Seroprevalencia de infecciones hemotransmisibles en donantes de sangre / Seroprevalence of transmissible infections in blood donors

Introducción. La seguridad transfusional es el objetivo primordial de los bancos de sangre, sin embargo, conlleva un alto riesgo de eventos adversos como son las infecciones transmisibles por transfusión (ITT). El conocimiento de la prevalencia de estas infecciones fue de particular interés en esta investigación, donde se determinó su frecuencia, coinfección y relación con el tipo de donantes admitidos. Metodología. Estudio observacional retrospectivo de 2017 y 2018, en el que se incluyeron todos los registros de donantes de sangre que contenían datos demográficos y resultados de los marcadores obligatorios en el país (Ecuador), tanto de pruebas serológicas como moleculares. Se obtuvo el permiso del custodio de la información y del subcomité de bioética de investigaciones en seres humanos. Para el análisis de los datos se utilizó estadística descriptiva e inferencial. Resultados. Se determinó una prevalencia del 3,18 % de resultados reactivos para una o más ITT, el rango de edad más prevalente fue de 29 a 40 años, el 89,8 % fueron donantes compensatorios, y de ellos el 90 % fueron reactivos para una o más ITT. El marcador serológico más prevalente fue el anti-core del virus de la hepatitis B (anti-HBc), seguido por el de sífilis y los anticuerpos contra el virus de la hepatitis C (VHC). La coinfección más prevalente fue con sífilis y hepatitis B. Se encontró una diferencia estadísticamente significativa entre los resultados obtenidos en las pruebas serológicas y las moleculares (x2=26,9; p=0,000). Conclusión. Las ITT en los bancos de sangre son un riesgo latente, por lo que es necesario conocer las variaciones epidemiológicas que existen en cada población. El conocimiento de la prevalencia de las ITT en donantes de sangre permite establecer nuevas estrategias de selección del donante, que garanticen la mejor seguridad posible en las transfusiones, además debe verificarse siempre la metodología utilizada y hacer monitoreo permanente del sistema de calidad establecido

Introduction. Transfusion safety is the primary objective of blood banks, however one of the adverse reactions to blood transfusion are the transfusion transmissible infections (TTIs). Knowledge of the prevalence of these infections was of particular interest in this study where we determined their frequency, co-infection and relationship with the type of donors admitted. Methodology. Retrospective observational study during 2017 and 2018, in which all blood donor records containing demographic data and results of the country's (Ecuador) mandatory serological markers of both serological and molecular tests were included. Permission was obtained from the data custodian and the Human Research Bioethics Subcommittee. Descriptive and inferential statistics were used for data analysis. Results. A prevalence of 3,18% of reactive results to one or more TTIs was determined, the most prevalent age range was 29 to 40 years, 89.8% were compensatory donors and 90% of them were reactive to one or more TTIs. The anti- core serological marker of the hepatitis B virus (anti-HBc) was the most prevalent, followed by syphilis and hepatitis C antibodies. Syphilis and hepatitis B were identified as the most prevalent coinfection. The correlation between the results obtained in the serological and molecular tests was determined to be different and statistically significant (x2=26.9; p=0.000). Conclusion. TTIs in blood banks are a latent risk, so it is necessary to know the epidemiological variations that exist in every population. Knowledge of the prevalence of TTIs in blood donors facilitates new donor selection strategies that guarantee the best possible safety in transfusions. In addition, the methodology used must always be verified and the established quality system must be permanently monitored

Evaluation of the seroprevalence of infectious diseases in 2, 445 in vitro fertilization cycles / Avaliação da soroprevalência de doenças infecciosas em 2. 445 ciclos de fertilização in vitro

Abstract Objective To evaluate the seroprevalence of positive markers for syphilis, human immunodeficiency virus (HIV) I and II, human T cell lymphotropic virus (HTLV) I and II, and hepatitis B and C among women undergoing in vitro fertilization (IVF). Methods We conducted a retrospective analysis among patients who underwent IVF, between January 2013 and February 2016, and who had complete screening records. Results We analyzed 1,008 patients who underwent IVF, amounting to 2,445 cycles. Two patients (0.2%) tested positive for HIV I and II and none for HTLV I and II. Three patients (0.3%) had positive screening for syphilis, and two (0.2%) had positive hepatitis C antibody test (anti-HCV). A positive hepatitis B virus surface antigen (HbsAg) test was observed in 4 patients (0.4%), while 47 (4.7%) patients were positive for IgG antibody to hepatitis B core antigen (anti-HbC IgG), and only 1 (0.1%) was positive for IgM antibody to hepatitis B core antigen (anti-HbC IgM). The anti-HbS test was negative in 659 patients (65.3%). Only 34.7% of the patients had immunity against the Hepatitis B virus. Patients with an anti-HbS negative result were older than those with a hepatitis B test (anti-HbS) positive result (36.3 versus 34.9; p<0.001). Conclusion The present study showed lower infection rates than the Brazilian ones for the diseases studied in patients undergoing IVF. Only a few patients were immunized against hepatitis B.

