B, Hepatitis C) in blood donors in Chiang Mai.
Main Methods:
- Retrospective analysis of HIV-1 antibody prevalence data by donor type (paid, replacement, voluntary) from 1988-1993.
- Prevalence assessment of HIV-1 p24 antigen, syphilis, Hepatitis B surface antigen, and Hepatitis C virus antibodies in blood donors.
Main Results:
- HIV-1 antibody prevalence rose from 0.84% in 1988 to 4.04% in 1991, peaking in paid donors.
- Following the exclusion of paid donors in 1993, HIV-1 antibody prevalence decreased to 3.34%.
- Replacement donor prevalence increased from 0.56% in 1988 to 5.82% in 1991. Seven donors (0.016%) tested p24 antigen positive but antibody negative.
Conclusions:
- Excluding paid donors and implementing p24 antigen testing are effective strategies for enhancing blood transfusion safety in northern Thailand.
- Developing and evaluating additional methods to screen high-risk donors and attract low-risk donors is essential for further improving blood safety.
Background:
A major epidemic of human immunodeficiency virus type 1 (HIV-1) infections that are primarily due to heterosexual transmission has developed in Thailand since 1988. The epidemic has been most severe in northern Thailand. The blood banks in Chiang Mai began screening donors for HIV-1 antibodies in February 1988 and for p24 antigen in April 1992.
Study Design And Methods:
The trends of HIV-1 antibody prevalence were analyzed by type of donor (i.e., paid, replacement, and voluntary) for the period of 1988 through 1993. In addition, the prevalence of HIV-1 p24 antigen and of antibodies to syphilis, hepatitis B surface antigen, and hepatitis C virus was evaluated among blood donors at Chiang Mai University Hospital and the Thai Red Cross blood banks in Chiang Mai.
Results:
The prevalence of HIV-1 antibodies increased from 0.84 percent in 1988 to 4.04 percent in 1991. Seropositivity was highest in paid professional donors. After discontinuation of the use of paid donors in 1993, HIV-1 antibody prevalence decreased to 3.34 percent. Antibody prevalence in replacement donors increased from 0.56 percent in 1988 to 5.82 percent in 1991. Among 44,446 donors tested, 7 (0.016%) were HIV-1 p24 antigen positive but antibody negative.
Conclusion:
The exclusion of paid donors and the use of p24 antigen testing are justified in northern Thailand. Additional strategies to exclude donors at very high risk and to attract those at low risk for infection should be developed and evaluated to increase blood transfusion safety in this and other, similar populations.