Resumo Objetivo Avaliar a soroprevalência de marcadores positivos para sífilis, vírus da imunodeficiência humana (HIV) I e II, vírus linfotrópicos de células T humanas (HTLV) I e II e hepatite B e C em mulheres submetidas a fertilização in vitro (FIV). Métodos Realizamos uma análise retrospectiva entre as pacientes submetidas a FIV, entre janeiro de 2013 e fevereiro de 2016, e que possuíam prontuários completos. Resultados Foram analisadas 1.008 pacientes submetidas a FIV, totalizando 2,445 ciclos. Duas pacientes (0,2%) apresentaram resultado positivo para HIV I e II, e nenhuma para HTLV I e II. Três pacientes (0,3%) apresentaram triagem positiva para sífilis, e duas (0,2%) apresentaram teste de pesquisa de anticorpos anti-HCV (anti-HCV) positivo. Um teste de antígeno de superfície do vírus da hepatite B (HbsAg) positivo foi observado em 4 pacientes (0,4%), enquanto 47 (4,7%) pacientes foram positivas para anticorpos IgG contra o antígeno de superfície da hepatite B (IgG anti-HbC), e apenas 1 (0,1%) foi positiva para anticorpos IgM contra o antígeno central da hepatite B (IgM anti-HbC). O teste de anticorpos contra hepatite B (anti-HbS) foi negativo em 659 pacientes (65,3%). Apenas 34,7% das pacientes tinham imunidade contra o vírus da hepatite B. Pacientes comresultado negativo anti-HbS erammais velhas do que aquelas com resultado positivo anti-HbS (36,3 versus 34,9; p<0,001). Conclusão Este estudo mostrou taxas de infecção inferiores às taxas brasileiras para as doenças estudadas em pacientes submetidas à FIV. Apenas alguns pacientes foram imunizados contra a hepatite B.

Seroprevalence of transfusion-transmissible infectious diseases at a hemotherapy service located in southwest Bahia, Brazil

ABSTRACT Introduction: The serological screening of blood donors has been instituted by the Brazilian Ministry of Health and is mandatory in the research on several diseases transmissible through blood transfusion. Blood banks need to establish a screening service capable of reducing associated transfusions risks. Objective: The objective of this study was to establish the prevalence of transfusion-transmissible infection markers in donors at a hemotherapy service located in southwest Bahia, Brazil. Methods: A retrospective study was performed between 2010 and 2016. Variables, such as the characterization of donors who were suitable and unsuitable for donation (in clinical screening), stratification by gender and age group and unsuitable samples for reactive test results (in serological screening) by aspecific antibodies against hepatitis B virus (anti-HBc and HBsAg), hepatitis C virus (anti-HCV), human T-lymphotropic virus (anti-HTLV I/II), HIV virus (anti-HIV I/II), chagas disease, and syphilis markers, were evaluated. Results: Collected data showed that 3.13% of the donors were considered unsuitable for serological screening and that the prevalence of reactive test results was higher in donors aged between 30 and 39 years and in males. The means of the serological markers was 1.09% for syphilis reagents, 0.63% for anti-HIV I/II, 0.51% for anti-HBc and anti-HCV, 0.15% for HBsAg, 0.14% for HTLV I/II and 0.10% for Chagas disease. Conclusion: These results reflect the importance of awareness campaigns on sexually transmitted diseases and transfusion safety measures taken by hemotherapy services.

Prevalence and trends in transfusion-transmissible infections among blood donors in Brazil from 2010 to 2016

ABSTRACT Background: Assessing trends in the rate of transfusion-transmissible infections (TTIs) in blood donors is critical to the monitoring of the blood supply safety and the donor screening effectiveness. The objective of this study was to conduct a trend analysis of TTIs and associated demographic factors of donors at a public blood bank in the central Brazil. Methods: A retrospective analysis (2010-2016) of blood donation data was performed to determine the prevalence of markers for TTIs. Multinomial and multivariate logistic regression were used to verify the association between the explanatory variables and TTIs. The trend was evaluated with the Prais Winsten's regression analysis. Results: The prevalence of TTIs was 4.04% (5,553 donors) among 137,209 donors, with a steady trend in the analyzed period. The seroprevalence for the hepatitis B virus (HBV), syphilis, hepatitis C virus (HCV), human immunodeficiency virus (HIV), Chagas disease, and human T-lymphotropic virus (HTLV) were 1.63%, 0.87%, 0.46%, 0.21%, 0.21% and 0.09%, respectively. The prevalence of HBV decreased (b = −0.021, p < 0.001), while syphilis increased (b = 0.112; p = 0.001), during the period investigated. The probability for a positive test for TTI was higher among donors with a low level of education, aged ≥30 years old, without stable marital status, and first-time donors. Conclusions: Even with the reduction in HBV, the increased rate of syphilis may have contributed to the fact that the overall rate of TTIs did not decrease in the evaluated period.

Manejo del HIV/SIDA en el Embarazo

El control obstétrico de las pacientes y sus implicaciones donde se detalla el historial clínico, estudios cervicovaginal para detectar el estadio clínico de la infección por VIH. Esta guía contiene los pasos para el diagnóstico y tratamiento del SIDA en la mujer embarazada. Aunque es importante mencionar el bajo peso en pacientes infectadas, los tratamientos antirretrovirales permiten una mejoría y expectativas en pacientes infectadas por el VIH.

HTLV-1/2 transfusional e hemovigilância: a contribuição dos estudos de look-back / Transfusion-transmitted HTLV-1/2 and hemovigilance: the contribution of look-back studies

Os vírus linfotrópicos de células T humana tipo 1 (HTLV-1) e tipo 2 (HTLV-2) foram os primeiros retrovírus identificados em humanos, em 1980 e 1982, respectivamente. O HTLV-1 é associado à leucemia/linfoma de células T do adulto (ATL) e mielopatia associada ao HTLV-1/ paraparesia espástica tropical (HAM/TSP). Tais vírus podem ser transmitidos por via vertical (mãe para criança) principalmente pela amamentação; por via sexual e via parenteral (usuários de drogas e transfusão de sangue e componentes). Nas áreas endêmicas, as transmissões vertical e sexual têm sido as principais vias para a disseminação da infecção por HTLV-1. Porém, a hemotransfusão parece ter importante participação na introdução do HTLV em populações não endêmicas. A via mais eficaz de transmissão transfusional do HTLV-1 é através de componentes celulares do sangue contaminado. No passado, isso ocorria principalmente através da transfusão de sangue não testado para o HTLV-1/2. Eficiência de transmissão transfusional da ordem de 60 por cento foi descrita nos primeiros trabalhos japoneses. Subseqüentemente, extremos de 13 por cento a 80 por cento foram descritos nos estudos retrospectivos realizados nos Estados Unidos. Tamanha variação na eficiência da transmissão transfusional foi influenciada pelos parâmetros: tipo do produto sangüíneo, tempo decorrido entre a coleta dos componentes celulares até seu uso transfusional e carga proviral do HTLV no doador. Estima-se que 4 por cento a 8 por cento dos receptores de unidades celulares infectados por HTLV-1 possam desenvolver HAM/TSP, sendo raros os casos descritos de ATL nestes receptores. "Look-back"é o termo usado em hemovigilância para um programa que notifica grupos de receptores de hemotransfusão, de seus riscos quanto à exposição a um agente infeccioso por ocasião de transfusão prévia. "Look-back targeted"é o programa para identificar receptores de unidades previamente doadas por doadores específicos e que subseqüentemente...

In 1980 and 1982, respectively human T-Lymphotropic virus type 1 (HTLV-1) and type 2 (HTLV-2) were the first retroviruses identified in human beings. HTLV-1 is associated with adult T cell leukemia/lymphoma (ATL) and HTLV-associated myelopathy/Tropical Spastic Paraparesis (HAM/TSP). These viruses can be transmitted vertically (from mother to child), mainly by breast feeding; by sexual relationships and parenteral drug delivery (intravenous drug users and transfusion of blood and blood components). In endemic areas, vertical and sexual transmission has been the principal manner of dissemination of HTLV-1 infection. However, blood transfusion seems to have an important role in introducing HTLV in non-endemic populations. The most efficient way of transmission of HTLV-1 is through cell components of contaminated blood. In the past, this occurred chiefly through blood transfusions not tested for HTLV-1. An efficiency of transfusion transmission of 60 percent was described in the first reports of Japanese research. Thereafter, extremes of 13 percent to 80 percent were described in retrospectives studies performed in the USA. Such variations in the efficiency of transmission by transfusions were influenced by parameters such as: blood product type, time spent from collection of the cell components until its transfusion and proviral load of the donor. It is estimated that about 4 to 8 percent of receptors of HTLV infected cell units can develop HAM/TSP, with ATL being rare in these receptors. Look-back is the term used in hemovigilance for a program that notifies blood transfusion receptors of the risks involved in exposure to infectious agents due to a preceding transfusion. "Targeted look-back"is the program used to identify receptors of blood units donated by specific individuals that subsequently have been identified as infected by a specific agent (for example HTLV). This involves identification of previous blood component units transfused...